Authorization for alternatives to reimbursement of coordinated care organizations
(1) In areas that are not served by a coordinated care organization, the Oregon Health Authority may execute prepaid capitated health service contracts for at least hospital, physician, physician assistant or nurse practitioner medical care, or any combination of such medical care, with hospital and medical organizations, health maintenance organizations and any other appropriate public or private persons.
(2) For purposes of ORS 279A.025 (Application of Public Contracting Code), 279A.140 (State procurement of goods and services), 414.145 (Implementation of ORS 414.115, 414.125 or 414.135) and 414.610 (Legislative intent) to 414.620 (System established), instrumentalities and political subdivisions of the state are authorized to enter into prepaid capitated health service contracts with the authority and shall not thereby be considered to be transacting insurance.
(3) In the event that there is an insufficient number of qualified bids for coordinated care organizations or prepaid capitated health services contracts for hospital, physician, physician assistant or nurse practitioner medical care in some areas of the state, the authority may continue a fee for service payment system.
(4) Payments to providers may be subject to contract provisions requiring the retention of a specified percentage in an incentive fund or to other contract provisions by which adjustments to the payments are made based on utilization efficiency.
(5) Contracts described in this section are not subject to ORS chapters 279A and 279B, except that the contracts are subject to ORS 279A.235 and 279A.250 (Definitions for ORS 279A.250 to 279A.290) to 279A.290 (Miscellaneous receipts accounts). [Formerly 414.630; 2014 c.45 §39]
Note: 414.618 (Authorization for alternatives to reimbursement of coordinated care organizations) (formerly 414.630) is repealed July 1, 2017. See section 64, chapter 602, Oregon Laws 2011, as amended by section 70, chapter 602, Oregon Laws 2011, section 23, chapter 8, Oregon Laws 2012, and section 2, chapter 792, Oregon Laws 2015.
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