Or. Admin. Code § 409-070-0020

Current through Register Vol. 64, No. 1, January 1, 2025

Section 409-070-0020 - Excluded Transactions

(1) Pursuant to ORS 415.500(6)(b) and (7), the following transactions are not material change transactions subject to review under these rules:

(a) A clinical affiliation of health care entities formed to collaborate on clinical trials or graduate medical education programs.

(b) A medical services contract or an extension of a medical services contract as described in paragraph (2) of this rule.

(c) An affiliation that, pursuant to ORS 415.500(6)(b)(C):

(A) Does not impact the corporate leadership, governance or control of a health care entity; and

(B) Is necessary to adopt AVP methodologies to meet the health care cost growth targets under ORS 442.386.

(d) Contracts under which one health care entity, for and on behalf of a second health care entity, provides patient care and related services or provides administrative services relating to, supporting or facilitating the provision of patient care and services, if the second health care entity:

(A) Maintains responsibility, oversight and control over the patient care and related services;

(B) Bills and receives reimbursement for the patient care and related services; and

(C) Does not provide comprehensive management services.

(e) Transactions in which a participant that is a health center as defined in 42 U.S.C. 254b, while meeting all of the participant's obligations, acquires, affiliates with, partners with or enters into any agreement with another entity unless the transaction would result in the participant no longer qualifying as a health center under 42 U.S.C. 254b.

(f) A transaction that consists solely of a change in the immediate or intermediate ownership of a health care entity but which

(i) does not change the ultimate ownership or control of the health care entity, and

(ii) does not result in the acquisition of control of the health care entity by any person not previously affiliated with the health care entity.

(g) Agreements between an affiliate and a health care entity that are subject to ORS 732.574(2)(d)(D).

(2) For purposes of paragraph (1)(b) of this rule:

(a) A "medical services contract" means a contract to provide medical or mental health services, including physical, behavioral or dental health services, entered into by:

(A) A carrier or coordinated care organization and an independent practice association;

(B) A carrier, coordinated care organization, independent practice association or network of providers and one or more providers;

(C) An independent practice association and an individual health professional or an organization of providers;

(D) A medical, dental, vision or mental health clinic; or

(E) A medical, dental, vision or mental health clinic and an individual health professional to provide medical, dental, vision or mental health services.

(b) A "medical services contract" does not include a contract of employment or a contract creating a legal entity and ownership of the legal entity that is authorized under ORS chapter 58, 60 or 70 or under any other law authorizing the creation of a professional organization similar to those authorized by ORS chapter 58, 60 or 70.

(3) If a complete notice of material change transaction submitted in accordance with OAR 409-070-0030(1) and OAR 409-070-0045(5) pertains to a transaction excluded under this rule, the Authority must notify the parties and the notice must be deemed withdrawn. All further proceedings in respect of the notice must be terminated and ended. The Authority's written notice to the parties under this paragraph (3) must be accompanied by a refund of the fee, if any, that was paid in connection with the notice of material change transaction.

Or. Admin. Code § 409-070-0020

OHP 1-2022, adopt filed 02/22/2022, effective 3/1/2022; OHP 6-2024, amend filed 12/13/2024, effective 12/16/2024

Statutory/Other Authority: ORS 415.501

Statutes/Other Implemented: ORS 415.500 - 415.900