All Payer All Claims (APAC) Rules Advisory Committee Meeting Details

All Payer All Claims (APAC) Rules Advisory Committee August 9, 2023 OHA welcomes all participants. If you have any questions about accommodations or need any assistance to participate, please ZOOM chat message Ashley Walchli, or text 503-385-6542. All relay calls are accepted. HEALTH POLICY AND ANALYTICS DIVISION

Zoom features, captions and transcript Your microphone and video controls Click the small arrow next to CC Live Transcript to access caption controls List of who is present Chat feature will open in new window You can hide the subtitles or view the full transcript Please note this meeting is being recorded for internal notetaking purposes. 2 2 2 2 2

Attendance Please enter your name and organization in the Chat after joining the meeting. For this meeting, indicate whether you are representing your organization formally for the Rules Advisory Committee. Example: Karen Hampton, OHA APAC or Karen Hampton, OHA APAC RAC This will indicate who we should list as RAC participants when submitting rule changes to the Secretary of State. As a formal committee, APAC requests only one official participant per organization. Anyone can ask a clarifying question but only RAC participants should advise . There will be a verbal request for those attending by telephone only. 3 3 3 3 3

Agenda Welcome Purpose of a Rules Advisory Committee (RAC); RAC policy Roll call Summary of proposed changes Review proposed changes Review Notice of proposed rulemaking worksheet Next steps 4 4 4 4 4

Purpose of Rules Advisory Committee (RAC) During the RAC meeting Opportunity for external experts, businesses and other interested persons or groups to give input to OHA about proposed rulemaking The RAC s role is advisory and consensus is not necessary Community involvement is required unless an exemption is received. As a secondary data set, APAC has not yet established connections with communities and has received an exemption this year. 5 5 5 5 5

Purpose of RAC (continued) After the RAC meeting OHA will discuss and thoughtfully consider all suggestions and concerns expressed by RAC members and the public OHA will finalize the proposed text and submit a notice of rulemaking or notice of hearing to the Secretary of State The public will have the opportunity to review and comment on the proposed rules as required by statute 6 6 6 6 6

Roll call Reminder to please enter your name and organization in the Chat Verbal request for those attending by telephone only Confirmation of attending as a RAC participant Everyone is welcome to attend the meeting 7 7 7 7 7

Review proposed rule changes

Proposed changes to rule language 409-025-0140 Waivers and Exceptions to Waivers, Exemptions and Extensions Changes use of word exceptions to exemptions and adds extension in title and (6) Opportunity to update statutes referenced 409-025-0160 Data Access and Release Clarifies that confidentiality is for member and subscriber (not provider or facility) Clarifies that public use data set is pre-made; file contents set Changes to application for public use data set rather than pre-application and payment to be received within 30 days (not with application) 9 9 9 9 9

Review proposed layout changes

Proposed changes for claims Enrollment (Appendix A) ME207 Dental Coverage Flag should be blank unless it is a dental enrollment file Including dental enrollment in medical/pharmacy enrollment files was creating double-counting and difficulties with validations 11 11 11 11 11

Proposed changes for the medical claims file (Appendix B) Two new fields MC208 NDC code if procedure codes start with J Requested by the Prescription Drug Affordability Board at DCBS MC209 Flagged as SUD (substance use disorder) Requested by reporter to support full reporting of information 12 12 12 12 12

Proposed changes for the pharmacy claims file (Appendix C) New field on COB (coordination of benefits) status Follows CMS values for reporting Identified as need to understand more fully cost of prescription drugs 13 13 13 13 13

Proposed changes for the provider file (Appendix E) New field MP201 Primary care designation Assist APAC in producing the primary care report Reporting whether provider is included in member guide as primary care provider NOT matching up to primary care definition 14 14 14 14 14

Proposed changes for the medical claims file (Appendix B) Two new fields MC208 NDC code if procedure codes start with J Requested by the Prescription Drug Affordability Board at DCBS MC209 Flagged as SUD (substance use disorder) Requested by reporter to support full reporting of information 15 15 15 15 15

Review Notice of proposed rulemaking worksheet

Timing Hearing: September 19, 2023 2-2:30 PM Virtual Hearing Officer: Pete Edlund Last Date and Time for Public Comment September 21, 2023 5:00 PM 17 17 17 17 17

Filing caption proposed Update All Payer All Claims claims files 18 18 18 18 18

Statement of Cost of Compliance (1) Identify any state agencies, units of local government, and members of the public likely to be economically affected by the rule(s). None (2) Effect on Small Businesses: None known (a) Estimate the number and type of small businesses subject to the rule(s); Zero (b) Describe the expected reporting, recordkeeping and administrative activities and cost required to comply with the rule(s); None (c) Estimate the cost of professional services, equipment supplies, labor and increased administration required to comply with the rule(s). No reporting requirements due to change in rules anticipated for small businesses. 19 19 19 19 19

Equity impact statement The program does not interact with individuals, providers or community groups. The All Payer All Claims program does not establish eligibility for coverage, determine services to be provided or establish the cost or payment for any services. The program receives administrative data from insurers, third party administrators, pharmacy benefit managers and other insurer-types on services provided including to whom, service, service provider, billed amount and paid amount. The program continues to work with the Equity and Inclusion Division for guidance on how to work with community groups to determine the best way to acknowledge and document the structural racism underlying data received to mitigate propagating inequities in the guise of quantitative unbiased data. 20 20 20 20 20

Next steps Publish with Secretary of State September 2023 Public comment period ends September 21, 2023 Public hearing September 19, 2023 Filing rules expected date TBD Rule in effect December 1, 2023 for use in submission of 2023 Q4 files on January 31, 2024 Secretary of State notice for proposed rules https://secure.sos.state.or.us/oard/displayCompilations.action 21 21 21 21 21

Thank You Questions? Contact APAC.Admin@odhsoha.oregon.gov