ORS 442.373
Health care data reporting by health insurers
- rules
(1)
The Oregon Health Authority shall establish and maintain a program that requires reporting entities to report health care data for the following purposes:(a)
Determining the maximum capacity and distribution of existing resources allocated to health care.(b)
Identifying the demands for health care.(c)
Allowing health care policymakers to make informed choices.(d)
Evaluating the effectiveness of intervention programs in improving health outcomes.(e)
Comparing the costs and effectiveness of various treatment settings and approaches.(f)
Providing information to consumers and purchasers of health care.(g)
Improving the quality and affordability of health care and health care coverage.(h)
Assisting the authority in furthering the health policies expressed by the Legislative Assembly in ORS 442.310 (Findings and policy).(i)
Evaluating health disparities, including but not limited to disparities related to race and ethnicity.(2)
The authority shall prescribe by rule standards that are consistent with standards adopted by the Accredited Standards Committee X12 of the American National Standards Institute, the Centers for Medicare and Medicaid Services and the National Council for Prescription Drug Programs that:(a)
Establish the time, place, form and manner of reporting data under this section, including but not limited to:(A)
Requiring the use of unique patient and provider identifiers;(B)
Specifying a uniform coding system that reflects all health care utilization and costs for health care services provided to Oregon residents in other states; and(C)
Establishing enrollment thresholds below which reporting will not be required.(b)
Establish the types of data to be reported under this section, including but not limited to:(A)
Health care claims and enrollment data used by reporting entities and paid health care claims data;(B)
Reports, schedules, statistics or other data relating to health care costs, prices, quality, utilization or resources determined by the authority to be necessary to carry out the purposes of this section; and(C)
Data related to race, ethnicity and primary language collected in a manner consistent with established national standards.(3)
Any third party administrator that is not required to obtain a license under ORS 744.702 (Third party administrator license) and that is legally responsible for payment of a claim for a health care item or service provided to an Oregon resident may report to the authority the health care data described in subsection (2) of this section.(4)
The authority shall adopt rules establishing requirements for reporting entities to train providers on protocols for collecting race, ethnicity and primary language data in a culturally competent manner.(5)
Intentionally left blank —Ed.(a)
The authority shall use data collected under this section to provide information to consumers of health care to empower the consumers to make economically sound and medically appropriate decisions. The information must include, but not be limited to, the prices and quality of health care services.(b)
The authority shall, using only data collected under this section from reporting entities described in ORS 442.372 (Definitions for ORS 442.372 and 442.373) (1) to (3), post to its website health care price information including the median prices paid by the reporting entities to hospitals and hospital outpatient clinics for, at a minimum, the 50 most common inpatient procedures and the 100 most common outpatient procedures.(c)
The health care price information posted to the website must be:(A)
Displayed in a consumer friendly format;(B)
Easily accessible by consumers; and(C)
Updated at least annually to reflect the most recent data available.(d)
The authority shall apply for and receive donations, gifts and grants from any public or private source to pay the cost of posting health care price information to its website in accordance with this subsection. Moneys received shall be deposited to the Oregon Health Authority Fund.(e)
The obligation of the authority to post health care price information to its website as required by this subsection is limited to the extent of any moneys specifically appropriated for that purpose or available from donations, gifts and grants from private or public sources.(6)
The authority may contract with a third party to collect and process the health care data reported under this section. The contract must prohibit the collection of Social Security numbers and must prohibit the disclosure or use of the data for any purpose other than those specifically authorized by the contract. The contract must require the third party to transmit all data collected and processed under the contract to the authority.(7)
The authority shall facilitate a collaboration between the Department of Human Services, the authority, the Department of Consumer and Business Services and interested stakeholders to develop a comprehensive health care information system using the data reported under this section and collected by the authority under ORS 442.370 (Ambulatory surgery and inpatient discharge abstract records) and 442.400 (“Health care facility” defined) to 442.463 (Annual utilization report). The authority, in consultation with interested stakeholders, shall:(a)
Formulate the data sets that will be included in the system;(b)
Establish the criteria and procedures for the development of limited use data sets;(c)
Establish the criteria and procedures to ensure that limited use data sets are accessible and compliant with federal and state privacy laws; and(d)
Establish a time frame for the creation of the comprehensive health care information system.(8)
Information disclosed through the comprehensive health care information system described in subsection (7) of this section:(a)
Shall be available, when disclosed in a form and manner that ensures the privacy and security of personal health information as required by state and federal laws, as a resource to insurers, employers, providers, purchasers of health care and state agencies to allow for continuous review of health care utilization, expenditures and performance in this state;(b)
Shall be available to Oregon programs for quality in health care for use in improving health care in Oregon, subject to rules prescribed by the authority conforming to state and federal privacy laws or limiting access to limited use data sets;(c)
Shall be presented to allow for comparisons of geographic, demographic and economic factors and institutional size; and(d)
May not disclose trade secrets of reporting entities.(9)
The collection, storage and release of health care data and other information under this section is subject to the requirements of the federal Health Insurance Portability and Accountability Act.(10)
Intentionally left blank —Ed.(a)
Notwithstanding subsection (9) of this section, in addition to the comprehensive health care information system described in subsection (7) of this section, the Department of Consumer and Business Services shall be allowed to access, use and disclose data collected under this section by certifying in writing that the data will be used only to carry out the department’s duties.(b)
Personally identifiable information disclosed to the department under paragraph (a) of this subsection, including a consumer’s name, address, telephone number or electronic mail address, is confidential and not subject to further disclosure under ORS 192.311 (Definitions for ORS 192.311 to 192.478) to 192.478 (Exemption for Judicial Department). [Formerly 442.466; 2021 c.205 §4](a)
“COVID-19” means a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).(b)
“Encounter” means an interaction between a patient, or the patient’s legal representative, and a health care provider, whether that interaction is in person or through telemedicine, for the purpose of providing health care services related to COVID-19, including but not limited to ordering or performing a COVID-19 test.(c)
“Health care provider” means:(A)
An individual licensed or certified by the:(i)
State Board of Examiners for Speech-Language Pathology and Audiology;(ii)
State Board of Chiropractic Examiners;(iii)
State Board of Licensed Social Workers;(iv)
Oregon Board of Licensed Professional Counselors and Therapists;(v)
Oregon Board of Dentistry;(vi)
State Board of Massage Therapists;(vii)
Oregon Board of Naturopathic Medicine;(viii)
Oregon State Board of Nursing;(ix)
Oregon Board of Optometry;(x)
State Board of Pharmacy;(xi)
Oregon Medical Board;(xii)
Occupational Therapy Licensing Board;(xiii)
Oregon Board of Physical Therapy;(xiv)
Oregon Board of Psychology; or(xv)
Board of Medical Imaging;(B)
An emergency medical services provider licensed by the Oregon Health Authority under ORS 682.216 (Issuance of licenses);(C)
A clinical laboratory licensed under ORS 438.110 (Standards for issuance and renewal of laboratory license); and(D)
A health care facility as defined in ORS 442.015 (Definitions).(d)
“Telemedicine” means the delivery of a health service through a two-way communication medium, including but not limited to telephone, Voice over Internet Protocol, transmission of telemetry or any Internet or electronic platform that allows a provider to interact in real time with a patient, a parent or guardian of a patient or another provider acting on a patient’s behalf.(2)
The authority shall adopt rules:(a)
Requiring a health provider to:(A)
Collect encounter data on race, ethnicity, preferred spoken and written language, English proficiency, interpreter needs and disability status in accordance with the standards adopted by the authority under ORS 413.161 (Collection of data on race, ethnicity, language, disability status, sexual orientation and gender identity); and(B)
Report the data in accordance with rules adopted under ORS 433.004 (Reportable diseases) for the reporting of diseases.(b)
Prescribing the manner of reporting.(c)
Ensuring, to the extent practicable, that the data collected and reported under this section by health care providers is not duplicative.(3)
The authority may provide incentives to health care providers and facilities to help defer the costs of making changes to electronic health records or similar systems.(4)
Data collected by health care providers under this section is confidential and subject to disclosure only in accordance with the federal Health Insurance Portability and Accountability Act privacy regulations, 45 C.F.R. parts 160 and 164, ORS 192.553 (Policy for protected health information) to 192.581 (Allowed retention or disclosure of genetic information) or other state or federal laws limiting the disclosure of health information. [2020 s.s.1 c.12 §40; 2020 s.s.1 c.12 §41a](1)
A health professional regulatory board specified in section 40 of this 2020 special session Act with respect to a provider under the jurisdiction of the board.(2)
The Oregon Health Authority or the Department of Human Services with regard to health care facilities under each agency’s respective jurisdiction.(3)
The authority with regard to emergency medical services providers licensed under ORS 682.216 (Issuance of licenses) and clinical laboratories licensed under ORS 438.110 (Standards for issuance and renewal of laboratory license). [2020 s.s.1 c.12 §41]
Source:
Section 442.373 — Health care data reporting by health insurers; rules, https://www.oregonlegislature.gov/bills_laws/ors/ors442.html.
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