Or. Admin. R. 410-141-3715 - CCO Governance; Public Meetings and Transparency

Current through Register Vol. 60, No. 12, December 1, 2021

(1) CCOs shall establish, maintain, and operate with a governance structure and community advisory council (CAC) that is consistent with the requirements of ORS 414.625 and applicable health system transformation laws.

(2) Consumer Representative means a person serving on a CAC who is currently or was within the previous six months a recipient of medical assistance and is at least 16 years of age, or a parent, guardian, or primary caregiver of an individual who is or was within the previous six months a recipient of medical assistance.

(3) Each CCO's governing body must include:

(a) At least one member representing persons that share in the financial risk of the organization;

(b) A representative of a dental care organization selected by the coordinated care organization;

(c) The major components of the health care delivery system;

(d) At least two health care providers in active practice, including:

(A) A physician licensed under ORS chapter 677 or a nurse practitioner certified under ORS 678.375, whose area of practice is primary care; and

(B) A mental health or chemical dependency treatment provider.

(e) At least two members from the community at large, to ensure that the organization's decision-making is consistent with the values of the members and the community; and

(f) At least two members of the CAC:

(A) At least one of the CAC representatives on the CCO's governing body must be a current CAC Consumer Representative;

(B) CAC members of the governing body shall have full voting rights.

(4) For purposes of the open meetings requirement in Section 2 of Enrolled 2018 HB 4018, 2018 Oregon Laws Chapter 49, "substantive decision" means a decision made by the governing board of a coordinated care organization (CCO) that relates to:

(a) Spending of public funds;

(b) The financial risk of the CCO;

(c) Provider network development and capacity; or

(d) The community advisory council, community health assessment, or community health improvement plan.

(5) Substantive decision does not require or include:

(a) Disclosure of trade secrets as defined in ORS 192.345;

(b) Confidential communications with a lawyer that are privileged under ORS 40.225;

(c) Information of a personal nature as described in ORS 192.355;

(d) Protected health information as defined in ORS 192.556;

(e) Names of Oregon Health Plan consumer members of a community advisory council who request to remain anonymous;

(f) Confidential human resource matters; or

(g) Provider credentialing, sanctioning, or termination.

(6) The term "substantive decision" excludes immaterial technical decisions.

Notes

Or. Admin. R. 410-141-3715

DMAP 56-2019, adopt filed 12/17/2019, effective 01/01/2020; DMAP 1-2020, temporary amend filed 01/02/2020, effective 01/02/2020 through 06/29/2020; DMAP 62-2020, amend filed 12/16/2020, effective 1/1/2021

Statutory/Other Authority: ORS 413.042, 414.615 & 414.625

Statutes/Other Implemented: Oregon Laws 2018 Chapter 49