Or. Admin. Code § 409-070-0060 - Comprehensive Review of a Notice of a Material Change Transaction

(1) Pursuant to ORS 415.501(7), the Authority must conduct a comprehensive review of a proposed transaction if the Authority determines not to approve the transaction at the conclusion of its preliminary review.

(2) The Authority must notify the entity that submitted the notice of material change transaction if a comprehensive review will occur and must notify the entity that submitted the notice of material change transaction the fee amount associated with the comprehensive review pursuant to OAR 409-070-0030. A party to the transaction must pay the fee amount in full no later than 30 calendar days after receipt of an invoice from the Authority.

(3) The Authority must issue proposed findings of fact and conclusion of law, along with the Authority's proposed order at the conclusion of its comprehensive review and must allow the parties and the public a reasonable opportunity to make written comments to the proposed findings and conclusions and the proposed order. If the comprehensive review includes a community review board, recommendations of the community review board must be in writing and appended to the proposed order. Unless otherwise directed by the Authority, written comments to the proposed findings and conclusions and the proposed order must be filed with the Authority within thirty calendar days following publication. The Authority must make any filed comments available to the public promptly following receipt.

(4) The Authority must consider the parties' and the public's written exceptions and issue a final order setting forth the Authority's findings and conclusions in respect of the proposed transaction. If the comprehensive review included a community review board, the Authority's findings and conclusions must include an explanation of the reasons why the Authority accepted, rejected or modified the recommendations of the community review board. The final order must include any commitments by the health care entity to continue services currently provided by the health care entity. A party to the proposed transaction may contest the final order as provided in OAR 409-070-0075.

(5) Subject to any conditions prescribed under these rules, the Authority must approve a material change transaction that does not involve a domestic insurer, or in the case of a material change transaction involving a domestic health insurer, recommend to the Department that the transaction be approved, if pursuant to ORS 415.501(9), the Authority determines that the transaction satisfies (a) below and also satisfies either (b) or (c) below:

(a) There is no substantial likelihood that the transaction would:

(A) Have material anticompetitive effects in the region (such as significantly increased market concentration among providers when contracting with payers, carriers, or coordinated care organizations, or among carriers when establishing health benefit premiums that is likely to increase costs for consumers) not outweighed by benefits in increasing or maintaining services to underserved populations;

(B) Be contrary to law;

(C) Jeopardize the financial stability of a health care entity involved in the transaction; or

(D) Otherwise be hazardous or prejudicial to consumers or the public.

(b) The transaction will benefit the public good and communities by:

(A) Reducing the growth in patient costs in accordance with the health care cost growth targets established under ORS 442.386 or maintain a rate of cost growth that exceeds the target that the entity demonstrates is in the best interest of the public;

(B) Increasing access to services in medically underserved areas; or

(C) Rectifying historical and contemporary factors contributing to a lack of health equity or access to services.

(c) The transaction will improve health outcomes for residents of this state.

(6) Unless extended by agreement among the Authority, the Department, as applicable, and the parties to the proposed transaction, the Authority must issue a proposed order, or in the case of a material change transaction involving a domestic health insurer, issue a recommendation to the Department, following its comprehensive review within 180 calendar days of the filing of a complete notice of material change transaction, subject to tolling or extension as provided in these rules. A transaction may be disapproved if the parties do not agree to an extension of time necessary to accomplish a tribal consultation.

Notes

Or. Admin. Code § 409-070-0060

OHP 1-2022, adopt filed 02/22/2022, effective 3/1/2022; OHP 10-2022, amend filed 12/08/2022, effective 12/8/2022; 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