reglab/statecodes huggingface dataset:
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.805 - Liability of individual for medical services received while in custody of law enforcement officer.

(1) An individual who receives medical services while in the custody of a law enforcement officer is liable:
(a) To the provider of the medical services for the charges and expenses therefor; and
(b) To the Oregon Health Authority for any charges or expenses paid by the authority out of the Law Enforcement Medical Liability Account for the medical services.
(2) A person providing medical services to an individual described in subsection (1) of this section shall first make reasonable efforts to collect the charges and expenses thereof from the individual before seeking to collect them from the authority out of the Law Enforcement Medical Liability Account.
(3)(a) If the provider has not been paid within 45 days of the date of the billing, the provider may bill the authority who shall pay the account out of the Law Enforcement Medical Liability Account.
(b) A bill submitted to the authority under this subsection must be accompanied by evidence documenting that:
(A) The provider has billed the individual or the individual’s insurer or health care service contractor for the charges or expenses owed to the provider; and
(B) The provider has made a reasonable effort to collect from the individual or the individual’s insurer or health care service contractor the charges and expenses owed to the provider.
(c) If the provider receives payment from the individual or the insurer or health care service contractor after receiving payment from the authority, the provider shall repay the authority the amount received from the public agency less any difference between payment received from the individual, insurer or contractor and the amount of the billing.
(4) As used in this section:
(a) "Law enforcement officer" means:
(A) An officer who is commissioned and employed by a public agency as a peace officer to enforce the criminal laws of this state or laws or ordinances of a public agency; or
(B) An authorized tribal police officer as defined in ORS 181A.940.
(b) "Public agency" means the state, a city, university that has established a police department under ORS 352.121 or 353.125, port, school district, mass transit district or county. [1991 c.778 §7; 2007 c.71 §105; 2009 c.595 §342; 2011 c.506 §37; 2011 c.644 §§29,52; 2013 c.180 §§38,39; 2015 c.174 §20]
Note:
414.805 to 414.815 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.807 - Oregon Health Authority to pay for medical services related to law enforcement activity; certification of injury.

(1)(a) When charges and expenses are incurred for medical services provided to an individual for injuries related to law enforcement activity and subject to the availability of funds in the account, the cost of such services shall be paid by the Oregon Health Authority out of the Law Enforcement Medical Liability Account established in ORS 414.815 if the provider of the medical services has made all reasonable efforts to collect the amount, or any part thereof, from the individual who received the services.
(b) When a law enforcement agency involved with an injury certifies that the injury is related to law enforcement activity, the Oregon Health Authority shall pay the provider:
(A) If the provider is a hospital, in accordance with current fee schedules established by the Director of the Department of Consumer and Business Services for purposes of workers’ compensation under ORS 656.248; or
(B) If the provider is other than a hospital, 75 percent of the customary and usual rates for the services.
(2) After the injured person is incarcerated and throughout the period of incarceration, the Oregon Health Authority shall continue to pay, out of the Law Enforcement Medical Liability Account, charges and expenses for injuries related to law enforcement activities as provided in subsection (1) of this section. Upon release of the injured person from actual physical custody, the Law Enforcement Medical Liability Account is no longer liable for the payment of medical expenses of the injured person.
(3) If the provider of medical services has filed a medical services lien as provided in ORS 87.555, the Oregon Health Authority shall be subrogated to the rights of the provider to the extent of payments made by the authority to the provider for the medical services. The authority may foreclose the lien as provided in ORS 87.585.
(4) The authority shall deposit in the Law Enforcement Medical Liability Account all moneys received by the authority from:
(a) Providers of medical services as repayment;
(b) Individuals whose medical expenses were paid by the authority under this section; and
(c) Foreclosure of a lien as provided in subsection (3) of this section.
(5) As used in this section:
(a) "Injuries related to law enforcement activity" means injuries sustained prior to booking, citation in lieu of arrest or release instead of booking that occur during and as a result of efforts by a law enforcement officer to restrain or detain, or to take or retain custody of, the individual.
(b) "Law enforcement officer" has the meaning given that term in ORS 414.805. [1991 c.778 §2; 1993 c.196 §9; 2009 c.595 §343]
Note:
See note under 414.805.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.815 - Law Enforcement Medical Liability Account; limited liability; rules; report.

(1) The Law Enforcement Medical Liability Account is established separate and distinct from the General Fund. Interest earned, if any, shall inure to the benefit of the account. The moneys in the Law Enforcement Medical Liability Account are appropriated continuously to the Oregon Health Authority to pay expenses in administering the account and paying claims out of the account as provided in ORS 414.807.
(2) The liability of the Law Enforcement Medical Liability Account is limited to funds allocated to the account from the Criminal Fine Account, or collected from individuals under ORS 414.805.
(3) The authority may contract with persons experienced in medical claims processing to provide claims processing for the account.
(4) The authority shall adopt rules to implement administration of the Law Enforcement Medical Liability Account including, but not limited to, rules that establish reasonable deadlines for submission of claims.
(5) Each biennium, the Oregon Health Authority shall submit a report to the Legislative Assembly regarding the status of the Law Enforcement Medical Liability Account. Within 30 days of the convening of each odd-numbered year regular session of the Legislative Assembly, the authority shall submit the report to the chair of the Senate Judiciary Committee and the chair of the House Judiciary Committee. The report shall include, but is not limited to, the number of claims submitted and paid during the biennium and the amount of money in the fund at the time of the report. [1991 c.778 §1; 1993 c.196 §10; 1999 c.1051 §256; 2005 c.804 §8; 2009 c.595 §344; 2011 c.545 §49; 2011 c.597 §62]
Note:
See note under 414.805.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.839

[2001 c.898 §11; 2003 c.14 §206; 2003 c.684 §7; 2003 c.735 §9; 2009 c.595 §344a; 2009 c.867 §38; 2013 c.365 §2; 2013 c.681 §51; renumbered 414.117 in 2019]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.853 - Definitions.

As used in ORS 414.853 to 414.869 and 414.900:
(1) "Charity care" means costs for providing inpatient or outpatient care services free of charge or at a reduced charge because of the indigence or lack of health insurance of the patient receiving the care services.
(2) "Contractual adjustments" means the difference between the amounts charged based on the hospital’s full established charges and the amount received or due from the payor.
(3)(a) "Hospital" means a hospital licensed under ORS chapter 441.
(b) "Hospital" does not include:
(A) Special inpatient care facilities;
(B) Hospitals that provide only psychiatric care;
(C) Pediatric specialty hospitals providing care to children at no charge; and
(D) Public hospitals other than hospitals created by health districts under ORS 440.315 to 440.410.
(4) "Net revenue":
(a) Means the total amount of charges for inpatient or outpatient care provided by the hospital to patients, less charity care, bad debts and contractual adjustments;
(b) Does not include revenue derived from sources other than inpatient or outpatient operations, including but not limited to interest and guest meals; and
(c) Does not include any revenue that is taken into account in computing a long term care facility assessment under ORS 409.800 to 409.816 and 409.900.
(5) "Type A hospital" has the meaning given that term in ORS 442.470.
(6) "Type B hospital" has the meaning given that term in ORS 442.470. [2003 c.736 §1; 2009 c.792 §34; 2017 c.538 §26]
Note:
414.853 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:
414.853 to 414.871 and 414.900 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.857 - Reduction in rate required by federal law.

Notwithstanding ORS 414.855, the Director of the Oregon Health Authority shall reduce the rate of assessment imposed under ORS 414.855 (1) to the maximum rate allowed under federal law if the reduction is required to comply with federal law. [2003 c.736 §3; 2013 c.608 §3; 2017 c.538 §30]
Note:
414.857 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.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.863 - Refund of hospital assessment; right to contested case hearing.

(1) Any hospital that has paid an amount that is not required under ORS 414.853 to 414.869 and 414.900 may file a claim for refund with the Oregon Health Authority.
(2) Any hospital that is aggrieved by an action of the authority or by an action of the Director of the Oregon Health Authority taken pursuant to subsection (1) of this section shall be entitled to notice and an opportunity for a contested case hearing under ORS chapter 183. [2003 c.736 §6; 2013 c.608 §4]
Note:
414.863 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.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.865 - Audits.

The Oregon Health Authority may audit the records of any hospital in this state to determine compliance with ORS 414.853 to 414.869 and 414.900. The authority may audit records at any time for a period of five years following the date an assessment is due to be reported and paid under ORS 414.855. [2003 c.736 §7; 2013 c.608 §5; 2017 c.538 §32]
Note:
414.865 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.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.867 - Deposit of assessments collected to Hospital Quality Assurance Fund.

Amounts collected by the Oregon Health Authority from the assessments imposed under ORS 414.855 shall be deposited in the Hospital Quality Assurance Fund established under ORS 414.869. [2003 c.736 §8; 2005 c.757 §1; 2013 c.608 §6]
Note:
414.867 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.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.869 - Establishment of Hospital Quality Assurance Fund.

(1) The Hospital Quality Assurance Fund is established in the State Treasury, separate and distinct from the General Fund. Interest earned by the Hospital Quality Assurance Fund shall be credited to the Hospital Quality Assurance Fund.
(2) Amounts in the Hospital Quality Assurance Fund are continuously appropriated to the Oregon Health Authority for the purpose of:
(a) Paying refunds due under ORS 414.863;
(b) Funding services under ORS 414.591, 414.631 and 414.688 to 414.745, including but not limited to increasing reimbursement rates for inpatient and outpatient hospital services under ORS 414.591, 414.631 and 414.688 to 414.745;
(c) Making payments described in ORS 414.855 (3)(a)(C);
(d) Making payments to coordinated care organizations to be used to provide additional reimbursement to type A hospitals and type B hospitals to improve and expand access to services for medical assistance recipients, to the extent permitted by federal requirements; and
(e) Paying administrative costs incurred by the authority to administer the assessments imposed under ORS 414.855.
(3) Except for assessments imposed pursuant to ORS 414.855 (3)(b), the authority may not use moneys from the Hospital Quality Assurance Fund to supplant, directly or indirectly, other moneys made available to fund services described in subsection (2) of this section. [2003 c.736 §9; 2005 c.757 §2; 2007 c.780 §2; 2009 c.828 §53; 2009 c.867 §19; 2011 c.602 §59; 2013 c.608 §7; 2017 c.538 §§33,34,35,36]
Note:
414.869 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.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.871 - Applicability of hospital assessment.

ORS 414.853 to 414.869 and 414.900 apply to net revenues earned by hospitals during a period beginning July 1, 2019, and ending the earlier of September 30, 2025, or the date on which the assessment no longer qualifies for federal financial participation under Title XIX or XXI of the Social Security Act. [2003 c.736 §10; 2007 c.780 §3; 2009 c.867 §20; 2013 c.608 §8; 2015 c.16 §2; 2017 c.538 §37a; 2019 c.2 §13]
Note:
See second note under 414.853.
Note:
Sections 12 (1) to 14, chapter 736, Oregon Laws 2003, provide:
Sec. 12.
(1) Sections 1 to 9, chapter 736, Oregon Laws 2003 [414.853 to 414.869 and 414.900], are repealed on January 2, 2031. [2003 c.736 §12; 2007 c.780 §4; 2009 c.867 §21; 2013 c.608 §9; 2015 c.16 §3; 2017 c.538 §38; 2019 c.2 §14(1)]
Sec. 13.
Nothing in the repeal of sections 1 to 9, chapter 736, Oregon Laws 2003 [414.853 to 414.869 and 414.900], and section 1, chapter 608, Oregon Laws 2013, by section 12, chapter 736, Oregon Laws 2003, affects the imposition and collection of a hospital assessment under sections 1 to 9, chapter 736, Oregon Laws 2003, for a calendar quarter beginning before September 30, 2025. [2003 c.736 §13; 2007 c.780 §5; 2009 c.867 §22; 2013 c.608 §10; 2015 c.16 §4; 2017 c.538 §39; 2019 c.2 §15]
Sec. 14.
Any moneys remaining in the Hospital Quality Assurance Fund on December 31, 2031, are transferred to the General Fund. [2003 c.736 §14; 2007 c.780 §6; 2009 c.867 §23; 2015 c.16 §5; 2017 c.538 §40; 2019 c.2 §16]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.880 - Managed care organization assessment; rate.

(1) As used in this section and ORS 414.882 and 414.902:
(a) "Managed care organization" means:
(A) A coordinated care organization as defined in ORS 414.025; and
(B) A prepaid managed care health services organization as defined in ORS 414.025.
(b) "Premium equivalent" means the payments made to the managed care organization by the Oregon Health Authority for providing health services under ORS chapter 414.
(2) No later than 45 days following the end of a calendar quarter, a managed care organization shall pay an assessment at a rate of two percent of the gross amount of premium equivalents received during that calendar quarter.
(3) The assessment shall be paid to the authority in a manner and form prescribed by the authority.
(4) Assessments 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.
(5) The assessment imposed under this section is in addition to and not in lieu of any tax, surcharge or other assessment imposed on a managed care organization. [2017 c.538 §9; 2019 c.2 §9]
Note:
414.880 to 414.884 and 414.902 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.882 - Refund of managed care organization assessment; right to contested case hearing.

(1) A managed care organization that has paid an amount that is not required under ORS 414.880 may file a claim for refund with the Oregon Health Authority.
(2) Any managed care organization that is aggrieved by an action of the authority taken pursuant to subsection (1) of this section shall be entitled to notice and an opportunity for a contested case hearing under ORS chapter 183. [2017 c.538 §11]
Note:
See note under 414.880.
2023 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.
2023 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.
2023 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.
2023 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]
2023 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;
(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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 415 - Regulation of Health Care Entities › Section 415.065 - Petition for in camera hearing on privilege of compliance self-evaluative audit document; hearing on petition; compelled disclosure.

(1) Within 30 days after a district attorney or the Attorney General serves on a coordinated care organization a written request by certified mail for disclosure of a compliance self-evaluative audit document, the coordinated care organization that prepared or caused the document to be prepared may file in circuit court a petition requesting an in camera hearing on whether the compliance self-evaluative audit document or portions of the document are privileged under ORS 415.062 or subject to disclosure. Failure by the coordinated care organization to file a petition waives the privilege only with respect to the specific request.
(2) A petition filed by a coordinated care organization under this section must contain the following information:
(a) The date of the compliance self-evaluative audit document.
(b) The identity of the person that conducted the audit.
(c) The general nature of the activities covered by the compliance audit.
(d) An identification of the portions of the compliance self-evaluative audit document for which the privilege is being asserted.
(3) Within 45 days after the filing of a petition by a coordinated care organization under this section, the court shall schedule an in camera hearing to determine whether the compliance self-evaluative audit document or portions of the document are privileged under ORS 415.062.
(4) The court, after an in camera review pursuant to this section, may require disclosure of material for which the privilege established by ORS 415.062 is asserted if the court determines that any of the conditions set forth in ORS 415.064 or 415.066 are met. Upon making such a determination, the court may compel the disclosure of only those portions of a compliance self-evaluative audit document relevant to issues in dispute in the underlying proceeding. Any disclosure that is compelled by the court will not be considered to be a public document or be deemed to be a waiver of the privilege for any other civil, criminal or administrative proceeding. A party unsuccessfully opposing disclosure may apply to the court for an appropriate order protecting the document from further disclosure.
(5) A coordinated care organization asserting the privilege established under ORS 415.062 has the burden of establishing that the privilege applies. If the coordinated care organization establishes that the privilege applies, a party seeking disclosure under ORS 415.064 has the burden of proving the elements set forth in ORS 415.064. [2019 c.478 §20]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 415 - Regulation of Health Care Entities › Section 415.066 - Exceptions to privilege of compliance self-evaluative audit document.

The privilege established under ORS 415.062 does not apply to any of the following:
(1) Documents, communications, data, reports or other information expressly required to be collected, developed, maintained or reported to the Oregon Health Authority or other regulatory agency under ORS 415.012 to 415.430, rules adopted pursuant to ORS 415.011 or other state or federal law;
(2) Information obtained by observation or monitoring by the authority or any regulatory agency; or
(3) Information obtained from a source other than the compliance audit. [2019 c.478 §21]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 415 - Regulation of Health Care Entities › Section 415.067 - Other applicable privileges not waived by release of compliance self-evaluative audit document.

Nothing in ORS 415.061 to 415.067, or in the release of any compliance self-evaluative audit document under ORS 415.061 to 415.067, shall limit, waive or abrogate the scope or nature of any statutory or common law privilege or other limitation on admissibility of evidence including, but not limited to, the work product doctrine, the lawyer-client privilege under ORS 40.225 or the subsequent remedial measures exclusion provided by ORS 40.185. [2019 c.478 §22]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 415 - Regulation of Health Care Entities › Section 415.101 - Requests for information.

The Oregon Health Authority may request information from any coordinated care organization or its officers in relation to the activities or condition of the coordinated care organization or any other matter connected with a coordinated care organization’s transactions, and the person of whom the information is requested shall promptly and truthfully reply using the form of communication requested by the authority and verified by an officer of the coordinated care organization, if the authority so requires. A response is subject to the provisions of ORS 415.103. [2019 c.478 §6]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 415 - Regulation of Health Care Entities › Section 415.103 - False or misleading filings prohibited.

A person may not file or cause to be filed with the Oregon Health Authority any article, certificate, report, statement, application or other information required or permitted to be filed 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 that is known by the person to be false or misleading in any material respect. [2019 c.478 §5; 2021 c.615 §13]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 415 - Regulation of Health Care Entities › Section 415.105 - Investigations authorized.

The Oregon Health Authority, whenever the authority deems it advisable in the interest of members of a coordinated care organization or for the public good, shall investigate into the affairs of:
(1) A coordinated care organization;
(2) A person proposing to form a coordinated care organization; or
(3) A person holding the capital stock, membership or other ownership or controlling interest in one or more coordinated care organizations for the purpose of controlling the management of the coordinated care organization as a voting trustee or otherwise. [2019 c.478 §8]
2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 415 - Regulation of Health Care Entities › Section 415.107 - Examinations and audits.

The Oregon Health Authority shall examine every coordinated care organization, including an audit of the financial affairs of the coordinated care organization, as often as the authority determines an examination to be necessary but at least once every five years. An examination shall be conducted for the purpose of determining the financial condition of the coordinated care organization, its ability to fulfill its obligations and its manner of fulfillment, the nature of its operations and its compliance with ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011. The authority may also examine any person holding the capital stock, membership or other ownership or controlling interest in a coordinated care organization for the purpose of controlling the management of the coordinated care organization as a voting trustee or otherwise. [2019 c.478 §7]