Chapter 415 — Chapter 415

ORS 415.001 Reinsurance program for coordinated care organizations (CCOs). (1) As used in this section

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ORS 415.010 [Amended by 1957 c.388 §1; repealed by 1985 c.511 §1]

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ORS 415.011 Oregon Health Authority regulation of financial solvency of CCOs to align with regulation of domestic insurers; rules. (1) The Oregon Health Authority may adopt rules to carry out the provisions of ORS 415.012 to 415.430

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ORS 415.012 Definitions for ORS 415.012 to 415.430. As used in ORS 415.012 to 415.430

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ORS 415.013 Powers and authority to enforce ORS 415.012 to 415.430 and 415.501. (1) The Oregon Health Authority shall enforce the provisions of ORS 415.012 to 415.430 and 415.501 and rules adopted pursuant to ORS 415.011, 415.012 to 415.430 and 415.501 for the public good

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ORS 415.015 Prohibited conflicts of interest of officer or employee of Oregon Health Authority with responsibility for enforcement. (1) An officer or employee of the Oregon Health Authority who is delegated responsibilities in the enforcement of ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011 may not

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ORS 415.019 Right to contested case hearing. (1) The Oregon Health Authority shall hold a contested case hearing upon written request for a hearing by a person aggrieved by any act, threatened act or failure of the authority to act under ORS 415.012 to 415.430 or 415.501 or rules adopted pursuant to ORS 415.011, 415.012 to 415.430 or 415.501

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ORS 415.020 [Repealed by 1957 c.388 §17]

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ORS 415.030 [Amended by 1983 c.179 §1; repealed by 1985 c.511 §1]

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ORS 415.040 [Amended by 1983 c.179 §2; repealed by 1985 c.511 §1]

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ORS 415.050 [Repealed by 1983 c.179 §3]

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ORS 415.055 Confidentiality of complaints; exceptions; publication of annual statistical report of complaints against all CCOs. (1) A complaint made to the Oregon Health Authority against a coordinated care organization for a violation of ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011, and the record of the complaint, is confidential and may not be disclosed except as provided in ORS 413.175 or 414.607. The complaint, and the record of the complaint, may not be used in any action, suit or proceeding except to the extent the authority considers necessary in prosecuting apparent violations of ORS 415.012 to 415.430, rules adopted pursuant to ORS 415.011 or other law

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ORS 415.056 Confidentiality of reports regarding certain financial information. (1) The Oregon Health Authority may disclose or use a report as considered necessary by the authority in the administration of ORS 415.012 to 415.430, rules adopted pursuant to ORS 415.011 or other law

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ORS 415.057 Authorized use of confidential reports regarding financial information. (1) The Oregon Health Authority may use reports and financial plans of action that are made confidential under ORS 415.056 only for the purpose of monitoring the solvency of coordinated care organizations and the need for possible corrective action with respect to coordinated care organizations

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ORS 415.060 [Amended by 1957 c.388 §2; 1969 c.597 §59; repealed by 1985 c.511 §1]

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ORS 415.061 Definitions for 415.061 to 415.067. As used in ORS 415.061 to 415.067

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ORS 415.062 Compliance self-evaluative audit document privileged; auditor not subject to examination in administrative or judicial proceeding. Except as provided in ORS 415.061 to 415.067

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ORS 415.063 Permissible use of compliance self-evaluative audit document by Oregon Health Authority; consideration of document in determining of civil penalty. (1) ORS 415.062 does not prohibit the Oregon Health Authority from acquiring any compliance self-evaluative audit document or examining any person in connection with the document. If the authority determines that the actions of a coordinated care organization are egregious, the authority may introduce and use the document in any administrative proceeding or civil action under ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011

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ORS 415.064 Waiver of privilege; permitted disclosures. (1) The privilege set forth in ORS 415.062 does not apply to the extent that the privilege is expressly waived by the coordinated care organization that prepared or caused to be prepared the compliance self-evaluative audit document

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ORS 415.065 Petition for in camera hearing on privilege of compliance self-evaluative audit document; hearing on petition; compelled disclosure. (1) Within 30 days after a district attorney or the Attorney General serves on a coordinated care organization a written request by certified mail for disclosure of a compliance self-evaluative audit document, the coordinated care organization that prepared or caused the document to be prepared may file in circuit court a petition requesting an in camera hearing on whether the compliance self-evaluative audit document or portions of the document are privileged under ORS 415.062 or subject to disclosure. Failure by the coordinated care organization to file a petition waives the privilege only with respect to the specific request

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ORS 415.066 Exceptions to privilege of compliance self-evaluative audit document. The privilege established under ORS 415.062 does not apply to any of the following

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ORS 415.067 Other applicable privileges not waived by release of compliance self-evaluative audit document. Nothing in ORS 415.061 to 415.067, or in the release of any compliance self-evaluative audit document under ORS 415.061 to 415.067, shall limit, waive or abrogate the scope or nature of any statutory or common law privilege or other limitation on admissibility of evidence including, but not limited to, the work product doctrine, the lawyer-client privilege under ORS 40.225 or the subsequent remedial measures exclusion provided by ORS 40.185. [2019 c.478 §22]

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ORS 415.070 [Repealed by 1957 c.388 §3 (415.090 enacted in lieu of 415.070)]

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ORS 415.080 [Repealed by 1957 c.388 §17]

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ORS 415.090 [1957 c.388 §4 (enacted in lieu of 415.070); repealed by 1985 c.511 §1]

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ORS 415.101 Requests for information. The Oregon Health Authority may request information from any coordinated care organization or its officers in relation to the activities or condition of the coordinated care organization or any other matter connected with a coordinated care organization’s transactions, and the person of whom the information is requested shall promptly and truthfully reply using the form of communication requested by the authority and verified by an officer of the coordinated care organization, if the authority so requires. A response is subject to the provisions of ORS 415.103. [2019 c.478 §6]

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ORS 415.103 False or misleading filings prohibited. A person may not file or cause to be filed with the Oregon Health Authority any article, certificate, report, statement, application or other information required or permitted to be filed under ORS 415.012 to 415.430 or 415.501 or rules adopted pursuant to ORS 415.011, 415.012 to 415.430 or 415.501 that is known by the person to be false or misleading in any material respect. [2019 c.478 §5; 2021 c.615 §13]

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ORS 415.105 Investigations authorized. The Oregon Health Authority, whenever the authority deems it advisable in the interest of members of a coordinated care organization or for the public good, shall investigate into the affairs of

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ORS 415.107 Examinations and audits. The Oregon Health Authority shall examine every coordinated care organization, including an audit of the financial affairs of the coordinated care organization, as often as the authority determines an examination to be necessary but at least once every five years. An examination shall be conducted for the purpose of determining the financial condition of the coordinated care organization, its ability to fulfill its obligations and its manner of fulfillment, the nature of its operations and its compliance with ORS 415.012 to 415.430 or rules adopted pursuant to ORS 415.011. The authority may also examine any person holding the capital stock, membership or other ownership or controlling interest in a coordinated care organization for the purpose of controlling the management of the coordinated care organization as a voting trustee or otherwise. [2019 c.478 §7]

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ORS 415.109 Conduct of examination; access to records; civil penalty. (1) When the Oregon Health Authority determines that an examination should be conducted, the authority shall appoint one or more examiners to perform the examination and instruct them as to the scope of the examination. The authority may prescribe the examiner handbook and employ other guidelines and procedures that the authority determines to be appropriate

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ORS 415.110 [Amended by 1957 c.388 §16; repealed by 1985 c.511 §1]

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ORS 415.111 Report of examination; opportunity to respond. (1) Not later than the 60th day after an examination is completed, the examiner in charge of the examination shall submit to the Oregon Health Authority a full and true report of the examination, verified by the oath of the examiner. The report shall comprise only facts appearing upon the books, papers, records, accounts, documents or computers and other recordings of the coordinated care organization, its agents or other persons being examined or facts ascertained from testimony of individuals concerning the affairs of the coordinated care organization, together with such conclusions and recommendations as reasonably may be warranted from the facts

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ORS 415.115 Annual audits; rules. (1) A coordinated care organization shall have an annual audit conducted by an independent certified public accountant and shall file an audited financial report annually with the Oregon Health Authority by June 30 following the end of the period to which the report applies. The annual audited financial report shall disclose

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ORS 415.119 Immunity from suit arising out of investigation, examination or provision or dissemination of information; attorney fees to prevailing party authorized. (1) Except in the case of malfeasance in office or willful or wanton neglect of duty, a cause of action does not arise and liability may not be imposed against the Oregon Health Authority, an authorized representative of the authority or any examiner appointed by the authority for

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ORS 415.120 [Repealed by 1985 c.511 §1]

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ORS 415.203 Opportunity to cure impairment of required capitalization. (1) Whenever the Oregon Health Authority determines from any showing or statement made to the authority from any examination made by the authority that the assets of a coordinated care organization are less than its liabilities plus required capitalization, the authority may

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ORS 415.204 Grounds for order of supervision; right to hearing to contest order. (1) For any reason stated in subsection (2) of this section, the Oregon Health Authority may order a coordinated care organization to be placed under supervision

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ORS 415.205 Period of supervision; cause of action for violation of order of supervision. (1) A coordinated care organization placed under supervision must correct, eliminate or remedy the acts, transactions or practices that are the basis for the order of supervision and otherwise comply with the requirements of the Oregon Health Authority within the period of time allowed by the authority, not to exceed 60 days, after the date on which the order is served on the coordinated care organization

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ORS 415.251 Jurisdiction of delinquency proceedings. (1) The circuit court shall have original jurisdiction of delinquency proceedings, and any court with jurisdiction is authorized to make all necessary or proper orders to carry out the purposes of ORS 415.203 to 415.430

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ORS 415.252 Exclusive remedy. (1) Delinquency proceedings constitute the sole and exclusive method of rehabilitating, liquidating or conserving a coordinated care organization, and a court may not entertain a petition for the commencement of such proceedings, or any other similar procedure, unless the Oregon Health Authority has filed such a petition in the name of the state

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ORS 415.253 Oregon Receivership Code inapplicable. Notwithstanding ORS 37.040, the Oregon Receivership Code does not apply to delinquency proceedings under ORS 415.203 to 415.430. [2019 c.478 §48]

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ORS 415.261 Petition for delinquency proceeding. (1) The Oregon Health Authority shall commence a delinquency proceeding by an application to the court for an order directing the coordinated care organization to show cause why the authority should not have the relief prayed for

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ORS 415.263 Cooperation with Oregon Health Authority in delinquency investigation or proceeding. (1) An officer, manager, member of the governing board, trustee, owner, employee or agent of a coordinated care organization, and any other person with authority over or in charge of any portion of the coordinated care organization’s affairs, including any person who exercises control directly or indirectly over the activities of the coordinated care organization through a holding company or other affiliate of the coordinated care organization, shall cooperate with the Oregon Health Authority in any delinquency proceeding or any investigation preliminary to the proceeding. For purposes of this section, cooperation with the authority includes at least the following

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ORS 415.265 Injunction prohibiting waste or disposition of property upon petition for delinquency proceeding. (1) Upon application by the Oregon Health Authority for an order to show cause under ORS 415.261, or at any time thereafter, the court may, without notice, issue an injunction restraining a coordinated care organization, its officers, members of its governing board, agents, employees and all other persons from the transaction of its business or the waste or disposition of its property until the further order of the court

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ORS 415.280 Petition for order for rehabilitation or liquidation of CCO. (1) The Oregon Health Authority may petition the circuit court for an order

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ORS 415.281 Court order for rehabilitation or liquidation proceeding against CCO. (1) Upon petition by the Oregon Health Authority under ORS 415.280, the court may issue the requested order immediately, ex parte and without hearing. The court in its order shall specify the duration of the order. The duration of an order shall be a period sufficient to enable the authority to ascertain the condition of the coordinated care organization

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ORS 415.284 Appointment of special deputy directors to assist in supervision of CCO or delinquency proceedings. The Oregon Health Authority, in connection with supervising a coordinated care organization or conducting a delinquency proceeding, may appoint one or more special deputy directors to act for the authority and may employ counsel, clerks and assistants as the authority deems necessary. Unless otherwise provided by the authority, a person so appointed is not a state employee solely by reason of the appointment. The compensation of the special deputies, counsel, clerks or assistants and all expenses of supervising the coordinated care organization or taking possession of a delinquent coordinated care organization and conducting delinquency proceedings must be paid out of the funds or assets of the coordinated care organization. A special deputy acting within limits the authority imposes with respect to supervising a coordinated care organization or conducting delinquency proceedings has a receiver’s powers and is subject to a receiver’s duties. [2019 c.478 §37]

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ORS 415.300 Rehabilitation proceeding. (1) An order to rehabilitate a coordinated care organization shall direct the Oregon Health Authority to take possession of the property of the coordinated care organization and to conduct the business of the coordinated care organization, and to take such steps toward removing the causes and conditions that made rehabilitation necessary as directed by the court

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ORS 415.330 Grounds for order to liquidate. The Oregon Health Authority may apply for an order directing the authority to liquidate the business of a coordinated care organization, regardless of whether there has been a prior order directing the authority to rehabilitate the coordinated care organization, upon any of the grounds specified in ORS 415.280, or if the coordinated care organization

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ORS 415.333 Powers of Oregon Health Authority in liquidation proceeding. The Oregon Health Authority, after taking possession of the property and business of any coordinated care organization, shall

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