OAR 410-120-1390
Premium Sponsorships


(1)

Premium donations made for the benefit of one or more specified the Division of Medical Assistance Programs (Division) clients will be referred to as a Premium Sponsorship and the donor shall be referred to as a sponsor.

(2)

The Authority may accept Premium Sponsorships consistent with the requirements of this rule. The Authority may adopt such forms and reporting requirements, and change the forms and reporting requirements, as necessary to carry out its functions under this rule. The Authority may identify one or more designees to perform one or more of the functions of Authority under this rule.

(3)

This rule does not create or establish any Premium Sponsorship program. The Authority does not operate or administer a Premium Sponsorship program. The Authority does not find sponsors for clients or take requests or applications from clients to be sponsored.

(4)

This rule does not create a right for any Division client to be sponsored. Premium Sponsorship is based solely on the decisions of sponsors. The Authority only applies the Premium Sponsorship funds that are accepted by the Authority as instructed by the sponsor. The Authority does not determine who may be sponsored. Any operations of a Premium Sponsorship program are solely the responsibility of the sponsoring entity.

(5)

A Premium Sponsorship amount that is not actually received by the Division client will not be deemed to be cash or other resource attributed to the Division client, except to the extent otherwise required by federal law. A Division client’s own payment of his or her obligation, or payment made by an authorized representative of the Division client, is not a sponsorship except to the extent that the authorized representative is otherwise subject to subsection (8) of this rule.

(6)

Nothing in this rule alters the Division client’s personal responsibility for assuring that his or her own payments (including current or past due premium payments) are made on time as required under any Authority rule

(7)

If the Authority accepts a Premium Sponsorship payment for the benefit of a specified client, the Authority or its designee will credit the amount of the sponsorship payment toward any outstanding amount owed by the specified client. The Authority or its designee is not responsible for notifying the client that a Premium Sponsorship payment is made or that a sponsorship payment has stopped being made.

(8)

If a sponsor is a health care Provider, or an entity related to a health care Provider, or an organization making a donation on behalf of such Provider or entity, the following requirements apply:

(a)

The Authority will decline to accept Premium Sponsorships that are not “bona fide donations” within the meaning of 42 CFR 433.54. A Premium Sponsorship is a “bona fide donation” if the sponsorship has no direct or indirect relationship to Medicaid payments made to a health care Provider, a related entity providing health care items or services, or other Providers furnishing the same class of items or services as the Provider or entity;

(b)

For purposes of this rule, terms “health care Provider,” “entity related to a health care Provider” and “Provider-related donation” will have the same meaning as those terms are defined in 42 CFR 433.52. A health care Provider includes but is not limited to any Provider enrolled with Division or contracting with a Prepaid Health Plan for services to Oregon Health Plan clients.

(c)

Premium Sponsorships made to the Authority by a health care Provider or an entity related to a health care Provider do not qualify as a “bona fide donation” within the meaning of subsection (a) of this section, and the Authority will decline to accept such sponsorships;

(d)

If a health care Provider or an entity related to a health care Provider donates money to an organization, which in turn donates money in the form of a Premium Sponsorship to the Authority, the organization will be referred to as an organizational sponsor. The Authority may accept Premium Sponsorship from an organizational sponsor if the organizational sponsor has completed the initial Authority certification process and complies with this rule. An organizational sponsor may not itself be a health care Provider, Provider-related entity, or a unit of local government;

(e)

All organizational sponsors that make Premium Sponsorships to the Authority may be required to complete at least annual certifications, but no more frequently than quarterly. Reports submitted to the Authority will include information about the percentage of its revenues that are from donations by Providers and Provider-related entities. The organization’s chief executive officer or chief financial officer must certify the report. In its certification, the organizational sponsor must agree that its records may be reviewed to confirm the accuracy, completeness and full disclosure of the donations, donation amounts and sources of donations. The Authority will decline to accept donations or gifts from an organization that refuses or fails to execute necessary certifications or to provide access to documentation upon request;

(f)

The Authority will decline to accept Premium Sponsorships from an organizational sponsor if the organization receives more than 25 percent of its revenue from donations from Providers or Provider-related entities during the State’s fiscal year;

(g)

Any health care Provider or entity related to a health care Provider making a donation to an organizational sponsor, or causing another to make a Premium Sponsorship on its behalf, and any organizational sponsor, is solely responsible for compliance with laws and regulations applicable to any donation, including but not limited to 42 CFR 1001.951 and 1001.952.

Source: Rule 410-120-1390 — Premium Sponsorships, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-120-1390.

410–120–0000
Acronyms and Definitions
410–120–0003
OHP Standard Benefit Package
410–120–0006
Medical Eligibility Standards
410–120–0011
Effect of COVID-19 Emergency Authorities on Administrative Rules
410–120–0025
Administration of Division of Medical Assistance Programs, Regulation and Rule Precedence
410–120–0030
Children’s Health Insurance Program
410–120–0035
Public Entity
410–120–0045
Applications for Medical Assistance at Provider locations
410–120–0250
Managed Care Entity
410–120–1140
Verification of Eligibility and Coverage
410–120–1160
Medical Assistance Benefits and Provider Rules
410–120–1180
Medical Assistance Benefits: Out-of-State Services
410–120–1190
Medically Needy Benefit Program
410–120–1195
SB 5548 Population
410–120–1200
Excluded Services and Limitations
410–120–1210
Medical Assistance Benefit Packages and Delivery System
410–120–1260
Provider Enrollment
410–120–1280
Billing
410–120–1285
Recoupment and Data Sharing with Third-Party Insurers
410–120–1295
Non-Participating Provider
410–120–1300
Timely Submission of Claims
410–120–1320
Authorization of Payment
410–120–1340
Payment
410–120–1350
Buying-Up
410–120–1360
Requirements for Financial, Clinical and Other Records
410–120–1380
Compliance with Federal and State Statutes
410–120–1385
Compliance with Public Meetings Law
410–120–1390
Premium Sponsorships
410–120–1395
Program Integrity
410–120–1396
Provider and Contractor Audits
410–120–1397
Recovery of Overpayments to Providers — Recoupments and Refunds
410–120–1400
Provider Sanctions
410–120–1460
Type and Conditions of Sanction
410–120–1510
Fraud and Abuse
410–120–1560
Provider Appeals
410–120–1570
Claim Re-Determinations
410–120–1580
Provider Appeals — Administrative Review
410–120–1600
Provider Appeals — Contested Case Hearings
410–120–1855
Client’s Rights and Responsibilities
410–120–1860
Contested Case Hearing Procedures
410–120–1865
Denial, Reduction, or Termination of Services
410–120–1870
Client Premium Payments
410–120–1875
Agency Hearing Representatives
410–120–1880
Contracted Services
410–120–1920
Institutional Reimbursement Changes
410–120–1940
Interest Payments on Overdue Claims
410–120–1960
Payment of Private Insurance Premiums
410–120–1980
Requests for Information and Public Records
410–120–1990
Telehealth
Last Updated

Jun. 8, 2021

Rule 410-120-1390’s source at or​.us