OAR 461-195-0321: Assigning a Lien

(1) The Personal Injury Liens Unit may assign a lien to a CCO (see OAR 461-195-0301) or prepaid managed care health services organization (see 461-195-0301) for the amount of covered health services (as defined in Oregon Health Plan Rules, OAR Division 410-141 and the General Rules, OAR Division 410-120, or other Department (see 461-195-0301) rules establishing covered medical assistance) for a recipient (see 461-195-0301) arising from a personal injury (see 461-195-0301) during the period the Department paid a CCO or prepaid managed care health services organization to provide covered health services to a recipient. (2) A CCO or prepaid managed care health services organization, within 30 days of receiving notice that an applicant (see OAR 461-195-0301) or recipient has a claim (see 461-195-0301) or action (see 461-195-0301), must give notice to the Personal Injury Liens Unit, and provide additional information as requested by the Personal Injury Liens Unit. (3) A CCO or prepaid managed care health services organization shall not use loan receipts (see OAR 461-195-0301), trust agreements (see 461-195-0301), or similar arrangements to seek reimbursement from an applicant, recipient, or third party. (4) The assignment described in section (1) of this rule is made only if the CCO or prepaid managed care health services organization makes a request for an assignment from the Personal Injury Liens Unit, after giving the notice required in section (2) of this rule. (5) The amount of the lien that may be assigned does not include amounts excluded from a lien according to OAR 461-195-0305(3) and (4), 461-195-0320, or 461-195-0350. (6) For purposes of ORS 416.510 to 416.610, assignment of the lien establishes the CCO or prepaid managed care health services organization as a designee of the Department in relation to the lien, pursuant to ORS 416.540(5), which designation shall include the following: (a) As the Department’s designee, the CCO or prepaid managed care health services organization is subject to these rules in the pursuit of the assigned lien and any actions taken by the CCO or prepaid managed care health services organization to settle, compromise (see OAR 461-195-0301), or release the assigned lien. (b) The CCO or prepaid managed care health services organization shall copy the Personal Injury Liens Unit on all documentation related to the assigned lien, including communications with the person or public body, agency or commission against whom a claim is made or an action is brought in relation to settlement (see OAR 461-195-0301), compromise, or release of the assigned lien. This requirement may be met by listing the Personal Injury Liens Unit on the "cc" portion of the documentation or certificate of service, and sending a copy to the Personal Injury Liens Unit when the document is sent or filed. (c) The Personal Injury Liens Unit may require the use of forms and procedures related to the assignment of liens and notices and the efficient administration of these rules to minimize redundancy in communications with a recipient and the parties to a claim or action. (7) The form of notice of lien that may be assigned to a CCO or prepaid managed care health services organization shall comply with ORS 416.560, with the CCO or prepaid managed care health services organization assigned as the designee. Upon receiving assignment of a lien from the Personal Injury Liens Unit, the CCO or prepaid managed care health services organization shall perfect the lien as required by ORS 416.550. A CCO or prepaid managed care health services organization with an assigned lien shall notify the Personal Injury Liens Unit no later than 10 calendar days after filing the notice of the lien. (8) A CCO or prepaid managed care health services organization with an assigned lien shall perfect the lien and document actions taken to recover under the lien. Consequences for failure to comply with requirements for perfecting the lien and recovering under the lien are the responsibility of the CCO or prepaid managed care health services organization and shall not prevent the Personal Injury Liens Unit from recovering amounts due the Department pursuant to the lien or from the statutory assignment of right to payment from the recipient. (9) Immediately after a judgment (see OAR 461-195-0301) has been rendered in favor of a recipient or a settlement or compromise has been agreed upon, the person or public body, agency or commission bound by such judgment, settlement, or compromise shall notify the Personal Injury Liens Unit. If a CCO or prepaid managed care health services organization perfected a lien, the person or public body, agency or commission shall notify the CCO or prepaid managed care health services organization. (a) If the CCO or prepaid managed care health services organization receives such notification on an assigned lien, the CCO or prepaid managed care health services organization shall provide a copy to the Personal Injury Liens Unit within 10 calendar days of receipt. (b) After notification, the Personal Injury Liens Unit shall send a statement of the amount of the lien to the person or public body, agency or commission by certified mail with return receipt. (c) After notification, if a CCO or prepaid managed care health services organization filed a notice of lien, the CCO or prepaid managed care health services organization shall send a statement of the amount of the lien to the person or public body, agency or commission. (10) A lien assigned by the Department to a CCO or prepaid managed care health services organization is subject to release or compromise as described in OAR 461-195-0325.