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OHA has finalized the 2023 capitation rates for 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. Learn more about those categories and 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.
In March 2022, Senate Bill 1538 and House Bill 4095 were signed into law by the Governor during the 2022 Legislation Session. These bills established two new dental-only programs within the Oregon Health Authority (OHA). These programs are:
- Veteran Dental Program
- Compact of Free Association (COFA) Dental Program
The programs open on January 1, 2023, but individuals can begin applying starting November 1st, 2022. Eligibility for the programs will be determined in the ONE system, and the Combined Medical Application (OHP 7210) is also being updated.
To apply for the programs, individuals must apply for Oregon Health Plan (OHP). Individuals must be determined ineligible for Medicaid (OHP Plus) before they can be reviewed for either dental program. Each program has their own eligibility requirements, which are limited.
Individuals approved for the COFA or Veteran Dental programs will get the same dental benefits as full OHP Plus members. Individuals will also be enrolled into the new CCO-F (dental-only) plans, which start January 1, 2023.
A new OHP Dental public-facing webpage has been created, and fact sheets for members, providers, and community partners will be posted here once finalized.
Oregon Administrative Rule changes are in the final review stages with the Secretary of State (SOS) and will be effective 01/01/2023.
September 19, 2022, the Oregon Health Authority (OHA) published the Community Integration Services Guide. The guide contains information about the services substance use disorder (SUD) residential treatment programs may provide to help individuals transition to an independent community setting:
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Employment Support Services: Services to help the individual obtain and maintain employment in the community (OAR 309-019-0105 (44)).
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Housing Support Services: Services to help the individual obtain housing and maintain their personal health and welfare in an independent community setting (OAR 309-019-0105 (56)).
Programs may bill for covered services provided on or after January 1, 2022. For a complete list of community integration services, please refer to the Community Integration Services Guide.
Why is this happening?
Oregon’s approved SUD 1115 Demonstration Waiver and related State Plan Amendment allow OHA to use federal matching funds to reimburse for these services.
What should you do?
SUD programs: Refer to the Community Integration Services Guide for information about service eligibility, covered services, billing and Oregon Medicaid provider enrollment. If enrolled with Oregon Medicaid, please bill the member’s coordinated care organization (CCO) or OHA for employment support and housing support services provided on or after January 1, 2022.
CCOs: Please review covered services, provider reimbursement schedules and contracts to ensure appropriate reimbursement for these services effective January 1, 2022.
Questions?
OHA is accepting applications for a vacant member-at-large position on the Metrics & Scoring Committee, which selects the health care quality measures and targets for the CCO Quality Incentive Program, through which CCOs can earn millions of dollars in bonus funds.
We are especially interested in applicants who can represent members of the Oregon Health Plan and communities experiencing inequities.
The recruitment is open through October 31, 2022. To apply, complete these two steps:
- Submit your (i) completed application (available in English and in Spanish) and (ii) your resume or bio sketch to metrics.questions@odhsoha.oregon.gov by October 31, 2022.
- Fill out the Oregon Health Policy Board committee membership application survey, also by October 31.
Learn more about the Metrics & Scoring Committee.
Every five years, Oregon applies for a waiver of some federal Medicaid rules that allows us to expand who is covered by the Oregon Health Plan (OHP), pay for health care differently and implement other reforms. The renewed Medicaid 1115 Demonstration Waiver for Oregon has been approved by the Centers for Medicare & Medicaid Services as of Oct. 1, 2022.
Join us to learn about what have been approved and included in Oregon’s renewed waiver for 2022-2027. There is information about continuous enrollment for children and adults, expanded benefits for children, and new benefit packages around housing, nutrition and climate supports for people going through life transitions. The day's full agenda is linked below.
Background
Medicaid is a state and federal program. A state must apply for a Medicaid waiver when it wants to make changes from normal federal guidelines. OHP, Oregon's Medicaid program, delivers health care to people who have low incomes. A state can ask to waive certain regulations for greater flexibility around the following and more:
- Who is eligible for Medicaid
- What benefits they receive
- How health care is delivered to Medicaid members
The overall goal for the renewed 1115 Medicaid waiver is to advance health equity in our state. Under that umbrella, there are four main goals:
- Creating a more equitable, culturally- and linguistically-responsive health care system
- Ensuring people can maintain their health coverage
- Improving health outcomes by addressing social needs that impact health
- Ensuring smart, flexible spending for health equity
During the next few years, Oregon will be making a number of changes to OHP as a part of the next phase of transforming our health system. When more Oregonians have health coverage and supporting social services, people and families are healthier, our communities thrive and health care costs are contained for everyone.
Come learn about the renewed Oregon Medicaid waiver and how it will transform our state's Medicaid program to better serve our members.
To learn more:
Further information about the waiver application process can be found at Oregon.gov/1115WaiverRenewal.
Questions?
If you have questions about this event, please reach out to 1115waiver.renewal@odhsoha.oregon.gov.
As of October 19, 2022
     
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October 25, 2022
October 26, 2022
October 27, 2022
Please visit the committee and workgroup links below for more information about meetings. You can also view the OHA Public Meeting calendar.
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