Or. Admin. Code § 409-023-0100

Current through Register Vol. 63, No. 11, November 1, 2024

Section 409-023-0100 - Definitions

The following definitions apply to OAR 409-023-0100 to 409-023-0115:

(1) "Affiliated clinic" or "hospital affiliated clinic" mean an outpatient clinic located in Oregon that is operating under the common control or ownership of a hospital.

(2) "Authority" means the Oregon Health Authority.

(3) "Charity care" means free or discounted health services provided to persons who cannot afford to pay and from whom a hospital has no expectation of payment. Charity care does not include bad debt, governmentally set fees, contractual allowances, or discounts for quick payment.

(4) "Community" means the geographic service area and patient population that the health care institution serves as defined by the hospital.

(5) "Community benefits" mean programs or activities that provide treatment or promote health and healing, address health disparities or address the social determinants of health in a response to identified community needs. They are not provided primarily for marketing purposes or to increase market share. Community benefit must generate a negative margin and meet at least one of the following criteria:

(a) Improve access to health services;

(b) Enhance population health or improve health disparities;

(c) Advance generalizable knowledge;

(d) Demonstrate charitable purpose; or

(e) Address social determinants of health.

(6) "Health System" means an organization that delivers health care services through hospitals, facilities, clinics, medical groups and other entities that are under common ownership or control.

(7) "Hospital" has the meaning provided in ORS 442.612.

(8) "Patient cost" has the meaning provided in ORS 442.612.

(9) "Prescreen" or "prescreening" means the process a hospital uses to proactively screen a patient for presumptive eligibility for financial assistance in accordance with ORS 442.615.

(10) "Presumptive eligibility" refers to a decision by the hospital that, based upon the hospital's prescreening, the patient qualifies for financial assistance.

(11) "Net cost" means the total expense incurred by the hospital minus any offsetting revenue such as grants, donations, or payments for service. Net costs may be provided using either a cost-to-charge ratio methodology or a cost accounting methodology.

(12) "Social Determinants of Health" has the meaning provided in ORS 442.612.

(13) "State medical assistance program" means a program for payment of health services provided to eligible Oregonians, including Medicaid and CHIP services under the OHP Medicaid Demonstration Project and Medicaid and CHIP services under the State Plan, or Healthier Oregon, or Bridge Program, or any other programs that may be prescribed by the Authority from time to time, in accordance with ORS 414.025(17).

Or. Admin. Code § 409-023-0100

OHP 2-2008, f. &cert. ef. 7-1-08; OHP 5-2020, amend filed 12/21/2020, effective 12/21/2020; OHP 1-2024, amend filed 05/07/2024, effective 5/7/2024

Statutory/Other Authority: ORS 442.602, 442.615, 442.618 & 442.624

Statutes/Other Implemented: ORS 442.601, 442.602 & 442.612