Oregon Statutes 414.593 – Reporting and public disclosure of expenditures by coordinated care organizations
(1) As used in this section:
Terms Used In Oregon Statutes 414.593
- Contract: A legal written agreement that becomes binding when signed.
- Coordinated care organization: means an organization meeting criteria adopted by the Oregon Health Authority under ORS § 414. See Oregon Statutes 414.025
- Health services: means at least so much of each of the following as are funded by the Legislative Assembly based upon the prioritized list of health services compiled by the Health Evidence Review Commission under ORS § 414. See Oregon Statutes 414.025
- Medical assistance: includes any care or services for any individual who is a patient in a medical institution or any care or services for any individual who has attained 65 years of age or is under 22 years of age, and who is a patient in a private or public institution for mental diseases. See Oregon Statutes 414.025
(a) ‘Coordinated care organization’ has the meaning given that term in ORS § 414.025.
(b) ‘Medical assistance’ has the meaning given that term in ORS § 414.025.
(c) ‘Related party’ means an entity that:
(A) Provides administrative services or financing to a coordinated care organization directly or through one or more unrelated parties; and
(B) Is associated with the coordinated care organization by any form of affiliation, control or investment.
(d) ‘Risk accepting entity’ means an entity that:
(A) Enters into an arrangement or agreement with a coordinated care organization to provide health services to members of the coordinated care organization;
(B) Assumes the financial risk of providing health services to medical assistance recipients; and
(C) Is compensated on a prepaid capitated basis for providing health services to members of a coordinated care organization.
(e) ‘Risk adjusted rate of growth’ means the percentage change in a coordinated care organization’s health care expenditures from one year to the next year, taking into account the variability in the relative health status of the members of the coordinated care organization from one year to the next year.
(2) It is the intent of the Legislative Assembly that the expenditures of a coordinated care organization serving medical assistance recipients be fully transparent and available to the public.
(3) The Oregon Health Authority shall make readily available to the public on an easily accessible website, and shall annually report to the Legislative Assembly, the following information for the preceding calendar year regarding each coordinated care organization contracting with the authority:
(a) All financial distributions by the coordinated care organization to shareholders, equity members, parent companies or any related parties.
(b) The annual audited financial statements of the coordinated care organization filed with the authority under ORS § 415.115.
(c) The annual risk adjusted rate of growth for the coordinated care organization.
(d) Every report submitted by the coordinated care organization to the authority as required in the coordinated care organization’s contract with the authority, except for reports containing information protected from disclosure by state or federal law or protected from disclosure as a trade secret, as defined in ORS § 192.345, including compensation paid to providers by a coordinated care organization.
(4) The information described in subsection (3) of this section must be provided for each calendar year beginning with 2020.
(5) The authority shall post the information described in subsection (3) of this section no later than August 1 of the year following the year for which the information is reported.
(6) The Oregon Health Authority shall report all information described in subsections (1) to (5) of this section that is made available to the public in a manner that is uniform and sufficiently detailed to ensure accurate comparisons of the data between coordinated care organizations. [2019 c.478 54,54a]
414.593 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.
Section 3, chapter 489, Oregon Laws 2017, provides:
(1) As used in this section, ‘primary care’ has the meaning given that term in section 2, chapter 575, Oregon Laws 2015.
(2) A coordinated care organization that spends on primary care less than 12 percent of its total expenditures on physical and mental health care, as required by ORS § 414.625 (1)(c) [renumbered 414.572 (1)(c)], shall submit to the Oregon Health Authority a plan to increase spending on primary care as a percentage of its total expenditures by at least one percent each year. [2017 c.489 § 3]
Section 5 (2), chapter 575, Oregon Laws 2015, provides:
(2) Section 3, chapter 489, Oregon Laws 2017, is repealed on December 31, 2027. [2015 c.575 § 5; 2016 c.26 § 8; 2017 c.489 § 19(2); 2022 c.37 § 15(2)]