CCO Reform Bill Faces Last-Minute Hurdle

HB 4018 opens up the governance boards of the 15 CCOs that administer the Oregon Health Plan.

The Senate Health Committee cleared the CCO reform bill on party lines, setting up a vote in the full Senate to require the state’s 15 coordinated care organizations to meet more openly and spend excess reserves on reducing the social determinants of health.

But at the last minute, Senate President Peter Courtney, D-Salem, ordered the bill sent to the Senate Rules Committee for a hearing Wednesday afternoon, for what appears to be a small technical change. A proposed amendment makes clear that most of the new law would take effect next year and clarifies that open meetings are only needed when "substantive" decisions are made.

In the House, two Republicans supported HB 4018, but both Republicans on the Senate Health Committee opposed.

The bill had earlier been amended in the House to set up public meetings for CCO governing boards based on a model already in use by the central Oregon CCO. This model replaced the original bill, which called for adherence to the regular state open meetings law, which has strict limits on the use of executive sessions, which bar the public. Under the central Oregon model, boards would still have to meet openly to make decisions but could meet privately otherwise.

HB 4018 also seeks to prevent a debacle like the FamilyCare pull out earlier this winter by requiring lengthier notice before a CCO can shutter operations.

The Coalition for a Healthy Oregon, which represents seven CCOs, remains opposed, arguing that they are transparent with their filings from the state and are routinely audited by the Oregon Health Authority and the federal government.

“This isn’t about less transparency,” said Josh Balloch, the lobbyist for AllCare Health, a southern Oregon CCO and COHO member. “This is about making sure the good things that we have been able to do inside CCOs we can continue to deliver, which have improved health outcomes and reduced costs for the state.”

Rep. Mitch Greenlick, D-Portland, called that nonsense. “These people spend $9 billion of our money and love to do it in the dark. … We need to get this bill done this session because OHA is creating the [new contract]”.

The other eight CCOs, including Health Share of Oregon, support HB 4018.

Charlie Swanson, a Eugene healthcare activist, spoke in support of HB 4018, arguing it would have been nice to have in place when Trillium Community Health Plan was sold to St. Louis healthcare giant Centene, which created a $131 million windfall for Trillium’s stockholders, based on the profit potential of its Medicaid insurance plan.

“CCOs have spent public money in questionable ways,” Swanson said. “It’s that much harder to get answers from entities who can hide their governance decisions.”

Sen. Tim Knopp, R-Bend, said this portion of the bill could use more work and he might be able to support the bill if this language was made more clear, with executive sessions more explicitly defined.

Sen. Lee Beyer, D-Springfield, supported HB 4018 but he agreed with Knopp that OHA’s administrative oversight of the open meetings would be critical to making the open governance work. “I feel comfortable leaving it up to the experts at OHA.”

Sen. Alan DeBoer, R-Ashland, opposed opening up governing boards, however, arguing that would undercut their ability to make good financial decisions. He blamed the struggles of the Ashland Community Hospital on adherence to open board meetings, which it could end once the hospital was sold to Asante Health.

That would be news to Oregon Health & Science University, one of the state’s most lucrative hospitals, which complies with the open meetings law for its board meetings.

Reach Chris Gray at [email protected].  

Correction: HB 4018 had been ordered from the Senate floor to the Rules Committee just before press time.

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