Reimbursement of rural hospitals by prepaid managed care health services organization
(1) A prepaid managed care health services organization, as defined in ORS 414.736 (Definitions), that contracts with the Department of Human Services under ORS 414.725 (Prepaid managed care health services contracts) (1) to provide prepaid managed care health services, including hospital services, shall reimburse Type A and Type B hospitals and rural critical access hospitals, as described in ORS 442.470 (Definitions for ORS 442.470 to 442.507) and identified by the Office of Rural Health as rural hospitals, fully for the cost of covered services based on the cost-to-charge ratio used for each hospital in setting the capitation rates paid to the prepaid managed care health services organization for the contract period.
(2) The department shall base the capitation rates described in subsection (1) of this section on the most recent audited Medicare cost report for Oregon hospitals adjusted to reflect the Medicaid mix of services.
(3) This section may not be construed to prohibit a prepaid managed care health services organization and a hospital from mutually agreeing to reimbursement other than the reimbursement specified in subsection (1) of this section.
(4) Hospitals reimbursed under subsection (1) of this section are not entitled to any additional reimbursement for services provided. [1997 c.642 §2; 1999 c.546 §2; 2005 c.806 §2]
Note: See note under 414.705 (Definitions for ORS 414.705 to 414.750).
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