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 (Definitions for ORS 415.012 to 415.430) to 415.430 (Liability of member of CCO to pay provider for cost of care) or rules adopted pursuant to ORS 415.011 (Oregon Health Authority regulation of financial solvency of CCOs to align with regulation of domestic insurers), and the record of the complaint, is confidential and may not be disclosed except as provided in ORS 413.175 (Prohibition on disclosure of information) or 414.607 (Use and disclosure of member information). 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 (Definitions for ORS 415.012 to 415.430) to 415.430 (Liability of member of CCO to pay provider for cost of care), rules adopted pursuant to ORS 415.011 (Oregon Health Authority regulation of financial solvency of CCOs to align with regulation of domestic insurers) or other law.

(2)

Data gathered pursuant to an investigation by the authority of a complaint is confidential, may not be disclosed except as provided in ORS 413.175 (Prohibition on disclosure of information) and 414.607 (Use and disclosure of member information) and may not be used in any action, suit or proceeding except to the extent the authority considers necessary in investigating or prosecuting apparent violations of ORS 415.012 (Definitions for ORS 415.012 to 415.430) to 415.430 (Liability of member of CCO to pay provider for cost of care), rules adopted pursuant to ORS 415.011 (Oregon Health Authority regulation of financial solvency of CCOs to align with regulation of domestic insurers) or other law.

(3)

Notwithstanding subsections (1) and (2) of this section, the authority shall establish by rule a method for publishing an annual statistical report containing the coordinated care organization’s name and the number, percentage, type and disposition of complaints the authority receives against each coordinated care organization that contracts with the authority. [2019 c.478 §12]

Source: Section 415.055 — Confidentiality of complaints; exceptions; publication of annual statistical report of complaints against all CCOs, https://www.­oregonlegislature.­gov/bills_laws/ors/ors415.­html.

415.001
Reinsurance program for coordinated care organizations (CCOs) 415.011
Oregon Health Authority regulation of financial solvency of CCOs to align with regulation of domestic insurers 415.012
Definitions for ORS 415.012 to 415.430 415.013
Powers and authority to enforce ORS 415.012 to 415.430 and 415.501 415.015
Prohibited conflicts of interest of officer or employee of Oregon Health Authority with responsibility for enforcement 415.019
Right to contested case hearing 415.055
Confidentiality of complaints 415.056
Confidentiality of reports regarding certain financial information 415.057
Authorized use of confidential reports regarding financial information 415.061
Definitions for 415.061 to 415.067 415.062
Compliance self-evaluative audit document privileged 415.063
Permissible use of compliance self-evaluative audit document by Oregon Health Authority 415.064
Waiver of privilege 415.065
Petition for in camera hearing on privilege of compliance self-evaluative audit document 415.066
Exceptions to privilege of compliance self-evaluative audit document 415.067
Other applicable privileges not waived by release of compliance self-evaluative audit document 415.101
Requests for information 415.103
False or misleading filings prohibited 415.105
Investigations authorized 415.107
Examinations and audits 415.109
Conduct of examination 415.111
Report of examination 415.115
Annual audits 415.119
Immunity from suit arising out of investigation, examination or provision or dissemination of information 415.203
Opportunity to cure impairment of required capitalization 415.204
Grounds for order of supervision 415.205
Period of supervision 415.251
Jurisdiction of delinquency proceedings 415.252
Exclusive remedy 415.253
Oregon Receivership Code inapplicable 415.261
Petition for delinquency proceeding 415.263
Cooperation with Oregon Health Authority in delinquency investigation or proceeding 415.265
Injunction prohibiting waste or disposition of property upon petition for delinquency proceeding 415.280
Petition for order for rehabilitation or liquidation of CCO 415.281
Court order for rehabilitation or liquidation proceeding against CCO 415.284
Appointment of special deputy directors to assist in supervision of CCO or delinquency proceedings 415.300
Rehabilitation proceeding 415.330
Grounds for order to liquidate 415.333
Powers of Oregon Health Authority in liquidation proceeding 415.335
Order to liquidate 415.340
Oregon Health Authority to be appointed receiver in delinquency proceeding 415.341
Immunity from civil liability for receivers 415.350
Right to assets of CCO fixed as of date of order to liquidate 415.400
Filing proof of claim against CCO declared by court to be insolvent 415.401
Requirements for proof of claim 415.402
Preference of claims 415.403
Priority of preferred claims 415.404
Contingent claims 415.405
Priority of special deposit claims 415.406
Priority of secured claims 415.420
Attachment or garnishment prohibited during delinquency proceeding 415.422
Voidable transfers or liens 415.424
Offsets of mutual debts or credits 415.430
Liability of member of CCO to pay provider for cost of care 415.500
Definitions 415.501
Procedures for review of material change transactions 415.505
Conflicts of interest prohibited 415.510
Quadrennial study of impact of health care consolidation 415.512
Fees 415.900
Civil penalties
Green check means up to date. Up to date

Current through early 2024

§ 415.055’s source at oregon​.gov