Coalition for a Healthy Oregon Backs CCO Transparency Bill

A last-minute intervention by Senate President Peter Courtney made a slight amendment to the bill’s creation of public meetings for coordinated care organizations, leading to unified support from the Medicaid insurers and a 28-1 approval vote in the Senate.

The Senate has passed the coordinated care organization transparency bill with the surprise last-minute support of the Coalition for a Healthy Oregon, the group of seven CCOs that had long opposed the bill, particularly its requirements for open board meetings.

The House of Representatives must first agree to the amendments before House Bill 4018 heads to Gov. Kate Brown, but that is likely a foregone conclusion.

COHO’s support ostensibly came after an eleventh-hour amendment to the bill from Senate President Peter Courtney, D-Salem, which clarified that meetings need only invite the public for “substantive” decisions. The amendment also made clear that most of the changes will not take effect until the new five-year contract starts in 2019.

“As community-based organizations, COHO has always supported community accountability and engagement,” said lobbyist Courtney Johnston. “COHO wanted to ensure that protected health information and sensitive or legally privileged information remains protected. The Senate amendments allowed for OHA to promulgate rules to add this clarity. COHO has confidence that [Oregon Health Authority] Director [Pat] Allen will ensure the provisions of this bill will not violate important privacy laws.”

Allen’s agency will oversee an administrative rulemaking process to define parameters for the open meetings that are not clearly spelled out in statute. The amendment also earned the support of Sen. Tim Knopp, R-Bend, and all but one of his fellow Republicans, Sen. Herman Baertschiger of Grants Pass. “I’m pleased to have a bipartisan bill to support today,” Knopp said.

Knopp said Monday that he would support the bill if only the language around the open meetings were tightened in the Senate Rules Committee, a promise he was able to make good on with the last-minute Rules hearing on Wednesday.

The amendment, while critical to COHO, was painless and largely a technical change that preserves the underlying spirit of the bill. “I’m very surprised and very pleased that we reached a consensus,” said Rep. Mitch Greenlick, D-Portland.

Sen. Laurie Monnes Anderson, D-Gresham, who carried HB 4018 on the Senate floor, said she was also surprised that all 15 CCOs came around to support the bill, a development she did not learn of until Thursday.

In addition to open meetings, the bill requires CCOs to invest in community health projects if their reserves exceed the amount necessary to stay comfortably solvent.

A provision that would take effect immediately upon signing requires the CCOs to give 120 days’ notice to the Oregon Health Authority before they can withdraw from service and give their members and providers 90 days’ notice. This part of the bill aims to prevent another situation like that with Portland CCO FamilyCare, which sought to end service with just two weeks’ notice, though it later agreed to operate for an additional month.

CCOs are small insurance companies in the state Medicaid system that are operated by local hospitals and physician groups, as well as other providers. They built upon an earlier managed care network by integrating dental care and mental healthcare with physical care for children, low-income residents and people with disabilities.

Nearly six years after CCOs were created, Greenlick saw the opportunity to improve transparency before that new five-year contract for the organizations is issued in January 2019.  He has been fighting for open meetings from the beginning, however, citing the $9 billion in public dollars the organizations spend annually.

He has fought tooth and nail on this issue with the Coalition for a Healthy Oregon, making their turnaround Thursday all the more surprising.

Greenlick’s efforts drew new support with the sale of the Eugene CCO, Trillium, to Centene, a large insurance company from St. Louis. The deal made $131 million for its group of local investors, based on the profitability of its Medicaid contract, which stoked fears that Oregon’s public investment in the health of its most vulnerable residents might instead be going to Wall Street.

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Once again, the Lund Report buys in to the OHA's propaganda about closing FamilyCare. FamilyCare was forced to close down due to highly insufficient rates that would have resulted in bankruptcy. We worked diligently to acheive adequate rates for four months. At the last minute, just two weeks before the end of 2017, the Governor gave us an ultimatum to sign the original contract or "get out". 

The new Bill now requires 120 days notice to terminate a contract. Because a previous law only requires the OHA to give 60 days notice of contract and rate changes, the OHA can now force a CCO to accept a highly unreasonable contract while it pretends to negotiate up to the last minute of the old contract.

And, as in previous Bills, Rep. Greenlick again only requires CCO's to be transparent in their operations. The Oregon Health Authority is free to continue hiding its rate making process from the public as it has done for 5 years. 

While the CCO's have provided exemplary service and open operations to the taxpayers and Medicaid population since 2013, the OHA has lost hundreds of millions of taxpayer dollars through incompetence and outright lies (Cover Oregon and now the "new" enrollment sytem) Rep. Greenlick lets the government off the hook once again.