Or. Admin. R. ch. 410, div. 141 – Oregon Health Plan | Midpage

Collections
Oregon Administrative Rules

Division 141

Or. Admin. R. ch. 410, div. 141

Oregon Health Plan

Oregon Health Authority

3500Definitions 3501Administration of Oregon Integrated and Coordinated Health Care Delivery System Regulation; Rule Precedence 3505Use of Subcontractors 3510Provider Contracting and Credentialing 3515Network Adequacy 3520Record Keeping and Use of Health Information Technology 3525Outcome and Quality Measures 3530Sanctions 3531Sanctions for Failure to Comply with State or Federal Information Security or Privacy Laws 3540Member Protections 3545CCO Behavioral Health Provider, Treatment and Facility Certification and Licensure 3550Resolving Disputes between MCEs and the Authority 3555Resolving Disputes between Health Care Entities and CCOs that Concern CCO Contact Award 3560Resolving Contract Disputes Between Health Care Entities and CCOs 3565Managed Care Entity Billing 3570Managed Care Entity Encounter Claims Data Reporting 3575MCE Member Relations: Marketing 3580MCE Member Relations: Potential Member Information 3585MCE Member Relations: Education and Information 3590MCE Member Relations: Member Rights and Responsibilities 3591MCE Interoperability Requirements 3600MCE Assessment: Definitions 3601MCE Assessment: General Administration 3605MCE Assessment: Disclosure of Information 3610MCE Assessment: Calculation, Report, Due Date, Verification 3615MCE Assessment: Filing an Amended Report 3620MCE Assessment: Determining the Date Filed 3625MCE Assessment: Authority to Audit Records 3630MCE Assessment: Determining Assessment Liability on Failure to File 3635MCE Assessment: Financial Penalty for Failure to File a Report or Failure to Pay Assessment When Due 3640MCE Assessment: Notice of Proposed Action 3645MCE Assessment: Hearing Process 3650MCE Assessment: Final Order of Payment 3655Assessment: Remedies Available after Final Order of Payment 3700CCO Application and Contracting Procedures 3705Criteria for CCOs 3710Contract Termination and Close-Out Requirements 3715CCO Governance; Public Meetings and Transparency 3720Service Area Change for Existing CCOs 3725CCO Contract Renewal Notification 3730Community Health Assessment and Community Health Improvement Plans 3735Social Determinants of Health and Equity; Health Equity 3740Traditional Health Workers 3800CCO Enrollment for Children Receiving Health Services 3805Mandatory MCE Enrollment Exceptions 3810Disenrollment from MCEs 3815CCO Enrollment for Temporary Out-of-Area Behavioral Health Treatment Services 3820Covered Services 3825Excluded Services and Limitations 3826Responsibility for Particular Covered Services Based on Plan Type 3830Prioritized List of Health Services 3835MCE Service Authorization 3840Emergency and Urgent Care Services 3845Flexible Services 3846Palliative Care Program.3850Transition of Care 3855Pharmaceutical Services 3860Care Coordination: Administration, Systems and Infrastructure 3865Care Coordination: Identification of Member Needs 3870Care Coordination: Service Coordination 3875MCE Grievances & Appeals: Definitions and General Requirements 3880Grievances & Appeals: Grievance Process Requirements 3885Grievances & Appeals: Notice of Action/Adverse Benefit Determination 3890Grievances & Appeals: Appeal Process 3895Grievances & Appeals: Expedited Appeal 3900Grievances & Appeals: Contested Case Hearings 3905Grievances & Appeals: Expedited Contested Case Hearings 3910Grievances & Appeals: Continuation of Benefits 3915Grievances & Appeals: System Recordkeeping 3920Transportation: NEMT General Requirements 3925Transportation: Vehicle Equipment and Driver Standards 3930Transportation: Out-of-Service Area and Out-of-State Transportation 3935Transportation: Attendants for Child and Special Needs Transports 3940Transportation: Secured Transports 3945Transportation: Ground and Air Ambulance Transports 3955Transportation: Member Service Modifications and Rights 3960Transportation: Member Reimbursed Mileage, Meals, and Lodging 3965Reports and Documentation 5000FINANCIAL SOLVENCY REGULATION: Definitions 5005FINANCIAL SOLVENCY REGULATION: CCO Financial Solvency Requirements 5010FINANCIAL SOLVENCY REGULATION: Procedure for General Financial Reporting and for Determining Financial Solvency Matters 5015FINANCIAL SOLVENCY REGULATION: Financial Statement Reporting 5020FINANCIAL SOLVENCY REGULATION: Annual Audited Financial Statements and Auditor’s Report 5025FINANCIAL SOLVENCY REGULATION: Qualifications of Independent Certified Public Accountant 5030FINANCIAL SOLVENCY REGULATION: Notification of Adverse Financial Condition 5035FINANCIAL SOLVENCY REGULATION: Accountant's Letter of Qualifications 5040FINANCIAL SOLVENCY REGULATION: Independent Certified Public Accountants Workpapers 5045FINANCIAL SOLVENCY REGULATION: Corporate Governance Annual Disclosure Filing 5050FINANCIAL SOLVENCY REGULATION: Requirements for Reinsurance 5055FINANCIAL SOLVENCY REGULATION: Requirements for Obtaining Credit for Reinsurance 5060FINANCIAL SOLVENCY REGULATION: Qualified Trust Agreements 5065FINANCIAL SOLVENCY REGULATION: Letters of Credit; Other Security 5070FINANCIAL SOLVENCY REGULATION: Assets, Liabilities, Reserves 5075FINANCIAL SOLVENCY REGULATION: Disallowance of Certain Reinsurance Transactions 5080FINANCIAL SOLVENCY REGULATION: Transparency 5085ASSET VALUATION AND PERMITTED INVESTMENTS: Definitions 5090ASSET VALUATION AND PERMITTED INVESTMENTS: Calculation of Value; Books and Records 5095ASSET VALUATION AND PERMITTED INVESTMENTS: Assets Other Than Securities; Bonds; Real Property; Mortgages; Compensating Balances 5100ASSET VALUATION AND PERMITTED INVESTMENTS: Investments Used to Provide Compensating Balances 5105ASSET VALUATION AND PERMITTED INVESTMENTS: Investment of Required Capitalization 5110ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Mortgage Loans 5115ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Real Property 5120ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Corporate Stocks 5125ASSET VALUATION AND PERMITTED INVESTMENTS: Loans; Security; Limitations 5130ASSET VALUATION AND PERMITTED INVESTMENTS: Investments; Certain Obligations, Property, Loans and Other Specified Items 5135ASSET VALUATION AND PERMITTED INVESTMENTS: Personal Property; Protection of Investment Property; Custom 5140ASSET VALUATION AND PERMITTED INVESTMENTS: “Prudent Investor” Standard 5145ASSET VALUATION AND PERMITTED INVESTMENTS: Prohibited Conduct by Directors, Trustees, Officers, Agents or Employees 5150ASSET VALUATION AND PERMITTED INVESTMENTS: Investment of Funds in Obligations That Are Not Investment Quality; Percentage of Assets 5155ASSET VALUATION AND PERMITTED INVESTMENTS: Approval by Board 5160ASSET VALUATION AND PERMITTED INVESTMENTS: Record of Investments 5165ASSET VALUATION AND PERMITTED INVESTMENTS: Prohibited Investments 5170CAPITALIZATION: Capital and Surplus 5175CAPITALIZATION: Impaired Capital and Surplus 5180CAPITALIZATION: Dividend and Distribution Restrictions 5185CAPITALIZATION: Restricted Reserve Account 5186CAPITALIZATION: Restricted Reserve Account—Permitted Investments in Obligations with Political Subdivisions; Public Supported Housing 5190CAPITALIZATION: Surplus Notes 5195CAPITALIZATION: Risk-based Capital (RBC) Definitions 5200CAPITALIZATION: RBC Reports 5205CAPITALIZATION: Company Action Level Event 5210CAPITALIZATION: Regulatory Action Level Event 5215CAPITALIZATION: Authorized Control Level Event 5220CAPITALIZATION: Mandatory Control Level Event 5225REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Extraordinary Dividends and Other Distributions 5230REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Reports of Material Acquisitions And Dispositions Of Assets, and Changes to Ceded Reinsurance Agreements; Assumption Reinsurance 5235REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Reports of Material Materiality and Reporting Standards for Asset Acquisitions and Dispositions 5240REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Materiality and Reporting Standards for Changes in Ceded Reinsurance Agreements 5245EXAMINATIONS: CCO Production of Books and Records 5250EXAMINATIONS: Authority Examinations of CCOs 5255CCO ACQUISITIONS AND MERGERS: Purpose; Definitions 5260CCO ACQUISITIONS AND MERGERS: Activities Prohibited Unless Certain Provisions Satisfied 5265CCO ACQUISITIONS AND MERGERS: Procedure For Acquiring Controlling Interest 5270CCO ACQUISITIONS AND MERGERS: Information to Be Included in Form A 5275CCO ACQUISITIONS AND MERGERS: Hearing, Request, Notice 5278CCO ACQUISITIONS AND MERGERS: Confidentiality 5280CCO ACQUISITIONS AND MERGERS: Determination Concerning Proposed Activity, Time For Decision, Grounds For Refusal 5283CCO ACQUISITIONS AND MERGERS: Compliance with Conditions 5285CCO HOLDING COMPANY REGULATION: Definitions 5290CCO HOLDING COMPANY REGULATION: Members of Holding Company Systems; Registration Requirements 5295CCO HOLDING COMPANY REGULATION: Form and Contents of Registration Statement 5300CCO HOLDING COMPANY REGULATION: Registration Statement Filing 5305CCO HOLDING COMPANY REGULATION: Information Required to Be Disclosed 5310CCO HOLDING COMPANY REGULATION: Presumption of Control; Rebuttal 5315CCO HOLDING COMPANY REGULATION: Disclaimer of Affiliation 5318CCO Holding Company Regulation: Group Capital Calculation 5320CCO HOLDING COMPANY REGULATION: Transactions Within Holding Company 5323CCO HOLDING COMPANY REGULATION: Transaction Types Within Holding Company for Disclosure 5325CCO HOLDING COMPANY REGULATION: Director and Officer Liability; Effect of Control of CCO Subject to Registration; Board of Directors 5330CCO HOLDING COMPANY REGULATION: Annual Enterprise Risk Report 5335CCO HOLDING COMPANY REGULATION: Disclaimers and Termination of Registration 5340CCO HOLDING COMPANY REGULATION: Forms; General Requirements 5345CCO HOLDING COMPANY REGULATION: Forms; Incorporation by Reference, Summaries, And Omissions 5350CCO HOLDING COMPANY REGULATION: Forms; Information Unknown or Unavailable and Extension of Time to Furnish 5355CCO HOLDING COMPANY REGULATION: Forms; Additional Information; Amendments 5360CCO INSOLVENCY AND DISSOLUTION: Access to Funds and Transition of Members and Records 5365CCO INSOLVENCY AND DISSOLUTION: Hazardous Operations 5370CCO INSOLVENCY AND DISSOLUTION: Recovery From Parent Corporation Or Holding Company In The Event Of Liquidation Or Rehabilitation 5375CCO INSOLVENCY AND DISSOLUTION: Voluntary Dissolution; Approval of Plan 5380Civil Penalties