Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-1510 - Prominent Carrier Reporting Requirements

(1) Not later than October 1 of each year from 2016 through 2018, each prominent carrier shall submit to the Department of Consumer and Business Services all non-claims based primary care expenditures for the prior calendar year using the approved file layout and format set forth on the website of the Division of Financial Regulation of the Department of Consumer and Business Services at dfr.oregon.gov.

(2) Each prominent carrier shall submit to department all non-claims based total health care expenditures for the prior calendar year using the approved file layout and format set forth on the website of the Division of Financial Regulation of the Department of Consumer and Business Services at dfr.oregon.gov.

(3) Each category included in the approved file format is mutually exclusive; therefore, expenditures shall only be accounted for in one category.

(4) All data shall be submitted to the department no later than October 1 of each year that the prominent carrier is required to report under section (1) of this rule.

(5) Claims-based primary care and total health care expenditures will be calculated for each prominent carrier by the Oregon Health Authority using data from the All-Payer All-Claims Database.

(6) Expenditures for services or activities outside the primary care setting, regardless of a primary care capacity building intent, are not considered primary care expenditures for purposes of this report.