ORS 415.430
Liability of member of CCO to pay provider for cost of care


(1)

For the purpose of this section only, and only in the event of a finding of impairment by the Oregon Health Authority, as described in ORS 415.203 (Opportunity to cure impairment of required capitalization), or of a final order of liquidation, any covered health care service furnished within this state by a provider to a member of a coordinated care organization shall be considered to have been furnished pursuant to a contract between the provider and the coordinated care organization with whom the member was enrolled when the services were furnished.

(2)

Each contract between a coordinated care organization and a provider of health care services shall provide that if the coordinated care organization fails to pay for covered health care services as set forth in the coordinated care organization’s contract with the authority, the member is not liable to the provider for any amounts owed by the coordinated care organization.

(3)

If the contract between the contracting provider and the coordinated care organization has not been reduced to writing or fails to contain the provisions required by subsection (2) of this section, the member is not liable to the authority for any amounts owed by the coordinated care organization.

(4)

A contracting provider or agent, trustee or assignee of the contracting provider may not maintain a civil action against a member to collect any amounts owed by the coordinated care organization for which the member is not liable to the contracting provider under this section.

(5)

Nothing in this section impairs the right of a provider to charge, collect from, attempt to collect from or maintain a civil action against a member for any of the following:

(a)

Health care services not covered by the medical assistance program.

(b)

Health care services rendered after the termination of the contract between the coordinated care organization and the provider, unless the health care services were rendered during the confinement in an inpatient facility and the confinement began prior to the date of termination or unless the provider has assumed post-termination treatment obligations under the contract.

(6)

Nothing in this section prohibits a member from seeking noncovered health care services from a provider and accepting financial responsibility for these services.

(7)

A coordinated care organization may not limit the right of a provider of health care services to contract with the patient for payment of services not within the scope of coverage under the medical assistance program. [2019 c.478 §52]

Source: Section 415.430 — Liability of member of CCO to pay provider for cost of care, 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
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