Or. Admin. Code § 410-141-3505 - Use of Subcontractors

(1) MCEs may delegate their activities or obligations to subcontractors except as otherwise provided by law or in the MCE contract:

(a) MCEs remain fully accountable for the performance of all subcontracted work, including that of all downstream entities contracted by MCE's subcontractor;

(b) MCEs shall monitor subcontractor performance on an ongoing basis;

(c) MCEs shall notify the Authority of subcontractor relationships. MCEs shall provide the Authority:

(A) A comprehensive list of subcontractor and downstream entities and, for each one, the activities and functions that have been delegated, to be submitted to OHA on an annual basis;

(B) Copies of all subcontracts upon request; and

(C) Adequate documentation demonstrating monitoring of subcontractor compliance or subcontractor auditing, as applicable, in accordance with the contract and with CMS requirements including 42 C.F.R §§ 438.230, 438.602(a) and 438.66.

(2) Each subcontract must include the following elements:

(a) With respect to any MCE activities or obligations defined by law or in the MCE's contract with the Authority that the MCE is delegating to a subcontractor:

(A) The subcontract must specify the delegated activities or obligations, as well as any related reporting responsibilities;

(B) The subcontractor agrees to perform the delegated activities and reporting responsibilities specified in compliance with the MCE's contract obligations; and

(C) The subcontract must either provide for revocation of the delegation or specify other remedies in instances where the Authority or the MCE determines that the subcontractor has not performed satisfactorily.

(b) The subcontractor agrees to comply with all applicable laws, regulations, sub-regulatory guidance, as well as the requirements in the MCE contract:

(A) The subcontractor agrees to comply with Section C Part 10 of Attachment I of the 2017-2022 Medicaid 1115 Waiver regarding timely Payment to IHCP Providers;

(B) Timely payments means that IHCPs must be paid the agreed upon rate within 30-90 calendar days of billing;

(C) The subcontractor agrees to perform any activities necessary to support the MCE and the Authority's obligations as specified in the MCE contract, state law, and federal law, including requirements related to:

(i) Program integrity and data submission, including the requirements in 42 CFR, Part 438, Subpart H.;

(ii) Grievances and appeals, including the requirements in 42 CFR, Part 438, Subpart F;

(iii) Exclusions, as noted in 42 CFR § 438.808; and

(iv) Linguistic and disability access for members, as outlined in 42 CFR § 438.10, as well as 42 U.S.C. § 18116 and 45 CFR Part 92.

Notes

Or. Admin. Code § 410-141-3505

DMAP 55-2019, adopt filed 12/17/2019, effective 1/1/2020; DMAP 143-2024, amend filed 12/29/2024, effective 1/1/2025

Statutory/Other Authority: ORS 413.042, 414.615, 414.625, 414.635 & 414.651

Statutes/Other Implemented: ORS 414.610 - 414.685