Or. Admin. Code § 410-141-5015 - FINANCIAL SOLVENCY REGULATION: Financial Statement Reporting
(1) Financial
reports to the Authority. A CCO shall submit the following to the Authority:
(a) On or before April 30 of each year, an
unaudited financial statement for the 12-month period ending the 31st day of
December immediately preceding;
(b)
Unaudited quarterly financial statements each year according to the following
schedule:
(A) On or before May 31 for the
quarter ending the 31st day of March immediately preceding;
(B) On or before August 31 for the quarter
ending the 30th day of June immediately preceding;
(C) On or before November 30 of each year for
the quarter ending the 30th day of September immediately preceding.
(c) On or before June 30 of each
year, an audited financial statement for the year ending the 31st of December
immediately preceding.
(2) Except as otherwise allowed or required
by the Authority, all annual and quarterly financial statements filed by a CCO
with the Authority shall:
(a) Follow and be
presented in accordance with Statutory Accounting Principles;
(b) Use a form established by the NAIC,
including the instructions, and must complete the form according to the
instructions:
(A) For the 2024 reporting year,
on the annual statement approved for the 2024 reporting year by the NAIC,
according to the applicable instructions published for that year by the
NAIC;
(B) For the 2025 reporting
year, on the annual statement approved for the 2025 reporting year by the NAIC,
according to the applicable instructions published for that year by the
NAIC;
(C) For the 2026 reporting
year, on the annual statement approved for the 2026 reporting year by the NAIC,
according to the applicable instructions published for that year by the
NAIC;
(D) For the 2027 reporting
year, on the annual statement approved for the 2027 reporting year by the NAIC,
according to the applicable instructions published for that year by the
NAIC.
(c) Be verified by
the oaths of the president and secretary of the CCO or, in their absence, by
two other duly authorized and acting principal officers; and
(d) Include the additional information listed
in sections (4), (5) and (6) of this rule.
(3) Audited annual financial statements shall
be subject to, and shall comply with, the requirements set forth in OAR
410-141-5020 through OAR
410-141-5040. Additional
instructions for the filing of financial statements and reports are posted on
the Authority's website at
https://www.oregon.gov/oha/hsd/ohp/pages/cco-contract-forms.aspx.
(4) A CCO shall include the following as
supplements to the CCO's quarterly and annual financial statement filings,
using forms and templates prescribed by the Authority:
(a) An Annual Disclosure of Compensation
Exhibit, disclosing the salary and benefits of the three officers or employees
having the highest total compensation for the period. This exhibit shall be
required only with the CCO's annual Exhibit L filing;
(b) A report of Health-Related Services (as
defined by OAR 410-141-3500 and
410-141-3845) and additional
supplemental information, including care coordination, case management,
flexible services, and community benefit expenses. CCOs shall comply with the
following additional requirements regarding Health-Related Services:
(A) Health-Related Services shall be
considered in the rate setting consistent with the State 1115 Waiver;
(B) Health-Related Services shall be included
as Activities that Improve Health Care Quality in the Minimum Medical Loss
Ratio Rebate Calculation report.
(c) A certification of compliance with
financial and encounter data reporting requirements;
(d) A report of third-party resources
collections (CCO contractor);
(e) A
report of Corporate Relationships of Contractors and Incentive Plan Disclosure
and Detail (CCOs);
(f) CCO-specific
utilization reports;
(g) Any other
supplemental information deemed necessary by the Authority and specified in
Exhibit L to the CCO Contract.
(5) A CCO shall report the following
information in respect of the CCO's Restricted Reserve, using forms and
templates prescribed by the Authority:
(a)
Identification of custodians, account balances and assets comprising Restricted
Reserve Funds held by a third-party;
(b) A bank statement from each custodian of
Restricted Reserve Funds of the account balance or aggregate fair market value
of the assets comprising the Restricted Reserve Funds held by the
custodian;
(c) Documentation of the
liability that would be owed to creditors in the event of the CCO's
insolvency;
(d) Documentation of
the dollar amount of that liability that is covered by any identified
risk-adjustment mechanisms.
(6) A CCO shall report the following
information in respect of any Sub-Capitation Arrangements to which the CCO is a
party, using forms and templates prescribed by the Authority:
(a) A CCO that sub-capitates any work
described in its agreements with the Authority shall require the Sub-Capitated
Counterparty to report financial information as specified in the CCO's
agreements with the Authority;
(b)
CCOs that make sub-capitation payments exceeding an annual amount defined by
financial reporting instructions under the CCO Contract shall submit to the
Authority on an annual basis the following financial reports with respect to
each of the CCO's Sub-Capitated Counterparties:
(A) Statements of revenue, expenses and net
income;
(B) Restricted Reserve
Account documentation;
(C)
Certification of compliance with financial and encounter data reporting
requirements;
(D) Any supplemental
information deemed necessary by the Authority.
(7) Following termination of the CCO
Contract, the annual reports described in this rule are due for the last
calendar year during which the CCO operated, and its quarterly reports are due
until its last annual report has been filed.
(8) The CCO shall make such additional
filings with the Authority as are required by the CCO's agreement with the
Authority and as otherwise may be determined by the Authority from time to time
to be necessary under the circumstances.
Notes
Statutory/Other Authority: ORS 413.042, ORS 414.572, 414.591 & 414.605
Statutes/Other Implemented: ORS 414.570-414.686 & ORS 415.001-415.430
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