Or. Admin. R. 410-141-3735 - Social Determinants of Health and Equity; Health Equity

Current through Register Vol. 60, No. 12, December 1, 2021

(1) This rule defines health disparities and the social determinants of health and equity (SDOH-E), establishes requirements for the Supporting Health for All through Reinvestment Initiative (SHARE Initiative), establishes the role of the Community Advisory Councils in supporting SDOH-E, establishes requirements for collecting data on race, ethnicity, and primary language, and establishes requirements for developing health equity infrastructure within a Coordinated Care Organization (CCO). This rule provides structure and guidance to CCOs to support long-term, community-specific investment and partnership in SDOH-E.
(2) The following definitions apply for purposes of this rule:
(a) "Health Disparities" are the structural health differences that adversely affect groups of people who systematically experience greater economic, social, or environmental obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, or mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. Health disparities are the indicators used to track progress toward achieving health equity.
(b) "Social Determinants of Health and Equity" (SDOH-E):
(A) SDOH-E encompasses three terms:
(i) The social determinants of health refer to the social, economic, and environmental conditions in which people are born, grow, work, live, and age, and are shaped by the social determinants of equity. These conditions significantly impact length and quality of life and contribute to health inequities;
(ii) The social determinants of equity refer to systemic or structural factors that shape the distribution of the social determinants of health in communities;
(iii) Health-related social needs refer to an individual's social and economic barriers to health, such as housing instability or food insecurity.
(B) SDOH-E initiatives may involve interventions that occur outside a clinical setting, and may pursue mechanisms of change including:
(i) Community-level interventions that directly address social determinants of health or social determinants of equity;
(ii) Interventions to address individual health-related social needs.
(c) "SDOH-E Partner" is a single organization, local government, one or more of the Federally-recognized Oregon tribal governments, the Urban Indian Health Program, or a collaborative, that delivers SDOH-E related services or programs, or supports policy and systems change, or both within a CCO's service area.
(3) The following requirements are specific to the Supporting Health for All through Reinvestment Initiative (SHARE Initiative):
(a) For each calendar year starting on or after January 1, 2021, CCOs shall dedicate a portion of their previous calendar year's net income or reserves to SDOH-E spending, pursuant to ORS 414.625(1)(b)(C) (as such statute was amended by 2018 HB 4018) and as set forth in the contract;
(b) CCOs shall select SDOH-E spending priorities that fall into at least one of four domains of SDOH-E: Neighborhood and Built Environment, Economic Stability, Education, and Social and Community Health, and are consistent with:
(A) The CCO's most recent Community Health Improvement Plan (CHP) that is a shared plan with the Collaborative Partners, as defined in 410-141-3730, including local public health authorities and local hospitals. If the CCO has not yet developed a shared CHP, the CCO shall align its priorities with those identified in CHPs developed by other stakeholders in the service area, such as local public health authorities, hospitals, and other CCOs; and
(B) Any SDOH-E priority areas identified by the Authority.
(c) A portion of SHARE Initiative dollars must go directly to SDOH-E Partner(s) for the delivery of services or programs, policy, or systems change, or any of these, to address the social determinants of health and equity as agreed by the CCO. CCOs shall enter into a contract, a Memorandum of Understanding, or other form of agreement including a grant agreement, with each SDOH-E Partner that defines the services to be provided and the CCO's data collection methods as provided in the contract between the Authority and the CCO.
(d) CCOs shall report completed and anticipated SDOH-E expenditures using the format specified by the Authority. These reports will be posted publicly.
(4) Community Advisory Councils (CAC):
(a) CCOs shall designate a role for the CAC in directing, tracking, and reviewing spending on the SHARE Initiative;
(b) CCOs shall designate a role for the CAC in health-related services community benefit initiative spending decisions, as defined in OAR 410-141-3845.
(c) CCOs shall have a conflict of interest policy that applies to its CAC members and accounts for financial interests related to potential health-related services, Share Initiative, or other SDOH-E spending;
(d) CCOs shall submit reports to the Authority no less than annually that describes the CAC's role in making decisions on these issues. These reports will be posted publicly with appropriate redactions.
(5) CCOs shall collect and maintain data on race, ethnicity, and primary language for all members on an ongoing basis in accordance with standards established by the Authority, including REAL-D. CCOs shall track and report on any quality measure by these demographic factors. The CCOs shall make this information available by posting on the web.
(6) Health Equity Infrastructure:
(a) The term "Health equity infrastructure" refers to the adoption and use of culturally and linguistically responsive models, policies and practices including and not limited to community and member engagement; provision of quality language access; workforce diversity; ADA compliance and accessibility of CCO and provider network; ACA 1557 compliance; CCO and provider network organizational training and development; implementation of the CLAS Standards; non-discrimination policies;
(b) The "Health Equity Plan" is part of the "Health Equity Infrastructure;"
(c) CCOs shall develop and implement the "Health Equity Plan" to embed health equity as a value and business practice into organizational policies, procedures, and processes; meet state and federal laws and contractual obligations regarding accessibility and culturally and linguistically responsive health care and services; inform using an equity framework in all policy, operational, and budget decisions; provide a structure to ensure oversight and management of programs and services with the goal to advance health equity and provide culturally and linguistically appropriate services. The health equity plan shall include the following:
(A) Narrative of the health equity plan development process, including description of meaningful community engagement;
(B) Health equity focus areas, including strategies, goals, objectives, activities and metrics;
(C) Organizational and Provider Network Cultural Responsiveness and Implicit Bias training plan:
(i) CCO shall incorporate Cultural Responsiveness and implicit bias continuing education and training into its existing organization-wide training plan and programs;
(ii) CCO shall align cultural responsiveness and implicit bias trainings with the "Cultural Competence Continuing Education" criteria developed by the Authority's Cultural Competence Continuing Education Advisory Committee referenced in OAR 943-090-0020;
(iii) CCO shall adopt the definition of Cultural Competence set forth in OAR 943-090-0010;
(iv) CCO shall provide and require all its employees, including directors, executives, and CAC members to participate in all such trainings;
(v) CCO's shall require all of the CCO's Provider Network to comply with Cultural Competency Continuing Education requirements set forth in ORS 676.850.
(d) The health equity plan and the language access self-assessment report are required to be submitted under OAR 410-141-3515 and shall be submitted every year to the Authority for review and approval;
(e) CCOs shall designate a Single Point of Accountability. The single point of accountability can also be called the Health Equity Administrator:
(A) The Single Point of Accountability ("Health Equity Administrator") shall be responsible and accountable for all matters relating to Health Equity within the CCO, CCO Provider Network and CCO service area;
(B) The Single Point of Accountability ("Health Equity Administrator") shall have budgetary decision- making authority and health equity expertise;
(C) The Single Point of Accountability ("Health Equity Administrator") shall be a high-level employee (e.g., director level or above) and can have more than one area of responsibility and job title;
(D) The CCO shall inform and describe to the authority any changes related to the "Health Equity Administrator" role or scope using the Health Equity Plan;
(E) The Single Point of Accountability ("Health Equity Administrator") shall have the authority to communicate directly with CCO executives and governing board.


Or. Admin. R. 410-141-3735
DMAP 56-2019, adopt filed 12/17/2019, effective 1/1/2020; DMAP 62-2020, amend filed 12/16/2020, effective 1/1/2021

Statutory/Other Authority: ORS 414.615, 414.625, 413.042, 414.635 & 414.651

Statutes/Other Implemented: ORS 414.610 - 414.685

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