ORS 414.593
Reporting and public disclosure of expenditures by coordinated care organizations


(1)

As used in this section:

(a)

“Coordinated care organization” has the meaning given that term in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414).

(b)

“Medical assistance” has the meaning given that term in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414).

(c)

“Related party” means an entity that:

(A)

Provides administrative services or financing to a coordinated care organization directly or through one or more unrelated parties; and

(B)

Is associated with the coordinated care organization by any form of affiliation, control or investment.

(d)

“Risk accepting entity” means an entity that:

(A)

Enters into an arrangement or agreement with a coordinated care organization to provide health services to members of the coordinated care organization;

(B)

Assumes the financial risk of providing health services to medical assistance recipients; and

(C)

Is compensated on a prepaid capitated basis for providing health services to members of a coordinated care organization.

(e)

“Risk adjusted rate of growth” means the percentage change in a coordinated care organization’s health care expenditures from one year to the next year, taking into account the variability in the relative health status of the members of the coordinated care organization from one year to the next year.

(2)

It is the intent of the Legislative Assembly that the expenditures of a coordinated care organization serving medical assistance recipients be fully transparent and available to the public.

(3)

The Oregon Health Authority shall make readily available to the public on an easily accessible website, and shall annually report to the Legislative Assembly, the following information for the preceding calendar year regarding each coordinated care organization contracting with the authority:

(a)

All financial distributions by the coordinated care organization to shareholders, equity members, parent companies or any related parties.

(b)

The annual audited financial statements of the coordinated care organization filed with the authority under ORS 415.115 (Annual audits).

(c)

The annual risk adjusted rate of growth for the coordinated care organization.

(d)

Every report submitted by the coordinated care organization to the authority as required in the coordinated care organization’s contract with the authority, except for reports containing information protected from disclosure by state or federal law or protected from disclosure as a trade secret, as defined in ORS 192.345 (Public records conditionally exempt from disclosure), including compensation paid to providers by a coordinated care organization.

(4)

The information described in subsection (3) of this section must be provided for each calendar year beginning with 2020.

(5)

The authority shall post the information described in subsection (3) of this section no later than August 1 of the year following the year for which the information is reported.

(6)

The Oregon Health Authority shall report all information described in subsections (1) to (5) of this section that is made available to the public in a manner that is uniform and sufficiently detailed to ensure accurate comparisons of the data between coordinated care organizations. [2019 c.478 §§54,54a]
Note: 414.593 (Reporting and public disclosure of expenditures by coordinated care organizations) was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
Note: Section 3, chapter 489, Oregon Laws 2017, provides:
Sec. 3. (1) As used in this section, “primary care” has the meaning given that term in section 2, chapter 575, Oregon Laws 2015.

(2)

A coordinated care organization that spends on primary care less than 12 percent of its total expenditures on physical and mental health care, as required by ORS 414.625 (1)(c) [renumbered 414.572 (Coordinated care organizations) (1)(c)], shall submit to the Oregon Health Authority a plan to increase spending on primary care as a percentage of its total expenditures by at least one percent each year. [2017 c.489 §3]
Note: Section 5 (2), chapter 575, Oregon Laws 2015, provides:
Sec. 5. (2) Section 3 of this 2017 Act is repealed on December 31, 2027. [2015 c.575 §5; 2016 c.26 §8; 2017 c.489 §19(2)]

Source: Section 414.593 — Reporting and public disclosure of expenditures by coordinated care organizations, https://www.­oregonlegislature.­gov/bills_laws/ors/ors414.­html.

414.018
Legislative intent
414.025
Definitions for ORS chapters 411, 413 and 414
414.033
Expenditures for medical assistance authorized
414.034
Acceptance of federal billing, reimbursement and reporting forms
414.041
Simplified application process
414.044
Notice to Department of Veterans’ Affairs of information regarding applications for health care coverage by uniformed service members and veterans
414.065
Determination of health care and services covered
414.066
Billing patient for services covered by medical assistance prohibited
414.067
Coordinated care organization assumption of costs
414.071
Timely payment for dental services
414.072
Prior authorization data and reports
414.075
Payment of deductibles imposed under federal law
414.095
Exemptions applicable to payments
414.109
Oregon Health Plan Fund
414.115
Medical assistance by insurance or service contracts
414.117
Premium assistance for health insurance coverage
414.125
Rates on insurance or service contracts
414.135
Contracts relating to direct providers of care and services
414.145
Implementation of ORS 414.115, 414.125 or 414.135
414.150
Purpose of ORS 414.150 to 414.153
414.152
Duty of state agencies to work with local health departments
414.153
Services provided by local health departments
414.211
Medicaid Advisory Committee
414.221
Duties of committee
414.225
Oregon Health Authority to consult with committee
414.227
Application of public meetings law to advisory committees
414.231
Eligibility for Cover All People program
414.312
Oregon Prescription Drug Program
414.314
Application and participation in Oregon Prescription Drug Program
414.318
Prescription Drug Purchasing Fund
414.320
Rules
414.325
Prescription drugs
414.326
Supplemental rebates from pharmaceutical manufacturers
414.327
Electronically transmitted prescriptions
414.328
Synchronization of prescription drug refills
414.329
Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage
414.330
Legislative findings on prescription drugs
414.332
Policy for Practitioner-Managed Prescription Drug Plan
414.334
Practitioner-Managed Prescription Drug Plan for medical assistance program
414.337
Limitation on rules regarding Practitioner-Managed Prescription Drug Plan
414.351
Definitions for ORS 414.351 to 414.414
414.353
Committee established
414.354
Meetings
414.356
Executive session
414.359
Mental Health Clinical Advisory Group
414.361
Committee to advise and make recommendations on drug utilization review standards and interventions
414.364
Intervention approaches
414.369
Prospective drug use review program
414.371
Retrospective drug use review program
414.372
Pharmacy lock-in program
414.381
Annual reports
414.382
Requirements for annual report
414.414
Use and disclosure of confidential information
414.426
Payment of cost of medical care for institutionalized persons
414.428
Coverage for American Indian and Alaska Native beneficiaries
414.430
Access to dental care for pregnant women
414.432
Reproductive health services for noncitizens
414.500
Findings regarding medical assistance for persons with hemophilia
414.510
Definitions
414.520
Hemophilia services
414.530
When payments not made for hemophilia services
414.532
Definitions for ORS 414.534 to 414.538
414.534
Treatment for breast or cervical cancer
414.536
Presumptive eligibility for medical assistance for treatment of breast or cervical cancer
414.538
Prohibition on coverage limitations
414.540
Rules
414.550
Definitions for ORS 414.550 to 414.565
414.555
Findings regarding medical assistance for persons with cystic fibrosis
414.560
Cystic fibrosis services
414.565
When payments not made for cystic fibrosis services
414.570
System established
414.572
Coordinated care organizations
414.575
Community advisory councils
414.577
Community health assessment and adoption of community health improvement plan
414.578
Community health improvement plan
414.581
Tribal Advisory Council established
414.584
Meetings of coordinated care organization governing body to be open to public
414.590
Coordinated care organization contracts
414.591
Coordinated care organization contracts
414.592
Requirements for contracts between authority and providers
414.593
Reporting and public disclosure of expenditures by coordinated care organizations
414.595
External quality reviews of coordinated care organizations
414.598
Alternative payment methodologies
414.605
Consumer and provider protections
414.607
Use and disclosure of member information
414.609
Network adequacy
414.611
Transfer of 500 or more members of coordinated care organization
414.613
Discrimination based on scope of practice prohibited
414.619
Coordination between Oregon Health Authority and Department of Human Services
414.628
Innovator agents
414.631
Mandatory enrollment in coordinated care organization
414.632
Services to individuals who are dually eligible for Medicare and Medicaid
414.638
Metrics and scoring subcommittee
414.654
Persons served by prepaid managed care health services organizations
414.655
Utilization of patient centered primary care homes and behavioral health homes by coordinated care organizations
414.665
Traditional health workers utilized by coordinated care organizations
414.667
Definition for ORS 414.667 to 414.669
414.668
Access to doula services
414.669
Payment for doula services
414.672
Tribal-based practices for mental health and substance abuse prevention, counseling and treatment
414.686
Health assessments for foster children
414.688
Commission established
414.689
Members
414.690
Prioritized list of health services
414.694
Commission review of covered reproductive health services
414.695
Medical technology assessment
414.698
Comparative effectiveness of medical technologies
414.701
Commission may not rely solely on comparative effectiveness research
414.704
Advisory committee
414.706
Persons eligible for medical assistance
414.709
Adjustment of population of eligible persons in event of insufficient resources prohibited
414.710
Services not subject to prioritized list
414.712
Health services for certain eligible persons
414.717
Palliative care program
414.719
Housing navigation services and social determinants of health
414.723
Telemedicine services
414.726
Requirement to use certified or qualified health care interpreters
414.728
Reimbursement of rural hospitals on fee-for-service basis
414.735
Reduction in scope of health services in event of insufficient resources
414.742
Payment for mental health drugs
414.743
Payment to noncontracting hospital by coordinated care organization
414.745
Liability of health care providers and plans
414.755
Payment for hospital services
414.756
Payments to Oregon Health and Science University
414.760
Payment for patient centered primary care home and behavioral health home services
414.762
Payment for child abuse assessment
414.764
Payment for services provided by pharmacy or pharmacist
414.766
Behavioral health treatment
414.767
Survey of medical assistance recipients regarding experience with behavioral health care and services
414.770
Participants in clinical trials
414.772
Limits on use of step therapy
414.780
Coordinated care organization reporting of data to assess compliance with mental health parity requirements
414.781
Fee-for-service reimbursement of co-occurring mental health and substance use disorder treatment services
414.782
Reimbursement to ensure access to addiction treatment statewide
414.805
Liability of individual for medical services received while in custody of law enforcement officer
414.807
Oregon Health Authority to pay for medical services related to law enforcement activity
414.815
Law Enforcement Medical Liability Account
414.853
Definitions
414.855
Hospital assessment
414.857
Reduction in rate required by federal law
414.863
Refund of hospital assessment
414.865
Audits
414.867
Deposit of assessments collected to Hospital Quality Assurance Fund
414.869
Establishment of Hospital Quality Assurance Fund
414.871
Applicability of hospital assessment
414.880
Managed care organization assessment
414.882
Refund of managed care organization assessment
414.884
Applicability of managed care organization assessment
414.900
Hospital assessment
414.902
Managed care organization assessment
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