Current through Register Vol. 63, No. 9, September 1, 2024
(1) Determination of a provider organization
that is required to report data.
(a) The
Authority must identify provider organizations with 10,000 or more attributed
patients in at least one market using the annual report titled Health Care Cost
Trends, which is set forth on the Program website.
(b) The Authority must make annual
determinations regarding which provider organizations are required to report
data. The Authority must provide written notification no later than April 30 of
each year to all provider organizations required to report data for the current
year.
(c) A provider organization
may appeal the Authority's determination of the status as a provider
organization required to report data pursuant to the procedure outlined in OAR
409-065-0050.
(2)
Provider organizations with less than 10,000 attributed patients in a given
market, pediatric provider organizations, or federally qualified health
centers, as identified by the Authority in the annual report titled Health Care
Cost Trends and set forth on the Program website, may voluntarily submit a
complete CGT-4 to the Authority.
(3) Data submission requirements.
(a) Annual data submission dates are provided
in the CGT-4; the data must not be submitted before September 1st of each year,
subject to section (7) of this rule.
(b) The Authority must review a submitted
CGT-4 within 90 calendar days after confirming receipt. If the Authority finds
errors during its review through edit checks or validation, the Authority must
issue a notice of the error(s) to the provider organization. Provider
organizations must correct and resubmit data within 30 calendar days after the
date the Authority issues notice of the error(s). The Authority will consider
the annual data submission complete after the provider organization submits all
necessary corrections and resubmissions, as determined by the Authority.
Voluntary reporters may correct and resubmit data, as applicable.
(4) Data submission waivers
(a) The Authority may grant a waiver or
deadline extension to the data submission requirements.
(b) If a provider organization believes they
are eligible for a waiver of all or part of the data submission requirements
they may request a waiver of reporting requirements by submitting a CGT-3 to
the Authority.
(A) A provider organization
must submit a CGT-3 form to request a waiver as follows:
(i) To request a partial waiver to the data
submission requirements, provider organizations must submit a completed CGT-3
form to the Authority no later than 14 calendar days before the annual
reporting deadline.
(ii) To request
a waiver of all data submission or validation requirements, a provider
organization must submit a completed CGT-3 form to the Authority no later than
60 calendar days before the annual reporting deadline.
(B) The Authority must approve or deny the
waiver request and provide written notification to the requestor within 14
calendar days following receipt of the request.
(c) If a provider organization believes they
need a deadline extension for the data submission requirements, they may
request a deadline extension by submitting a CGT-3 form to the Authority.
(A) Provider organizations may submit a CGT-3
form to request a deadline extension as follows:
(i) To request a deadline extension for data
submission, provider organizations must submit a completed CGT-3 form to the
Authority no later than 14 calendar days before the annual reporting
deadline.
(ii) To request a
deadline extension for data correction, resubmission, or validation
requirements, mandatory reporters must submit a completed CGT-3 form to the
Authority no later than seven calendar days after the date of the notice issued
by the Authority requesting data correction, resubmission, or
validation.
(B) The
Authority must issue its determination on a provider organization's CGT-3
deadline extension request within 14 calendar days after the date of the
request.
(d) If the
Authority denies a CGT-3 request, the mandatory reporter may request a
contested case hearing following the procedure outlined in OAR
409-065-0050.
(e) The Authority
will only grant CGT-3 requests for one data submission cycle at a
time.
(5) Data
submission Compliance and Enforcement
(a)
Unless the Authority approves a waiver submitted pursuant to section (4) of
this rule, a provider organization fails to comply with data submission
requirements under section (3) of this rule when a provider organization fails
to submit data files by the specified submission date.
(b) Unless the Authority approves a waiver
submitted pursuant to section (4) of this rule, a provider organization fails
to comply with data file requirements when a provider organization:
(A) Submits a data file in an unapproved
layout;
(B) Submits a data element
in an unapproved format;
(C)
Submits a data element with unapproved coding;
(D) Fails to submit a required data element;
or
(E) Fails to comply with
validation and quality control efforts, including resubmitting or correcting
data in a timely fashion as requested by the Authority.
(c) The Authority must issue a notice of
noncompliance to provider organizations before imposing a civil penalty under
section (6) of this rule. Provider organizations must come into compliance
within 30 calendar days from the date the Authority issues its notice of
noncompliance.
(6) The
Authority may impose a civil penalty on a provider organization for a violation
of this rule if the provider organization does not come into compliance as
required under section (5) of this rule. Civil penalties must be imposed in the
manner provided in ORS
183.745. Pursuant to ORS
442.993, the Authority adopts
the following schedule of civil penalties:
(a)
Up to $500 per day starting from the date of the notice in (5)(c) of this rule
for each violation of (5)(a) of this rule;
(b) Up to $400 per day starting from the date
of the notice in (5)(c) of this rule for each violation of (5)(b) of this
rule.
(7) For calendar
year 2024, the Authority will notify provider organizations that are required
to submit a CGT-4 file under section (1) of this rule no later than July 31,
2024, with submissions due to the Authority no later than December 6, 2024.
Annual data submissions for subsequent years must comply with the requirements
of section (3) of this rule.
Statutory/Other Authority: ORS
442.386
Statutes/Other Implemented: ORS
442.385 &
442.386
