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CCO Reform Bill Heads for Floor Vote and Possible Partisan Scuffle

In a tense, party-line committee vote, Democrats and Republicans accused each other of being unreasonable and unwilling to negotiate.
February 16, 2018

Rep. Mitch Greenlick shepherded his latest attempt at reform of the coordinated care organizations through the House Health Committee on Wednesday, setting up a probable partisan battle on the House floor.

House Bill 4018 requires all 15 CCOs to adopt the open meetings model now in use by the PacificSource Central Oregon CCO, to invest excess reserves into the social determinants of health and to give the Oregon Health Authority three to four months’ notice before ending their contracts.

The new requirements, if successful, would take effect with the new five-year contract in 2019 for the CCOs, which are Oregon’s locally driven model of Medicaid insurers, or managed care organizations. The notice requirement is designed to prevent a debacle similar to FamilyCare’s departure from the Medicaid market, which nearly left its members in the lurch with less than a month’s notice, though it was later extended by 31 days.

The 2018 bill does not include controversial provisions in the 2017 version that would have forced the state’s for-profit CCOs to transition to a non-profit business structure. Seven of the CCOs are supporting Greenlick’s bill, but the eight for-profit members of the Coalition for a Healthy Oregon remain opposed.

Republicans said they felt thwarted getting their own amendments taken seriously, and they plan to stage a floor fight by submitting their own proposal for a vote.

Rep. Knute Buehler of Bend sought better controls on how the CCOs invest in social determinants of health, while Rep. Cedric Hayden of Cottage Grove tried to create a task force to meet publicly to discuss how the state plans to keep the Oregon Health Plan funded in the 2019-2021 budget, when it will face a $1.5 billion hole.

“There’s not adequate guidelines to the social determinants,” Buehler said, noting that one CCO used their money to sponsor a Little League baseball team. “I’d have set up an expectation on how much each CCO should invest. … It’s totally consistent with the intent of the bill.”

Buehler had introduced his measures as a stand-alone bill -- which did not get a hearing, and he then attempted to add his bill as an amendment to HB 4018, which Greenlick had seemed open to support. The amendment called for OHA to work with each CCO to adopt a plan for upstream investments in social determinants of health, which would have to follow the federal waiver approved by the feds, with funds going toward priorities such as supportive housing, transportation vouchers and community health.

The Democratic House leadership has repeatedly tried to kill Buehler’s legislation in the past, presumably to limit his legislative victories as the Republican runs for governor, even when they supported his ideas. But the Bend Republican said he did not believe that was the case this time, since Hayden’s amendment was also rejected.

Greenlick disputed Buehler’s contention that HB 4018 legislation headed to the floor was overly partisan, noting that he took out a provision that would have allowed for a statewide CCO and modeled the open meetings model after the CCO in Buehler’s district.

“Bipartisanship requires both parties,” Greenlick told the committee. “I tried to move pieces of what you wanted into this bill. I changed the bill a lot in the direction that the minority party wanted.”

He told The Lund Report that Buehler’s amendments came too late in the short session  to be considered. The Republicans were considerably less willing to negotiate in the 2017 long session.

“I don’t count on Republican support anymore,” Greenlick said. “I think it’s a good bill in this form and the Republicans should get behind it.”

Hayden was a chief opponent of Measure 101 in part because the state’s Medicaid funding deal had been hashed out in secret between the healthcare industry, the governor’s office and state legislators. He happened to be on that closed-door committee, but he did not like the outcome and the public was shut out of the process.

He said Greenlick’s attempt to make the CCOs more transparent was ironic: “We in the Legislature do that process in secret,” he said. “We in the Legislature are not willing to do a public task force. I think we need transparency on both sides of the equation, not just half.”

Greenlick said he was for greater transparency all around, particularly at OHA.

Reach Chris Gray at [email protected].