Oregon Statutes 442.615 – Financial assistance; screening for eligibility; processing; appeals; collections; rules
(1) As used in this section:
Terms Used In Oregon Statutes 442.615
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
- Credit Score: A number, roughly between 300 and 800, that measures an individual's credit worthiness. The most well-known type of credit score is the FICO score. This score represents the answer from a mathematical formula that assigns numerical values to various pieces of information in your credit report. Source: OCC
(a) ‘Financial assistance’ includes:
(A) Charity care, as defined in ORS § 442.601; or
(B) An adjustment to a patient’s costs for care under ORS § 442.614 (1)(a).
(b) ‘Hospital’ has the meaning given that term in ORS § 442.612.
(2) Using the process prescribed by the Oregon Health Authority under subsection (3) of this section, a hospital licensed under ORS § 441.025 shall screen a patient for presumptive eligibility for financial assistance if the patient:
(a) Is uninsured;
(b) Is enrolled in the state medical assistance program; or
(c) Owes the hospital more than $500.
(3) The authority shall adopt by rule the process for screening a patient for presumptive eligibility for financial assistance under subsection (2) of this section. The rules and process must:
(a) Prohibit a hospital from requiring a patient to provide documentation or other verification;
(b) Ensure that the process will not cause any negative impact on the patient’s credit score;
(c) Require a hospital, before sending a bill to the patient, to conduct the screening and apply any financial assistance for which the patient qualifies to the bill; and
(d) Require the hospital to notify a patient if the patient has been screened and to explain to the patient, in language approved by the authority, how to apply for financial assistance if financial assistance was denied, or how to apply for additional financial assistance above what the patient received.
(4) A patient may apply for financial assistance:
(a) If the patient was screened for presumptive eligibility for financial assistance and was found not to be eligible or the patient disagrees with the amount of the financial assistance that was offered;
(b) If a patient was not screened for presumptive eligibility for financial assistance; or
(c) Any time up to 12 months after a patient pays for the services that the hospital provided.
(5) A hospital may require a patient who applies for financial assistance under subsection (4) of this section to provide documentation or verification of information reported as necessary for the hospital to determine the patient’s eligibility for financial assistance.
(6) If a patient applies for financial assistance after having paid for the services and the patient is found to have been eligible for financial assistance when the services were provided:
(a) The hospital shall refund the amount of financial assistance for which the patient qualified;
(b) If the hospital previously determined, incorrectly, that the patient did not qualify for financial assistance for the services based on information provided by the patient at the time of the incorrect determination, the hospital shall also pay the patient interest on the amount of financial assistance at the rate set by the Federal Reserve and any other associated reasonable costs, such as legal expenses and fees, incurred by the patient in securing financial assistance; and
(c) If the hospital sold the debt to a collection agency or authorized a collection agency to collect debts on behalf of the hospital, the hospital shall notify the collection agency that the debt is invalid.
(7) If a patient applies for financial assistance and the hospital determines that the patient is eligible for financial assistance based on documentation provided by the patient, the patient’s eligibility for financial assistance continues for nine months following the hospital’s determination, and the patient may not be required to reapply for financial assistance for services provided during that nine-month period.
(8)(a) A hospital must have a written process that is in plain English, and in other languages as required by law, for a patient to appeal a hospital’s denial of financial assistance, in whole or in part, and that allows the patient, or an individual acting on behalf of the patient, to correct any deficiencies in documentation or to request a review of the denial by the hospital’s chief financial officer or the chief financial officer’s designee. The authority shall prescribe by rule the requirements for the appeal process.
(b) If a hospital denies a patient’s application for financial assistance, whether in whole or in part, the hospital must notify the patient of the denial and include in the notice an explanation of the hospital’s appeal process.
(9) During the pendency of an appeal that is filed using a hospital’s appeal process under subsection (8) of this section, if:
(a) The hospital has initiated collection activities, the hospital must suspend all collection activities; and
(b) The hospital sold the debt under appeal to a collection agency or has authorized a collection agency to collect debts on behalf of the hospital, the hospital must notify the collection agency to suspend collection activities. [2023 c.263 § 1]
442.615 becomes operative July 1, 2024. See section 6, chapter 263, Oregon Laws 2023.
442.615 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS Chapter 442 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
Section 5, chapter 263, Oregon Laws 2023, provides:
A hospital is not required to have in place an appeals process described in section 1 (8) of this 2023 Act [442.615 (8)] before January 1, 2025. [2023 c.263 § 5]