reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5235 - REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Reports of Material Materiality and Reporting Standards for Asset Acquisitions and Dispositions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) No acquisitions
			 or dispositions of assets need be reported pursuant to OAR 410-141-5230  if the
			 acquisition or disposition is not material. For purposes of OAR 410-141-5230, a
			 material acquisition (or the aggregate of any series of related acquisitions
			 during any 30-day period) or disposition (or the aggregate of any series of
			 related dispositions during any 30-day period) is one that is non-recurring and
			 not in the ordinary course of business and involves more than five percent of
			 the reporting CCO's total allowed assets as reported in its most recent
			 statutory statement filed with the Authority.
(2) OAR 410-141-5230  applies to the following
			 asset acquisitions and asset dispositions:
(a) Asset acquisitions include every
			 purchase, lease, exchange, merger, consolidation, succession or other
			 acquisition by or for the reporting CCO.
(b) Asset dispositions include every sale,
			 lease, exchange, merger, consolidation, mortgage, hypothecation, assignment
			 (whether for the benefit of creditors or otherwise), abandonment, destruction
			 or other disposition.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5240 - REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Materiality and Reporting Standards for Changes in Ceded Reinsurance Agreements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) No nonrenewals, cancellations or
			 revisions of ceded reinsurance agreements need be reported pursuant to OAR
			 410-141-5230  if the nonrenewals, cancellations or revisions are not material. A
			 material nonrenewal, cancellation or revision is one that affects:
(a) More than fifty percent of the CCO's
			 total ceded capitated revenue;
(b)
			 More than fifty percent of the CCO's total ceded indemnity and loss adjustment
			 reserves; or
(c) More than fifty
			 percent of the total reserve credit taken for business ceded, on an annualized
			 basis, as indicated in the CCO's most recent annual statement.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5245 - EXAMINATIONS: CCO Production of Books and Records

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may require a CCO to
			 produce books, records, accounts, papers, documents and computer and other
			 recordings in the possession, custody or control of the CCO or the CCO's
			 affiliates that the Authority determines are needed for the Authority to
			 investigate or examine the CCO's financial condition or to investigate, examine
			 or determine the CCO's compliance with Applicable Law or with the CCO's
			 contracts and agreements with the Authority.
(2) No person shall file or cause to be filed
			 with the Authority or DCBS any article, certificate, report, statement,
			 application or any other information required or permitted to be so filed under
			 Applicable Law or the CCO Contract and known to such person to be false or
			 misleading in any material respect.
(3) If a CCO, without good cause, fails to
			 comply with its obligations under subsections (1) or (2), the Authority may
			 impose a civil penalty on the CCO pursuant to OAR 410-141-5380  and/or may
			 suspend or revoke the CCO's agreement with the Authority.
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 410-141-5250 - EXAMINATIONS: Authority Examinations of CCOs

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may examine every CCO,
			 including an audit of the financial affairs of a CCO, as often as the Authority
			 determines an examination to be necessary or otherwise appropriate under the
			 circumstances. Without limiting the Authority's right to examine a CCO at such
			 times and with such frequency as the Authority determines to be necessary or
			 otherwise appropriate under the circumstances, a CCO will be examined at least
			 once during the CCO's contract period. An examination will be conducted for
			 such purposes and such scope as the Authority determines to be necessary or
			 otherwise appropriate under the circumstances, including, without limitation,
			 an investigation and examination of the financial condition of the CCO, its
			 ability to fulfill its obligations and its manner of fulfillment, the nature of
			 its operations and its compliance with these rules and applicable CCO contract
			 requirements.
(2) Examinations will
			 be conducted under and pursuant to the following practices and procedures,
			 subject to such exceptions, modifications and other practices and procedures as
			 the Authority determines to be necessary or otherwise appropriate under the
			 circumstances:
(a) The Authority will appoint
			 one or more examiners to perform the examination and instruct them as to the
			 scope of the examination. The Authority may contract and coordinate all or
			 portions of the examination with DCBS. Any reference to the Authority in this
			 section shall include DCBS when DCBS is working under an interagency agreement
			 with the Authority to conduct the examination. DCBS is authorized to make
			 recommendations to the Authority and to act in conjunction with the Authority
			 in accordance with this section.
(b) The examiner(s) shall conduct the
			 examination in accordance with the guidelines, practices, principles and
			 procedures set forth in the Examiners Handbook published by the NAIC. The
			 Authority may instruct or allow the examiner(s) to follow or employ such other
			 guidelines, practices, principles and procedures as the Authority determines to
			 be necessary or otherwise appropriate under the circumstances.
(c) The Authority may retain appraisers,
			 independent actuaries, independent certified public accountants and other
			 professionals and specialists as needed.
(d) The Authority, including its appointed
			 examiners, may examine under oath all persons who may have material information
			 regarding the property or business of the person being examined or
			 investigated.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5255 - CCO ACQUISITIONS AND MERGERS: Purpose; Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The purpose of
			 OAR 410-141-5255  to OAR 410-141-5285  is that of regulating the control or
			 ownership of a CCO or of a CCO holding company system, in order to promote the
			 public interest including the interests of CCO Members and stakeholders and to
			 advance the goals and mission of the Authority and the Oregon Integrated and
			 Coordinated Care Delivery System described in ORS 414.018 and ORS
			 414.620.
(2) The Authority shall adhere to
			 the following guiding principles when reviewing proposed acquisitions:
(a) The health of Oregon Health Plan members
			 and all Oregonians are at the center when analyzing potential impacts of
			 proposed acquisitions;
(b) Health
			 equity, access to care, health care quality, and costs are
			 fundamental;
(c) The process shall
			 be transparent, robust and informed by the public and stakeholders through
			 meaningful engagement; and
(d) The
			 Authority shall use resources wisely and collaborate with DCBS when
			 applicable.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5260 - CCO ACQUISITIONS AND MERGERS: Activities Prohibited Unless Certain Provisions Satisfied

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Unless a
			 person first satisfies the provisions of OAR 410-141-5265  to OAR 410-141-5280,
			 the person may not engage in any of the following activities:
(a) A person other than the person that
			 issues voting securities of a CCO may not acquire or attempt to acquire control
			 of the CCO. For purposes of this paragraph, a person acquires or attempts to
			 acquire control of a CCO if, as a result of engaging in and completing any of
			 the following actions, in the open market or otherwise, the person would
			 directly or indirectly control the CCO, or would control the CCO by exercising
			 a right to acquire or by conversion:
(A)
			 Making a tender offer for or a request or invitation for tenders of any voting
			 security of the CCO;
(B) Entering
			 into any agreement to exchange securities for any voting security of the
			 CCO;
(C) Acquiring or seeking to
			 acquire any voting security of the CCO; or
(D) Otherwise engaging in any activity that
			 constitutes a change in control of a CCO requiring pre-approval from the
			 Authority, as described in the CCO Health Plan Services Contract with the
			 Authority.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5265 - CCO ACQUISITIONS AND MERGERS: Procedure For Acquiring Controlling Interest

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An acquiring
			 party shall:
(a) Complete and file Form A
			 which is described in OAR 410-141-5270  with the Authority for approval. If more
			 than one acquiring party must file Form A under this paragraph, any or all
			 acquiring parties that are acting in concert may jointly file Form A.
(b) Deliver or mail to the CCO to which the
			 activity described in OAR 410-141-5260  applies, concurrently with filing the
			 statement under paragraph (a) of this subsection, a statement that has the
			 information specified in this section. A statement mailed under this paragraph
			 must be sent by certified mail, return receipt requested. If a joint statement
			 is filed under paragraph (a) of this subsection, the joint statement must be
			 the statement mailed or delivered under this paragraph;
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5275 - CCO ACQUISITIONS AND MERGERS: Hearing, Request, Notice

Current through Register Vol. 63, No. 7, July 1, 2024
(1) If a person has
			 duly filed a written request for a hearing or if, within 10 days after an
			 acquiring party has filed its completed Form A in accordance with OAR
			 410-141-5265, the Authority finds that holding a hearing is necessary or
			 advisable, the Authority shall cause a hearing to be held.
(2) The Authority will determine whether a
			 hearing is necessary or advisable within 30 days after the acquiring party has
			 filed its completed Form A. In the event the Authority orders a hearing, the
			 Authority shall designate the date, time, and place of the hearing, which shall
			 be held within 30 days of the Authority's order for a hearing. In addition to
			 any other notice required under this section, at least 20 days before the
			 hearing the Authority shall notify the person that filed the written request
			 and the acquiring party of the hearing. At least seven days before the hearing,
			 one or more of the acquiring parties shall give notice of date, time, and place
			 of the hearing to those persons the Authority designates. The acquiring party
			 shall bear the expense of providing the notice.
(3) The hearing must be conducted in
			 accordance with the provisions for a contested case proceeding under ORS
			 chapter 183.
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 410-141-5280 - CCO ACQUISITIONS AND MERGERS: Determination Concerning Proposed Activity, Time For Decision, Grounds For Refusal

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Prior to approving or disapproving the
			 proposed activity, the Authority shall engage the public, Oregon's Medicaid
			 Advisory Committee, and the Community Advisory Councils of the CCO. The
			 Authority's engagement of the public shall include the following, coordinated
			 with DCBS where efficient:
(a) Seeking
			 recommendations by the Community Advisory Councils of the CCO regarding persons
			 who should be notified,
(b) A
			 public hearing in each service area of the CCO,
(c) A public comment period,
(d) An opportunity to provide input on a
			 draft of the Authority's detailed analyses described under subsection
			 (4),
(e) Seeking feedback from the
			 Medicaid Advisory Committee, and
(f) Posting on the Authority's web site of
			 the Form A and significant documents relating to the Form A. If any such
			 document contains 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 the CCO, then the Authority shall
			 redact the document pursuant to ORS
			 192.338.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5285 - CCO HOLDING COMPANY REGULATION: Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
Unless the context otherwise requires, as used in OAR
				410-141-5225  to OAR 410-141-5355:
(1)
			 "Affiliate" means a person that directly or indirectly, through one or more
			 intermediaries, controls, is controlled by, or is under common control with,
			 another person.
(2) "CCO holding
			 company system" means two or more affiliated persons, one or more of which is a
			 CCO, and includes a financial holding company as described in section 103 of
			 the federal Gramm-Leach-Bliley Act (P.L.
			 106-102).
(a)
			 "Person" means an individual, corporation, limited liability company,
			 partnership, association, joint stock company, trust or unincorporated
			 organization, or an entity or combination of entities similar to the entities
			 described in this paragraph.
(b)
			 "Person" does not include:
(A) A joint
			 venture partnership that is engaged exclusively in owning, managing, leasing or
			 developing real or tangible personal property; or
(B) For the purposes of OAR 410-141-5000  through 410-141-5380, a securities broker that holds, in the usual and
			 customary broker's function, less than 20 percent of the voting securities of a
			 CCO or of any person that controls.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5290 - CCO HOLDING COMPANY REGULATION: Members of Holding Company Systems; Registration Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Every
			 CCO that is a member of a CCO holding company system shall register with the
			 Authority as provided in this section.
(2) A CCO that is subject to registration
			 under this section shall register not later than 15 days after the date the CCO
			 becomes subject to registration, and annually thereafter on or before April 30
			 for the previous calendar year, unless the Authority for good cause shown
			 extends the time for registration, and then within such extended
			 time.
(3) The Authority may require
			 or allow two or more affiliated CCOs subject to registration to file a
			 consolidated registration statement.
(4) The registration requirements of OAR
			 410-141-5290  to OAR 410-141-5380  do not apply to any CCO, information or
			 transaction the Authority exempts by rule or order.
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 410-141-5300 - CCO HOLDING COMPANY REGULATION: Registration Statement Filing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A CCO required
			 to file an annual registration statement pursuant to OAR 410-141-5290  shall:
(a) Furnish the required information on Form
			 B. Form B is set forth on the website of the Authority at
https://www.oregon.gov/oha/HSD/OHP/Pages/CCO-Contract-Forms.aspx
.
(b) Include a statement that the
			 CCO's Board oversees corporate governance and internal controls.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5305 - CCO HOLDING COMPANY REGULATION: Information Required to Be Disclosed

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Information
			 that is not material for the purposes of registration under OAR 410-141-5285  to
			 OAR 410-141-5380  need not be disclosed on the registration statement filed
			 pursuant to OAR 410-141-5290.
(2)
			 Unless the Authority by rule or order provides otherwise, sales, purchases,
			 exchanges, loans or extensions of credit, investments or guarantees involving
			 one-half of one percent or less of a CCO's admitted assets as of the December
			 31 immediately preceding the date of the registration statement or amendment
			 shall not be deemed material for purposes of registration under OAR
			 410-141-5290  to OAR 410-141-5380.
(3) Any person within a CCO holding company
			 system subject to registration shall provide complete and accurate information
			 to a CCO when such information is necessary to enable the CCO to comply with
			 the registration requirements of OAR 410-141-5285  to OAR
			 410-141-5355.
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 410-141-5310 - CCO HOLDING COMPANY REGULATION: Presumption of Control; Rebuttal

Current through Register Vol. 63, No. 7, July 1, 2024
The Authority shall presume that a person controls another
				person if the person, directly or indirectly, owns, controls, holds with the
				power to vote, or holds proxies representing, 10 percent or more of the voting
				securities of the other person. A person may rebut this presumption with a
				showing in the manner provided under OAR 410-141-5315  that control does not
				exist in fact. The Authority may determine, after giving persons that have an
				interest in the Authority's determination notice and opportunity to be heard
				and after making specific findings of fact to support the determination that
				control exists in fact, notwithstanding the absence of a presumption that
				control exists in fact.
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 410-141-5315 - CCO HOLDING COMPANY REGULATION: Disclaimer of Affiliation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any person, CCO or member of a CCO
			 holding company system may file with the Authority a disclaimer of affiliation
			 with any authorized CCO. The disclaimer must fully disclose all material
			 relationships and bases for affiliation between the person, CCO or member and
			 the CCO to which the disclaimer of affiliation applies, as well as the basis
			 for disclaiming the affiliation.
(2) After the person, CCO or member files a
			 disclaimer, the person, CCO or member and the CCO to which the disclaimer
			 applies are relieved of any duty to register or report under OAR 410-141-5290  to OAR 410-141-5380  that may arise out of the CCO's relationship with the
			 person, CCO or member of the CCO holding company system that filed the
			 disclaimer unless the Authority disallows the disclaimer.
(3) A disclaimer that the person, CCO or
			 member of the CCO holding company system files under this section is effective
			 unless within 30 days after the Authority receives the disclaimer the Authority
			 notifies the person, the CCO or the member of the CCO holding company system
			 that Authority has disallowed the disclaimer.
(4) The Authority shall grant a hearing if
			 the person, CCO or member of a CCO holding company system that filed the
			 disclaimer requests a hearing.
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 410-141-5320 - CCO HOLDING COMPANY REGULATION: Transactions Within Holding Company

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A transaction
			 within a CCO holding company system to which a CCO subject to registration is a
			 party is subject to the following standards:
(a) The terms must be fair and
			 reasonable.
(b) Charges or fees for
			 services performed must be reasonable.
(c) Expenses incurred and payment received
			 must be allocated to the CCO in conformity with customary insurance accounting
			 practices that are consistently applied.
(d) The books, accounts and records of each
			 party to the transaction must be maintained so as to disclose clearly and
			 accurately the nature and details of the transaction, including accounting
			 information that is necessary to support the reasonableness of the charges or
			 fees to the respective parties.
(e)
			 The combined capital and surplus of the CCO following any transaction with an
			 affiliate or any shareholder dividend must be reasonable in relation to the
			 CCO's outstanding liabilities and adequate to the CCO's financial
			 needs.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5325 - CCO HOLDING COMPANY REGULATION: Director and Officer Liability; Effect of Control of CCO Subject to Registration; Board of Directors

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A person's control of a CCO that is
			 subject to registration does not relieve the officers and directors of the CCO
			 of any obligation or liability to which the officers and directors would
			 otherwise be subject by law. The CCO must be managed so as to assure the CCO's
			 separate operating identity.
(2)
			 This section does not preclude a CCO from having or sharing a common
			 management, or from using personnel, property or services jointly or
			 cooperatively, with another person under an arrangement that meets the
			 standards set forth in OAR 410-141-5320.
(3) At least one-third of a CCO's directors
			 and at least one-third of the members of each committee of the CCO's Board must
			 be persons who are not:
(a) Officers or
			 employees of the CCO or of any entity that controls, is controlled by or is
			 under common control with the CCO; or
(b) Beneficial owners of a controlling
			 interest in the voting securities of the CCO or of an entity that controls, is
			 controlled by or is under common control with the CCO.
(c) A quorum for transacting business at a
			 meeting of the CCO's Board or any committee of the CCO's Board must include at
			 least one person with the qualifications described in paragraph (a) of this
			 subsection.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5330 - CCO HOLDING COMPANY REGULATION: Annual Enterprise Risk Report

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Every CCO
			 subject to registration shall file an enterprise risk report each year. The
			 enterprise risk report must identify, to the best of the CCO's knowledge and
			 belief, the material risks within the holding company system of which the CCO
			 is a part that could pose enterprise risk to the CCO. The Director of the
			 Authority shall make the determination in accordance with procedures the
			 director adopts by rule after considering procedures set forth in a Financial
			 Analysis Handbook that the National Association of Insurance Commissioners has
			 adopted.
(2) A CCO required to file
			 an enterprise risk report pursuant to this rule shall furnish the required
			 information on Form F. Form F is set forth on the website of the Authority at
https://www.oregon.gov/oha/HSD/OHP/Pages/CCO-Contract-Forms.aspx
.
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 410-141-5335 - CCO HOLDING COMPANY REGULATION: Disclaimers and Termination of Registration

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority
			 shall terminate the registration of any CCO which demonstrates that it no
			 longer is a member of a CCO holding company system.
(2) A disclaimer of affiliation or a request
			 for termination of registration claiming that a person does not, or will not
			 upon the taking of some proposed action, control another person (referred to as
			 the "subject" in this section) shall contain:
(a) The number of authorized, issued and
			 outstanding voting securities of the subject;
(b) With respect to the person whose control
			 is denied and all affiliates of such person, the number and percentage of
			 shares of the subject's voting securities that are held of record or known to
			 be beneficially owned, and the number of such shares concerning which there is
			 a right to acquire, directly or indirectly;
(c) All material relationships and bases for
			 affiliation between the subject and the person whose control is denied and all
			 affiliates of such person; and
(d)
			 A statement explaining why such person should not be considered to control the
			 subject.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5340 - CCO HOLDING COMPANY REGULATION: Forms; General Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Forms A, B, C,
			 D, E and F are intended to be guides in the preparation of the statements
			 required by OAR 410-141-5290  to OAR 410-141-5380, including but not limited to
			 the registration provisions thereof. The forms are not intended to be blank
			 forms that are to be filled in. The statements filed shall contain the numbers
			 and captions of all items, but the text of the items may be omitted if the
			 answers to the items are prepared so as to indicate clearly the scope and
			 coverage of the items. All instructions, whether appearing under the items of
			 the form or elsewhere, are to be omitted. Unless expressly provided otherwise,
			 if any item is inapplicable or the answer to any item is in the negative, an
			 appropriate statement to that effect shall be made.
(2) One complete copy of each statement,
			 including exhibits and all other papers and documents filed as a part of the
			 statement, shall be filed with the Authority by electronic delivery. Each
			 statement shall be signed and certified in the manner prescribed on the form.
			 Unsigned copies shall be confirmed. If the signature of any person is affixed
			 pursuant to a power of attorney or other similar authority, a copy of such
			 power of attorney or other authority shall also be filed with the
			 statement.
(3) Statements must be
			 prepared electronically and clearly named. Exhibits and financial statements,
			 unless specifically prepared for the filing, may be submitted in their original
			 size. All copies of any statement, financial statements or exhibits shall be
			 clear, easily readable, and suitable for printing. Debits in credit categories
			 and credits in debit categories shall be designated so as to be clearly
			 distinguishable as such on photocopies. Statements shall be in the English
			 language and monetary values shall be stated in United States currency. If any
			 exhibit or other paper or document filed with the statement is in a foreign
			 language, it shall be accompanied by a translation into the English language
			 and any monetary value shown in a foreign currency shall be converted into
			 United States currency.
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 410-141-5345 - CCO HOLDING COMPANY REGULATION: Forms; Incorporation by Reference, Summaries, And Omissions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Information
			 required by any item of Form A, B, D, E or F may be incorporated by reference
			 in answer or partial answer to any other item. Information contained in any
			 financial statement, annual report, proxy statement, statement filed with a
			 governmental authority or any other document may be incorporated by reference
			 in answer or partial answer to any item of Form A, B, D, E or F if the document
			 or paper is filed as an exhibit to the statement. Excerpts of documents may be
			 attached as exhibits if the documents are extensive. Documents currently on
			 file with the Authority that were filed within three years need not be filed as
			 exhibits. References to information contained in exhibits or in documents
			 already on file shall clearly identify the material and shall specifically
			 indicate that such material is to be incorporated by reference in answer to the
			 item. Matter shall not be incorporated by reference in any case in which the
			 incorporation would render the statement incomplete, unclear, or
			 confusing.
(2) If an item requires
			 a summary or outline of the provisions of any document, only a brief statement
			 of the pertinent provisions of the document shall be made. The summary or
			 outline may in addition incorporate by reference particular parts of any
			 exhibit or document currently on file with the Authority that was filed within
			 three years and may be qualified in its entirety by such reference. If two or
			 more documents required to be filed as exhibits are substantially identical in
			 all material respects except as to the parties thereto, the dates of execution
			 or other details, a copy of only one of such documents need be filed, but it
			 shall have attached a schedule identifying the omitted documents and setting
			 forth the material details in which such documents differ from the documents of
			 which a copy is filed.
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 410-141-5350 - CCO HOLDING COMPANY REGULATION: Forms; Information Unknown or Unavailable and Extension of Time to Furnish

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Required information need be given only insofar as it is known or reasonably
			 available to the person filing the statement. If any required information is
			 unknown and not reasonably available to the person filing, either because
			 obtaining it would involve unreasonable effort or expense, or because it rests
			 peculiarly within the knowledge of another person not affiliated with the
			 person filing, the information may be omitted. However, the person filing
			 shall:
(a) Give such information on the
			 subject as the person possesses or can acquire without unreasonable effort or
			 expense, together with the sources thereof; and
(b) Include a statement either showing that
			 unreasonable effort or expense would be involved or indicating the absence of
			 any affiliation with the person within whose knowledge the information rests
			 and stating the result of a request made to such person for the
			 information.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5355 - CCO HOLDING COMPANY REGULATION: Forms; Additional Information; Amendments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In addition to
			 the information expressly required to be included in Forms A, B, C, D, E and F
			 there shall be included further material information, if any, as may be
			 necessary to make the information contained in the form not misleading. The
			 person filing may also file exhibits in addition to those expressly required by
			 the statement. Such exhibits shall be marked to indicate clearly the subject
			 matters to which they refer.
(2) A
			 change to Form A, B, C, D, E and F shall include on the top of the cover page
			 the phrase: "Change No. _____ to" and shall indicate the date of the change and
			 not the date of the original filing.
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 410-141-5360 - CCO INSOLVENCY AND DISSOLUTION: Access to Funds and Transition of Members and Records

Current through Register Vol. 63, No. 7, July 1, 2024
(1) CCOs shall
			 provide the Authority access to Restricted Reserve Funds if insolvency
			 occurs.
(2) CCOs shall have written
			 policies and procedures to ensure that if insolvency occurs, Members and
			 related clinical records are transitioned to other CCOs or providers with
			 minimal disruption.
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 410-141-5365 - CCO INSOLVENCY AND DISSOLUTION: Hazardous Operations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Without
			 limitation or exclusion of any other authority, actions or remedies that are
			 available to the Authority under these rules or under Applicable Law, if the
			 Authority determines that the continued operation of a CCO is hazardous to its
			 Members or to the public in general, the Authority may order the CCO to take
			 one or more of the following actions:
(a)
			 Reduce the total amount of present and potential liability for Member services
			 by reinsurance.
(b) Reduce, suspend
			 or limit the volume of business being accepted or renewed.
(c) Reduce general expenses by methods
			 specified by the Authority.
(d)
			 Increase the capital and surplus of the CCO.
(e) Suspend or limit the declaration and
			 payment of dividends by the CCO to its stockholders or members.
(f) Limit or withdraw from certain
			 investments or discontinue certain investment practices to the extent the
			 Authority determines such action to be necessary.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5375 - CCO INSOLVENCY AND DISSOLUTION: Voluntary Dissolution; Approval of Plan

Current through Register Vol. 63, No. 7, July 1, 2024
(1) No CCO may be
			 dissolved voluntarily until the Authority has approved a plan for liquidation
			 of the CCO's assets and obligations.
(2) The plan of dissolution must provide for
			 the reinsurance and assumption of all in-force Member Contracts to which the
			 CCO is a party.
(3) The Authority
			 shall require that the plan of dissolution provide adequate reserves in trust
			 or otherwise for the satisfaction of all remaining obligations of the
			 CCO.
Statutory/Other Authority: ORS
				  414.615,
				  414.625,
				  414.635,
				  414.651 & ORS
				  413.042
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 410-141-5380 - CIVIL PENALTIES

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A person
			 that violates any provision of Sections 5000 through 5380 or any final order of
			 the Authority entered under any of Sections 5000 through 5380, shall forfeit
			 and pay to the General Fund of the State Treasury a civil penalty in an amount
			 determined by the Authority that shall not exceed $10,000 for each
			 offense.
(2) In addition to the
			 civil penalty specified in subsections (1), (3) and (4) of this section, a
			 person that violates any provision of OAR 410-141-5000  to 410-141-5380  or any
			 final order of the Authority entered under any of OAR 410-141-5000  to
			 410-141-5380, may be required by the Authority to forfeit and pay to the
			 General Fund of the State Treasury a civil penalty in an amount determined by
			 the Authority that shall not exceed the amount by which the person profited by
			 or through or as a result of such violation, as determined by the
			 Authority.
(3) In addition to the
			 penalties specified in subsection (1), (2) and (4) of this section, a director
			 or officer of a CCO or any affiliate within a CCO's holding company system who
			 engages in a transaction or makes an investment that has not been properly
			 reported under, or that otherwise does not comply with, OAR 410-141-5360  to OAR
			 410-141-5510, who knowingly participates in or assents to the transaction or
			 investment, or who permits another officer or an agent of the holding company
			 system to engage in the transaction or make the investment, shall pay, in the
			 director or officer's individual capacity, a civil penalty in an amount
			 determined by the Authority that shall not exceed $10,000.
(4) In addition to the penalties specified in
			 subsections (1), (2) and (3) of this section, a CCO or other person that fails
			 to make a required filing or demonstrate a good faith effort to comply with a
			 filing requirement under OAR 410-141-5350  to OAR 410-141-5285  shall pay a civil
			 penalty in an amount determined by the Authority that does not exceed
			 $50,000.
(5) Civil penalties under
			 this section shall be imposed and enforced in accordance with ORS
			 183.745.
(6) A civil penalty imposed under this
			 section may be recovered either as provided in subsection (5) of this section
			 or in an action brought in the name of the State of Oregon in any court of
			 appropriate jurisdiction.
(7) The
			 provisions of this section are in addition to and not in lieu of, any other
			 enforcement provisions specified in Division OAR 410 of Chapter 141 or in the
			 CCO's contract with the Authority.
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 142 - HOSPICE SERVICES › Section 410-142-0040 - Eligibility for the Hospice Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Hospice services are covered for clients
			 who have:
(a) Been certified as terminally
			 ill in accordance with OAR 410-142-0060; and
(b) Have Oregon Health Plan (OHP) Plus
			 benefit package coverage.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 142 - HOSPICE SERVICES › Section 410-142-0060 - Certification of Terminal Illness

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 In order to receive reimbursement from the Division of Medical Assistance
			 Programs (Division), the hospice must obtain and retain a physician's written
			 certification of a client's terminal illness in accordance with the following
			 procedures. The Division will not pay for services provided prior to
			 certification.
(2) The attending
			 physician is a doctor of medicine or osteopathy or a nurse practitioner and is
			 identified by the client at the time he or she elects to receive hospice care,
			 as having the most significant role in the determination and delivery of the
			 client's medical care. A nurse practitioner serving as the attending physician
			 may not certify or re-certify the terminal illness.
(3) Certifications may be completed up to two
			 weeks before hospice care is elected.
(4) The certification of a client who elects
			 hospice is based on the physician's or medical director's clinical judgment
			 regarding the normal course of the client's illness and must include:
(a) The statement that the client's medical
			 prognosis indicates a life expectancy of six months or less if the terminal
			 illness runs its normal course; and
(b) Clinical information and other
			 documentation which support the medical prognosis must accompany the
			 certification and be filed in the medical record with the
			 certification.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 142 - HOSPICE SERVICES › Section 410-142-0080 - Informed Consent

Current through Register Vol. 63, No. 7, July 1, 2024
A hospice must demonstrate respect for an individual's rights
				by ensuring that an informed consent form has been obtained for every
				individual, either from the individual or representative as defined in OAR
				410-142-0020. The form must specify the type of care and services that may be
				provided as hospice care during the course of the illness.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: ORS
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 142 - HOSPICE SERVICES › Section 410-142-0100 - Election of Hospice Care

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 individual who meets the eligibility requirements of OAR 410-142-0040  may file
			 an election statement with a particular hospice. If the individual is
			 physically or mentally incapacitated, his or her representative may file the
			 election statement.
(2) The
			 election statement must include the following:
(a) Identification of the particular hospice
			 that will provide care to the individual;
(b) The individual's or representative's
			 acknowledgment that he or she has been given a full understanding of the
			 palliative rather than curative nature of hospice care, as related to the
			 individual's terminal illness;
(c)
			 Except for children (see 410-124-0110), acknowledgment that certain otherwise
			 covered services are waived by the election. Election of a hospice benefit
			 means that the Division will only reimburse the hospice for those services
			 included in the hospice benefit;
(d) The effective date of the election, which
			 may be the first day of hospice care or a later date, but may be no earlier
			 than the date of the election statement;
(e) The signature of the individual or
			 representative.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 142 - HOSPICE SERVICES › Section 410-142-0110 - Concurrent Care for Children

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Under Section 2302 of the Affordable Care Act, Medicaid or Children's Health
			 Insurance Program (CHIP) eligible children are eligible to receive curative
			 treatment upon the election of the hospice benefit.
(2) The criteria for receiving hospice
			 services does not change for children eligible for Medicaid and CHIP programs.
			 However these children may now receive hospice services without forgoing any
			 other service to which the child is entitled under Medicaid for treatment of
			 the terminal condition.
(3) All
			 other eligibility, coverage, and hospice rules for the Division of Medical
			 Assistance Programs apply.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: ORS
				  414.065
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 142 - HOSPICE SERVICES › Section 410-142-0120 - Duration of Hospice Care

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 eligible individual may elect to receive hospice care during one or more of the
			 following election periods:
(a) An initial
			 90-day period;
(b) A subsequent
			 90-day period;
(c) An unlimited
			 number of subsequent 60-day periods.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 142 - HOSPICE SERVICES › Section 410-142-0140 - Changing the Designated Hospice

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual or representative may
			 change, once in each election period, the designation of the particular hospice
			 from which hospice care will be received.
(2) The change of the designated hospice is
			 not a revocation of the election for the period in which it is made.
(3) To change the designation of hospice
			 programs, the individual or representative must file, with the hospice from
			 which care has been received and with the newly designated hospice, a statement
			 that includes the following:
(a) The name of
			 the hospice from which the individual has received care and the name of the
			 hospice from which he or she plans to receive care;
(b) The date the change is to be
			 effective.
Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 142 - HOSPICE SERVICES › Section 410-142-0160 - Revoking the Election of Hospice Care

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual or representative may
			 revoke the individual's election of hospice care at any time during an election
			 period.
(2) Revocation Procedure:
			 To revoke the election of hospice care, the individual or representative must
			 file with the Hospice a statement to be placed in the medical record that
			 includes the following information:
(a) A
			 signed statement that the individual or representative revokes the individual's
			 election for coverage of hospice care for the remainder of that election
			 period;
(b) The date that the
			 revocation is to be effective. (An individual or representative may not
			 designate an effective date earlier than the date that the revocation is
			 made.)