Or. Admin. Code § 409-065-0010 - General Reporting Requirements for Mandatory Reporters
(1) Determination of a mandatory reporter.
(a) For payers or licensed third-party
administrators, the Authority must identify mandatory reporters using health
insurance enrollment data from DCBS and Medicaid enrollment reports from the
Authority.
(A) The Authority must aggregate
the most recent four (4) quarters of data.
(B) The Authority must calculate the mean
total lives for each payer and licensed third-party administrator for each
reporting year.
(b) All
payers or licensed third-party administrators with calculated mean total lives
of 1,000 or more across all lines of business must be mandatory
reporters.
(c) The Authority must
make annual mandatory reporter determinations and provide written notification
no later than April 30 of each year to all mandatory reporters subject to the
reporting requirements of OAR
409-065-0010 to
409-065-0030 for the current
year.
(2) All Mandatory
reporters must submit data files in a manner and form as prescribed by
409-065-0015.
(3) The Authority must identify voluntary
reporters that have calculated mean total lives of 1,000 or higher across all
lines of business and invite them to participate in the annual data
submission.
(4) New mandatory
reporters submitting for the first time, or mandatory reporters that did not
submit data in the previous year, must attend a data submission training
session prior to their first submission of data, as provided by the
Authority.
(5) A mandatory reporter
may submit a waiver of reporting in compliance with OAR
409-065-0020.
(6) An entity may appeal the Authority's
determination of mandatory reporter status pursuant to the procedure outlined
in OAR 409-065-0050.
Notes
Statutory/Other Authority: ORS 442.386
Statutes/Other Implemented: ORS 442.385 & 442.386
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.