OAR 410-141: Oregon Health Plan

160 rules in Division 141, Chapter 410 (Oregon Health Authority, Health Systems Division: Medical Assistance Programs).

  1. OAR 410-141-3500: Definitions
  2. OAR 410-141-3501: Administration of Oregon Integrated and Coordinated Health Care Delivery System Regulation; Rule Precedence
  3. OAR 410-141-3505: Use of Subcontractors
  4. OAR 410-141-3510: Provider Contracting and Credentialing
  5. OAR 410-141-3515: Network Adequacy
  6. OAR 410-141-3520: Record Keeping and Use of Health Information Technology
  7. OAR 410-141-3525: Outcome and Quality Measures
  8. OAR 410-141-3530: Sanctions
  9. OAR 410-141-3531: Sanctions for Failure to Comply with State or Federal Information Security or Privacy Laws
  10. OAR 410-141-3540: Member Protections
  11. OAR 410-141-3545: Temporary rule language in effect until 12/25/2026. CCO Behavioral Health Provider, Treatment and Facility Certification and Licensure
  12. OAR 410-141-3550: Resolving Disputes between MCEs and the Authority
  13. OAR 410-141-3555: Resolving Disputes between Health Care Entities and CCOs that Concern CCO Contact Award
  14. OAR 410-141-3560: Resolving Contract Disputes Between Health Care Entities and CCOs
  15. OAR 410-141-3565: Managed Care Entity Billing
  16. OAR 410-141-3570: Managed Care Entity Encounter Claims Data Reporting
  17. OAR 410-141-3575: MCE Member Relations: Marketing
  18. OAR 410-141-3580: MCE Member Relations: Potential Member Information
  19. OAR 410-141-3585: CCO Member Relations: Education and Information
  20. OAR 410-141-3590: MCE Member Relations: Member Rights and Responsibilities
  21. OAR 410-141-3591: MCE Interoperability Requirements
  22. OAR 410-141-3600: MCE Assessment: Definitions
  23. OAR 410-141-3601: MCE Assessment: General Administration
  24. OAR 410-141-3605: MCE Assessment: Disclosure of Information
  25. OAR 410-141-3610: MCE Assessment: Calculation, Report, Due Date, Verification
  26. OAR 410-141-3615: MCE Assessment: Filing an Amended Report
  27. OAR 410-141-3620: MCE Assessment: Determining the Date Filed
  28. OAR 410-141-3625: MCE Assessment: Authority to Audit Records
  29. OAR 410-141-3630: MCE Assessment: Determining Assessment Liability on Failure to File
  30. OAR 410-141-3635: MCE Assessment: Financial Penalty for Failure to File a Report or Failure to Pay Assessment When Due
  31. OAR 410-141-3640: MCE Assessment: Notice of Proposed Action
  32. OAR 410-141-3645: MCE Assessment: Hearing Process
  33. OAR 410-141-3650: MCE Assessment: Final Order of Payment
  34. OAR 410-141-3655: Assessment: Remedies Available after Final Order of Payment
  35. OAR 410-141-3700: CCO Application and Contracting Procedures
  36. OAR 410-141-3705: Criteria for CCOs
  37. OAR 410-141-3710: Contract Termination and Close-Out Requirements
  38. OAR 410-141-3715: CCO Governance; Public Meetings and Transparency
  39. OAR 410-141-3720: Service Area Change for Existing CCOs
  40. OAR 410-141-3725: CCO Contract Renewal Notification
  41. OAR 410-141-3730: Community Health Assessment and Community Health Improvement Plans
  42. OAR 410-141-3735: Social Determinants of Health and Equity; Health Equity
  43. OAR 410-141-3740: Traditional Health Workers
  44. OAR 410-141-3800: CCO Enrollment for Children Receiving Health Services
  45. OAR 410-141-3805: Mandatory MCE Enrollment Exceptions
  46. OAR 410-141-3810: Disenrollment from MCEs
  47. OAR 410-141-3815: CCO Enrollment for Temporary Out-of-Area Behavioral Health Treatment Services
  48. OAR 410-141-3820: Covered Services
  49. OAR 410-141-3825: Excluded Services and Limitations
  50. OAR 410-141-3826: Responsibility for Particular Covered Services Based on Plan Type
  51. OAR 410-141-3830: Prioritized List of Health Services
  52. OAR 410-141-3835: CCO Service Authorization
  53. OAR 410-141-3840: Emergency and Urgent Care Services
  54. OAR 410-141-3845: Flexible Services
  55. OAR 410-141-3846: Palliative Care Program.
  56. OAR 410-141-3850: Transition of Care
  57. OAR 410-141-3855: Temporary rule language in effect until 10/27/2026. Pharmaceutical Services
  58. OAR 410-141-3860: Care Coordination: Administration, Systems and Infrastructure
  59. OAR 410-141-3865: Care Coordination: Identification of Member Needs
  60. OAR 410-141-3870: Care Coordination: Service Coordination
  61. OAR 410-141-3875: MCE Grievances & Appeals: Definitions and General Requirements
  62. OAR 410-141-3880: Grievances & Appeals: Grievance Process Requirements
  63. OAR 410-141-3885: Grievances & Appeals: Notice of Action/Adverse Benefit Determination
  64. OAR 410-141-3890: Grievances & Appeals: Appeal Process
  65. OAR 410-141-3895: Grievances & Appeals: Expedited Appeal
  66. OAR 410-141-3900: Grievances & Appeals: Contested Case Hearings
  67. OAR 410-141-3905: Grievances & Appeals: Expedited Contested Case Hearings
  68. OAR 410-141-3910: Grievances & Appeals: Continuation of Benefits
  69. OAR 410-141-3915: Grievances & Appeals: System Recordkeeping
  70. OAR 410-141-3920: Transportation: NEMT General Requirements
  71. OAR 410-141-3925: Transportation: Vehicle Equipment and Driver Standards
  72. OAR 410-141-3930: Transportation: Out-of-Service Area and Out-of-State Transportation
  73. OAR 410-141-3935: Transportation: Attendants for Child and Special Needs Transports
  74. OAR 410-141-3940: Transportation: Secured Transports
  75. OAR 410-141-3945: Transportation: Ground and Air Ambulance Transports
  76. OAR 410-141-3955: Transportation: Member Service Modifications and Rights
  77. OAR 410-141-3960: Transportation: Member Reimbursed Mileage, Meals, and Lodging
  78. OAR 410-141-3965: Reports and Documentation
  79. OAR 410-141-5000: FINANCIAL SOLVENCY REGULATION: Definitions
  80. OAR 410-141-5005: FINANCIAL SOLVENCY REGULATION: CCO Financial Solvency Requirements
  81. OAR 410-141-5010: FINANCIAL SOLVENCY REGULATION: Procedure for General Financial Reporting and for Determining Financial Solvency Matters
  82. OAR 410-141-5015: FINANCIAL SOLVENCY REGULATION: Financial Statement Reporting
  83. OAR 410-141-5020: FINANCIAL SOLVENCY REGULATION: Annual Audited Financial Statements and Auditor’s Report
  84. OAR 410-141-5025: FINANCIAL SOLVENCY REGULATION: Qualifications of Independent Certified Public Accountant
  85. OAR 410-141-5030: FINANCIAL SOLVENCY REGULATION: Notification of Adverse Financial Condition
  86. OAR 410-141-5035: FINANCIAL SOLVENCY REGULATION: Accountant's Letter of Qualifications
  87. OAR 410-141-5040: FINANCIAL SOLVENCY REGULATION: Independent Certified Public Accountants Workpapers
  88. OAR 410-141-5045: FINANCIAL SOLVENCY REGULATION: Corporate Governance Annual Disclosure Filing
  89. OAR 410-141-5050: FINANCIAL SOLVENCY REGULATION: Requirements for Reinsurance
  90. OAR 410-141-5055: FINANCIAL SOLVENCY REGULATION: Requirements for Obtaining Credit for Reinsurance
  91. OAR 410-141-5060: FINANCIAL SOLVENCY REGULATION: Qualified Trust Agreements
  92. OAR 410-141-5065: FINANCIAL SOLVENCY REGULATION: Letters of Credit; Other Security
  93. OAR 410-141-5070: FINANCIAL SOLVENCY REGULATION: Assets, Liabilities, Reserves
  94. OAR 410-141-5075: FINANCIAL SOLVENCY REGULATION: Disallowance of Certain Reinsurance Transactions
  95. OAR 410-141-5080: FINANCIAL SOLVENCY REGULATION: Transparency
  96. OAR 410-141-5085: ASSET VALUATION AND PERMITTED INVESTMENTS: Definitions
  97. OAR 410-141-5090: ASSET VALUATION AND PERMITTED INVESTMENTS: Calculation of Value; Books and Records
  98. OAR 410-141-5095: ASSET VALUATION AND PERMITTED INVESTMENTS: Assets Other Than Securities; Bonds; Real Property; Mortgages; Compensating Balances
  99. OAR 410-141-5100: ASSET VALUATION AND PERMITTED INVESTMENTS: Investments Used to Provide Compensating Balances
  100. OAR 410-141-5105: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment of Required Capitalization
  101. OAR 410-141-5110: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Mortgage Loans
  102. OAR 410-141-5115: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Real Property
  103. OAR 410-141-5120: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Corporate Stocks
  104. OAR 410-141-5125: ASSET VALUATION AND PERMITTED INVESTMENTS: Loans; Security; Limitations
  105. OAR 410-141-5130: ASSET VALUATION AND PERMITTED INVESTMENTS: Investments; Certain Obligations, Property, Loans and Other Specified Items
  106. OAR 410-141-5135: ASSET VALUATION AND PERMITTED INVESTMENTS: Personal Property; Protection of Investment Property; Custom
  107. OAR 410-141-5140: ASSET VALUATION AND PERMITTED INVESTMENTS: “Prudent Investor” Standard
  108. OAR 410-141-5145: ASSET VALUATION AND PERMITTED INVESTMENTS: Prohibited Conduct by Directors, Trustees, Officers, Agents or Employees
  109. OAR 410-141-5150: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment of Funds in Obligations That Are Not Investment Quality; Percentage of Assets
  110. OAR 410-141-5155: ASSET VALUATION AND PERMITTED INVESTMENTS: Approval by Board
  111. OAR 410-141-5160: ASSET VALUATION AND PERMITTED INVESTMENTS: Record of Investments
  112. OAR 410-141-5165: ASSET VALUATION AND PERMITTED INVESTMENTS: Prohibited Investments
  113. OAR 410-141-5170: CAPITALIZATION: Capital and Surplus
  114. OAR 410-141-5175: CAPITALIZATION: Impaired Capital and Surplus
  115. OAR 410-141-5180: CAPITALIZATION: Dividend and Distribution Restrictions
  116. OAR 410-141-5185: CAPITALIZATION: Restricted Reserve Account
  117. OAR 410-141-5186: CAPITALIZATION: Restricted Reserve Account—Permitted Investments in Obligations with Political Subdivisions; Public Supported Housing
  118. OAR 410-141-5190: CAPITALIZATION: Surplus Notes
  119. OAR 410-141-5195: CAPITALIZATION: Risk-based Capital (RBC) Definitions
  120. OAR 410-141-5200: CAPITALIZATION: RBC Reports
  121. OAR 410-141-5205: CAPITALIZATION: Company Action Level Event
  122. OAR 410-141-5210: CAPITALIZATION: Regulatory Action Level Event
  123. OAR 410-141-5215: CAPITALIZATION: Authorized Control Level Event
  124. OAR 410-141-5220: CAPITALIZATION: Mandatory Control Level Event
  125. OAR 410-141-5225: REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Extraordinary Dividends and Other Distributions
  126. OAR 410-141-5230: REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Reports of Material Acquisitions And Dispositions Of Assets, and Changes to Ceded Reinsurance Agreements; Assumption Reinsurance
  127. OAR 410-141-5235: REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Reports of Material Materiality and Reporting Standards for Asset Acquisitions and Dispositions
  128. OAR 410-141-5240: REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Materiality and Reporting Standards for Changes in Ceded Reinsurance Agreements
  129. OAR 410-141-5245: EXAMINATIONS: CCO Production of Books and Records
  130. OAR 410-141-5250: EXAMINATIONS: Authority Examinations of CCOs
  131. OAR 410-141-5255: CCO ACQUISITIONS AND MERGERS: Purpose; Definitions
  132. OAR 410-141-5260: CCO ACQUISITIONS AND MERGERS: Activities Prohibited Unless Certain Provisions Satisfied
  133. OAR 410-141-5265: CCO ACQUISITIONS AND MERGERS: Procedure For Acquiring Controlling Interest
  134. OAR 410-141-5270: CCO ACQUISITIONS AND MERGERS: Information to Be Included in Form A
  135. OAR 410-141-5275: CCO ACQUISITIONS AND MERGERS: Hearing, Request, Notice
  136. OAR 410-141-5278: CCO ACQUISITIONS AND MERGERS: Confidentiality
  137. OAR 410-141-5280: CCO ACQUISITIONS AND MERGERS: Determination Concerning Proposed Activity, Time For Decision, Grounds For Refusal
  138. OAR 410-141-5283: CCO ACQUISITIONS AND MERGERS: Compliance with Conditions
  139. OAR 410-141-5285: CCO HOLDING COMPANY REGULATION: Definitions
  140. OAR 410-141-5290: CCO HOLDING COMPANY REGULATION: Members of Holding Company Systems; Registration Requirements
  141. OAR 410-141-5295: CCO HOLDING COMPANY REGULATION: Form and Contents of Registration Statement
  142. OAR 410-141-5300: CCO HOLDING COMPANY REGULATION: Registration Statement Filing
  143. OAR 410-141-5305: CCO HOLDING COMPANY REGULATION: Information Required to Be Disclosed
  144. OAR 410-141-5310: CCO HOLDING COMPANY REGULATION: Presumption of Control; Rebuttal
  145. OAR 410-141-5315: CCO HOLDING COMPANY REGULATION: Disclaimer of Affiliation
  146. OAR 410-141-5318: CCO Holding Company Regulation: Group Capital Calculation
  147. OAR 410-141-5320: CCO HOLDING COMPANY REGULATION: Transactions Within Holding Company
  148. OAR 410-141-5323: CCO HOLDING COMPANY REGULATION: Transaction Types Within Holding Company for Disclosure
  149. OAR 410-141-5325: CCO HOLDING COMPANY REGULATION: Director and Officer Liability; Effect of Control of CCO Subject to Registration; Board of Directors
  150. OAR 410-141-5330: CCO HOLDING COMPANY REGULATION: Annual Enterprise Risk Report
  151. OAR 410-141-5335: CCO HOLDING COMPANY REGULATION: Disclaimers and Termination of Registration
  152. OAR 410-141-5340: CCO HOLDING COMPANY REGULATION: Forms; General Requirements
  153. OAR 410-141-5345: CCO HOLDING COMPANY REGULATION: Forms; Incorporation by Reference, Summaries, And Omissions
  154. OAR 410-141-5350: CCO HOLDING COMPANY REGULATION: Forms; Information Unknown or Unavailable and Extension of Time to Furnish
  155. OAR 410-141-5355: CCO HOLDING COMPANY REGULATION: Forms; Additional Information; Amendments
  156. OAR 410-141-5360: CCO INSOLVENCY AND DISSOLUTION: Access to Funds and Transition of Members and Records
  157. OAR 410-141-5365: CCO INSOLVENCY AND DISSOLUTION: Hazardous Operations
  158. OAR 410-141-5370: CCO INSOLVENCY AND DISSOLUTION: Recovery From Parent Corporation Or Holding Company In The Event Of Liquidation Or Rehabilitation
  159. OAR 410-141-5375: CCO INSOLVENCY AND DISSOLUTION: Voluntary Dissolution; Approval of Plan
  160. OAR 410-141-5380: CIVIL PENALTIES