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Nov. 1, 2021
Contact: Philip Schmidt (503) 383-6079
Portland, Ore. - The Oregon Health Authority (OHA) has notified Trillium Community Health Plan that it has not complied with the terms of a corrective action plan (CAP) which it had been working on with the state regarding its Oregon Health Plan (OHP) service area in Clackamas, Multnomah and Washington counties.
Effective Dec. 1, 2021, the Oregon Health Authority will suspend all new enrollment in Trillium Community Health Plan’s Tri-County service area and continue the CAP. This sanction will be imposed until Trillium resolves network adequacy and health equity concerns. Current Trillium members should see no change in service levels due to this action and this does not impact Trillium’s Lane County membership.
Trillium was placed on a CAP in September 2020 after failure to adequately address OHA’s concerns around the plan’s expansion into the Tri-County service area. The CAP is comprised of four main finding areas: network development, health equity & language access, community engagement, and intensive care coordination (ICC).
Since September 2020, OHA’s Quality Assurance and CCO Contract Oversight team conducted regular reviews of documentation submitted by Trillium to determine whether substantial progress was made towards closing out the CAP finding areas and met on a regular basis with Trillium to discuss the CAP and any outstanding issues.
Based on the reviews and Trillium’s documentation, OHA has determined that Trillium is still non-compliant, with minimal progress towards correcting most of the violations set forth in the September 2, 2020 Notice and Order.
The CAP will be extended an additional six months to fully resolve all remaining CAP findings. Further, Trillium must fully resolve a subset of CAP findings (network adequacy and health equity findings) outlined in the CAP within three months of notice issuance. OHA with work closely with Trillium during this time to address the requirements of the CAP and assure ongoing quality services for existing members. If Trillium is unable to resolve the network adequacy and health equity findings within three months, OHA reserves the right to impose additional sanctions, up to and including termination of the Contract, or other remedies available to it under the Contract.
The notice to Trillium can be found here.
About coordinated care organizations
Oregon first established CCOs in 2012 to transform health care delivery in the state. CCOs bring together physical, behavioral, and oral health providers to coordinate care for people on the Oregon Health Plan. They improve health and reduce costs by providing more coordinated, flexible and innovative services. CCOs are rewarded for achieving specific health outcomes and quality measures.
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