PORTLAND, Ore. March 24, 2016 -- Today, FamilyCare Health submitted its response to the Oregon Health Authority's (OHA) March 22 offer. FamilyCare's proposal does not include the $8 million OHA offered to FamilyCare on Tuesday, March 22. Equally important, FamilyCare's latest proposal resolves all rate issues between the parties for both 2015 and 2016 in a consistent manner across both years.
In its March 22 offer to FamilyCare, OHA accepted FamilyCare's rate solution for 2015 but rejected applying the same rate methodology to 2016, despite OHA's emphasis for a year or more that it must treat FamilyCare in a consistent manner. OHA has stated repeatedly that the 2016 rates for all the other CCOs are based on their 2015 rates.
OHA's refusal to apply a consistent rate methodology to both 2015 and 2016 is baseless.
* There is no reason that CMS's position on FamilyCare's 2016 rates would differ from its position on FamilyCare's 2015 rates. If OHA can agree to FamilyCare's proposal for 2015 as consistent with its methodology (which OHA now accepts), there is no reason why that same proposal would not be approved for 2016.
* OHA's claim that applying the rate methodology consistently to the 2016 rates might put the state's federal Medicaid waiver at risk is false. The proposed increase in FamilyCare's 2016 rates would have at most a negligible effect on OHA's Medicaid budget and would not prevent OHA from meeting its commitments under the Medicaid waiver.
* OHA claims that it allowed FamilyCare to participate in meetings concerning the 2016 rate-setting process in form, and that FamilyCare then signed the 2016 amendment. But OHA ignored FamilyCare's objections, consistently asserted throughout the process, leaving FamilyCare with no choice but to sign -- or go out of business.
* OHA's argument that FamilyCare has had time to adjust its operations or to lower provider payments to mitigate impending losses clearly indicates that the OHA set the 2016 rates to put FamilyCare in a deficit position, and that the 2016 rates for FamilyCare are flawed and not actuarially sound.
* FamilyCare's overall rates for 2015 and 2016 have decreased more than any other CCO and are the lowest in the State. While all other CCO rates have remained stable and slightly increased, FamilyCare's rates have decreased by 19%.
FamilyCare's proposal meets all requirements established by OHA for consistency and compliance with approved rate ranges and does not require any payment to FamilyCare from the general fund. FamilyCare has set a deadline for 5:00 pm tomorrow (March 25) to hear back from OHA.
FamilyCare looks forward to a prompt resolution of all issues and ending the uncertainty for its 130,000 members who are concerned about future access to care because of OHA's Notice of Breach and Default, which threatens termination of FamilyCare's contract.
About FamilyCare Health
FamilyCare is an Oregon Not-for-Profit organization that has been providing patient-centered healthcare to Oregonians for 32 years. With over 130,000 members, FamilyCare Health is a Medicare and Medicaid managed care organization providing health plan services in Multnomah, Clackamas, Washington and some parts of 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/
FamilyCare Proposal Saves State $8 Million; Insures Consistent Rate Methodology for 2015 and 2016
March 25, 2016
