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.(2)
The authority may place a coordinated care organization under supervision if upon examination or at any other time the authority determines that:(a)
The condition of the coordinated care organization renders the continuance of its business hazardous to the public or to its members.(b)
The coordinated care organization has refused to permit examination of its books, papers, accounts, records or affairs by the authority or any deputy, examiner or employee representing the authority.(c)
A coordinated care organization has unlawfully removed from this state books, papers, accounts or records necessary for an examination of the coordinated care organization.(d)
The coordinated care organization has failed to comply promptly with the applicable financial reporting statutes or rules and any request of the authority relating to financial reporting.(e)
The coordinated care organization has failed to observe an order of the authority to make good, within the time prescribed by law, any prohibited deficiency in its restricted reserves, capital, capital stock or surplus.(f)
The coordinated care organization is continuing to conduct business after its contract has been revoked or suspended by the authority.(g)
The coordinated care organization, by contract or otherwise, has done any of the following unlawfully, in violation of an order of the authority or without first having obtained written approval of the authority:(A)
Totally reinsured its entire outstanding business; or(B)
Merged or consolidated substantially its entire property or business with another entity.(h)
The coordinated care organization has engaged in any transaction in which it is not authorized to engage under the laws of the state.(i)
The coordinated care organization has failed to comply with any other order of the authority.(j)
The coordinated care organization has failed to comply with any other applicable provisions 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).(k)
The business of the coordinated care organization is being conducted fraudulently.(L)
The coordinated care organization agrees to supervision.(3)
If the authority determines that one or more conditions set forth in subsection (2) of this section exist, the authority may do all of the following:(a)
Notify the coordinated care organization of the determination of the authority.(b)
Furnish to the coordinated care organization a written list of the requirements to abate the condition or conditions determined to exist.(c)
Notify the coordinated care organization that it is under the supervision of the authority and that the authority is applying this section and ORS 415.205 (Period of supervision).(4)
The authority may act as the supervisor to conduct the supervision and otherwise carry out an order under subsection (1) of this section or may appoint another person as supervisor.(5)
The authority or the appointed supervisor may prohibit any person from taking any of the following actions during the period of supervision without the prior approval of the authority or supervisor:(a)
Disposing of, conveying or encumbering any of the coordinated care organization’s assets or its business in force.(b)
Withdrawing from any of the coordinated care organization’s bank accounts.(c)
Lending any of the coordinated care organization’s funds.(d)
Investing any of the coordinated care organization’s funds.(e)
Transferring any of the coordinated care organization’s property.(f)
Incurring any debt, obligation or liability on behalf of the coordinated care organization.(g)
Merging or consolidating the coordinated care organization with another coordinated care organization or other person.(h)
Entering into any new reinsurance contract or treaty.(i)
Making any material change in management.(j)
Increasing salaries and benefits of officers or directors.(k)
Making or increasing preferential payment of bonuses, dividends or other payments determined by the authority to be preferential.(L)
Any other action affecting the business or condition of the coordinated care organization.(6)
The authority may apply to any circuit court for any restraining order, preliminary and permanent injunctions and other orders necessary to enforce a supervision order.(7)
During the period of supervision, the coordinated care organization may file a written request for a hearing to review the supervision or any action taken or proposed to be taken. A request under this subsection does not suspend the supervision. The coordinated care organization must specify in the request the manner in which the action being complained of would not result in improving the condition of the coordinated care organization. The hearing shall be held within 30 days after the filing of the request. The authority shall complete the review of the supervision or other action and shall take action under subsection (8) of this section if appropriate within 30 days after the record for the hearing is closed.(8)
The authority shall release a coordinated care organization from supervision if the authority determines upon hearing that none of the conditions giving rise to the supervision exist. [2019 c.478 §24]
Source:
Section 415.204 — Grounds for order of supervision; right to hearing to contest order, https://www.oregonlegislature.gov/bills_laws/ors/ors415.html.
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