OAR 410-141-3715: CCO Governance; Public Meetings and Transparency

(1) CCOs shall establish, maintain, and operate with a governance structure and community advisory council (CAC) that is consistent with the requirements of ORS 414.625 and applicable health system transformation laws. (2) Consumer Representative means a person serving on a CAC who is currently or was within the previous six months a recipient of medical assistance and is at least 16 years of age, or a parent, guardian, or primary caregiver of an individual who is or was within the previous six months a recipient of medical assistance. (3) Each CCO’s governing body must include: (a) At least one member representing persons that share in the financial risk of the organization; (b) A representative of a dental subcontractor selected by the coordinated care organization; (c) The major components of the health care delivery system; (d) At least two health care providers in active practice, including: (A) A physician licensed under ORS chapter 677 or a nurse practitioner certified under ORS 678.375, whose area of practice is primary care; and (B) A mental health or chemical dependency treatment provider. (e) At least two members from the community at large, to ensure that the organization's decision-making is consistent with the values of the members and the community; and (f) At least two members of the CAC: (A) At least one of the CAC representatives on the CCO’s governing body must be a current CAC Consumer Representative; (B) CAC members of the governing body shall have full voting rights. (4) For purposes of the open meetings requirement in Section 2 of Enrolled 2018 HB 4018, 2018 Oregon Laws Chapter 49, “substantive decision” means a decision made by the governing board of a coordinated care organization (CCO) that relates to: (a) Spending of public funds; (b) The financial risk of the CCO; (c) Provider network development and capacity; or (d) The community advisory council, community health assessment, or community health improvement plan. (5) Substantive decision does not require or include: (a) Disclosure of trade secrets as defined in ORS 192.345; (b) Confidential communications with a lawyer that are privileged under ORS 40.225; (c) Information of a personal nature as described in ORS 192.355; (d) Protected health information as defined in ORS 192.556; (e) Names of Oregon Health Plan consumer members of a community advisory council who request to remain anonymous; (f) Confidential human resource matters; or (g) Provider credentialing, sanctioning, or termination. (6) The term “substantive decision” excludes immaterial technical decisions.