justicedao/ipfs_state_laws huggingface dataset:
410-141-5323 CCO HOLDING COMPANY REGULATION: Transaction Types Within Holding Company for Disclosure (1) A CCO required to give notice of a proposed transaction pursuant OAR 410-141-5320 shall furnish the required information on Form D. Form D is set forth on the website of the Authority at https://www.oregon.gov/oha/HSD/OHP/Pages/CCO-Contract-Forms.aspx . (2) Agreements for cost sharing services and management services shall at a minimum and as applicable: (a) Identify the person providing services and the nature of such services; (b) Set forth the methods to allocate costs; (c) Require timely settlement, not less frequently than on a quarterly basis, and compliance with the requirements in the Accounting Practices and Procedures Manual; (d) Prohibit advancement of funds by the CCO to the affiliate except to pay for services defined in the agreement; (e) State that the CCO shall maintain oversight for functions provided to the CCO by the affiliate and that the CCO shall monitor services annually for quality assurance; (f) Define books and records of the CCO to include all books and records developed or maintained under or related to the agreement; (g) Specify that all books and records of the CCO are and remain the property of the CCO and are subject to the control of the CCO; (h) State that all funds and invested assets of the CCO are the exclusive property of the CCO, held for the benefit of the CCO and are subject to the control of the CCO; (i) Include standards for termination of the agreement with and without cause; (j) Include provisions for indemnification of the CCO in the event of gross negligence or willful misconduct on the part of the affiliate providing the services; (k) Specify that, if the CCO is placed in receivership or seized by the Authority under ORS chapter 415: (A) All of the rights of the CCO under the agreement extend to the receiver or the Authority, and, (B) All books and records shall immediately be made available to the receiver or the Authority, and shall be turned over to the receiver or the Authority immediately upon the receiver or the Authority’s request; (L) Specify that the affiliate has no automatic right to terminate the agreement if the CCO is placed in receivership pursuant to ORS chapter 415; and (m) Specify that the affiliate shall continue to maintain any systems, programs, or other infrastructure notwithstanding a seizure by the Authority under ORS chapter 415, and shall make them available to the receiver, for so long as the affiliate continues to receive timely payment for services rendered. Statutory/Other Authority: ORS 413.042, 414.572, 414.591 & 414.605 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, adopt filed 12/29/2024, effective 01/01/2025
410-141-5325 CCO HOLDING COMPANY REGULATION: Director and Officer Liability; Effect of Control of CCO Subject to Registration; Board of Directors (1) A person’s control of a CCO that is subject to registration does not relieve the officers and directors of the CCO of any obligation or liability to which the officers and directors may otherwise be subject by law. The CCO must be managed so as to assure the CCO’s separate operating identity. (2) This section does not preclude a CCO from having or sharing a common management, or from using personnel, property or services jointly or cooperatively, with another person under an arrangement that meets the standards set forth in OAR 410-141-5320. (3) At least one-third of a CCO’s directors and at least one-third of the members of each committee of the CCO’s Board must be persons who are not: (a) Officers or employees of the CCO or of any entity that controls, is controlled by or is under common control with the CCO; or (b) Beneficial owners of a controlling interest in the voting securities of the CCO or of an entity that controls, is controlled by or is under common control with the CCO. (4) A quorum for transacting business at a meeting of the CCO’s Board or any committee of the CCO’s Board must include at least one person with the qualifications described in paragraph (a) of this subsection. (5) A CCO’s Board shall establish at least one committee of which the entire membership consists of persons who have the qualifications described in subsection (3) of this section. The CCO Board shall give the committee established under this subsection responsibility for: (a) Recommending independent certified public accountants for the board to select; (b) Reviewing the CCO’s financial condition and the scope and results of any independent or internal audit; (c) Nominating candidates for election to the CCO Board; (d) Recommending principal officers for selection and the compensation for the principal officers; and (e) Evaluating the principal officers’ performance. (6) Subsections (3), (4) and (5) of this section do not apply to a CCO if the person that controls the CCO has a board of directors, and committees of the person’s board of directors, that meet the requirements set forth in subsections (3), (4) and (5) of this section. Statutory/Other Authority: ORS 413.042, 414.572, 414.591 & 414.605 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 72-2023, minor correction filed 08/22/2023, effective 08/22/2023 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5330 CCO HOLDING COMPANY REGULATION: Annual Enterprise Risk Report (1) Every CCO subject to registration shall file an enterprise risk report each year. The enterprise risk report must identify, to the best of the CCO’s knowledge and belief, the material risks within the holding company system of which the CCO is a part that may pose enterprise risk to the CCO. (2) A CCO required to file an enterprise risk report pursuant to this rule shall furnish the required information on Form F. Form F is set forth on the website of the Authority at https://www.oregon.gov/oha/HSD/OHP/Pages/CCO-Contract-Forms.aspx. Statutory/Other Authority: ORS 413.042, 414.572, 414.591 & 414.605 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5335 CCO HOLDING COMPANY REGULATION: Disclaimers and Termination of Registration (1) The Authority shall terminate the registration of any CCO which demonstrates that it no longer is a member of a CCO holding company system. (2) A request for termination of registration claiming that a person does not, or shall not upon the taking of some proposed action, control another person (referred to as the “subject” in this section) shall contain: (a) The number of authorized, issued and outstanding voting securities of the subject; (b) With respect to the person whose control is denied and all affiliates of such person, the number and percentage of shares of the subject’s voting securities that are held of record or known to be beneficially owned, and the number of such shares concerning which there is a right to acquire, directly or indirectly; (c) All material relationships and bases for affiliation between the subject and the person whose control is denied and all affiliates of such person; and (d) A statement explaining why such person may not be considered to control the subject. (3) A request for termination of registration shall be considered granted unless the Authority, within thirty (30) days after the Authority receives the request, notifies the registrant otherwise. Statutory/Other Authority: ORS 413.042, 414.572, 414.591 & 414.605 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5340 CCO HOLDING COMPANY REGULATION: Forms; General Requirements (1) Forms A, B, C, D, E and F are intended to be guides in the preparation of the statements required by OAR 410-141-5290 to OAR 410-141-5355, including but not limited to the registration provisions thereof. The forms are not intended to be blank forms that are to be filled in. The statements filed shall contain the numbers and captions of all items, but the text of the items may be omitted if the answers to the items are prepared so as to indicate clearly the scope and coverage of the items. All instructions, whether appearing under the items of the form or elsewhere, are to be omitted. Unless expressly provided otherwise, if any item is inapplicable or the answer to any item is in the negative, an appropriate statement to that effect shall be made. (2) One complete copy of each statement, including exhibits and all other papers and documents filed as a part of the statement, shall be filed with the Authority by electronic delivery according to the terms of the CCO Contract. Each statement shall be signed and certified in the manner prescribed on the form. Unsigned copies shall be confirmed. If the signature of any person is affixed pursuant to a power of attorney or other similar authority, a copy of such power of attorney or other authority shall also be filed with the statement. (3) Statements must be prepared electronically and clearly named. Exhibits and financial statements, unless specifically prepared for the filing, may be submitted in their original size. All copies of any statement, financial statements or exhibits shall be clear, easily readable, and suitable for printing. Debits in credit categories and credits in debit categories shall be designated so as to be clearly distinguishable as such on photocopies. Statements shall be in the English language and monetary values shall be stated in United States currency. If any exhibit or other paper or document filed with the statement is in a foreign language, it shall be accompanied by a translation into the English language and any monetary value shown in a foreign currency shall be converted into United States currency. Statutory/Other Authority: ORS 413.042, 414.572, 414.591 & 414.605 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5345 CCO HOLDING COMPANY REGULATION: Forms; Incorporation by Reference, Summaries, And Omissions (1) Information required by any item of Form A, B, D, E or F may be incorporated by reference in answer or partial answer to any other item. Information contained in any financial statement, annual report, proxy statement, statement filed with a governmental authority or any other document may be incorporated by reference in answer or partial answer to any item of Form A, B, D, E or F if the document or paper is filed as an exhibit to the statement. Excerpts of documents may be attached as exhibits if the documents are extensive. Documents currently on file with the Authority that were filed within three (3) years need not be filed as exhibits. References to information contained in exhibits or in documents already on file shall clearly identify the material and shall specifically indicate that such material is to be incorporated by reference in answer to the item. Matter shall not be incorporated by reference in any case in which the incorporation would render the statement incomplete, unclear, or confusing. (2) If an item requires a summary or outline of the provisions of any document, only a brief statement of the pertinent provisions of the document shall be made. The summary or outline may in addition incorporate by reference particular parts of any exhibit or document currently on file with the Authority that was filed within three (3) years and may be qualified in its entirety by such reference. If two or more documents required to be filed as exhibits are substantially identical in all material respects except as to the parties thereto, the dates of execution or other details, a copy of only one of such documents need be filed, but it shall have attached a schedule identifying the omitted documents and setting forth the material details in which such documents differ from the documents of which a copy is filed. Statutory/Other Authority: ORS 413.042, 414.572, 414.591 & 414.605 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5350 CCO HOLDING COMPANY REGULATION: Forms; Information Unknown or Unavailable and Extension of Time to Furnish (1) Required information need be given only insofar as it is known or reasonably available to the person filing the statement. If any required information is unknown and not reasonably available to the person filing, either because obtaining it would involve unreasonable effort or expense, or because it rests peculiarly within the knowledge of another person not affiliated with the person filing, the information may be omitted. However, the person filing shall: (a) Give such information on the subject as the person possesses or can acquire without unreasonable effort or expense, together with the sources thereof; and (b) Include a statement either showing that unreasonable effort or expense would be involved or indicating the absence of any affiliation with the person within whose knowledge the information rests and stating the result of a request made to such person for the information. (2) If it is impractical to furnish any required information, document, or report at the time it is required to be filed, a person may file a waiver request with the Authority: (a) Identifying the information, document, or report in question; (b) Stating why the filing thereof at the time required is impractical; and (c) Requesting an extension of time for filing the information, document, or report to a specified date. (3) An waiver request submitted under subsection (2) shall be considered granted unless the Authority, within thirty (30) days after receipt thereof, enters an order denying the application. Statutory/Other Authority: ORS 413.042, 414.572, 414.591 & 414.605 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5355 CCO HOLDING COMPANY REGULATION: Forms; Additional Information; Amendments (1) In addition to the information expressly required to be included in Forms A, B, C, D, E and F, a person filing such forms shall include further material information, if any, as may be necessary to make the information contained in the form not misleading. The person filing may also file exhibits in addition to those expressly required by the statement. Such exhibits shall be marked to clearly indicate the subject matters to which they refer. (2) A change to Form A, B, C, D, E and F shall include on the top of the cover page the phrase: “Change No. _____ to” and shall indicate the date of the change and not the date of the original filing. Statutory/Other Authority: ORS 413.042, 414.572, 414.591 & 414.605 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5360 CCO INSOLVENCY AND DISSOLUTION: Access to Funds and Transition of Members and Records (1) CCOs shall provide the Authority access to Restricted Reserve Funds if insolvency occurs. (2) CCOs shall have written policies and procedures to ensure that if insolvency occurs, Members and related clinical records are transitioned to other CCOs or providers with minimal disruption. Statutory/Other Authority: ORS 413.042, 414.572, 414.591, 414.605, 415.013 & 415.101-415.430 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5375 CCO INSOLVENCY AND DISSOLUTION: Voluntary Dissolution; Approval of Plan (1) No CCO may be dissolved voluntarily until the Authority has approved a plan for liquidation of the CCO's assets and obligations. (2) The plan of dissolution must provide for the reinsurance and assumption of all in-force CCO contracts to which the CCO is a party. (3) The Authority shall require that the plan of dissolution provide adequate reserves in trust or otherwise for the satisfaction of all remaining obligations of the CCO. Statutory/Other Authority: ORS 413.042, 414.572, 414.591, 414.605, 415.013 & 415.101-415.430 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-141-5380 CIVIL PENALTIES (1) The Director of the Oregon Health Authority may impose a civil penalty for violations of OAR 410-141-5000 to 410-141-5380 or any final order of the Authority entered under any of OAR 410-141-5000 to 410-141-5380, in an amount determined by the Authority that shall not exceed $10,000 for each offense. Each violation is a separate offense. (2) In addition to the civil penalty specified in subsections (1), (3) and (4) of this section, the Director of the Authority may require a person that violates any provision of OAR 410-141-5000 to 410-141-5380 or any final order of the Authority entered under any of OAR 410-141-5000 to 410-141-5380, to forfeit and pay a civil penalty in an amount determined by the Authority that shall not exceed the amount by which the person profited by or through or as a result of such violation. (3) In addition to the penalties specified in subsection (1), (2) and (4) of this section, the Director of the Authority may impose on a director or officer of a CCO or any affiliate within a CCO’s holding company system who engages in a transaction or makes an investment that has not been properly reported under, or that otherwise does not comply with OAR 410-141-5360 to 410-141-5375, who knowingly participates in or assents to the transaction or investment, or who permits another officer or an agent of the holding company system to engage in the transaction or make the investment, in the director or officer's individual capacity, a civil penalty in an amount determined by the Authority that shall not exceed $10,000. (4) In addition to the penalties specified in subsections (1), (2) and (3) of this section, the Director of the Authority may impose a civil penalty on a CCO or other person that fails to make a required filing or demonstrate a good faith effort to comply with a filing requirement under OAR 410-141-5285 to OAR 410-141-5355 in an amount determined by the Authority that does not exceed $50,000. (5) Civil penalties under this section shall be imposed and enforced in accordance with ORS 183.745. (6) The provisions of this section are in addition to and not in lieu of, any other enforcement provisions imposed by law, including ORS Chapter 415, OAR Chapter 410, Division 141, or in the CCO Contract. (7) Moneys received by the Authority under this section shall be paid to the State Treasury and credited to the General Fund. Statutory/Other Authority: ORS 413.042, 414.572, 414.591, 414.605, 415.063 & 415.109 Statutes/Other Implemented: ORS 414.570-414.686 & 415.001-415.430 History: DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025 DMAP 60-2019, adopt filed 12/18/2019, effective 01/01/2020
410-142-0040 Eligibility for the Hospice Services (1) Hospice services are covered for clients who have: (a) Been certified as terminally ill in accordance with OAR 410-142-0060; and (b) Have Oregon Health Plan (OHP) Plus benefit package coverage. (2) Providers must bill Medicare for hospice services for clients with Medicare Part A coverage. Medicare’s payment is considered payment in full. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: DMAP 23-2014, f. & cert. ef. 4-4-14 DMAP 75-2013(Temp), f. 12-31-13, cert. ef. 1-1-14 thru 6-30-14 DMAP 40-2011, f. 12-15-11, cert. ef. 1-1-12 OMAP 43-2005, f. 9-2-05, cert. ef. 10-1-05 HR 16-1995, f. & cert. ef. 8-1-95 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0060 Certification of Terminal Illness (1) In order to receive reimbursement from the Division of Medical Assistance Programs (Division), the hospice must obtain and retain a physician’s written certification of a client’s terminal illness in accordance with the following procedures. Division will not pay for services provided prior to certification. (2) The attending physician is a doctor of medicine or osteopathy or a nurse practitioner and is identified by the client at the time he or she elects to receive hospice care, as having the most significant role in the determination and delivery of the client’s medical care. A nurse practitioner serving as the attending physician may not certify or re-certify the terminal illness. (3) Certifications may be completed up to two weeks before hospice care is elected. (4) The certification of a client who elects hospice is based on the physician’s or medical director’s clinical judgment regarding the normal course of the client’s illness and must include: (a) The statement that the client’s medical prognosis indicates a life expectancy of six months or less if the terminal illness runs its normal course; and (b) Clinical information and other documentation which support the medical prognosis must accompany the certification and be filed in the medical record with the certification. (5) A written certification signed by the physician(s) must be on file in the hospice client’s record prior to submission of a claim to Division for all benefit periods. (6) For the initial period of hospice coverage, the hospice must obtain, no later than two calendar days after hospice care is initiated (that is, by the end of the third day), oral or written certification of the terminal illness by the medical director of the hospice or the physician member of the hospice interdisciplinary group and the client’s attending physician (if the client has an attending physician). If the written certification is not dated, a notarized statement or some other acceptable documentation may be obtained to verify the actual certification date. (7) For any subsequent periods, the hospice must obtain, no later than two calendar days after the first date of each period, a written certification from the medical director of the hospice or the physician member of the hospice’s interdisciplinary group. If the hospice cannot obtain written certification within two calendar days, it must obtain oral certification within two calendar days. (8) The requirements specified in this rule also apply to clients who had been previously discharged during a benefit period and are again being certified for hospice care. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 34-2006, f. 9-15-06 OMAP 58-2002, f. & cert. ef. 10-1-02 HR 28-1997, f. 12-31-97, cert. ef. 1-1-98 HR 9-1994, f. & cert. ef. 2-1-94
410-142-0080 Informed Consent A hospice must demonstrate respect for an individual's rights by ensuring that an informed consent form has been obtained for every individual, either from the individual or representative as defined in OAR 410-142-0020. The form must specify the type of care and services that may be provided as hospice care during the course of the illness. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.065 History: OMAP 1-2003, f. 1-31-03, cert. ef. 2-1-03 HR 28-1997, f. 12-31-97, cert. ef. 1-1-98 HR 9-1994, f. & cert. ef. 2-1-94