Current through Register Vol. 63, No. 9, September 1, 2024
(1) If the Department has not assigned a lien
to a prepaid managed care health services organization (organization) or if the
organization failed to perfect its assigned lien, the Department may release or
compromise its lien -- for the amount of the settlement, compromise, or
judgment that is subject to the lien -- and distribute collections under its
lien as follows:
(a) To the Department, an
amount equal to the State share of Department's assistance expenditures for the
amount of the settlement, compromise, or judgment that is subject to the
lien.
(b) To the federal
government, the federal share of the Department's assistance expenditures for
the amount of the settlement, compromise, or judgment that is subject to the
lien, pursuant to applicable law.
(c) To the recipient, any remaining amount
after distributions provided for in subsections (a) and (b) of this section.
The amount distributed to the recipient must be treated as income or resources
consistent with applicable law.
(2) If the Department has assigned a lien to
a prepaid managed care health services organization (organization) and the
organization properly perfected its lien, the Department and the organization
may release or compromise and distribute collections under the liens for the
amount of the settlement, compromise, or judgment that is subject to the lien,
consistent with OAR 461-195-0305(5),
as follows:
(a) To the Department, an amount
equal to the State share of assistance and the federal share of medical
assistance expenditures for the amount of the settlement, compromise, or
judgment that is subject to the lien.
(b) The Department will reimburse to the
federal government, the federal share of the State assistance expenditures for
the amount of the settlement, compromise, or judgment that is subject to the
lien for which federal match was claimed by the Department.
(c) To the organization, the assistance
expenditures subject to the lien by the organization except as otherwise
provided in subsections (a) and (b) of this section.
(d) To the recipient, the amount remaining
after the distributions provided for in subsections (a), (b), and (c) of this
section. The amount distributed to the recipient must be treated as income or
resources consistent with applicable law.
(e) As between the Department and the
organization after the distributions provided for in subsections (a), (b), (c)
and (d) of this rule, ORS
416.540(6)
requires that the Department's lien must be satisfied first.
Stat. Auth.: ORS
409.050,
411.060 &
416.510 -
416.610
Stats. Implemented: ORS
25.020,
25.080,
409.020,
411.060,
416.510-416.610
