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Today OHA announced it has signed contracts with 15 organizations to serve as coordinated care organizations (CCOs) for the Oregon Health Plan’s nearly 1 million members. The contracts set new requirements for CCOs to improve care for OHP members and hold down cost increases in Oregon’s Medicaid program. The contracts represent the largest procurement in state history, totaling more than $6 billion for the 2020 contract year.
Eleven of the organizations received five-year contracts, and four organizations received one-year contracts. The new CCO contract services start January 1, 2020. Total costs for the 2020 contract year are within the state’s 3.4 percent growth target.
"These contracts build on the original vision for CCOs," said Oregon Health Authority director Patrick Allen. "At the same time, they hold CCOs and the Oregon Health Authority more accountable for working together to deliver better results for OHP members and taxpayers. Over the next five years, these contracts will give us more tools to help Oregonians be healthier at home, in school and in their communities, improve access to mental health and substance use services, reduce health disparities, and get better health and quality outcomes for dollars we spend on health care."
All CCOs are required to show they have a network that is adequate to serve their members. Eight of the contracts include conditions that must be met to address provider network adequacy and pending provider contracts. These eight CCOs have service areas where members will have CCO choices this fall.
The conditions require the CCOs to ensure OHA has appropriate, up-to-date information on their contracted providers to determine how many members they can serve in 2020. They must also demonstrate they can meet state and federal requirements that apply to all CCOs for access to in-network hospitals, primary care providers, specialists, and pediatric oral health providers. CCOs have until December 1 to meet the conditions.
Readiness review
OHA is also announcing the initial results of the first round of the federally mandated readiness review. CCOs were evaluated for their readiness to provide services starting January 1. All 15 CCOs met most or nearly all of the requirements.
The first round of evaluation included eight "critical" categories that directly impact a member’s ability to access health care services. In each category, CCOs were rated in 93 elements as: complete, progress sufficient to start operations, or incomplete. OHA is asking all CCOs to take actions to improve items rated as incomplete or progress sufficient to start operations. CCOs will be required to provide documentation showing the issues have been resolved by December 1.
OHA is finalizing remediation plans for the four CCOs that received one-year contracts (AllCare, Cascade Health Alliance, Umpqua, and Yamhill County Care Organization). During readiness review, many deficiencies in the applications were improved and requirements to correct those have been removed. OHA is working closely with the four CCOs to ensure they have the necessary plans, procedures and practices to meet the goals of CCO 2.0.
2020 capitation rates
OHA has also finalized the 2020 capitation rates for CCOs. These rates are the per-member-per-month amounts the state pays CCOs to coordinate health care for OHP members. The average net payment in 2020 is $471. The 2020 rates include multiple budget-neutral adjustments such as the inclusion of the quality pool program within the rates and a change in how hospitals are reimbursed. These changes impact a comparison between 2019 and 2020 rates. The rate increase meets the 3.4 percent rate-of-growth target for state general funds.
Due to the passage of HB 2267 in the Legislature’s 2019 session, 2020 rates will be recalculated in summer 2020 and be applied retroactively to January 2020. The recalculation is intended to account for any changes to CCO member enrollment during the transition from 2019 to 2020 contracts.
Additional resources:
The Contract Awardees page on the CCO 2.0 website has additional information about the contracts, readiness review and rates including:
- Signed 2020 contracts.
- Conditional letters.
- Readiness review reports.
- 2020 capitation rates.
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