Current through Register Vol. 63, No. 9, September 1, 2024
(1)
Pursuant to ORS 415.500(6) and
(10) and subject to the materiality standards
under OAR 409-070-0015, transactions that
are subject to review under these rules are the following:
(a) A merger or consolidation of a health
care entity with another entity;
(b) An acquisition of a health care entity by
another entity;
(c) A transaction
to form a new contract, new clinical affiliation or new contracting affiliation
between or among health care entities that will eliminate or significantly
reduce essential services;
(d)
Formation of a corporate affiliation involving at least one health care entity;
or
(e) A transaction to form a new
partnership, joint venture, accountable care organization, parent organization
or management services organization between or among health care entities that
will:
(A) Eliminate or significantly reduce
essential services;
(B) Consolidate
or combine providers of essential services when contracting payment rates with
payers, insurers, or coordinated care organizations; or
(C) Consolidate or combine insurers when
establishing health benefit premiums.
(2) An acquisition of a health care entity
occurs when:
(a) Another person acquires
control of the health care entity including acquiring a controlling interest as
described in OAR 409-070-0025;
(b) Another person acquires, directly or
indirectly, voting control of more than fifty percent (50%) of any class of
voting securities of the health care entity other than a domestic insurer as
described in OAR 409-070-0025(1)(c);
(c) Another person acquires all or
substantially all of the health care entity's assets and operations;
(d) Another person undertakes to provide the
health care entity with comprehensive management services; or
(e) The health care entity merges tax
identification numbers or corporate governance with another entity.
(3) A significant reduction of
services occurs when the transaction will result in a change of one-third or
more of any of the following:
(a) An increase
in time or distance for community members to access essential services,
particularly for historically or currently underserved populations or community
members using public transportation;
(b) A reduction in the number of providers,
including the number of culturally competent providers, health care
interpreters, or traditional healthcare workers, or a reduction in the number
of clinical experiences or training opportunities for individuals enrolled in a
professional clinical education program;
(c) A reduction in the number of providers
serving new patients, providers serving individuals who are uninsured, or
providers serving individuals who are underinsured;
(d) Any restrictions on providers regarding
rendering, discussing, or referring for any essential services;
(e) A decrease in the availability of
essential services or the range of available essential services;
(f) An increase in appointment wait times for
essential services;
(g) An increase
in any barriers for community members seeking care, such as new prior
authorization processes or required consultations before receiving essential
services; or
(h) A reduction in the
availability of any specific type of care such as primary care, behavioral
health care, oral health care, specialty care, pregnancy care, inpatient care,
outpatient care, or emergent care as relates to the provision of essential
services.
(4) Any change
in the sub-regulatory guidance document pertaining to paragraph (3) of this
rule shall be effective no less than 180 calendar days after
publication.
(5) The foregoing
standards in paragraph (3) of this rule do not alter any regulatory standards
that may otherwise apply to a health care entity.
Statutory/Other Authority: ORS
415.501
Statutes/Other Implemented: ORS
415.500 to
415.900
