ORS 414.595: External quality reviews of coordinated care organizations; limits on documentation and reporting requirements.
Edition: 2025 EditionEffective: 2026-01-01Last verified: 2026-09-07
(1) As used in this section: (a) “Coordinated care organization” has the meaning given that term in ORS 414.025. (b) “Subcontractor” means an entity that contracts with a coordinated care organization to provide health care, dental care, behavioral health care or other services to medical assistance recipients enrolled in the coordinated care organization. (2) The Oregon Health Authority shall conduct one external quality review of each coordinated care organization annually. The authority may contract with an external quality review organization to conduct the review. (3) The authority shall compile a standard list of documents that the authority or contracted review organization collects from coordinated care organizations and subcontractors. When requesting information from a coordinated care organization about its subcontractors, the authority or contracted review organization shall inform the coordinated care organization of the documents on the standard list that have been collected from the coordinated care organization’s subcontractors in the preceding 12-month period. (4) The authority or a contracted review organization may not request information from a coordinated care organization that is duplicative of or redundant with information previously provided by the coordinated care organization or a subcontractor if the information was provided within the preceding 12-month period and the relevant content of the information has not changed. (5) The authority shall provide a contracted review organization with all information about a coordinated care organization in the authority’s possession as necessary for the contracted review organization to conduct the external quality review. A contracted review organization may not seek information from a coordinated care organization before first requesting the information from the authority. (6) This section does not apply to documents requested, submitted or collected in connection with an audit for or an investigation of fraud, waste or abuse and does not: (a) Prohibit a coordinated care organization from requesting from a subcontractor information required by law or contract; (b) Require the authority or a contracted review organization to disclose to a coordinated care organization any information described in this section collected from a coordinated care organization or a subcontractor; or (c) Permit the authority or a contracted review organization to disclose to a coordinated care organization confidential or proprietary information reported to the authority or contracted review organization by another coordinated care organization or a subcontractor. [Formerly 414.661]
Official history and status
History: Note: 414.595 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
Administrative rules citing this section
- OAR 410-141-3505: Use of Subcontractors — implements
- OAR 410-141-3515: Network Adequacy — implements
- OAR 410-141-3525: Outcome and Quality Measures — implements
- OAR 410-141-3570: Managed Care Entity Encounter Claims Data Reporting — implements
- OAR 410-141-3575: MCE Member Relations: Marketing — implements
- OAR 410-141-3700: CCO Application and Contracting Procedures — implements
- OAR 410-141-3730: Community Health Assessment and Community Health Improvement Plans — implements
- OAR 410-141-3735: Social Determinants of Health and Equity; Health Equity — implements
- OAR 410-141-3855: Temporary rule language in effect until 10/27/2026. Pharmaceutical Services — implements
- OAR 410-141-3870: Care Coordination: Service Coordination — implements
- OAR 410-141-3900: Grievances & Appeals: Contested Case Hearings — implements
- OAR 410-141-5000: FINANCIAL SOLVENCY REGULATION: Definitions — implements
- OAR 410-141-5005: FINANCIAL SOLVENCY REGULATION: CCO Financial Solvency Requirements — implements
- OAR 410-141-5010: FINANCIAL SOLVENCY REGULATION: Procedure for General Financial Reporting and for Determining Financial Solvency Matters — implements
- OAR 410-141-5015: FINANCIAL SOLVENCY REGULATION: Financial Statement Reporting — implements
- OAR 410-141-5020: FINANCIAL SOLVENCY REGULATION: Annual Audited Financial Statements and Auditor’s Report — implements
- OAR 410-141-5025: FINANCIAL SOLVENCY REGULATION: Qualifications of Independent Certified Public Accountant — implements
- OAR 410-141-5030: FINANCIAL SOLVENCY REGULATION: Notification of Adverse Financial Condition — implements
- OAR 410-141-5035: FINANCIAL SOLVENCY REGULATION: Accountant's Letter of Qualifications — implements
- OAR 410-141-5040: FINANCIAL SOLVENCY REGULATION: Independent Certified Public Accountants Workpapers — implements
- OAR 410-141-5045: FINANCIAL SOLVENCY REGULATION: Corporate Governance Annual Disclosure Filing — implements
- OAR 410-141-5050: FINANCIAL SOLVENCY REGULATION: Requirements for Reinsurance — implements
- OAR 410-141-5055: FINANCIAL SOLVENCY REGULATION: Requirements for Obtaining Credit for Reinsurance — implements
- OAR 410-141-5060: FINANCIAL SOLVENCY REGULATION: Qualified Trust Agreements — implements
- OAR 410-141-5065: FINANCIAL SOLVENCY REGULATION: Letters of Credit; Other Security — implements
- OAR 410-141-5070: FINANCIAL SOLVENCY REGULATION: Assets, Liabilities, Reserves — implements
- OAR 410-141-5075: FINANCIAL SOLVENCY REGULATION: Disallowance of Certain Reinsurance Transactions — implements
- OAR 410-141-5080: FINANCIAL SOLVENCY REGULATION: Transparency — implements
- OAR 410-141-5085: ASSET VALUATION AND PERMITTED INVESTMENTS: Definitions — implements
- OAR 410-141-5090: ASSET VALUATION AND PERMITTED INVESTMENTS: Calculation of Value; Books and Records — implements
- OAR 410-141-5095: ASSET VALUATION AND PERMITTED INVESTMENTS: Assets Other Than Securities; Bonds; Real Property; Mortgages; Compensating Balances — implements
- OAR 410-141-5100: ASSET VALUATION AND PERMITTED INVESTMENTS: Investments Used to Provide Compensating Balances — implements
- OAR 410-141-5105: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment of Required Capitalization — implements
- OAR 410-141-5110: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Mortgage Loans — implements
- OAR 410-141-5115: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Real Property — implements
- OAR 410-141-5120: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment in Corporate Stocks — implements
- OAR 410-141-5125: ASSET VALUATION AND PERMITTED INVESTMENTS: Loans; Security; Limitations — implements
- OAR 410-141-5130: ASSET VALUATION AND PERMITTED INVESTMENTS: Investments; Certain Obligations, Property, Loans and Other Specified Items — implements
- OAR 410-141-5135: ASSET VALUATION AND PERMITTED INVESTMENTS: Personal Property; Protection of Investment Property; Custom — implements
- OAR 410-141-5140: ASSET VALUATION AND PERMITTED INVESTMENTS: “Prudent Investor” Standard — implements
- OAR 410-141-5145: ASSET VALUATION AND PERMITTED INVESTMENTS: Prohibited Conduct by Directors, Trustees, Officers, Agents or Employees — implements
- OAR 410-141-5150: ASSET VALUATION AND PERMITTED INVESTMENTS: Investment of Funds in Obligations That Are Not Investment Quality; Percentage of Assets — implements
- OAR 410-141-5155: ASSET VALUATION AND PERMITTED INVESTMENTS: Approval by Board — implements
- OAR 410-141-5160: ASSET VALUATION AND PERMITTED INVESTMENTS: Record of Investments — implements
- OAR 410-141-5165: ASSET VALUATION AND PERMITTED INVESTMENTS: Prohibited Investments — implements
- OAR 410-141-5170: CAPITALIZATION: Capital and Surplus — implements
- OAR 410-141-5175: CAPITALIZATION: Impaired Capital and Surplus — implements
- OAR 410-141-5180: CAPITALIZATION: Dividend and Distribution Restrictions — implements
- OAR 410-141-5185: CAPITALIZATION: Restricted Reserve Account — implements
- OAR 410-141-5186: CAPITALIZATION: Restricted Reserve Account—Permitted Investments in Obligations with Political Subdivisions; Public Supported Housing — implements
- OAR 410-141-5190: CAPITALIZATION: Surplus Notes — implements
- OAR 410-141-5195: CAPITALIZATION: Risk-based Capital (RBC) Definitions — implements
- OAR 410-141-5200: CAPITALIZATION: RBC Reports — implements
- OAR 410-141-5205: CAPITALIZATION: Company Action Level Event — implements
- OAR 410-141-5210: CAPITALIZATION: Regulatory Action Level Event — implements
- OAR 410-141-5215: CAPITALIZATION: Authorized Control Level Event — implements
- OAR 410-141-5220: CAPITALIZATION: Mandatory Control Level Event — implements
- OAR 410-141-5225: REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Extraordinary Dividends and Other Distributions — implements
- 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 — implements
- OAR 410-141-5235: REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Reports of Material Materiality and Reporting Standards for Asset Acquisitions and Dispositions — implements
- OAR 410-141-5240: REPORTING AND APPROVAL OF CERTAIN TRANSACTIONS: Materiality and Reporting Standards for Changes in Ceded Reinsurance Agreements — implements
- OAR 410-141-5245: EXAMINATIONS: CCO Production of Books and Records — implements
- OAR 410-141-5250: EXAMINATIONS: Authority Examinations of CCOs — implements
- OAR 410-141-5255: CCO ACQUISITIONS AND MERGERS: Purpose; Definitions — implements
- OAR 410-141-5260: CCO ACQUISITIONS AND MERGERS: Activities Prohibited Unless Certain Provisions Satisfied — implements
- OAR 410-141-5265: CCO ACQUISITIONS AND MERGERS: Procedure For Acquiring Controlling Interest — implements
- OAR 410-141-5270: CCO ACQUISITIONS AND MERGERS: Information to Be Included in Form A — implements
- OAR 410-141-5275: CCO ACQUISITIONS AND MERGERS: Hearing, Request, Notice — implements
- OAR 410-141-5278: CCO ACQUISITIONS AND MERGERS: Confidentiality — implements
- OAR 410-141-5280: CCO ACQUISITIONS AND MERGERS: Determination Concerning Proposed Activity, Time For Decision, Grounds For Refusal — implements
- OAR 410-141-5283: CCO ACQUISITIONS AND MERGERS: Compliance with Conditions — implements
- OAR 410-141-5285: CCO HOLDING COMPANY REGULATION: Definitions — implements
- OAR 410-141-5290: CCO HOLDING COMPANY REGULATION: Members of Holding Company Systems; Registration Requirements — implements
- OAR 410-141-5295: CCO HOLDING COMPANY REGULATION: Form and Contents of Registration Statement — implements
- OAR 410-141-5300: CCO HOLDING COMPANY REGULATION: Registration Statement Filing — implements
- OAR 410-141-5305: CCO HOLDING COMPANY REGULATION: Information Required to Be Disclosed — implements
- OAR 410-141-5310: CCO HOLDING COMPANY REGULATION: Presumption of Control; Rebuttal — implements
- OAR 410-141-5315: CCO HOLDING COMPANY REGULATION: Disclaimer of Affiliation — implements
- OAR 410-141-5318: CCO Holding Company Regulation: Group Capital Calculation — implements
- OAR 410-141-5320: CCO HOLDING COMPANY REGULATION: Transactions Within Holding Company — implements
- OAR 410-141-5323: CCO HOLDING COMPANY REGULATION: Transaction Types Within Holding Company for Disclosure — implements
- OAR 410-141-5325: CCO HOLDING COMPANY REGULATION: Director and Officer Liability; Effect of Control of CCO Subject to Registration; Board of Directors — implements
- OAR 410-141-5330: CCO HOLDING COMPANY REGULATION: Annual Enterprise Risk Report — implements
- OAR 410-141-5335: CCO HOLDING COMPANY REGULATION: Disclaimers and Termination of Registration — implements
- OAR 410-141-5340: CCO HOLDING COMPANY REGULATION: Forms; General Requirements — implements
- OAR 410-141-5345: CCO HOLDING COMPANY REGULATION: Forms; Incorporation by Reference, Summaries, And Omissions — implements
- OAR 410-141-5350: CCO HOLDING COMPANY REGULATION: Forms; Information Unknown or Unavailable and Extension of Time to Furnish — implements
- OAR 410-141-5355: CCO HOLDING COMPANY REGULATION: Forms; Additional Information; Amendments — implements
- OAR 410-141-5360: CCO INSOLVENCY AND DISSOLUTION: Access to Funds and Transition of Members and Records — implements
- OAR 410-141-5365: CCO INSOLVENCY AND DISSOLUTION: Hazardous Operations — implements
- OAR 410-141-5370: CCO INSOLVENCY AND DISSOLUTION: Recovery From Parent Corporation Or Holding Company In The Event Of Liquidation Or Rehabilitation — implements
- OAR 410-141-5375: CCO INSOLVENCY AND DISSOLUTION: Voluntary Dissolution; Approval of Plan — implements
- OAR 410-141-5380: CIVIL PENALTIES — implements
This rule cites
- ORS 414.025 — resolved
Cited by
No inbound citations found.
Official source: https://www.oregonlegislature.gov/bills_laws/ors/ors414.html