Current through Register Vol. 60, No. 12, December 1, 2021
(1) The MCE
assessment on the premium equivalents paid to an MCE on or after January 1,
2018, is based on calendar quarters. Calendar quarter start dates are January
1, April 1, July 1, and October 1. For purposes of this rule, premium
equivalents shall be assessed as of the calendar quarter in which the premium
equivalents are received by the MCE.
(2) Premium equivalents include all
capitation payments received by the MCE for the provision of health services
and all other payments received by the MCE from the Authority for providing
health services under ORS chapter 414, including maternity payments, quality
incentive pool payments, and qualified directed payments as defined in OAR
410-125-0230. Premium equivalents do not include Medicare premiums or any form
of payment by Oregon Health Plan (OHP) enrollees.
Adjustments to premium equivalents
subject to assessment shall be determined as follows:
(a) Premium equivalents attributable to
periods prior to January 1, 2018, except annual quality incentive pool
payments, are not subject to the assessment and shall be deducted from the
assessable premium equivalents when calculating the assessment due;
(b) Adjustments due to changes in client
status and other premium equivalents adjustments resulting in additional
payments received by the MCE on or after April 1, 2018, are subject to the
(c) If premium
equivalents are reduced by a recoupment by the Authority for an overpayment,
then the assessable premium equivalents shall be the reduced amount after
(d) If both an
overpayment and recoupment occur, the MCE shall be subject to the assessment on
the premium equivalents received in the calendar quarter; and
(e) Sub-capitation payments made to an MCE by
another MCE are not included in the total premium equivalents subject to
assessment if the paying MCE certifies to the receiving MCE in writing that the
paying MCE is already responsible for the managed care assessment on the
originating premium equivalents.
(4) The MCE must pay the MCE assessment and
file the report on a form approved by the Authority on or before the 45th day
following the end of the calendar quarter for which an assessment is due unless
the Authority permits a later payment date. The MCE must provide all required
information on the report.
report, statement, or other document required to be filed shall be certified by
the MCE's chief financial officer or designee. The certification must attest,
based on best knowledge, information, and belief to the accuracy, completeness,
and truthfulness of the document.
(6) Payments may be made electronically or by
paper check. If the MCE pays electronically, the accompanying report may either
be faxed or mailed to the Authority. If the MCE pays by paper check, the
accompanying report must be mailed with the check to the address provided on
the report form.
(7) The Authority
may charge the MCE a fee of $100 if for any reason the check, draft, order, or
electronic funds transfer request is dishonored. This charge is in addition to
any penalty for nonpayment of the assessments that may also be due.