2023 Oregon Revised Statutes › Volume : 11 - Juvenile Code, Human Services › Chapter 414 - Medical Assistance › Section 414.593 - Reporting and public disclosure of expenditures by coordinated care organizations.

(1) As used in this section:
(a) "Coordinated care organization" has the meaning given that term in ORS 414.025.
(b) "Medical assistance" has the meaning given that term in ORS 414.025.
(c) "Related party" means an entity that:
(A) Provides administrative services or financing to a coordinated care organization directly or through one or more unrelated parties; and
(B) Is associated with the coordinated care organization by any form of affiliation, control or investment.
(d) "Risk accepting entity" means an entity that:
(A) Enters into an arrangement or agreement with a coordinated care organization to provide health services to members of the coordinated care organization;
(B) Assumes the financial risk of providing health services to medical assistance recipients; and
(C) Is compensated on a prepaid capitated basis for providing health services to members of a coordinated care organization.
(e) "Risk adjusted rate of growth" means the percentage change in a coordinated care organization’s health care expenditures from one year to the next year, taking into account the variability in the relative health status of the members of the coordinated care organization from one year to the next year.
(2) It is the intent of the Legislative Assembly that the expenditures of a coordinated care organization serving medical assistance recipients be fully transparent and available to the public.
(3) The Oregon Health Authority shall make readily available to the public on an easily accessible website, and shall annually report to the Legislative Assembly, the following information for the preceding calendar year regarding each coordinated care organization contracting with the authority:
(a) All financial distributions by the coordinated care organization to shareholders, equity members, parent companies or any related parties.
(b) The annual audited financial statements of the coordinated care organization filed with the authority under ORS 415.115.
(c) The annual risk adjusted rate of growth for the coordinated care organization.
(d) Every report submitted by the coordinated care organization to the authority as required in the coordinated care organization’s contract with the authority, except for reports containing information protected from disclosure by state or federal law or protected from disclosure as a trade secret, as defined in ORS 192.345, including compensation paid to providers by a coordinated care organization.
(4) The information described in subsection (3) of this section must be provided for each calendar year beginning with 2020.
(5) The authority shall post the information described in subsection (3) of this section no later than August 1 of the year following the year for which the information is reported.
(6) The Oregon Health Authority shall report all information described in subsections (1) to (5) of this section that is made available to the public in a manner that is uniform and sufficiently detailed to ensure accurate comparisons of the data between coordinated care organizations. [2019 c.478 §§54,54a]
Note:
414.593 was enacted into law by the Legislative Assembly but was 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.
Note:
Section 3, chapter 489, Oregon Laws 2017, provides:
Sec. 3.
(1) As used in this section, "primary care" has the meaning given that term in section 2, chapter 575, Oregon Laws 2015.
(2) A coordinated care organization that spends on primary care less than 12 percent of its total expenditures on physical and mental health care, as required by ORS 414.625 (1)(c) [renumbered 414.572 (1)(c)], shall submit to the Oregon Health Authority a plan to increase spending on primary care as a percentage of its total expenditures by at least one percent each year. [2017 c.489 §3]
Note:
Section 5 (2), chapter 575, Oregon Laws 2015, provides:
Sec. 5.
(2) Section 3, chapter 489, Oregon Laws 2017, is repealed on December 31, 2027. [2015 c.575 §5; 2016 c.26 §8; 2017 c.489 §19(2); 2022 c.37 §15(2)]