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managed care organization (MCO) must provide the director
of the Department of Consumer and Business Services (DCBS)
with a copy of any MCO/insurer contract agreement, signed
by both the insurer and the MCO, within 30 days of execution
of the contract. Contract amendments, addendums, and cancellations,
together with the entire text of any underlying contract,
must also be submitted to the director within 30 days of
execution.
When
an MCO/insurer contract agreement contains a specific
expiration or termination date, the MCO must provide the
director with a copy of a contract extension, signed by
both the insurer and MCO, no later than the contract's
date of expiration or termination. Workers are not subject
to an expired or terminated managed care contract [see
ORS
656.245(4)(a) and OAR
436-010-0275(13)].
When
an MCO amends its certified plan, it must first submit
the plan amendment to the director for review and approval
before taking any action based on the amendment.
Reports
are submitted to the director of DCBS containing: (a)
A summary of any sanctions or punitive actions taken by
the MCO against its members; (b) A summary of actions
taken by the MCO's peer review committee; and (c) An affidavit
that the approved MCO plan is consistent with the MCO's
business practices, and that any amendments to the plan
have been approved by the director.
On
a quarterly basis, each MCO must provide the director
with data regarding its panel provider membership.
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