|
Oregon House Bill (HB) 2517, passed during the 2021 Legislative Session, requires OHA to compile and post information reported from CCOs regarding prior authorizations received during the calendar year.
The HB 2517 Prior Authorization Report has been posted. The inaugural report contains aggregate CCO data, including the number of requests for prior authorization (PA) received by the CCOs, the number of requests initially denied, the reasons for the denials, and the number of denials that were reversed on appeal.
OHA compiled data received from the Nov. 15, 2022 Grievance and Appeal Logs from each CCO, along with data received from a separate email inquiry sent to CCOs on Dec. 5, 2022, requesting their Q1 and Q2 PA data by Dec. 19, 2022. OHA performed an analysis of the data and provided the results in the “2022 Statewide CCO Aggregate Prior Authorization Data”, included below.
PA information for Q4 2022 will be reported as an addendum to this report after OHA receives that information from CCOs as part of their quarterly Exhibit I reporting in February 2023.
The Health Systems Division has scheduled the following RAC meeting:
- Program: Division 410 Chapter 120 OHP General Rules; Division 410 Chapter 141 Oregon Health Plan (MCE & CCO) Administrative Rules
- Meeting date and time: Thursday, January 26, 2023 9:30–11:30 AM
- Meeting location: This is a Zoom meeting only. Seated RAC members can join the meeting here. For participation by phone, RAC members can call (669) 254-5252; Meeting ID: 161 9647 5962 Passcode: 359874
- Seeking RAC members? Yes, please contact Diane Quiring at Diane.s.quiring@oha.oregon.gov
At the RAC, members will provide input that will help us develop the Notice of Proposed Rulemaking, help us better understand the fiscal impact of the proposed rule, as well as the racial equity impact of the proposed rule change per HB 2993 (2021 Regular Session).
Please share this information with others who may be affected by, and interested in providing input about, the proposed rule changes.
The 2023 SHARE Initiative guidance documents and reporting templates are now posted on the SHARE Initiative webpage: https://www.oregon.gov/oha/HPA/dsi-tc/Pages/SHARE.aspx
The two biggest changes are the following:
- The minimum spending formula is now in effect (for 2022 financials and 2023 spending plans); and
- The 1115 Medicaid waiver makes some health-related social needs for specific populations covered benefits (starting in 2024), making them not eligible for SHARE spending.
Core SHARE requirements remain the same, with clarifications made throughout the guidance and FAQ. The change log will give you a quick overview of what’s new, and the Jan. 30 webinar (details below) will walk through updates.
Guidance
Reporting templates
Webinar: 2023 SHARE guidance updates
- January 30, 11 a.m.–Noon
- Register here
- In this session we will provide a brief overview of the SHARE Initiative intent and requirements, walk through 2023 guidance updates, and answer questions.
For questions, please contact Transformation.Center@odhsoha.oregon.gov.
Do you have news or a story to share? Submit your content for an upcoming CCO Weekly Update!
For the week of 01/04/23
    
January 9, 2023
January 10, 2023
January 11, 2023
Please visit the committee and workgroup links below for more information about meetings. You can also view the OHA Public Meeting calendar.
|
