Circumstances under which fully capitated health plan may contract as physician care organization
(1) A fully capitated health plan may apply to the Department of Human Services to contract with the department as a physician care organization rather than as a fully capitated health plan to provide services under ORS 414.705 (Definitions for ORS 414.705 to 414.750) to 414.750 (Authority of Legislative Assembly to authorize services for other persons).
(2) The Office for Oregon Health Policy and Research shall develop the criteria that the department must use to determine the circumstances under which the department may accept an application by a fully capitated health plan to contract as a physician care organization. The criteria developed by the office shall include but not be limited to the following:
(a) The fully capitated health plan must show documented losses due to hospital risk and must show due diligence in managing those risks; and
(b) Contracting as a physician care organization is financially viable for the fully capitated health plan. [2003 c.810 §5a]
Note: See note under 414.736 (Definitions).
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