ORS 442.386
Health Care Cost Growth Target program established

  • rules

(1)

The Legislative Assembly intends to establish a health care cost growth target, for all providers and payers, to:

(a)

Support accountability for the total cost of health care across all providers and payers, both public and private;

(b)

Build on the state’s existing efforts around health care payment reform and containment of health care costs; and

(c)

Ensure the long-term affordability and financial sustainability of the health care system in this state.

(2)

The Health Care Cost Growth Target program is established. The program shall be administered by the Oregon Health Authority in collaboration with the Department of Consumer and Business Services, subject to the oversight of the Oregon Health Policy Board. The program shall establish a health care cost growth target for increases in total health expenditures and shall review and modify the target on a periodic basis.

(3)

The health care cost growth target must:

(a)

Promote a predictable and sustainable rate of growth for total health expenditures as measured by an economic indicator adopted by the board, such as the rate of increase in this state’s economy or of the personal income of residents of this state;

(b)

Apply to all providers and payers in the health care system in this state;

(c)

Use established economic indicators; and

(d)

Be measurable on a per capita basis, statewide basis and health care entity basis.

(4)

The program shall establish a methodology for calculating health care cost growth:

(a)

Statewide;

(b)

For each provider and payer, taking into account the health status of the patients of the provider or the beneficiary of the payer; and

(c)

Per capita.

(5)

The program shall establish requirements for providers and payers to report data and other information necessary to calculate health care cost growth under subsection (4) of this section.

(6)

Annually, the program shall:

(a)

Hold public hearings on the growth in total health expenditures in relation to the health care cost growth in the previous calendar year;

(b)

Publish a report on health care costs and spending trends that includes:

(A)

Factors impacting costs and spending; and

(B)

Recommendations for strategies to improve the efficiency of the health care system; and

(c)

For providers and payers for which health care cost growth in the previous calendar year exceeded the health care cost growth target:

(A)

Analyze the cause for exceeding the health care cost growth target; and

(B)

Require the provider or payer to develop and undertake a performance improvement plan.

(7)

Intentionally left blank —Ed.

(a)

The authority shall adopt by rule criteria for waiving the requirement for a provider or payer to undertake a performance improvement plan, if necessitated by unforeseen market conditions or other equitable factors.

(b)

The authority shall collaborate with a provider or payer that is required to develop and undertake a performance improvement plan by:

(A)

Providing a template for performance improvement plans, guidelines and a time frame for submission of the plan;

(B)

Providing technical assistance such as webinars, office hours, consultation with technical assistance providers or staff, or other guidance; and

(C)

Establishing a contact at the authority who can work with the provider or payer in developing the performance improvement plan.

(8)

A performance improvement plan must:

(a)

Identify key cost drivers and include concrete steps a provider or payer will take to address the cost drivers;

(b)

Identify an appropriate time frame by which a provider or payer will reduce the cost drivers and be subject to an evaluation by the authority; and

(c)

Have clear measurements of success.

(9)

The authority shall adopt by rule criteria for imposing a financial penalty on any provider or payer that exceeds the cost growth target without reasonable cause in three out of five calendar years or on any provider or payer that does not participate in the program. The criteria must be based on the degree to which the provider or payer exceeded the target and other factors, including but not limited to:

(a)

The size of the provider or payer organization;

(b)

The good faith efforts of the provider or payer to address health care costs;

(c)

The provider’s or payer’s cooperation with the authority or the department;

(d)

Overlapping penalties that may be imposed for failing to meet the target, such as requirements relating to medical loss ratios; and

(e)

A provider’s or payer’s overall performance in reducing cost across all markets served by the provider or payer. [2019 c.560 §2; 2021 c.51 §2]
Note: Section 7, chapter 51, Oregon Laws 2021, provides:
Sec. 7. A financial penalty described in ORS 442.386 (Health Care Cost Growth Target program established) (9), as amended by section 2 of this 2021 Act, may be imposed no earlier than January 1, 2026, for performance by a provider or payer in meeting cost growth targets during calendar years 2021 to 2025. [2021 c.51 §7]
Note: See note under 442.385 (Definitions).

Source: Section 442.386 — Health Care Cost Growth Target program established; rules, https://www.­oregonlegislature.­gov/bills_laws/ors/ors442.­html.

442.011
Health Policy and Analytics Division created in Oregon Health Authority
442.015
Definitions
442.310
Findings and policy
442.315
Certificate of need
442.325
Certificate of need for health care facility of health maintenance organization
442.342
Waiver of requirements
442.344
Exemptions from requirements
442.347
Rural hospital required to report certain actions
442.361
Definitions for ORS 442.361, 442.362 and 442.991
442.362
Reporting of proposed capital projects by hospitals and ambulatory surgical centers
442.370
Ambulatory surgery and inpatient discharge abstract records
442.372
Definitions for ORS 442.372 and 442.373
442.373
Health care data reporting by health insurers
442.385
Definitions
442.386
Health Care Cost Growth Target program established
442.392
Uniform payment methodology for hospital and ambulatory surgical center services
442.394
Acceptance by facilities as payment in full
442.396
Attestation of compliance by insurers
442.400
“Health care facility” defined
442.405
Legislative findings and policy
442.420
Application for financial assistance
442.425
Financial reporting systems
442.430
Investigations
442.450
Exemption from cost review regulations
442.460
Information about utilization and cost of health care services
442.463
Annual utilization report
442.470
Definitions for ORS 442.470 to 442.507
442.475
Office of Rural Health
442.480
Rural Health Care Revolving Account
442.485
Responsibilities of Office of Rural Health
442.490
Rural Health Coordinating Council
442.495
Responsibilities of council
442.500
Technical and financial assistance to rural communities
442.502
Determination of size of rural hospital
442.503
Eligibility for economic development grants
442.505
Technical assistance to rural hospitals
442.507
Assistance to rural emergency medical service systems
442.515
Rural hospitals
442.520
Risk assessment formula
442.561
Certifying individuals licensed under ORS chapter 679 for tax credit
442.562
Certifying podiatrists for tax credit
442.563
Certifying certain individuals providing rural health care for tax credit
442.564
Certifying optometrists for tax credit
442.566
Certifying emergency medical services providers for tax credit
442.568
Oregon Health and Science University to recruit persons interested in rural practice
442.570
Primary Care Services Fund
442.601
Definitions
442.602
Community benefit reporting
442.610
Notice of financial assistance policies
442.612
Definitions
442.614
Requirements for financial assistance policies
442.618
Annual reports related to financial assistance policies and nonprofit status
442.624
Establishment of community benefit spending floor
442.630
Community health needs assessment and three-year strategy
442.700
Definitions for ORS 442.700 to 442.760
442.705
Legislative findings
442.710
Application for approval of cooperative program
442.715
Authorized practices under approved cooperative program
442.720
Board of governors for cooperative program
442.725
Annual report of board of governors
442.730
Review and evaluation of report
442.735
Complaint procedure
442.740
Powers of director over action under cooperative program
442.745
Disclosure of confidential information not waiver of right to protect information
442.750
Status of actions under cooperative program
442.755
Rules
442.760
Status to contest order
442.819
Definitions for ORS 442.819 to 442.851
442.820
Oregon Patient Safety Commission
442.825
Funds received by commission
442.830
Oregon Patient Safety Commission Board of Directors
442.831
Powers of board relating to Oregon Patient Safety Reporting Program
442.835
Appointment of administrator
442.837
Oregon Patient Safety Reporting Program
442.839
Commission as central patient safety organization
442.844
Patient safety data
442.846
Patient safety data not admissible in civil actions
442.850
Fees
442.851
Limit on amounts collected to fund Oregon Patient Safety Reporting Program
442.853
Legislative findings
442.854
Definitions
442.855
Oregon Health Care Acquired Infection Reporting Program established
442.856
Health Care Acquired Infection Advisory Committee established
442.860
Comprehensive system of maternity care
442.870
Emergency Medical Services Enhancement Account
442.991
Civil penalties for failure to report proposed capital projects
442.993
Civil penalties for failure to report health care data
442.994
Civil penalty for failure to perform
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