ORS 415.500
Definitions
(1)
“Corporate affiliation” has the meaning prescribed by the Oregon Health Authority by rule, including:(a)
Any relationship between two organizations that reflects, directly or indirectly, a partial or complete controlling interest or partial or complete corporate control; and(b)
Transactions that merge tax identification numbers or corporate governance.(2)
“Essential services” means:(a)
Services that are funded on the prioritized list described in ORS 414.690 (Prioritized list of health services); and(b)
Services that are essential to achieve health equity.(3)
“Health benefit plan” has the meaning given that term in ORS 743B.005 (Definitions).(4)
Intentionally left blank —Ed.(a)
“Health care entity” includes:(A)
An individual health professional licensed or certified in this state;(B)
A hospital, as defined in ORS 442.015 (Definitions), or hospital system, as defined by the authority by rule;(C)
A carrier, as defined in ORS 743B.005 (Definitions), that offers a health benefit plan in this state;(D)
A Medicare Advantage plan;(E)
A coordinated care organization or a prepaid managed care health services organization, as both terms are defined in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414); and(F)
Any other entity that has as a primary function the provision of health care items or services or that is a parent organization of, or is an entity closely related to, an entity that has as a primary function the provision of health care items or services.(b)
“Health care entity” does not include:(A)
Long term care facilities, as defined in ORS 442.015 (Definitions).(B)
Facilities licensed and operated under ORS 443.400 (Definitions for ORS 443.400 to 443.455) to 443.455 (Civil penalties).(5)
“Health equity” has the meaning prescribed by the Oregon Health Policy Board and adopted by the authority by rule.(6)
Intentionally left blank —Ed.(a)
“Material change transaction” means:(A)
A transaction in which at least one party had average revenue of $25 million or more in the preceding three fiscal years and another party:(i)
Had an average revenue of at least $10 million in the preceding three fiscal years; or(ii)
In the case of a new entity, is projected to have at least $10 million in revenue in the first full year of operation at normal levels of utilization or operation as prescribed by the authority by rule.(B)
If a transaction involves a health care entity in this state and an out-of-state entity, a transaction that otherwise qualifies as a material change transaction under this paragraph that may result in increases in the price of health care or limit access to health care services in this state.(b)
“Material change transaction” does not include:(A)
A clinical affiliation of health care entities formed for the purpose of collaborating on clinical trials or graduate medical education programs.(B)
A medical services contract or an extension of a medical services contract.(C)
An affiliation that:(i)
Does not impact the corporate leadership, governance or control of an entity; and(ii)
Is necessary, as prescribed by the authority by rule, to adopt advanced value-based payment methodologies to meet the health care cost growth targets under ORS 442.386 (Health Care Cost Growth Target program established).(D)
Contracts under which one health care entity, for and on behalf of a second health care entity, provides patient care and services or provides administrative services relating to, supporting or facilitating the provision of patient care and services, if the second health care entity:(i)
Maintains responsibility, oversight and control over the patient care and services; and(ii)
Bills and receives reimbursement for the patient care and services.(E)
Transactions in which a participant that is a health center as defined in 42 U.S.C. 254b, while meeting all of the participant’s obligations, acquires, affiliates with, partners with or enters into any agreement with another entity unless the transaction would result in the participant no longer qualifying as a health center under 42 U.S.C. 254b.(7)
Intentionally left blank —Ed.(a)
“Medical services contract” means a contract to provide medical or mental health services entered into by:(A)
A carrier and an independent practice association;(B)
A carrier, coordinated care organization, independent practice association or network of providers and one or more providers, as defined in ORS 743B.001 (Definitions);(C)
An independent practice association and an individual health professional or an organization of health care providers;(D)
Medical, dental, vision or mental health clinics; or(E)
A medical, dental, vision or mental health clinic and an individual health professional to provide medical, dental, vision or mental health services.(b)
“Medical services contract” does not include a contract of employment or a contract creating a legal entity and ownership of the legal entity that is authorized under ORS chapter 58, 60 or 70 or under any other law authorizing the creation of a professional organization similar to those authorized by ORS chapter 58, 60 or 70, as may be prescribed by the authority by rule.(8)
“Net patient revenue” means the total amount of revenue, after allowance for contractual amounts, charity care and bad debt, received for patient care and services, including:(a)
Value-based payments;(b)
Incentive payments;(c)
Capitation payments or payments under any similar contractual arrangement for the prepayment or reimbursement of patient care and services; and(d)
Any payment received by a hospital to reimburse a hospital assessment under ORS 414.855 (Hospital assessment).(9)
“Revenue” means:(a)
Net patient revenue; or(b)
The gross amount of premiums received by a health care entity that are derived from health benefit plans.(10)
“Transaction” means:(a)
A merger of a health care entity with another entity;(b)
An acquisition of one or more health care entities by another entity;(c)
New contracts, new clinical affiliations and new contracting affiliations that will eliminate or significantly reduce, as defined by the authority by rule, essential services;(d)
A corporate affiliation involving at least one health care entity; or(e)
Transactions to form a new partnership, joint venture, accountable care organization, parent organization or management services organization, as prescribed by the authority by rule. [2021 c.615 §1]
Source:
Section 415.500 — Definitions, https://www.oregonlegislature.gov/bills_laws/ors/ors415.html.
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