Or. Admin. Code § 410-141-3540 - Member Protections

(1) In the event of a finding of MCE impairment by the Authority, or of a termination of the MCE contract, members of the MCE shall be offered disenrollment from the MCE and enrollment in accordance with the Authority's rules.

(2) For the purpose of this section only, and only in the event of a finding of MCE impairment by the Authority or of a termination of the MCE contract, any covered health care service furnished within the state by a provider to a member of the impaired or terminated MCE shall be considered to have been furnished pursuant to a contract between the provider and the MCE with whom the member was enrolled when the services were furnished.

(3) Each contract between an MCE and a provider of health services shall provide that if the MCE fails to pay for covered health services as set forth in the contract, the member is not liable to the provider for any amounts owed by the MCE.

(4) If the contract between the contracting provider and the MCE has not been reduced to writing or fails to contain the provisions required by this rule, the member is not liable to the contracting provider for any amounts owed by the MCE.

(5) No contracting provider or agent, trustee or assignee of the contracting provider shall bill a member, send a member's bill to a Collection Agency, or maintain a civil action against a member to collect any amounts owed by the MCE for which the member is not liable to the contracting provider in this rule and under 410-120-1280.

(6) Nothing in this section impairs the right of a provider to charge, collect from, and attempt to collect from or maintain a civil action against a member for any of the following:

(a) Health services not covered by the MCE, if a valid OHP Client Agreement to Pay for Health Services form OHP 3165, or facsimile, signed by the client, has been completed as described in OAR 410-120-1280; or

(b) Health services rendered after the termination of the contract between the MCE and the provider, unless the health 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. Before providing a non-covered service, the provider must complete an OHP 3165, or facsimile, as described in OAR 410-120-1280.

Notes

Or. Admin. Code § 410-141-3540

DMAP 55-2019, adopt filed 12/17/2019, effective 1/1/2020

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

Statutes/Other Implemented: ORS 414.610 - 414.685