reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3247

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 413.042, 414.615, 414.625, 414.635
				  & 414.651
Statutes/Other Implemented:
				  414.610-414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3248

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 413.042, 414.615, 414.625, 414.635
				  & 414.651
Statutes/Other Implemented:
				  414.610-414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3250

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 413.032, 414.615, 414.625, 414.635
				  & 414.651
Statutes/Other Implemented:
				  414.610-414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3255

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 413.042, 414.615, 414.625, 414.635
				  & 414.651
Statutes/Other Implemented:
				  414.610-414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3258

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042
Statutes/Other Implemented: ORS
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3259

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042
Statutes/Other Implemented: ORS
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3267

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth: ORS 413.042
Stats. Implemented: ORS 183.484, 183.502 &
				  413.042
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3269

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  414.042,
				  414.615,
				  414.625,
				  414.635 &
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3270

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635 &
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3280

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 413.042, 414.615, 414.625, 414.635
				  & 414.651
Statutes/Other Implemented: 414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3300

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 413.042, 414.615, 414.625, 414.635
				  & 414.651
Statutes/Other Implemented: 414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3320

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635  & 414.651
Statutes/Other Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3340

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635,
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3345

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635  & 414.651
Statutes/Other Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3350

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635,
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3355

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635,
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3360

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635,
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3365

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  414.032,
				  414.615,
				  414.625,
				  414.635 &
				  414.651
Stats. Implemented: ORS
				  414.610 - 685 2011 OL Ch. 602
				  Sec. 13, 14, 16, 17, 62, 64(2), 65 & HB
				  3650
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3370

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  414.032,
				  414.615,
				  414.625,
				  414.635 &
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685, 2011 OL Ch. 602 Sec.
				  13, 14, 16, 17, 62, 64(2) & 65 & HB
				  3650
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3375

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635,
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3380

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635,
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3385

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635,
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3390

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635,
				  414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3395

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635 & 414.651
Stats. Implemented: ORS
				  414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3420

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 413.042, 414.065, 414.615,
				  414.625, 414.635 & 414.651
Statutes/Other Implemented: 414.065 & 414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3430

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: 413.042, 414.615, 414.625, 414.635
				  & 414.651
Statutes/Other Implemented: 414.610 -
				  414.685
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3435

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3440

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS 413.042 & 414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3445

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3450

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3455

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3460

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3465

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3470

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3475

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3480

Current through Register Vol. 63, No. 7, July 1, 2024
Statutory/Other Authority: ORS
				  413.042 & 414.625
Statutes/Other Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3485

Current through Register Vol. 63, No. 7, July 1, 2024
Stat. Auth.: ORS
				  413.042 &
				  414.625
Stats. Implemented: ORS
				  414.625
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3501 - Administration of Oregon Integrated and Coordinated Health Care Delivery System Regulation; Rule Precedence

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Authority may adopt reasonable and lawful policies, procedures, rules and
			 interpretations to promote the orderly and efficient administration of the
			 Oregon Integrated and Coordinated Health Care Delivery System and medical
			 assistance programs. This includes the Oregon Health Plan (OHP) pursuant to ORS
			 Chapter 414, subject to the rulemaking requirements of Oregon Revised Statutes
			 and Oregon Administrative Rule (OAR) procedures.
(2) To the extent possible, the Authority's
			 policies, procedures, rules, and MCE contracts shall be interpreted to avoid a
			 conflict among themselves or with governing state or federal law. In the event
			 of an irreconcilable conflict, the following order of precedence shall govern:
(a) Medicaid Plan and waivers or other
			 directives from CMS;
(b) Federal
			 Statutes;
(c) Federal
			 Regulations;
(d) Oregon Revised
			 Statutes;
(e) Oregon Administrative
			 Rules using the following order of precedence:
(A) This OAR chapter 410 division 141
			 ("Oregon Health Plan");
(B) OAR
			 chapter 410 division 120 ("Medical Assistance Programs");
(C) Any applicable Provider rules in OAR 410
			 based on the category of health service;
(D) OAR Chapter 943, Division 120;
(E) OAR Chapter 309;
(F) All other applicable OARs;
(f) The MCE Contract, including
			 any internal order of precedence established therein.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3505 - Use of Subcontractors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) MCEs
			 may delegate their activities or obligations to subcontractors except as
			 otherwise provided by law or in the MCE contract:
(a) MCEs remain fully accountable for the
			 performance of all subcontracted work;
(b) MCEs shall monitor subcontractor
			 performance on an ongoing basis;
(c) MCEs shall notify the Authority of
			 subcontractor relationships. MCEs shall provide the Authority:
(A) A comprehensive list of subcontractor
			 entities and, for each one, the activities and functions that have been
			 delegated, to be submitted to OHA on an annual basis;
(B) Copies of all subcontracts upon request;
			 and
(C) Adequate documentation
			 demonstrating monitoring of subcontractor compliance or subcontractor auditing,
			 as applicable, in accordance with the contract and with CMS requirements
			 including
			 42
			 C.F.R §§
											438.230,
			 438.602(a)
			 and
			 438.66.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3530 - Sanctions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority
			 may establish and impose sanctions on Managed Care Entities (MCEs), pursuant to
			 42 CFR §
									438.700, if the Authority makes a
			 determination specified in paragraph (3) of this rule.
(2) The Authority may base its determinations
			 on findings from onsite surveys, enrollee or other complaints, financial
			 status, or any other source.
(3)
			 The Authority may impose sanctions if the Authority determines that an MCE acts
			 or fails to act as follows:
(a) Fails
			 substantially to provide medically necessary services required under law or
			 under its contract with the Authority to an enrollee covered under the
			 contract;
(b) Imposes on enrollee's
			 premiums or charges that are in excess of the premiums or charges permitted
			 under the Medicaid program;
(c)
			 Acts to discriminate among enrollees on the basis of their health status or
			 need for health care services. This includes termination of enrollment or
			 refusal to re-enroll a beneficiary, except as permitted under the Medicaid
			 program, or any practice that would reasonably be expected to discourage
			 enrollment by beneficiaries whose medical condition or history indicates
			 probable need for substantial future medical services;
(d) Misrepresents or falsifies information
			 that it furnishes to the Centers for Medicare and Medicaid Services (CMS) or to
			 the Authority;
(e) Misrepresents or
			 falsifies information that it furnishes to an enrollee, potential enrollee,
			 health care provider, or HRSN Service Provider;
(f) Fails to comply with the requirements for
			 physician incentive plans, as set forth in
			 42 CFR §§
										422.208 and
			 422.210;
(g) Distributes directly or indirectly
			 through any agent or independent contractor marketing materials that are not
			 approved by the Authority or that contain false or materially misleading
			 information;
(h) Violates any of
			 the other applicable requirements of state or federal Medicaid law;
			 or
(i) Fails to comply with any
			 legal or contractual requirements that, pursuant to the MCE contract, may form
			 a basis for sanctions.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3531 - Sanctions for Failure to Comply with State or Federal Information Security or Privacy Laws

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Pursuant to
			 42 CFR §
									438.700, the Authority may impose sanctions
			 on an MCE if the Authority makes a determination that an MCE failed to comply
			 with any one or more of the following:
(a) The
			 contractual requirements of accessing or using the Authority's or State Data,
			 Network and Information Systems and Information Assets; or
(b) The Health Insurance Portability and
			 Accountability Act (HIPAA) and the federal regulations implementing the HIPAA
			 Privacy and Security Rules as set forth in 45 CFR Parts 160 and 164;
			 or
(c) The Authority's privacy
			 administrative rules in Chapter 407, Division 014; or
(d) The federal regulations implementing the
			 HIPAA Transaction Rule as set forth in  45 CFR Part 162, and any other federal
			 statutes or regulations relating to health information technology that may come
			 into effect, including, without limitation, the 21st Century Cures Act and the
			 Interoperability and Patient Access regulations; or
(e) The Authority's rules for electronic data
			 transactions in OAR 943-120-0100  through 943-120-0200.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3540 - Member Protections

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In the
			 event of a finding of MCE impairment by the Authority, or of a termination of
			 the MCE contract, members of the MCE shall be offered disenrollment from the
			 MCE and enrollment in accordance with the Authority's rules.
(2) For the purpose of this section only, and
			 only in the event of a finding of MCE impairment by the Authority or of a
			 termination of the MCE contract, any covered health care service furnished
			 within the state by a provider to a member of the impaired or terminated MCE
			 shall be considered to have been furnished pursuant to a contract between the
			 provider and the MCE with whom the member was enrolled when the services were
			 furnished.
(3) Each contract
			 between an MCE and a provider of health services shall provide that if the MCE
			 fails to pay for covered health services as set forth in the contract, the
			 member is not liable to the provider for any amounts owed by the MCE.
(4) If the contract between the contracting
			 provider and the MCE has not been reduced to writing or fails to contain the
			 provisions required by this rule, the member is not liable to the contracting
			 provider for any amounts owed by the MCE.
(5) No contracting provider or agent, trustee
			 or assignee of the contracting provider shall bill a member, send a member's
			 bill to a Collection Agency, or maintain a civil action against a member to
			 collect any amounts owed by the MCE for which the member is not liable to the
			 contracting provider in this rule and under 410-120-1280.
(6) Nothing in this section impairs the right
			 of a provider to charge, collect from, and attempt to collect from or maintain
			 a civil action against a member for any of the following:
(a) Health services not covered by the MCE,
			 if a valid OHP Client Agreement to Pay for Health Services form OHP 3165, or
			 facsimile, signed by the client, has been completed as described in OAR
			 410-120-1280; or
(b) Health
			 services rendered after the termination of the contract between the MCE and the
			 provider, unless the health services were rendered during the confinement in an
			 inpatient facility and the confinement began prior to the date of termination
			 or unless the provider has assumed post-termination treatment obligations under
			 the contract. Before providing a non-covered service, the provider must
			 complete an OHP 3165, or facsimile, as described in OAR 410-120-1280.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3545 - Coordinated Care Organization Behavioral Health Provider, Treatment and Facility Certification and Licensure

Current through Register Vol. 63, No. 7, July 1, 2024
Behavioral health treatment services are covered for eligible
				OHP clients when provided by a CCO under the following circumstances:
(1) Provider Organizations (as defined under
			 OAR 410-120-0000) of outpatient behavioral health services shall:
(a) Be certified by the Authority as
			 described in OAR 309-008-0250  for the scope of services provided; and
(b) Comply with applicable rules, including
			 but not limited to, those defined in OAR chapter 309 and any requirements in
			 the CCO contract.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3550 - Resolving Disputes between MCEs and the Authority

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If an MCE has a dispute with the
			 Authority as a result of a decision that is perceived as adversely affecting an
			 MCE, the MCE may submit a request to the Director of the Authority, or the
			 Director's designee, requesting an Administrative Review, as prescribed in OAR
			 410-120-1580.
(a) These disputes primarily
			 address legal or policy issues that may arise in the context of an Authority
			 decision that is perceived by the MCE to adversely affect the MCE and is not
			 otherwise reviewed as a claim redetermination, a contested case, or client
			 appeal. An example of such disputes includes, but is not limited to, Authority
			 decisions made through the OHA Provider Discrimination Review Process as a
			 result of a provider discrimination appeal;
(b) This rule does not address claims that
			 the Authority has breached its contract with an MCE;
(c) This MCE process is not mandatory, and it
			 need not be exhausted before an MCE seeks judicial review or brings any other
			 form of action related to any MCE/Authority dispute related decision.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3555 - Resolving Disputes between Health Care Entities and CCOs that Concern CCO Contact Award

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The dispute
			 resolution process described in this rule applies only when, under ORS
			 414.635:
(a) An entity is applying to the Authority
			 for contract award as a CCO (applicant);
(b) A Health Care Entity (HCE) and the
			 applicant (together, the "parties" for purposes of this rule) have failed to
			 agree upon terms for a contract; and
(c) One or more of the following occurs:
(A) The applicant states that the HCE is
			 necessary for the applicant to qualify as a CCO;
(B) An HCE states that its inclusion is
			 necessary for the applicant to be awarded a CCO; or
(C) In reviewing the applicant's information,
			 the Authority identifies the HCE as necessary for the applicant to qualify as a
			 CCO.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3560 - Resolving Contract Disputes Between Health Care Entities and CCOs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Pursuant to ORS
			 414.635, Coordinated Care
			 Organizations (CCOs) and Health Care Entities (HCEs) shall participate in good
			 faith contract negotiations. This rule covers the termination, extension, and
			 renewal of an HCE's contract with a CCO.
(2) In the event of a dispute involving the
			 termination, extension, or renewal of an HCE's contract with a CCO, the parties
			 may take the following actions in an attempt to reach a good faith resolution:
(a) Both parties shall provide a written
			 offer of terms and conditions to the other party. The parties shall explain the
			 basis for their disagreement with the terms and conditions offered by the other
			 party;
(b) The CCO's and HCE's
			 chief financial officer, chief executive officer, or an individual authorized
			 to make decisions on behalf of the HCE or CCO shall have at least one
			 face-to-face meeting in a good faith effort to resolve the
			 disagreement;
(c) The CCO or HCE
			 may request the Authority to provide technical assistance. The Authority's
			 technical assistance is limited to clarifying the CCO contractual provisions,
			 subcontracting criteria, current reimbursement requirements, access standards,
			 and other legal requirements.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3565 - Managed Care Entity Billing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Providers shall
			 submit all claims for MCE members in the following timeframes:
(a) Submit initial claims within no more than
			 120 days of the date of service for all cases, except as provided for in
			 section (1)(b) of this rule. MCEs may negotiate terms within this timeframe
			 agreeable to both parties;
(b)
			 Submit initial claims within 365 days of the date of service in the following
			 cases:
(A) Pregnancy;
(B) Eligibility issues such as retroactive
			 deletions or retroactive enrollments;
(C) Medicare is the primary payer, except
			 where the MCE is responsible for the Medicare reimbursement;
(D) Other cases that delay the initial claim
			 to the MCE, not including failure of the provider to verify the member's
			 eligibility; or
(E) Third Party
			 Liability (TPL). Pursuant to
			 42 CFR
			 136.61, subpart G: Indian Health Services and
			 the amended Public Law
			 93-638 under the Memorandum of Agreement that
			 Indian Health Service and 638 Tribal Facilities are the payers of last resort
			 and are not considered an alternative liability or TPL.
(c) For initial claims submitted timely that
			 need correction, have prompted a provider appeal as outlined in OAR
			 410-120-1560, or for a reason not included in (1)(b) of this rule that
			 otherwise require a re-submission, MCEs shall establish a time-frame in their
			 policies and procedures which allow a billing provider to make such
			 re-submissions or appeals for a minimum of 180 days after the initial
			 adjudication date.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3570 - Managed Care Entity Encounter Claims Data Reporting

Current through Register Vol. 63, No. 7, July 1, 2024
(1) MCEs shall meet the data content and
			 submission standards as required by HIPAA  45 CFR Part 162, the Authority's
			 electronic data transaction rules (OAR 943-120-0100  through 943-120-0200), the
			 Authority's 837 technical specifications for encounter data, and the
			 Authority's encounter data submission guidelines that are subject to periodic
			 revisions and available on the Authority's website.
(2) MCEs shall collect service information in
			 standardized formats to the extent feasible and appropriate; if HIPAA standard,
			 the MCE must utilize the HIPAA standards:
(a)
			 MCEs shall submit encounter claims for all covered services, except for
			 health-related services, provided to members as defined in OAR 410-120-0000  and
			 410-141-3500;
(b) MCEs shall submit
			 encounter claims data including encounters for:
(A) Services where the MCE determined that
			 liability exists, even if the MCE did not make any payment for a
			 claim;
(B) Services where the MCE
			 determined that no liability exists;
(C) Services to members provided by a
			 provider under a subcontract, capitation, or special arrangement with another
			 facility or program;
(D) Paid
			 amounts regardless of whether the servicing provider is paid on a
			 fee-for-service (FFS) basis, on a capitated basis by the MCE, or the MCE's
			 subcontractor; and
(E) Services to
			 members who also have Medicare coverage, if a claim has been submitted to the
			 MCE.
(c) MCEs shall
			 obtain a Coordination of Benefits Agreement (COBA) number and coordinate with
			 COBA to receive direct crossover claims for dually eligible members with
			 traditional Medicare pursuant to
			 42 CFR
			 438.3(t);
(d) MCEs shall report encounter claims data
			 whether the provider is an in-network participating or out-of-network,
			 non-participating provider.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3580 - MCE Member Relations: Potential Member Information

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In addition to
			 the requirements below, information for potential members shall comply with the
			 marketing requirements and prohibitions in
			 42 CFR §
									438.104 and OAR 410-141-3575 and any
			 requirements or guidelines adopted by the Authority there under.
(2) MCEs shall develop informational
			 materials for potential members and provide such materials to the Authority. An
			 MCE or the Authority may include informational materials in the application
			 packet for potential members.
(3)
			 MCEs' informational materials shall be sufficient for the potential member to
			 make an informed decision about provider selection.
(4) The MCE shall make available to potential
			 members, upon request, information on participating providers. MCE provider
			 directories for potential members shall include all specified elements and be
			 made readily accessible as defined in
			 42 CFR
			 438.10.
(5) MCEs' informational materials shall
			 include the following information for potential members regarding the rights of
			 American Indians and Alaskan Natives:
(a)
			 MCEs' informational materials shall state that American Indians and Alaskan
			 Natives enrolled in the MCEs may select an Indian health care provider (IHCP)
			 that is participating as a primary care provider within the network of the MCE,
			 insofar as the individual is otherwise eligible to receive primary care
			 services from such IHCP and the IHCP has the capacity to provide primary care
			 services to such American Indians and Alaskan Natives.
(b) MCEs shall clearly explain to potential
			 members that American Indians and Alaskan Natives enrolled in an MCE shall also
			 be permitted to obtain primary care services covered under the contract between
			 the state and MCE from out-of-network IHCPs from whom the enrollee is otherwise
			 eligible to receive primary care services. American Indians and Alaskan Natives
			 may be referred by out-of-network IHCPs to a network provider without prior
			 authorization or referral from a participating provider.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3585 - MCE Member Relations: Education and Information

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Managed Care Entitys (MCEs) may engage in
			 activities for existing members related to outreach, health promotion, and
			 health education. MCE must obtain approval of the Authority prior to
			 distribution of any written communication by the MCE or its subcontractors and
			 providers that:
(a) Is intended solely for
			 members; and
(b) Pertains to
			 requirements for obtaining coordinated care services at service area sites or
			 benefits.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3590 - MCE Member Relations: Member Rights and Responsibilities

Current through Register Vol. 63, No. 7, July 1, 2024
(1) MCEs shall:
(a) Have written policies and procedures that
			 ensure that members have the rights and responsibilities included in this
			 rule;
(b) Communicate these
			 policies and procedures to participating providers;
(c) Monitor compliance with these policies
			 and procedures, take corrective action as needed, and report findings to the
			 Quality Improvement Committee defined under OAR 410-141-3525.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3591 - MCE Interoperability Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Interoperability and Access to Health
			 Information
(a) MCEs shall comply with all
			 federal regulations set forth in the CMS Interoperability and Patient Access
			 Final Rule.
(b) All MCEs shall
			 review the Office of National Coordinator for Health Information Technology
			 (ONC) 21st Century Cures Act Final Rule relating to determine the applicably of
			 the rule to their organizations' s obligation to comply with the final rule.
			 This includes the organization's status as an Actor and the applicability of
			 information blocking.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3600 - MCE Assessment: Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
The following definitions apply for purposes of OAR
				410-141-3600  through 3655:
(1)
			 "Deficiency" means the amount by which the assessment as correctly computed
			 exceeds the assessment, if any, reported by the managed care entities
			 (MCEs).
(2) "Delinquency" means the
			 MCE failed to file a report when due or to pay the assessment as correctly
			 computed when the assessment was due.
(3) "MCE Assessment" means the managed care
			 assessment defined under OAR 410-141-3610.
(4) "Recoupment" means an accounts receivable
			 system that collects money owed by the provider to the Authority by withholding
			 all or a portion of a provider's future payments.
Statutory/Other Authority: ORS
				  413.042 & 414.025
Statutes/Other Implemented: ORS
				  414.065 & 2017 HB
				  2391
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3601 - MCE Assessment: General Administration

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The purpose of these rules is to govern
			 the administration, enforcement, and collection of the managed care assessment
			 on MCEs.
(2) MCEs shall pay an
			 assessment on the gross amount of premium equivalents received during a
			 calendar quarter:
(a) The MCE assessment rate
			 for the period beginning January 1, 2018 and ending December 31, 2019, is 1.5
			 percent;
(b) The MCE assessment
			 rate for the period beginning January 1, 2020 and ending December 31, 2026, is
			 2 percent.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3605 - MCE Assessment: Disclosure of Information

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Except as otherwise required by law, the
			 Authority may not publicly divulge or disclose the amount of income, expense,
			 or other particulars set forth or disclosed in any report or return required in
			 the administration of the assessments. Particulars include but are not limited
			 to social security numbers, employer numbers, or other organization
			 identification numbers, and any business records required to be submitted to or
			 inspected by the Authority to allow it to determine the amount of any
			 assessments, delinquencies, or deficiencies payable or paid, or otherwise
			 administer, enforce, or collect a health care assessment to the extent that the
			 information would be exempt from disclosure under ORS
			 192.345(5).
(2) The Authority may:
(a) Upon request, furnish any MCE or its
			 authorized representative with a copy of the MCE's report filed with the
			 Authority for any quarter, or with a copy of any other information filed by the
			 MCE in connection with the report, or as the Authority considers
			 necessary;
(b) Publish information
			 or statistics so classified as to prevent the identification of income or any
			 particulars contained in any report or return; and
(c) Disclose and give access to an officer or
			 employee of the Authority or its designee, or to the authorized representatives
			 of the U.S. Department of Health and Human Services, Centers for Medicare and
			 Medicaid Services, the Controller General of the United States, the Oregon
			 Secretary of State, the Oregon Department of Justice, the Oregon Department of
			 Justice Medicaid Fraud Control Unit, and other employees of the state or
			 federal government unless the Authority deems disclosure or access necessary or
			 appropriate for the performance of official duties in the Authority's
			 administration, enforcement, or collection of these assessments.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3610 - MCE Assessment: Calculation, Report, Due Date, Verification

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The MCE
			 assessment on the premium equivalents paid to an MCE on or after January 1,
			 2018, is based on calendar quarters. Calendar quarter start dates are January
			 1, April 1, July 1, and October 1. For purposes of this rule, premium
			 equivalents shall be assessed as of the calendar quarter in which the premium
			 equivalents are received by the MCE.
(2) Premium equivalents include all
			 capitation payments received by the MCE for the provision of health services
			 and all other payments received by the MCE from the Authority for providing
			 health services under ORS chapter 414, including maternity payments, quality
			 incentive pool payments, and qualified directed payments as defined in OAR
			 410-125-0230. Premium equivalents do not include Medicare premiums or any form
			 of payment by Oregon Health Plan (OHP) enrollees.
(3) Adjustments to premium equivalents
			 subject to assessment shall be determined as follows:
(a) Premium equivalents attributable to
			 periods prior to January 1, 2018, except annual quality incentive pool
			 payments, are not subject to the assessment and shall be deducted from the
			 assessable premium equivalents when calculating the assessment due;
(b) Adjustments due to changes in client
			 status and other premium equivalents adjustments resulting in additional
			 payments received by the MCE on or after April 1, 2018, are subject to the
			 assessment;
(c) If premium
			 equivalents are reduced by a recoupment by the Authority for an overpayment,
			 then the assessable premium equivalents shall be the reduced amount after
			 recoupment;
(d) If both an
			 overpayment and recoupment occur, the MCE shall be subject to the assessment on
			 the premium equivalents received in the calendar quarter; and
(e) Sub-capitation payments made to an MCE by
			 another MCE are not included in the total premium equivalents subject to
			 assessment if the paying MCE certifies to the receiving MCE in writing that the
			 paying MCE is already responsible for the managed care assessment on the
			 originating premium equivalents.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3615 - MCE Assessment: Filing an Amended Report

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The claims for refunds or payments of
			 additional MCE assessment must be submitted by the MCE on an Authority approved
			 form. The MCE must provide all information required on the report. The
			 Authority may audit the MCE, request additional information, or request an
			 informal conference prior to granting a refund or as part of its review of a
			 payment of a deficiency.
(2) Claim
			 for refund:
(a) If the amount of the MCE
			 assessment imposed is less than the amount paid by the MCE and the MCE does not
			 then owe an assessment for any other calendar period, the Authority may refund
			 the overpayment. In no event shall a refund applicable to a particular calendar
			 quarter exceed the assessment amount actually paid by the MCE;
(b) The MCE may file a claim for refund on an
			 Authority approved form within 180 days after the end of the calendar quarter
			 to which the claim for refund applies;
(c) If there is an amount due from the MCE to
			 the Authority for any past due assessments or penalties, any refund otherwise
			 allowable shall first be applied to the unpaid assessments and penalties, and
			 the Authority shall notify the MCE.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3620 - MCE Assessment: Determining the Date Filed

Current through Register Vol. 63, No. 7, July 1, 2024
(1) For the purposes of these rules, any
			 reports, requests, appeals, payments, or other response by the MCE must be
			 either:
(a) Received by the Authority before
			 the close of business on the date due; or
(b) If mailed, postmarked before midnight of
			 the due date.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3625 - MCE Assessment: Authority to Audit Records

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The MCE must maintain financial records
			 necessary and adequate to determine the amount of premium equivalents for any
			 period for which an MCE assessment may be due.
(2) The Authority may audit the MCE's records
			 at any time for a period of five years following the date the assessment is due
			 to verify or determine the premium equivalents for the MCE.
(3) Any audit, finding, or position may be
			 reopened if there is evidence of fraud, malfeasance, concealment,
			 misrepresentation of material fact, omission of income, or collusion either by
			 the MCE or by the MCE and an Authority representative.
(4) The Authority may notify the MCE of a
			 potential deficiency or issue a refund based upon its audit findings.
Statutory/Other Authority: ORS
				  413.042 & 414.025
Statutes/Other Implemented: ORS
				  414.065 & 2017 HB
				  2391
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3630 - MCE Assessment: Determining Assessment Liability on Failure to File

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In the case of
			 a failure by the MCE to file a report or to maintain necessary and adequate
			 records, the Authority shall determine the MCE assessment liability according
			 to the best of its information and belief.
(2) Best of its information and belief means
			 the Authority shall use evidence available to the Authority at the time of the
			 determination on which a reasonable person would rely on to determine the
			 assessment.
(3) The Authority's
			 determination of assessment liability shall be the basis for the assessment due
			 in any notice of proposed action.
Statutory/Other Authority: ORS
				  413.042 & 414.025
Statutes/Other Implemented: ORS
				  414.065 & 2017 HB
				  2391
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-3635 - MCE Assessment: Financial Penalty for Failure to File a Report or Failure to Pay Assessment When Due

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 An MCE that fails to file a report or pay an MCE assessment in full when due is
			 subject to a penalty of up to $500 per day of delinquency. The penalty accrues
			 from the date of delinquency, notwithstanding the date of any notice under
			 these rules.
(2) The total amount
			 of penalty imposed under this section for each reporting period may not exceed
			 five percent of the assessment for the reporting period for which the penalty
			 is being imposed.
(3) In
			 determining the amount of the penalty, the Authority shall consider evidence,
			 such as:
(a) The MCE's history of prior late
			 payments and prior penalties;
(b)
			 The MCE's actions to come into compliance;
(c) The occurrence of unforeseeable
			 circumstances against which it would have been unreasonable for the MCE to take
			 precautions and which the MCE cannot avoid even by using its best efforts. Such
			 circumstances include, but are not limited to, a natural disaster (e.g.,
			 earthquakes, floods, tornadoes), fires, an act of war (e.g., hostilities,
			 invasion, terrorism, civil disorder), or other circumstances not within the
			 reasonable control of the MCE;
(d)
			 In the case of a deficiency due to an error when the MCE files a timely
			 original return and pays the assessment identified in the return, the nature
			 and extent of the error, evidence of prior errors, and the MCE's explanation of
			 the circumstances related to the error.