Portland, OR – According to a February 24, 2016 letter from the Centers for Medicare and Medicaid (CMS) to the Oregon Health Authority, if the OHA submits a contract action with FamilyCare including calendar year 2015 capitation rates that are consistent with the approved rate ranges, CMS will consider the rates actuarially sound.
Since the inception of its concerns over the 2015 rates more than a year ago, FamilyCare has asserted that it should have been paid a regional average for the Affordable Care Act (ACA) Medicaid expansion population due to the lack of credible data and significant unknowns surrounding this population. FamilyCare has been willing to settle its dispute with the OHA that would allow the OHA to claim full financial participation for all payments made to FamilyCare. The rates requested from FamilyCare are within the actuarially certified rate range.
With this letter, FamilyCare seeks a timely resolution of this matter.
###
About FamilyCare Health
For 30 + years, FamilyCare Health has been providing patient-centered healthcare to Oregonians. With over 130,000 members, FamilyCare Health is a Medicare and Medicaid managed care organization providing health plan services in Multnomah, Clackamas, Washington and Marion counties. FamilyCare was the first health plan in Oregon to integrate models of physical and mental health. It was the first Coordinated Care Organization in the tri‐county area certified by the Oregon Health Authority. More information at http://www.familycareinc.org/
