Waiver of requirements
- • rules
- • penalties
(1) Notwithstanding any other provision of law, a hospital licensed under ORS 441.025 (License issuance), in accordance with rules adopted by the Oregon Health Authority, may apply for waiver from the provisions of ORS 442.325 (Certificate for health care facility of health maintenance organization), and the authority shall grant the waiver if, for the most recently completed hospital fiscal year preceding the date of application for waiver and each succeeding fiscal year thereafter, the percentage of qualified inpatient revenue is not less than that described in subsection (2) of this section.
(2)(a) The percentage of qualified inpatient revenue for the first year in which a hospital is granted a waiver under subsection (1) of this section may not be less than 60 percent.
(b) The percentage in paragraph (a) of this subsection shall be increased by five percentage points in each succeeding hospital fiscal year until the percentage of qualified inpatient revenue equals or exceeds 75 percent.
(3) As used in this section:
(a) “Qualified inpatient revenue” means revenue earned from public and private payers for inpatient hospital services approved by the authority pursuant to rules, including:
(A) Revenue earned pursuant to Title XVIII, United States Social Security Act, when such revenue is based on diagnostic related group prices that include capital-related expenses or other risk-based payment programs as approved by the authority;
(B) Revenue earned pursuant to Title XIX, United States Social Security Act, when such revenue is based on diagnostic related group prices that include capital-related expenses;
(C) Revenue earned under negotiated arrangements with public or private payers based on all-inclusive per diem rates for one or more hospital service categories;
(D) Revenue earned under negotiated arrangements with public or private payers based on all-inclusive per discharge or per admission rates related to diagnostic related groups or other service or intensity-related measures;
(E) Revenue earned under arrangements with one or more health maintenance organizations; or
(F) Other prospectively determined forms of inpatient hospital reimbursement approved in advance by the authority in accordance with rules.
(b) “Percentage of qualified inpatient revenue” means qualified inpatient revenue divided by total gross inpatient revenue as defined by administrative rule of the authority.
(4)(a) The authority shall hold a hearing to determine the cause if any hospital granted a waiver pursuant to subsection (1) of this section fails to reach the applicable percentage of qualified inpatient revenue in any subsequent fiscal year of the hospital.
(b) If the authority finds that the failure was without just cause and that the hospital has undertaken projects that, except for the provisions of this section, would have been subject to ORS 442.325 (Certificate for health care facility of health maintenance organization), the authority shall impose one of the penalties outlined in paragraph (c) of this subsection.
(c)(A) A one-time civil penalty of not less than $25,000 or more than $250,000; or
(B) An annual civil penalty equal to an amount not to exceed 110 percent of the net profit derived from such project or projects for a period not to exceed five years.
(5) Nothing in this section shall be construed to permit a hospital to develop a new inpatient hospital facility or provide new services authorized by facilities defined as “long term care facility” under ORS 442.015 (Definitions) under a waiver granted pursuant to subsection (1) of this section. [1985 c.747 §35; 1987 c.660 §9; 1991 c.470 §18; 1995 c.727 §41; 2009 c.595 §753; 2013 c.1 §65]
Note: 442.342 (Waiver of requirements) was enacted into law by the Legislative Assembly and added to or made a part of ORS chapter 442 by legislative action but not to any series therein. See Preface to Oregon Revised Statutes for further explanation.
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.