Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 141 - OREGON HEALTH PLAN › Section 410-141-5010 - FINANCIAL SOLVENCY REGULATION: Procedure for General Financial Reporting and for Determining Financial Solvency Matters

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority shall determine financial
			 solvency of a CCO in accordance with OAR 410-141-5010  through OAR 410-141-5469,
			 and the CCO contract. In implementing OAR 410-141-5010  to OAR 410-141-5469, the
			 Authority may enter into a cooperative agreement with the DCBS to carry out
			 these provisions. For purposes of obtaining necessary information to determine
			 financial solvency, any reference to the Authority in these rules shall include
			 DCBS when DCBS is working cooperatively with the Authority to implement these
			 provisions. However, only the Authority may take enforcement action or other
			 regulatory sanctions related to the implementation of OAR 410-141-5010  to OAR
			 410-141-5380  and the CCO contract.
(2) Where these rules specify that the
			 Authority may request or receive information or provide a response or take any
			 action, DCBS may act on behalf of the Authority. A response to DCBS under these
			 rules shall be considered a response to the Authority on the matter, consistent
			 with the objective of providing a single point of reporting by CCOs.
(3) The Authority shall collaborate with DCBS
			 to review CCO financial reports and evaluate financial solvency. CCOs are not
			 required to file financial reports with both the Authority and DCBS except as
			 may otherwise be provided in the CCO contract.
(4) Applicants for a CCO contract shall
			 submit all required information to the Authority as part of the application
			 process, and the Authority shall transmit certain information to DCBS for its
			 review. In making its determination about the qualifications of the applicant,
			 the Authority shall consult with DCBS about the financial materials and reports
			 submitted with the application.
(5)
			 For purposes of these financial reporting and solvency rules, DCBS is
			 authorized to make recommendations to the Authority and to act in conjunction
			 with the Authority in accordance with these rules. If quarterly reports or
			 other evidence suggest that a CCO's financial solvency is in jeopardy, the
			 Authority shall act as necessary to protect the public interest.
(6) The Authority may address inquiries to a
			 CCO or its officers in relation to the activities or condition of the CCO or
			 any other matter connected with its transactions. All such persons shall
			 promptly and truthfully reply to the inquiries using the form of communication
			 requested by the Authority. The reply shall be timely, accurate, and complete
			 and, if the Authority requires, verified by an officer of the CCO.
(7) CCOs may be required to use specific
			 required reporting forms or items in order to supply information related to
			 financial responsibility, financial solvency, and financial management. The
			 Authority or DCBS, as applicable, shall provide supplemental instructions about
			 the use of these forms.
(8) The
			 Authority may require a CCO to produce books, records, accounts, papers,
			 documents, and computer and other electronic or digital records in the
			 possession, custody or control of the CCO or the CCO's affiliates that are
			 needed to determine the CCO's financial condition or compliance with Applicable
			 Law, or which are needed to determine the CCO's compliance with the CCO's
			 contracts and agreements with the Authority.
(9) The standards established in OAR
			 410-141-5005  through OAR 410-141-5380  are intended to be consistent with and
			 may utilize procedures and standards common to CCOs and to DCBS in its
			 administration of financial reporting and solvency requirements. Any reference
			 in these rules to the Insurance Code or to rules or regulations adopted by DCBS
			 under the Insurance Code shall not make a CCO subject to regulation as an
			 insurer, but instead shall be construed to adopt and incorporate such rules by
			 reference as Authority rules applicable to CCOs.
Statutory/Other Authority: ORS
				  413.042,
				  414.615,
				  414.625,
				  414.635 & 414.651
Statutes/Other Implemented: ORS
				  414.610 -
				  414.685