Oregon
Rule Rule 111-080-0070
Exempt Hospitals


(1)

As specified in ORS 243.879 (Reimbursement methodology for payment to hospitals), these payment limits do not apply to reimbursements paid by a carrier or third-party administrator to:
(a) Type A or type B hospitals (defined in ORS 442.470 (Definitions for ORS 442.470 to 442.507));
(b) Rural critical access hospitals (defined in ORS 315.613 (Credit available to persons providing rural medical care and affiliated with certain rural hospitals)); or
(c) Hospitals that are located in a county with a population of less than 70,000 on August 15, 2017, classified as a sole community hospital by the Centers for Medicare and Medicaid Services, and have Medicare payments composing at least 40 percent of the hospital’s total annual patient revenue.
(2)(a) Total annual patient revenue for a hospital will be calculated using the Allowed Amount for all inpatient and outpatient claim records in the state’s All Payer All Claims (APAC) database for that hospital in a calendar year, and
(b) Total Medicare payments to a hospital will be calculated using the Allowed Amount for all inpatient and outpatient claim records paid by Medicare in the APAC for that hospital in a calendar year.
(3) OEBB will annually review this calculation under section (2) of this rule using the most recent available twelve months of data in APAC.
Source
Last accessed
Jul. 9, 2020