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October 20, 2022
Media Contact: Liz Gharst, elizabeth.a.gharst@state.or.us, 971-666-2476
Oregon Health Authority (OHA) has finalized the 2023 capitation rates for coordinated care organizations (CCOs). These rates are the per-member-per-month amounts the state pays CCOs to coordinate health care for Oregonians who are members of the Oregon Health Plan (OHP). Overall CCO rates were below the legislatively approved budget for 2023 and CCOs continue to be financially stable. Financial statements for CCOs through Q2 2020 can be found here, along with additional CCO program financial summaries.
The baseline 2023 CCO rate growth was -0.6% compared to 2022; significantly below the long-term growth rate goal of 3.4%. The slow per-member baseline growth was driven in part by reduced costs and higher enrollment, producing a relatively healthier covered population. This allowed OHA to reinvest savings into behavioral health reimbursement increases along with additional funds from the legislature for behavioral health totaling $221 million, or 3.0% CCO rate growth. OHA is also providing a temporary increase for large hospital reimbursement from 80% of Medicare to 85% of Medicare ($84 million, 1.2%). With these enhancements factored in, the CCO 2023 rates will be 3.6% higher than in 2022.
“These reimbursement increases in behavioral health will allow mental health and substance use treatment providers to get paid more for the critical services they provide. By keeping growth down generally, we are able to target increased investments in the system where it is needed most,” OHA CFO David Baden.
The Oregon Legislature appropriated funds to increase behavioral health rates in HB 5202. OHA intends for these funds to help remedy existing disparities in reimbursement rates among behavioral health providers to create significant and sustained increases in wages and address the lack of access to behavioral health providers across the state.
OHA is increasing behavioral health reimbursement rates by directing CCOs in 2023 to increase payments to behavioral health providers across a broad array of services:
- Providers will receive a 30% increase to reimbursement when compared to January 2022 if they have more than 50% service revenue from Medicaid.
- Providers will receive a 15% increase to reimbursement when compared to January 2022 if they have less than 50% service revenue from Medicaid.
- In addition, differentials are also available for providers who deliver culturally and linguistically specific services and serve members who have co-occuring disorders.
Hospitals across the state report sharp growth in operating expenses which is outpacing revenue. OHA is increasing expectations around CCO payments to large hospitals for 2023. OHA expects that CCOs will pay large hospitals $84 million in 2023, a temporary one-year increase as a response to the challenges faced by these hospitals.
The average net per-member per-month payment in 2023 will be $507.90, which is approximately 3.6% more than the comparable average per-member-per-month payment in 2022. The rates are actuarially sound and are below the allowable growth target.
The 2023 capitation rates are pending federal approval and are currently under review by the Centers for Medicare and Medicaid Services (CMS).
There are 12 rate categories for CCOs, which take into account the average cost for members in these specific categories. To learn more about those categories, click here to review the full 2023 capitation rate certification. Rates are also based on average provider rate costs in each region.
A full breakdown of final amended 2023 CCO rates can be found on OHA's website.
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