(a) "Assessment" means an on-site quality assessment of an organizational provider that is conducted:
(A) If the provider has not been accredited by a national organization meeting the quality standards of the Oregon Health Authority;
(B) By the Oregon Health Authority, another state agency or a contractor on behalf of the authority or another state agency; and
(C) For the purpose of issuing a certificate of approval.
(b) "Organizational provider" means an organization that provides mental health treatment or chemical dependency treatment and is not a coordinated care organization.
(2) The Oregon Health Authority shall convene a committee, in accordance with ORS 183.333, to advise the authority with respect to the adoption, by rule, of criteria for an assessment. The advisory committee shall advise the authority during the development of the criteria. The advisory committee shall be reconvened as needed to advise the authority with respect to updating the criteria to conform to changes in national accreditation standards or federal requirements for health plans and to advise the authority on opportunities to improve the assessment process. The advisory committee shall include, but is not limited to:
(a) A representative of each coordinated care organization certified by the authority;
(b) Representatives of organizational providers;
(c) Representatives of insurers and health care service contractors that have been accredited by the National Committee for Quality Assurance; and
(d) Representatives of insurers that offer Medicare Advantage Plans that have been accredited by the National Committee for Quality Assurance.
(3) The advisory committee described in subsection (2) of this section shall recommend:
(a) Objective criteria for a shared assessment tool that complies with national accreditation standards and federal requirements for health plans;
(b) Procedures for conducting an assessment;
(c) Procedures to eliminate redundant reporting requirements for organizational providers; and
(d) A process for addressing concerns that arise between assessments regarding compliance with quality standards.
(4) If another state agency, or a contractor on behalf of the state agency, conducts an assessment that meets the criteria adopted by the authority under subsection (2) of this section, the authority may rely on the assessment as evidence that the organizational provider meets the assessment requirement for receiving a certificate of approval.
(5) The authority shall provide a report of an assessment to the organizational provider that was assessed and, upon request, to a coordinated care organization, insurer or health care service contractor.
(6) If an organizational provider has not been accredited by a national organization that is acceptable to a coordinated care organization, the coordinated care organization shall rely on the assessment conducted in accordance with the criteria adopted under subsection (2) of this section as evidence that the organizational provider meets the assessment requirement.
(7) This section does not:
(a) Prevent a coordinated care organization from requiring its own on-site quality assessment if the authority, another state agency or a contractor on behalf of the authority or another state agency has not conducted an assessment in the preceding 36-month period; or
(b) Require a coordinated care organization to contract with an organizational provider.
(8)(a) The authority shall adopt by rule standards for determining whether information requested by a coordinated care organization from an organizational provider is redundant with respect to the reporting requirements for an assessment or if the information is outside of the scope of the assessment criteria.
(b) A coordinated care organization may request additional information from an organizational provider, in addition to the report of the assessment, if the request:
(A) Is not redundant and is within the scope of the assessment according to standards adopted by the authority as described in this subsection; and
(B) Is necessary to resolve questions about whether an organizational provider meets the coordinated care organization’s policies and procedures for credentialing.
(c) The authority shall implement a process for resolving a complaint by an organizational provider that a reporting requirement imposed by a coordinated care organization is redundant or outside of the scope of the assessment criteria.
(9)(a) The authority shall establish and maintain a database containing the documents required by coordinated care organizations for the purpose of credentialing an organizational provider.
(b) With the advice of the committee described in subsection (2) of this section, the authority shall adopt by rule the content and operational function of the database including, at a minimum:
(A) The types of organizational providers for which information is stored in the database;
(B) The types and contents of documents that are stored in the database;
(C) The frequency by which the documents the authority shall obtain updated documents;
(D) The means by which the authority will obtain the documents; and
(E) The means by which coordinated care organizations can access the documents in the database.
(c) The authority shall provide training to coordinated care organization staff who are responsible for processing credentialing requests on the use of the database. [2013 c.362 §1; 2015 c.152 §1]
Note: 430.637 and 430.638 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 430 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.