Oregon Administrative Rules Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS
Oregon Administrative Rules (OAR) Chapter 409 is dedicated to the Oregon Health Authority (OHA), Health Policy and Analytics (HPA). This chapter outlines the detailed administrative rules that the HPA division of the OHA uses to carry out its responsibilities related to health policy development, strategic planning, data analysis, and oversight of various health-related programs in Oregon.
The Health Policy and Analytics Division plays a crucial role in the Oregon Health Authority's mission to improve the health of Oregonians and ensure access to quality, affordable healthcare. Their work focuses on achieving the "Triple Aim" of better health, better care, and lower costs.
Key Areas Covered by OAR Chapter 409 (Health Policy and Analytics):
The rules within Chapter 409 are diverse, reflecting the broad scope of HPA's functions. Some of the major divisions and topics include:
Procedural Rules (Division 1): General administrative procedures, including how HPA adopts rules, conducts hearings, and handles public records requests.
Health Care Facility Financial Reporting (Division 15): Rules requiring healthcare facilities to submit financial data, enabling the OHA to monitor financial health and cost trends within the healthcare system.
Dental Services: Underserved Populations (Division 17): Regulations related to improving access to dental care for populations that are underserved.
Access of Data and Fees for Data Search (Division 21): Rules governing the access to and fees for health data collected by the OHA, ensuring proper use and privacy.
Health Care Facility Utilization and Discharge Data Submission Requirements (Division 22): Specifies how healthcare facilities must report data on patient utilization and discharges, providing insights into healthcare service patterns.
Community Benefit Reporting (Division 23): Rules for hospitals and other healthcare entities to report on the community benefits they provide, such as charity care, health education, and research.
Capital Project Reporting Program (Division 24): Regulations for reporting on significant capital projects undertaken by healthcare facilities.
All Payer All Claims Data Reporting Program (Division 25): This is a critical program that collects claims data from all payers (insurers, Medicaid, etc.) to create a comprehensive database of healthcare services and costs in Oregon. The rules here define reporting requirements, data elements, and access protocols.
Oregon Healthcare Workforce Database (Division 26): Rules pertaining to the collection and use of data on the healthcare workforce in Oregon to assess supply, demand, and diversity.
Primary Care Payments (Division 28): Rules related to how primary care services are paid for, including reporting requirements for Coordinated Care Organizations (CCOs).
Health Care Provider Incentive Program (Division 36): Rules governing programs designed to incentivize certain healthcare practices or providers.
Medicaid Primary Care Loan Repayment Program (Division 37): Regulations for a program that helps repay student loans for primary care providers who commit to serving Medicaid patients.
Temporary Health Care Staff Rate Setting Program (Division 39): Recent rules addressing the setting of rates for temporary healthcare staff, potentially in response to staffing shortages and cost concerns.
Patient-Centered Primary Care Home Program (Division 55): Rules related to the recognition and operation of Patient-Centered Primary Care Homes, a model of care delivery aimed at improving coordination and quality of primary care.
Health Evidence Review Commission (Division 60): Rules governing the processes and methodologies used by the Health Evidence Review Commission (HERC) to evaluate medical evidence and develop the Prioritized List of Health Services for the Oregon Health Plan.
Sustainable Health Care Cost Growth Target Program (Division 65): This program aims to control the growth of healthcare costs in Oregon. The rules define reporting requirements for mandatory reporters, data submission, compliance, and potential financial penalties for exceeding cost growth targets.
Health Care Market Oversight Program (Division 70): This division contains rules for the review of "material change transactions" (mergers, acquisitions, affiliations) between healthcare entities. The goal is to ensure such transactions don't negatively impact access to affordable care, health equity, or the quality of services.
In summary, OAR Chapter 409 is fundamental to the Oregon Health Authority's efforts to analyze, regulate, and improve the state's healthcare system. It provides the legal framework for data collection, policy implementation, and strategic initiatives aimed at achieving better health outcomes and a more sustainable healthcare environment for all Oregonians.
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