COMP-02 Delegated Functions and Oversight
TITLE: DELEGATED FUNCTIONS AND OVERSIGHT
To establish the authority of Health Share of Oregon (Health Share) to delegate specific functions to
other entities and the process through which that delegation occurs.
To establish the annual process for monitoring performance of Delegated Entities.
Delegation: The assignment of responsibility or authority to another entity to carry out specific
activities or perform certain administrative or operational functions on behalf of the delegating
Delegation Agreement: A mutual agreement between a delegating organization and its Delegated Entity
that specifies the activities and reporting responsibilities delegated. A contract entered into between
Health Share and the Delegated Entity is considered to be the Delegation Agreement.
Delegated Entity: An entity with which Health Share has entered into a written agreement to perform
certain functions required under, or governed by, the Health Plan Services Contract, federal and/or state
regulations that would otherwise be the responsibility of Health Share.
Delegation Audit: An annual evaluation of a Delegated Entity's capacity to perform delegated activities
using established criteria.
Health Plan Services Contract (CCO Contract): Contract entered into between Health Share of Oregon
and the Oregon Health Authority pertaining to the administration of the Oregon Health Plan Medicaid
I. Health Share may subcontract work to be performed under the ceo Contract, and may delegate
specific responsibilities to qualified entities. Health Share oversees and retains accountability
for any functions and responsibilities that it delegates to any entity. When a business need has
been established for delegation of functions, appropriate Health Share staff shall follow the
guidelines outlined in this policy.
II. Pre-delegation assessments are conducted prior to entering into a Delegation Agreement to
assess the organization's ability to perform the functions identified in the proposed Delegation
Agreement. If deficiencies are identified, the organization must submit a plan of correction that
is acceptable to and approved by Health Share prior to entering into a Delegation Agreement.
Ill. Health Share shall conduct an annual Delegation Audit of Delegated Entities to ensure
compliance with Health Share policies, requirements of the CCO Contract, Oregon
Administrative Rules and all other related state and federal rules and regulations relevant to the
functions delegated. If deficiencies are found, the organization must submit a plan of correction
that is acceptable to and approved by Health Share.
IV. If Health Share amends the Delegation Agreement to include additional activities less than 12
months prior to the annual Delegation Audit date, a pre-delegation evaluation must be
performed for the additional duties.
V. A Delegation Agreement must be in place prior to any delegated activities being performed. The
Delegation Agreement includes a business associate agreement consistent with privacy
requirements for protected health information.
I. Health Share will perform a pre-delegation assessment ofthe organization's ability to perform
the specific functions to be delegated. At a minimum, the pre-delegation assessment shall
• Review of relevant policies and procedures;
• An assessment ofthe organization's administrative, operational and staffing capabilities
and past performance record;
• An evaluation of the organization's processes and systems related to each delegated
• Site visits and/or pre-delegation meetings, as needed; and
• An evaluation of the organization's programs and compatibility with Health Share
policies related to the delegated function(s) under consideration.
II. Results of the pre-delegation assessment will be documented and retained by the Manager for
Compliance and Quality Assurance and a summary presented to the Compliance and Delegation
Oversight Committee. A recommendation will be provided to the Committee to proceed with
delegation, proceed with stipulations, or deny the Delegation Agreement.
Il l. Health Share shall monitor Delegated Entities on an on-going basis and shall perform a formal
Delegation Audit annually to assess performance of the Delegated Entity in accordance with 42
A. The annual review may be composed of elements that are universal to all Delegated
Entities as well as elements that are specific to each Entity.
B. The annual audit process will follow the same general process as the pre-delegation
assessment described in I above.
C. Upon completion of the audit, a draft report with findings will be provided to the
Delegated Entity, which will be given the opportunity to resolve findings before a final
report is provided.
D. The final report is presented to the Compliance and Delegation Oversight Committee.
IV. Upon identification of areas of non-compliance or inadequate performance, Health Share shall
notify the Delegated Entity and require submission of a plan of corrective action. The
Compliance and Delegation Oversight Committee is accountable for on-going monitoring of
plans of corrective action submitted by Delegated Entities.
V. A summary of plans of corrective action and their status shall be submitted to the Quality and
Governance Committee on a quarterly basis or as needed to inform the Committee of areas of
non-compliance or inadequate performance by Delegated Entities. The Quality and Governance
Committee may request additional information be presented by the Delegated Entity to ensure
the prompt and adequate resolution of deficiencies.
VI. Health Share staff shall submit a summary of annual Delegation Audits to the Quality and
Governance Committee to inform them of the status of each Delegated Entity's performance.
VII. Health Share retains ultimate accountability for any functions or responsibilities it delegates.
Department: Compliance and Quality Assurance Author: Barbara Carey, Sr. Manager,
Compliance and Quality Assurance
Effective Date(s): August 2013 Review Frequency: Every 2 years
Revision Date(s): December 2015; November