1. (1) MCEs may delegate their activities or obligations to subcontractors except as otherwise provided by law or in the MCE contract:

   1. (a) MCEs remain fully accountable for the performance of all subcontracted work, including that of all downstream entities contracted by MCE’s subcontractor;
   2. (b) MCEs shall monitor subcontractor performance on an ongoing basis;

   3. (c) MCEs shall notify the Authority of subcontractor relationships. MCEs shall provide the Authority:

      1. (A) A comprehensive list of subcontractor and downstream entities and, for each one, the activities and functions that have been delegated, to be submitted to OHA on an annual basis;
      2. (B) Copies of all subcontracts upon request; and
      3. (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.

2. (2) Each subcontract must include the following elements:

   1. (a) With respect to any MCE activities or obligations defined by law or in the MCE’s contract with the Authority that the MCE is delegating to a subcontractor:

      1. (A) The subcontract must specify the delegated activities or obligations, as well as any related reporting responsibilities;
      2. (B) The subcontractor agrees to perform the delegated activities and reporting responsibilities specified in compliance with the MCE’s contract obligations; and
      3. (C) The subcontract must either provide for revocation of the delegation or specify other remedies in instances where the Authority or the MCE determines that the subcontractor has not performed satisfactorily.

   2. (b) The subcontractor agrees to comply with all applicable state and federal statutes, rules, regulations, executive orders and sub-regulatory guidance, as well as any and all other applicable requirements in the MCE contract:

      1. (A) The subcontractor agrees to comply with Section C Part 10 of Attachment D of the 2022-2027 Medicaid 1115 Waiver regarding timely Payment to IHCP Providers;
      2. (B) Timely payments means that IHCPs must be paid the agreed upon rate within 30-90 calendar days of billing;

   3. (c) The subcontractor agrees to perform any activities necessary to support the MCE and the Authority’s obligations as specified in the MCE contract, state and federal statutes, rules, regulations, and sub-regulatory guidance.

      1. (A) This includes, but is not limited to, requirements related to:

         1. (i) Program integrity and data submission, including the requirements in 42 CFR, Part 438, Subpart H;
         2. (ii) Grievances and appeals, including the requirements in 42 CFR, Part 438, Subpart F;
         3. (iii) Exclusions, as noted in 42 CFR § 438.808; and
         4. (iv) Linguistic and disability access for members, as outlined in 42 CFR § 438.10, as well as 42 U.S.C. § 18116 and 45 CFR Part 92.
      2. (B) Any other activities that may be required under state and federal statutes, rules, regulations, and sub-regulatory guidance.

3. (3) In addition to all of the requirements set out in section (2) above of this rule, an MCE subcontract with a dental subcontractor must also include the following terms and conditions:

   1. (a) Clearly define the activities the MCE is delegating to the dental subcontractor, including activities related to the provision of Covered Services and to the dental subcontractor’s fitness to enter into a subcontract under state and federal law and rule;
   2. (b) Require a dental subcontractor to provide any and all reports, documents, or other information, or any combination thereof, that the MCE is required to provide under its contract with OHA, under this OAR chapter 410,  and as may be additionally required under state and federal statutes, rules, regulations, executive orders and sub-regulatory guidance; and
   3. (c) Dental subcontractor must agree to the delegated activities, related requirements and the associated compensation through a signed agreement before MCE can include dental subcontractor on its list of subcontractors to be submitted to OHA.

Statutory/Other Authority

ORS 413.042, 414.572, 414.591 & 414.605

Statutes/Other Implemented

ORS 414.570 - 414.686

History

DMAP 94-2025, amend filed 12/22/2025, effective 01/01/2026
DMAP 143-2024, amend filed 12/29/2024, effective 01/01/2025
DMAP 55-2019, adopt filed 12/17/2019, effective 01/01/2020