reglab/housing_qa huggingface dataset:
OR Rev Stat § 414.884 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.884 - Applicability of managed care organization assessment.

ORS 414.880, 414.882 and 414.902 apply to any payments made to a managed care organization by the Oregon Health Authority for the period beginning January 1, 2020, and ending December 31, 2026. [2017 c.538 §12; 2019 c.2 §10] Note: See note under 414.880.
OR Rev Stat § 414.900 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.900 - Hospital assessment; penalties.

(1) A hospital that fails to file a report or pay an assessment under ORS 414.855 by the date the report or payment is due shall be subject to a penalty of up to $500 per day of delinquency. The total amount of penalties imposed under this section for each reporting period may not exceed five percent of the assessment for the reporting period for which penalties are being imposed. (2) Penalties imposed under this section shall be collected by the Oregon Health Authority and deposited in the Oregon Health Authority Fund established under ORS 413.101. (3) Penalties paid under this section are in addition to and not in lieu of any assessment imposed under ORS 414.855. [2003 c.736 §5; 2009 c.828 §52; 2009 c.867 §18; 2017 c.538 §31] Note: 414.900 is repealed January 2, 2031, and applies to net revenues earned by hospitals during the period specified in 414.871. See section 12, chapter 736, Oregon Laws 2003, as amended (note following 414.871). Note: See second note under 414.853.
OR Rev Stat § 414.902 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 414 - Medical Assistance|Section 414.902 - Managed care organization assessment; penalties.

(1) If a managed care organization fails to timely pay an assessment under ORS 414.880, the Oregon Health Authority shall impose a penalty on the managed care organization of up to $500 per day of delinquency. The total amount of penalties imposed under this section for a calendar quarter may not exceed five percent of the assessment due for that calendar quarter. (2) Any penalty imposed under this section is in addition to and not in lieu of the assessment imposed under ORS 414.880. (3) Penalties received by the authority under this section shall be paid into the State Treasury and credited to the Health System Fund established under section 2, chapter 538, Oregon Laws 2017. [2017 c.538 §10] Note: See note under 414.880.
OR Rev Stat § 415.001 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.001 - Reinsurance program for coordinated care organizations (CCOs).

(1) As used in this section: (a) "Attachment point" means the threshold dollar amount, adopted by the Oregon Health Authority by rule, for costs incurred by a coordinated care organization in a calendar year for a member, after which threshold the costs are eligible for state reinsurance payments. (b) "Coinsurance rate" means the rate, adopted by the authority by rule, at which the authority will reimburse a coordinated care organization for costs incurred by the coordinated care organization in a calendar year after the attachment point and before the reinsurance cap. (c) "Reinsurance" has the meaning given that term in ORS 731.126. (d) "Reinsurance cap" means the maximum dollar amount, adopted by the authority by rule, for costs incurred by a coordinated care organization in a calendar year, after which maximum the costs are no longer eligible for state reinsurance payments. (e) "Reinsurance payment" means a payment by the reinsurance program described in subsection (2) of this section to cover part of a coordinated care organization’s costs. (2) The Oregon Health Authority may establish a reinsurance program to: (a) Make payments to coordinated care organizations that face particularly high costs in caring for members who require new, exceptionally costly drugs or treatments; and (b) Better manage costs systemically. (3) The following requirements apply to a reinsurance program established under subsection (2) of this section: (a) A coordinated care organization becomes eligible for a reinsurance payment when the coordinated care organization’s costs in a calendar year exceed the attachment point. The amount of the payment shall be the product of the coinsurance rate and the coordinated care organization’s costs that exceed the attachment point, up to the reinsurance cap. (b) After the authority adopts by rule the attachment point, reinsurance cap or coinsurance rate for a calendar year, the authority may not: (A) Change the attachment point or the reinsurance cap during the calendar year; or (B) Increase the coinsurance rate during the calendar year. (c) The authority may adopt rules necessary to carry out the provisions of this section including, but not limited to, rules prescribing: (A) The amount, manner and frequency of reinsurance payments; (B) Assessments, if any, necessary to provide funding for the program; and (C) Financial reporting requirements for coordinated care organizations necessary to administer the program. (d) The authority shall take into account reinsurance payments received by a coordinated care organization in the determination of a global budget for the coordinated care organization. (4) The authority shall work with the Centers for Medicare and Medicaid Services in establishing a reinsurance program under subsection (2) of this section to ensure compliance with federal requirements and federal financial participation in the costs of the program. [2019 c.529 §2]
OR Rev Stat § 415.011 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.011 - Oregon Health Authority regulation of financial solvency of CCOs to align with regulation of domestic insurers; rules.

(1) The Oregon Health Authority may adopt rules to carry out the provisions of ORS 415.012 to 415.430. (2) The authority shall adopt rules for regulating the financial solvency of coordinated care organizations that align with the following provisions of the Insurance Code regulating domestic insurers, to the extent the provisions regarding insurers are applicable to coordinated care organizations and are in accordance with ORS chapters 413 and 414: (a) ORS 731.385; (b) ORS 731.504; (c) ORS 731.508; (d) ORS 731.509 (1) to (10) and (12); (e) ORS 731.574 (1) to (5); (f) ORS 731.730; (g) ORS 731.988; (h) ORS 732.235; (i) ORS 732.517 to 732.546, other than ORS 732.527, 732.531 and 732.541; (j) ORS 732.548; (k) ORS 732.549; (L) ORS 732.551; (m) ORS 732.552; (n) ORS 732.553; (o) ORS 732.554; (p) ORS 732.556; (q) ORS 732.558; (r) ORS 732.564; (s) ORS 732.566; (t) ORS 732.567; (u) ORS 732.568; (v) ORS 732.569; (w) ORS 732.574; (x) ORS 732.576; (y) ORS 732.578; (z) ORS 732.592; (aa) ORS 733.010 to 733.050; (bb) ORS 733.140 to 733.170; (cc) ORS 733.510 to 733.680; (dd) ORS 733.695 to 733.780; and (ee) ORS 734.014. (3) Rules adopted by the authority in accordance with ORS 731.385 that establish minimum standards for risk-based capital may not require a coordinated care organization to take preventive or corrective measures to increase the coordinated care organization’s capital, surplus or reserves to achieve more than 200 percent of the minimum risk-based capital. [2019 c.478 §53]
OR Rev Stat § 415.012 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.012 - Definitions for ORS 415.012 to 415.430.

As used in ORS 415.012 to 415.430: (1) "Coordinated care organization" has the meaning given that term in ORS 414.025. (2) "Medical assistance program" means the Oregon Integrated and Coordinated Health Care Delivery System established in ORS 414.570. [2019 c.478 §1]
OR Rev Stat § 415.013 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.013 - Powers and authority to enforce ORS 415.012 to 415.430 and 415.501.

(1) The Oregon Health Authority shall enforce the provisions of ORS 415.012 to 415.430 and 415.501 and rules adopted pursuant to ORS 415.011, 415.012 to 415.430 and 415.501 for the public good. (2) The authority has the powers and authority expressly conferred by or reasonably implied from the provisions of ORS 415.012 to 415.430 and 415.501 and rules adopted pursuant to ORS 415.011, 415.012 to 415.430 and 415.501. (3) The authority may conduct examinations and investigations and require the production of books, records, accounts, papers, documents and computer and other recordings the authority considers necessary to administer and enforce ORS 415.012 to 415.430 or 415.501 and any rules adopted pursuant to ORS 415.011, 415.012 to 415.430 or 415.501. [2019 c.478 §3; 2021 c.615 §11]
OR Rev Stat § 415.015 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.015 - Prohibited conflicts of interest of officer or employee of Oregon Health Authority with responsibility for enforcement.

(1) An officer or employee of the Oregon Health Authority who is delegated responsibilities in the enforcement of ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011 may not: (a) Be a director, officer or employee of or be financially interested in any coordinated care organization, except as a member of a coordinated care organization or by reason of rights vested in compensation or benefits related to services performed prior to affiliation with the authority; or (b) Be engaged in any other business or occupation interfering with or inconsistent with the duties of the authority. (2) This section does not permit any conduct, affiliation or interest that is otherwise prohibited by public policy. [2019 c.478 §2]
OR Rev Stat § 415.019 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.019 - Right to contested case hearing.

(1) The Oregon Health Authority shall hold a contested case hearing upon written request for a hearing by a person aggrieved by any act, threatened act or failure of the authority to act under ORS 415.012 to 415.430 or 415.501 or rules adopted pursuant to ORS 415.011, 415.012 to 415.430 or 415.501. (2) The provisions of ORS chapter 183 govern the hearing procedures and any judicial review of a final order issued in a contested case hearing. [2019 c.478 §4; 2021 c.615 §12]
OR Rev Stat § 415.055 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.055 - Confidentiality of complaints; exceptions; publication of annual statistical report of complaints against all CCOs.

(1) A complaint made to the Oregon Health Authority against a coordinated care organization for a violation of ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011, and the record of the complaint, is confidential and may not be disclosed except as provided in ORS 413.175 or 414.607. The complaint, and the record of the complaint, may not be used in any action, suit or proceeding except to the extent the authority considers necessary in prosecuting apparent violations of ORS 415.012 to 415.430, rules adopted pursuant to ORS 415.011 or other law. (2) Data gathered pursuant to an investigation by the authority of a complaint is confidential, may not be disclosed except as provided in ORS 413.175 and 414.607 and may not be used in any action, suit or proceeding except to the extent the authority considers necessary in investigating or prosecuting apparent violations of ORS 415.012 to 415.430, rules adopted pursuant to ORS 415.011 or other law. (3) Notwithstanding subsections (1) and (2) of this section, the authority shall establish by rule a method for publishing an annual statistical report containing the coordinated care organization’s name and the number, percentage, type and disposition of complaints the authority receives against each coordinated care organization that contracts with the authority. [2019 c.478 §12]
OR Rev Stat § 415.056 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.056 - Confidentiality of reports regarding certain financial information.

(1) The Oregon Health Authority may disclose or use a report as considered necessary by the authority in the administration of ORS 415.012 to 415.430, rules adopted pursuant to ORS 415.011 or other law. (2) A report filed with the authority according to requirements established by rule for disclosure of material acquisitions or dispositions of assets is confidential. (3) A report filed with the Oregon Health Authority according to requirements established by rule for the purpose of determining the amount of restricted reserves, capital or surplus that a coordinated care organization must maintain under ORS 414.572 (1)(b)(A) is confidential and may not be disclosed. (4) A financial plan of action stating corrective actions to be taken by a coordinated care organization in response to a determination of inadequate restricted reserves, capital or surplus that is filed by the coordinated care organization with the authority according to requirements established by rule is confidential and may not be disclosed. (5) The results or report of any examination or analysis of a coordinated care organization performed by the authority in connection with a financial plan described in subsection (4) of this section and any corrective order issued by the authority pursuant to such an examination or analysis is confidential and may not be disclosed. (6) Information contained in documents described in subsections (1) to (4) of this section that is also contained in final examination reports filed under ORS 415.111 is not confidential under this section. (7) All financial analysis ratios and examination synopses concerning coordinated care organizations that are submitted to the authority by the Insurance Regulatory Information System of the National Association of Insurance Commissioners are confidential. [2019 c.478 §14]
OR Rev Stat § 415.057 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.057 - Authorized use of confidential reports regarding financial information.

(1) The Oregon Health Authority may use reports and financial plans of action that are made confidential under ORS 415.056 only for the purpose of monitoring the solvency of coordinated care organizations and the need for possible corrective action with respect to coordinated care organizations. (2) The authority may not use reports and financial plans of action referred to in subsection (1) of this section for establishing global budgets or in any proceeding related to global budgets. (3) This section does not prohibit authority from using information included in reports or financial plans referred to in subsection (1) of this section that is available from other sources. [2019 c.478 §15]
OR Rev Stat § 415.061 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.061 - Definitions for 415.061 to 415.067.

As used in ORS 415.061 to 415.067: (1) "Compliance audit" means a voluntary internal evaluation, review, assessment, audit or investigation that is undertaken to identify or prevent noncompliance with, or promote compliance with, laws, regulations, orders or professional standards, and that is conducted by or on behalf of a coordinated care organization. (2)(a) "Compliance self-evaluative audit document" means a document prepared as a result of or in connection with a compliance audit. (b) "Compliance self-evaluative audit document" includes, but is not limited to: (A) A written response to the findings of a compliance audit. (B) Field notes and records of observations, findings, opinions, suggestions, conclusions, drafts, memoranda, drawings, photographs, exhibits, computer-generated or electronically recorded information, phone records, maps, charts, graphs and surveys, provided this supporting information is collected or developed solely for the purpose of a compliance audit. (C) A compliance audit report prepared by an auditor, who may be an employee of the coordinated care organization or an independent contractor, which may include the scope of the audit, the information gained in the audit and conclusions and recommendations, with exhibits and appendices. (D) Memoranda and documents analyzing portions or all of the compliance audit report and discussing potential implementation issues. (E) An implementation plan that addresses correcting past noncompliance, improving current compliance and preventing future noncompliance. (F) Analytic data generated in the course of conducting the compliance audit, not including any analytic data that exists independently of the audit or existed before the audit was conducted. [2019 c.478 §16]
OR Rev Stat § 415.062 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.062 - Compliance self-evaluative audit document privileged; auditor not subject to examination in administrative or judicial proceeding.

Except as provided in ORS 415.061 to 415.067: (1) A compliance self-evaluative audit document is privileged information and is not discoverable or admissible as evidence in any civil, criminal or administrative proceeding. (2) Any person who performs or directs the performance of an compliance audit, any officer, employee or agent of a coordinated care organization who is involved with a compliance audit and any consultant who is hired for the purpose of performing a compliance audit may not be examined in any civil, criminal or administrative proceeding about the compliance audit or any compliance self-evaluative audit document. [2019 c.478 §17]
OR Rev Stat § 415.063 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.063 - Permissible use of compliance self-evaluative audit document by Oregon Health Authority; consideration of document in determining of civil penalty.

(1) ORS 415.062 does not prohibit the Oregon Health Authority from acquiring any compliance self-evaluative audit document or examining any person in connection with the document. If the authority determines that the actions of a coordinated care organization are egregious, the authority may introduce and use the document in any administrative proceeding or civil action under ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011. (2) Any compliance self-evaluative audit document submitted to the authority under this section and in the possession of the authority remains the property of the coordinated care organization and is not subject to disclosure or production under ORS 192.311 to 192.478. (3)(a) The authority shall consider the corrective action taken by a coordinated care organization to eliminate problems identified in the compliance self-evaluative audit document as a mitigating factor when determining a civil penalty or other action against the coordinated care organization. (b) The authority may, in the authority’s sole discretion, decline to impose a civil penalty or take other action against a coordinated care organization based on information obtained from a compliance self-evaluative audit document if the coordinated care organization has taken reasonable corrective action to eliminate the problems identified in the document. (4) Disclosure of a compliance self-evaluative audit document to a governmental agency, whether voluntarily or pursuant to compulsion of law, does not constitute a waiver of the privilege set forth in ORS 415.062 for any other purpose. (5) The authority may not be compelled to produce a compliance self-evaluative audit document. [2019 c.478 §18]
OR Rev Stat § 415.064 (2021)
2021 Oregon Revised Statutes|Volume : 11 - Juvenile Code, Human Services|Chapter 415 - Regulation of Health Care Entities|Section 415.064 - Waiver of privilege; permitted disclosures.

(1) The privilege set forth in ORS 415.062 does not apply to the extent that the privilege is expressly waived by the coordinated care organization that prepared or caused to be prepared the compliance self-evaluative audit document. (2) The privilege set forth in ORS 415.062 does not apply in any civil, criminal or administrative proceeding commenced by the Attorney General relating to Medicaid fraud, without regard to whether the proceeding is brought on behalf of the state, a state agency or a federal agency. A coordinated care organization may request an in camera review of any document or other evidence to be released or used under this subsection and may request that appropriate protective orders be entered governing release and use of the material. (3) In any civil proceeding a court of record may, after an in camera review, require disclosure of material for which the privilege set forth in ORS 415.062 is asserted if the court determines that the material is not subject to the privilege, or that the privilege is asserted for a fraudulent purpose, including but not limited to an assertion of the privilege for a compliance audit that was conducted for the purpose of concealing a violation of any federal, state or local law or rule. This subsection may not be construed to prohibit the Oregon Health Authority from acquiring, examining and using compliance self-evaluative audit documents under ORS 415.062. (4) In a criminal proceeding, a court of record may, after an in camera review, require disclosure of material for which the privilege set forth in ORS 415.062 is asserted if the court determines that: (a) The privilege is asserted for a fraudulent purpose, including but not limited to an assertion of the privilege for a compliance audit that was conducted for the purpose of concealing a violation of any federal, state or local law or rule; (b) The material is not subject to the privilege; or (c) The material contains evidence relevant to commission of a criminal offense, and: (A) A district attorney or the Attorney General has a compelling need for the information; (B) The information is not otherwise available; or (C) The district attorney or Attorney General is unable to obtain the substantial equivalent of the information by any other means without incurring unreasonable cost and delay. [2019 c.478 §19]