OAR 409-025-0150
Compliance and Enforcement
(1)
Unless approved by a waiver or exception, failure to comply with general reporting requirements includes but is not limited to:(a) Failure to submit data files for a required line of business; or
(b) Submitting health information for an excluded line of business.
(2) Unless approved by a waiver or exception, failure to comply with data file requirements includes but is not limited to:
(a) Submitting a data file in an unapproved layout;
(b) Submitting a data element in an unapproved format;
(c) Submitting a data element with unapproved coding;
(d) Failure to submit a required data element; or
(e) Failure to comply with validation and quality control efforts, including resubmitting or correcting data as requested by the Authority.
(3) Unless approved by a waiver or exception, failure to comply with data submission requirements includes but is not limited to:
(a) Failure to submit test files as specified by the data vendor;
(b) Submitting data files later than five days after the submission due date as detailed in Data Submission Schedule;
(c) Rejection of a data file by the data vendor that is not resubmitted or corrected by the submitter within 14 calendar days from notification of error; or
(d) Transmitting data files using an unapproved process.
(4) The Authority shall provide mandatory reporters written notification of each failure to comply prior to imposing a civil penalty under this rule. Mandatory reporters will have 30 calendar days to come into compliance.
(5) The Authority may impose civil penalties against mandatory reporters for each failure to comply that is not resolved within 30 calendar days of written notification. If a mandatory reporter does not come into compliance within 30 days of written notification, penalties will be assessed starting from the date the mandatory reporter was notified of non-compliance. Pursuant to ORS 442.993 (Civil penalties for failure to report health care data of health insurers), the Authority adopts the following schedule of civil penalties:
(a) Up to $400.00 per day for violations of OAR 409-025-0150 (Compliance and Enforcement)(1);
(b) Up to $300.00 per day for violations of OAR 409-025-0150 (Compliance and Enforcement)(2) or OAR 409-025-0140 (Waivers and Exceptions)(2)(a); and
(c) Up to $200.00 per day for violations of OAR 409-025-0150 (Compliance and Enforcement)(3);
(6) If a mandatory reporter was issued a final order imposing civil penalties within 24 months from the date the Authority issues a notice of intent to impose a civil penalty, the Authority may impose an additional $100.00 per day for each of the category of violations listed in section (5) of this rule.
(7) If a mandatory reporter has made documented efforts to comply with these rules, the Authority may consider this a mitigating factor before imposing civil penalties against the mandatory reporter.
Source:
Rule 409-025-0150 — Compliance and Enforcement, https://secure.sos.state.or.us/oard/view.action?ruleNumber=409-025-0150.