OAR 409-027-0015
Definitions
(1)
“Authority” means the Oregon Health Authority.(2)
“Coordinated care organization (CCO)” has the meaning given that term in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414).(3)
“Non-claims based primary care expenditures” means resources given to a primary care provider or practice for the following services or arrangements:(a)
Capitation and salaried arrangements with primary care providers or practices not billed or captured through claims.(b)
Risk-based reconciliation for arrangements with primary care providers or practices not billed or captured through claims.(c)
Payments to Patient-Centered Primary Care Homes or Patient-Centered Medical Homes based upon that recognition or payments for participation in proprietary or other multi-payer medical home initiatives.(d)
Retrospective incentive payments to primary care providers or practices based on performance aimed at decreasing cost or improving value for a defined population of patients.(e)
Prospective incentive payments to primary care providers or practices aimed at developing capacity for improving care for a defined population of patients.(f)
Payments for Health Information Technology structural changes at a primary care practice such as electronic records and data reporting capacity from those records.(g)
Workforce expenses including payments or expenses for supplemental staff or supplemental activities integrated into the primary care practice such as practice coaches, patient educators, patient navigators, and nurse care managers.(4)
“Non-claims based total health care expenditures” means resources given to a provider or practice for the following services or arrangements:(a)
Capitation or salaried arrangements with providers or practices not billed or captured through claims.(b)
Risk-based reconciliation for arrangements with providers or practices not billed or captured through claims.(c)
Payments to Patient-Centered Primary Care Homes, Patient-Centered Medical Homes, or Patient-Centered Specialty Practices based upon that recognition or payments for participation in proprietary or other multi-payer medical home or specialty care practice initiatives.(d)
Retrospective incentive payments to providers or practices based on performance aimed at decreasing cost or improving value for a defined population of patients.(e)
Prospective incentive payments to providers or practices aimed at developing capacity for improving care for a defined population of patients.(f)
Payments for Health Information Technology structural changes at a practice such as electronic records and data reporting capacity from those records.(g)
Workforce expenses including payments or expenses for supplemental staff or supplemental activities integrated into the practice such as practice coaches, patient educators, patient navigators, and nurse care managers.(5)
“Patient-Centered Medical Home (PCMH)” means a practice or provider who has been recognized as such by the National Committee for Quality Assurance.(6)
“Patient-Centered Primary Care Home (PCPCH)” means a health care team or clinic as defined in ORS 414.655 (Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations), meets the standards pursuant to OAR 409-055-0040 (Recognition Criteria), and has been recognized through the process pursuant to OAR 409-055-0040 (Recognition Criteria).(7)
“Patient Centered Specialty Practice (PCSP)” means a practice or provider who has been recognized as such by the National Committee for Quality Assurance.(8)
“Practice” means an individual, facility, institution, corporate entity, or other organization which provides direct health care services or items, also termed a performing provider, or bills, obligates and receives reimbursement on behalf of a performing provider of services, also termed a billing provider (BP). The term provider refers to both performing providers and BPs unless otherwise specified.(9)
“Primary care” means family medicine, general internal medicine, naturopathic medicine, obstetrics and gynecology, pediatrics or general psychiatry.(10)
“Primary care provider” means:(a)
A physician, naturopath, nurse practitioner, physician assistant or other health professional licensed or certified in this state, whose clinical practice is in the area of primary care.(b)
A health care team or clinic certified by the Authority as a PCPCH.
Source:
Rule 409-027-0015 — Definitions, https://secure.sos.state.or.us/oard/view.action?ruleNumber=409-027-0015.