ORS Chapter 414 — Medical Assistance

ORS 414.584. (A) At least one member representing persons that share in the financial risk of the organization; (B) A representative of a dental care organization selected by the coordinated care organization; (C) The major components of the health care delivery system; (D) At least two health care providers in active practice, including: (i) A physician licensed under ORS chapter 677 or a nurse practitioner licensed under ORS 678.375, whose area of practice is primary care; and (ii) A behavioral health provider; (E) At least two members from the community at large, to ensure that the organizations decision-making is consistent with the values of the members and the community; and (F) At least two members of the community advisory council, one of whom is or was within the previous six months a recipient of medical assistance and is at least 16 years of age or a parent, guardian or primary caregiver of an individual who is or was within the previous six months a recipient of medical assistance. (p) Each coordinated care organizations governing body establishes standards for publicizing the activities of the coordinated care organization and the organizations community advisory councils, as necessary, to keep the community informed. (q) Each coordinated care organization publishes on a website maintained by or on behalf of the coordinated care organization, in a manner determined by the authority, a document designed to educate members about best practices, care quality expectations, screening practices, treatment options and other support resources available for members who have mental illnesses or substance use disorders. (r) Each coordinated care organization works with the Tribal Advisory Council established in ORS 414.581 and has a dedicated tribal liaison, selected by the council, to: (A) Facilitate a resolution of any issues that arise between the coordinated care organization and a provider of Indian health services within the area served by the coordinated care organization; (B) Participate in the community health assessment and the development of the health improvement plan; (C) Communicate regularly with the Tribal Advisory Council; and (D) Be available for training by the office within the authority that is responsible for tribal affairs, any federally recognized tribe in Oregon and the urban Indian health program that is located within the area served by the coordinated care organization and operated by an urban Indian organization pursuant to 25 U.S.C. 1651. (3) The authority shall consider the participation of area agencies and other nonprofit agencies in the configuration of coordinated care organizations. (4) In selecting one or more coordinated care organizations to serve a geographic area, the authority shall: (a) For members and potential members, optimize access to care and choice of providers; (b) For providers, optimize choice in contracting with coordinated care organizations; and (c) Allow more than one coordinated care organization to serve the geographic area if necessary to optimize access and choice under this subsection. (5) On or before July 1, 2014, each coordinated care organization must have a formal contractual relationship with any dental care organization that serves members of the coordinated care organization in the area where they reside. (6) In addition to global budgets, the authority may employ other payment mechanisms to reimburse coordinated care organizations for specified health services during limited periods of time if: (a) Global budgets remain the primary means of reimbursing coordinated care organizations for care and services provided to the coordinated care organizations members; (b) The other payment mechanisms are consistent with the legislative intent expressed in ORS 414.018 and the system design described in ORS 414.570 (1); and (c) The payment mechanisms are employed only for health-related social needs services, such as housing supports, nutritional assistance and climate-related assistance, approved for the demonstration project under 42 U.S.C. 1315 by the Centers for Medicare and Medicaid Services.