Title 34, Human Services; Juvenile Code; Corrections

(1) As used in this section: (a) “Attachment point” means the threshold dollar amount, adopted by the Oregon Health Authority by rule, for costs incurred by a coordinated care organization in a calendar year for a member, after which threshold the costs are eligible for state rei…

(1) The Oregon Health Authority may adopt rules to carry out the provisions of ORS 415.012 to 415.430. (2) The authority shall adopt rules for regulating the financial solvency of coordinated care organizations that align with the following provisions of the Insurance Code regula…

As used in ORS 415.012 to 415.430: (1) “Coordinated care organization” has the meaning given that term in ORS 414.025. (2) “Medical assistance program” means the Oregon Integrated and Coordinated Health Care Delivery System established in ORS 414.570. [2019 c.478 §1]

(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. (2) The authority has the powers and authority expressly conferred by or reasonably im…

(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: (a) Be a director, officer or employee of or be financially interested in any coordinated car…

(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 …

(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.…

(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. (2) A report filed with the authority according to requirements established b…

(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 car…

As used in ORS 415.061 to 415.067: (1) “Compliance audit” means a voluntary internal evaluation, review, assessment, audit or investigation that is undertaken to identify or prevent noncompliance with, or promote compliance with, laws, regulations, orders or professional standard…

Except as provided in ORS 415.061 to 415.067: (1) A compliance self-evaluative audit document is privileged information and is not discoverable or admissible as evidence in any civil, criminal or administrative proceeding. (2) Any person who performs or directs the performance of…

(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 a…

(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. (2) The privilege set forth in ORS 415.062 doe…

(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…

The privilege established under ORS 415.062 does not apply to any of the following: (1) Documents, communications, data, reports or other information expressly required to be collected, developed, maintained or reported to the Oregon Health Authority or other regulatory agency un…

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 includi…

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 pe…

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…

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: (1) A coordinated care organization; (2) A person proposing to form a coordinated ca…

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 …

(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…

(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…

(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 …

(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 fo…

(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: (a)…

(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. (2) The authority may place a coordinated care organization under supervision if upon examination or at any other tim…

(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 a…

(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. (2) The venue of delinquency proceedings and proceedings un…

(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 …

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]

(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. (2) The application shall be by petition, verifie…

(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 co…

(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, emplo…

(1) The Oregon Health Authority may petition the circuit court for an order: (a) Directing the authority to rehabilitate a coordinated care organization on one or more of the following grounds: (A) The coordinated care organization is impaired. (B) The coordinated care organizati…

(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 t…

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 neces…

(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 t…

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 g…

The Oregon Health Authority, after taking possession of the property and business of any coordinated care organization, shall: (1) Subject to a court’s direction, immediately conduct the business of the coordinated care organization or take steps authorized by law to rehabilitate…

(1) An order to liquidate the business of a coordinated care organization shall direct the Oregon Health Authority to: (a) Take possession of the property of the coordinated care organization; (b) Liquidate the business of the coordinated care organization; (c) Deal with the coor…

(1) Whenever a receiver is to be appointed in delinquency proceedings for a coordinated care organization, the court shall appoint the Oregon Health Authority as the receiver. The court shall direct the receiver to take possession of the property of the coordinated care organizat…

(1) The following persons are entitled to protection under this section: (a) All receivers responsible for the conduct of a delinquency proceeding under ORS 415.203 to 415.430, including present and former receivers. (b) All employees of the receiver described in paragraph (a) of…

The rights and liabilities of the coordinated care organization, its creditors and all other persons interested in its assets shall, unless otherwise directed by the court, be fixed as of the date on which an order directing the liquidation of the coordinated care organization is…

(1) A court may make an order declaring a coordinated care organization insolvent at the time it grants an order of liquidation or at any time during the liquidation proceedings. When the order is issued, the Oregon Health Authority shall provide notice, in the manner determined …

(1) All claims against a coordinated care organization against which delinquency proceedings have been begun shall: (a) Set forth in reasonable detail: (A) The amount of the claim or the basis upon which the amount can be ascertained; (B) The facts upon which the claim is based; …

Except as provided in ORS 415.406 for secured claims, the claims to be paid in full in delinquency proceedings against a coordinated care organization prior to the payment of any other claims, and the order of payment, shall be: (1) The expenses of administering the delinquency p…

All claims that are preferred under the laws of the state, whether owing to residents or nonresidents, shall be given equal priority of payment from the general assets of a coordinated care organization in a delinquency proceeding against the coordinated care organization regardl…

(1) A contingent claim against a coordinated care organization shall be filed, presented and reported in the same manner and within the same time limitations as provided in ORS 415.400 for a noncontingent claim. Contingent claims shall be allowed to share in a distribution of ass…

The owners of special deposit claims against a coordinated care organization for which a receiver is appointed shall be given priority against their several special deposits in accordance with the provisions of the statutes governing the creation and maintenance of the deposits. …

The owner of a secured claim against a coordinated care organization for which a receiver has been appointed may surrender the security and file a claim as a general creditor, or the claim may be discharged by resort to the security, in which case the deficiency, if any, shall be…