Or. Admin. Code § 461-195-0321 - Assigning a Lien
(1) The
Personal Injury Liens Unit may assign a lien to a CCO (see OAR
461-195-0301) or prepaid managed
care health services organization (see
461-195-0301) for the amount of
covered health services (as defined in Oregon Health Plan Rules, OAR Division
410-141 and the General Rules, OAR Division 410-120, or other Department (see
461-195-0301) rules establishing
covered medical assistance ) for a recipient (see
461-195-0301) arising from a
personal injury (see 461-195-0301) during the period
the Department paid a CCO or prepaid managed care health services organization
to provide covered health services to a recipient .
(2) A CCO or prepaid managed care health
services organization , within 30 days of receiving notice that an applicant
(see OAR 461-195-0301) or recipient has a
claim (see 461-195-0301) or action (see
461-195-0301), must give notice
to the Personal Injury Liens Unit, and provide additional information as
requested by the Personal Injury Liens Unit.
(3) A CCO or prepaid managed care health
services organization shall not use loan receipts (see OAR
461-195-0301), trust agreements
(see 461-195-0301), or similar
arrangements to seek reimbursement from an applicant, recipient , or third
party.
(4) The assignment
described in section (1) of this rule is made only if the CCO or prepaid
managed care health services organization makes a request for an assignment
from the Personal Injury Liens Unit, after giving the notice required in
section (2) of this rule.
(5) The
amount of the lien that may be assigned does not include amounts excluded from
a lien according to OAR
461-195-0305(3) and
(4),
461-195-0320, or
461-195-0350.
(6) For purposes of ORS
416.510 to
416.610, assignment of the lien
establishes the CCO or prepaid managed care health services organization as a
designee of the Department in relation to the lien, pursuant to ORS
416.540(5),
which designation shall include the following:
(a) As the Department 's designee, the CCO or
prepaid managed care health services organization is subject to these rules in
the pursuit of the assigned lien and any actions taken by the CCO or prepaid
managed care health services organization to settle, compromise (see OAR
461-195-0301), or release the
assigned lien.
(b) The CCO or
prepaid managed care health services organization shall copy the Personal
Injury Liens Unit on all documentation related to the assigned lien, including
communications with the person or public body, agency or commission against
whom a claim is made or an action is brought in relation to settlement (see OAR
461-195-0301), compromise, or
release of the assigned lien. This requirement may be met by listing the
Personal Injury Liens Unit on the "cc" portion of the documentation or
certificate of service, and sending a copy to the Personal Injury Liens Unit
when the document is sent or filed.
(c) The Personal Injury Liens Unit may
require the use of forms and procedures related to the assignment of liens and
notices and the efficient administration of these rules to minimize redundancy
in communications with a recipient and the parties to a claim or action .
(7) The form of notice
of lien that may be assigned to a CCO or prepaid managed care health services
organization shall comply with ORS
416.560, with the CCO or prepaid
managed care health services organization assigned as the designee. Upon
receiving assignment of a lien from the Personal Injury Liens Unit, the CCO or
prepaid managed care health services organization shall perfect the lien as
required by ORS 416.550. A CCO or prepaid
managed care health services organization with an assigned lien shall notify
the Personal Injury Liens Unit no later than 10 calendar days after filing the
notice of the lien.
(8) A CCO or
prepaid managed care health services organization with an assigned lien shall
perfect the lien and document actions taken to recover under the lien.
Consequences for failure to comply with requirements for perfecting the lien
and recovering under the lien are the responsibility of the CCO or prepaid
managed care health services organization and shall not prevent the Personal
Injury Liens Unit from recovering amounts due the Department pursuant to the
lien or from the statutory assignment of right to payment from the recipient .
(9) Immediately after a judgment
(see OAR 461-195-0301) has been rendered
in favor of a recipient or a settlement or compromise has been agreed upon, the
person or public body, agency or commission bound by such judgment, settlement,
or compromise shall notify the Personal Injury Liens Unit. If a CCO or prepaid
managed care health services organization perfected a lien, the person or
public body, agency or commission shall notify the CCO or prepaid managed care
health services organization .
(a) If the CCO
or prepaid managed care health services organization receives such notification
on an assigned lien, the CCO or prepaid managed care health services
organization shall provide a copy to the Personal Injury Liens Unit within 10
calendar days of receipt.
(b)
After notification, the Personal Injury Liens Unit shall send a statement of
the amount of the lien to the person or public body, agency or commission by
certified mail with return receipt.
(c) After notification, if a CCO or prepaid
managed care health services organization filed a notice of lien, the CCO or
prepaid managed care health services organization shall send a statement of the
amount of the lien to the person or public body, agency or commission.
(10) A lien assigned by
the Department to a CCO or prepaid managed care health services organization is
subject to release or compromise as described in OAR
461-195-0325.
Notes
Stat. Auth.: ORS 409.050, 411.060, 411.070, 413.033, 413.042, 416.350, 416.351, Or Laws 2013, ch 14, sec. 10
Stats. Implemented: ORS 409.050, 411.060, 411.070, 413.033, 413.042, 416.350, 416.351, 416.510, 416.540, 416.560, 416.570, Or Laws 2013, ch 14, sec. 10
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