Current through Register Vol. 60, No. 12, December 1, 2021
Type A and Type B hospitals must submit
the following information to the Division of Medical Assistance Programs
(a) The aggregate percent
increase in patient charges and the effective date of the increase within 30
days following the end of their fiscal year for increases in the preceding
year. Aggregate percent increase in patient charges is defined as the percent
increase in patient revenues due to charge increases; and
(b) The amount of payment received by the
hospital, from each Division contracted managed care plan and third-party
payers, for inpatient and outpatient hospital services provided to managed care
members, within the hospital's fiscal year.
When a hospital is contracted with a
Prepaid Health Plan (PHP), within thirty (30) days of the Division request the
hospital will supply the Division the following information:
(a) The name of the contracting PHP;
(b) The dates for which the
contract will be effective; and
The contracted services and reimbursement rates.
(3) The hospital and PHP must coordinate
payment information to verify and return the PHP payment data file sent by the
Division within ninety (90) days from date the data file is received by the
(4) Failure to supply the
requested information within timelines stated may result in a discretionary
sanction or fine (see OAR 410-120-1440). No sanction or fine will be imposed if
the Division determines, at its sole discretion, that the hospital was unable
to coordinate payment information with the PHP through no fault of the
Or. Admin. R.
OMAP 12-2001, f. 3-30-01,
cert. ef. 4-1-01; OMAP 31-2005, f. 6-20-05, cert. ef. 7-1-05; DMAP 34-2008, f.
11-26-08, cert. ef. 12-1-08
Stat. Auth.: ORS
Stats. Implemented: ORS