Oregon Health Authority
Health Policy and Analytics - Chapter 409
Division 25
ALL PAYER ALL CLAIMS DATA REPORTING PROGRAM
409-025-0140
Waivers, Exemptions and Extensions
(1) The Authority may grant a waiver, deadline extension, or exemption to the reporting and validation requirements.
(2) A mandatory reporter is required by law and rule to submit all required data files no later than the submission deadline and at sufficient quality to meet or exceed the published validation requirements. Mandatory reporters shall notify the Authority of their inability to meet any requirement within the timeline stated in rule or incorporated by reference.
(3) A mandatory reporter may request a waiver of reporting requirements. The request shall be submitted 60 calendar days prior to the applicable reporting deadline using the APAC-1a form.
(a) Mandatory reporters may request a waiver of reporting for the following reasons:
(A) A mandatory reporter who is a carrier or a third party administrator and, either due to decrease in covered lives or covered lives excluded as reporting to the federal Department of Labor under the Employment Retirement Income Security Act (ERISA), has fewer than 5,000 covered lives in Oregon to report;
(B) A mandatory reporter does not bill subscribers for premiums (Appendix F only);
(C) A mandatory reporter has no contracts sitused in Oregon for Appendices 1 and 2 under OAR 409-025-0125; or
(D) A mandatory reporter whose data is reported by another affiliated or contracted Oregon All Payer All Claims mandatory reporter if submitting files would create duplicate claims.
(b) A mandatory reporter who intends to withhold data under OAR 409-025-0110(8) must request a waiver and receive approval prior to withholding data.
(c) Mandatory reporters other than carriers and third party administrators may request a waiver of reporting based on the number of covered lives potentially reported. The Authority may approve a waiver if it determines the burden of reporting outweighs the value of the data in understanding services and costs in Oregon.
(d) Waivers are required only for the file types identified for the mandatory reporter type under OAR 409-025-0120 and OAR 409-025-0125.
(e) The Authority shall approve or deny the waiver request and provide written notification to the requestor within 14 calendar days of receipt of the request.
(f) Waivers of reporting are approved for one calendar year and may cover partial reporting years. Waivers must be requested each year that the reason for waiver continues to be in effect.
(4) A mandatory reporter may request a deadline extension for initial submission or correction of validation errors of required files. The request shall be submitted within the APAC vendor’s reporting portal at least 14 calendar days prior to the applicable reporting deadline.
(a) The mandatory reporter must explain why sufficient data or resources are not allocated to reporting to meet the published expectations for timing and data quality. The request must include the organization’s plan to mitigate future incidents and whether the plan has been approved and resources allocated to accomplish the activity within the stated timeline.
(b) The Authority shall approve or deny the extension request and provide notification to the requestor within seven (7) calendar days of receipt of the request.
(c) Extensions are approved for one reporting period. Failure to submit acceptable files at the end of the extension may result in a civil penalty under OAR 409-025-0150.
(5) A mandatory reporter may request an exemption for validation rules identified as ‘Exemption’ level. The request must be submitted through the APAC vendor’s reporting portal and cannot be submitted in advance of validation failure.
(a) Specific review of the failed validation results is required prior to requesting an exemption. Mandatory reporters must explain why the validation rule cannot be met and should not rely on receipt of poor-quality data as a reason for exemption. Requests that are not specific to the validation rule and data file submitted will be denied.
(b) The Authority shall approve or deny the exemption request and provide notification to the requestor through the APAC vendor’s reporting portal within seven (7) calendar days of receipt of the request.
(c) Exemptions are approved for a single submission or up to one calendar year. Failure to submit acceptable files based on approved exemptions may result in a civil penalty under OAR 409-025-0150.
(6) If the Authority denies the request, the requestor may appeal the denial by requesting a contested case hearing. The appeal must be filed within 30 business days of the denial. The appeal process is conducted pursuant to ORS Chapter 183 and the Attorney General’s Uniform and Model rules of Procedure for the Office of Administrative Hearings, OAR 137-003-0501 to 137-003-0700. The requestor shall have the burden to prove a compelling need for the waiver, exemption or extension.
Statutory/Other Authority: ORS 442.373
Statutes/Other Implemented: ORS 442.373 & ORS 442.372
History:
OHP 4-2023, amend filed 12/01/2023, effective 12/01/2023
OHP 8-2022, amend filed 12/01/2022, effective 12/01/2022
OHP 1-2016, f. & cert. ef. 1-5-16
OHP 1-2010, f. 2-26-10, cert. ef. 3-1-10