The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS




 

DIVISION 22


REQUIREMENTS FOR SUBMISSION OF HEALTH CARE FACILITY

UTILIZATION DATA; AMBULATORY SURGERY

409-022-0005
Annual Reports
(1) By December 31 of each year, each licensed health care facility shall file with the Office for Oregon Health Policy and Research an annual report on the facility's utilization. The report will consist of properly completed copies of any of the office's Forms AR-1 to AR-3 which relate to services offered by the facility.
(2) Within 15 days of the submission of an annual report by a facility, the office will either acknowledge in writing that the annual report has been completed, or will inform the facility verbally or in writing of any incomplete or incorrectly completed items.
(3) Pursuant to ORS 442.445(2), the office adopts the following schedule of civil penalties:
(a) $250.00 per day for the first five days of failure to file in accord with this rule; and
(b) $500.00 per day from the sixth day until filing in accord with this rule is satisfactorily accomplished.
(4) Any amount of civil penalty imposed by the office shall not be allowed as a reimbursable cost item and shall not be recoverable from any category of payment source or patient.
[ED. NOTE: Forms referred are available from the agency.]
Stat. Auth.: ORS 442.420(3)(d), 442.445(2) & 442.463

Stats. Implemented: ORS 442.445 & ORS 442.463

Hist.: HP 2-1988, f. & cert. ef. 3-25-88; HP 1-1996, f. & cert. ef. 1-2-96; OHP 1-1997, f. & cert. ef. 8-25-97; OHP 1-1999, f. 10-22-99, cert. ef. 10-23-99; OHP 1-2002, f. & cert. ef. 1-2-02
Ambulatory Surgical Data Reporting Program
409-022-0010
Definitions
Pursuant to ORS 442.120, the Oregon
Health Authority has established an ambulatory surgical data reporting program.
These definitions apply to OAR 409-022-0010 to 409-022-0070.
(1) "Ambulatory surgery data"
means the consolidation of complete billing, medical, and personal information describing
a patient, the services received, and charges billed for a surgical or diagnostic
procedure treatment in a hospital outpatient setting or an ambulatory surgical facility
setting into a data record.
(2) “APAC” means
the Oregon All-Payer All-Claims Reporting Program as defined in ORS 442.466 and
OAR 409-025-0100 to 409-025-0170.
(3) "Authority" means the
Oregon Health Authority.
(4) "Hospital" means a facility
with an organized medical staff, with permanent facilities that include inpatient
beds and with medical services, including physician services and continuous nursing
services under the supervision of registered nurses, to provide diagnosis and medical
or surgical treatment that is licensed under ORS 441.015.
Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06,
cert. ef. 1-1-07; OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15
409-022-0020
Reporting Source of Ambulatory Surgical
Data
(1) The reporting sources for ambulatory
surgery data are the mandatory reporters of the Oregon All-Payer All-Claims Reporting
Program (APAC).
(2) The Oregon Health Authority
may source discharge abstracts for surgical procedures from the APAC database as
authorized by ORS 442.120.
Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06,
cert. ef. 1-1-07; OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15

409-022-0060
Access to Health Data
(1) An inspection or examination of
a Limited Data Set derived from the health data that are filed at the Oregon Health
Authority shall be allowed during the normal working days and business hours of
the office.
(2) The inspection or examination
shall take place at the Authority or other reasonable locations designated by the
Authority.
(3) Health data reported
to the Authority from hospitals and facilities may include information that is protected
health information when it is maintained at the hospital or facility. The Authority
obtains such information because it is required by law, and because the Authority
acts in the capacity of a health oversight agency. The Authority is not a covered
entity or a business associate of a covered entity. The terms used in this rule
have the same meaning as those terms in the HIPAA Privacy Rules, 45 CFR Parts 160
and 164.
(4) Except under rules outlined
in OAR 409-22-0070 for access to a Limited Data Set, access to health data reported
to the Authority will be limited to health data that does not identify any individual
patient, or permit the identification of any patient when used alone or in combination
with other information, or individual licensed health care professionals.
Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06,
cert. ef. 1-1-07; OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15
409-022-0070
Limited Data Sets with a Data Use
Agreement
(1) The Authority may authorize the
disclosure of health data in accordance with a data use agreement entered into by
both the Authority and a researcher, pursuant to which the Authority may disclose
a limited data set to a researcher for research, public health, or health care operations.
The intent of this rule is to generally apply the legal standard established in
the HIPAA Privacy Rule applicable to limited data sets, 45 CFR 164.514(e).
(2) A limited data set excludes
specified direct identifiers of the individual or of relatives, employers, or household
members of the individual. The data use agreement must:
(a) Establish the permitted
uses and disclosures of the limited data set by the recipient, consistent with the
purposes of the research, and which may not include any use or disclosure that would
violate the data use agreement;
(b) Limit who can use or
receive the data; and
(c) Require the recipient
to agree to the following:
(A) Not to use or disclose
the information other than as permitted by the data use agreement or as otherwise
required by law;
(B) Use appropriate safeguards
to prevent the use or disclosure of the information other than as provided for in
the data use agreement;
(C) Report to the covered
entity any use or disclosure of the information not provided for by the data use
agreement of which the recipient becomes aware;
(D) Ensure that any agents,
including a subcontractor, to whom the recipient provides the limited data set agrees
to the same restrictions and conditions that apply to the recipient with respect
to the limited data set; and
(E) Not to identify the information
or contact the individual.
Stat. Auth.: ORS 442.120
Stats. Implemented: ORS 442.120
Hist.: OHP 3-2006, f. 12-14-06,
cert. ef. 1-1-07; OHP 3-2015, f. 6-30-15, cert. ef. 7-1-15

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