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, 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] REGULATION OF MATERIAL CHANGE TRANSACTIONS INVOLVING HEALTH CARE ENTITIES