Greenlick Withdraws Sweeping CCO Bill; Two Others Should Advance

The House Health Care chairman said he wants to postpone dramatic changes to the CCO structure until next year, while two smaller bills remain that would limit the ability of the Oregon Health Authority to retroactively and unilaterally alter the contracts of the CCOs, and prevent further actions like those that involved FamilyCare in 2015.

Rep. Mitch Greenlick, D-Portland, has retracted his proposal to require a greater community focus and transparency for CCOs, but a pair of small-bore bills are likely to pass out of the House Health Committee on Wednesday.

These simple bills focus on parts of an omnibus CCO bill that Sen. Alan Bates, D-Medford, has put together and would likely have to be reconciled if both the Bates’ and the House bills pass.

House Bill 4107 would end one of the most controversial policies at the Oregon Health Authority regarding coordinated care organizations -- the “clawback” of money already paid to CCOs after the state agency decides it has overpaid them and wants to change its methodology, as happened last year.

“We can’t operate effective if we can’t count on the money coming to us prospectively,” said Heather Raeburn, the lobbyist for FamilyCare, a Portland-area CCO, which the health authority demanded repay $50 million this August after the rate recalculation.

Several other CCOs, including Umpqua Health Alliance in Roseburg and All-Care Health Plan in Medford, also had to pay back millions of dollars.

House Bill 4141, brought forward by Rep. Cedric Hayden, R-Cottage Grove, will also stop the Oregon Health Authority from pulling a CCO’s geographic territory out from under it unless the CCO is substantively failing to provide quality care to its members.

“The patients of a CCO need to know that that service is going to be there,” Hayden said.

As with HB 4107, the impetus for HB 4141 also stems from the rancor between the health authority and FamilyCare. A contracting impasse led the state agency to solicit requests from competing CCOs to take over FamilyCare’s clients in case of an emergency, and the legislation restricts but does not eliminate that authority.

“If the CCO is not performing, the agency does have remedies to deal with that,” said Cindy Becker of FamilyCare.

The state’s moves last year would have pulled FamilyCare’s contract out from under it during their ongoing dispute over reimbursement. The competing Portland CCO, Health Share of Oregon, and several other organizations stepped up to take responsibility for the health of members in FamilyCare’s contract if the health authority decided it could not count on FamilyCare to serve its members. HB 4141 raises the bar for diverting members away from a CCO.

But Greenlick’s sweeping legislation -- which would require open meetings along with continuous improvement within quality care metrics and a nonprofit, community-based CCO structure -- will have to wait for another year.

Greenlick also said he learned that the current CCO contracts do not expire till the end of 2018, instead of 2017 as he had thought -- which allows for a discussion about the new contracts in next year’s long session rather than during this year’s truncated, five-week session. He also indubitably understood the tough political realities of challenging the status quo of the CCOs, whose parent organizations have gained hefty political clout by bankrolling political campaigns.

Still, Martin Taylor of CareOregon spoke approvingly of Greenlick’s reforms, arguing that HB 4100 cut a middle path between the guaranteed contracts in the bill brought by Sen. Alan Bates, D-Medford, SB 1531, and a default position that would allow the Oregon Health Authority to call for an open-bidding process with zero guarantees that the current 16 CCOs would remain in business, regardless of how effective they’ve been.

“We’re going to raise the bar every five years,” Taylor said, explaining the protocols in the bill. “We expect you to expect more out of us.”

Sen. Chip Shields, D-Portland, has also proposed an amendment to SB 1531 that would require CCO boards to follow public meetings law. That amendment is still alive and may serve as part of the negotiations for the CCOs reluctant to be more transparent but eager to get the protections that Bates has proposed. Bates said that several CCOs are now willing to accept open board meetings.

CareOregon operates the Jackson Care Connect CCO in Medford and the Columbia Pacific CCO in Astoria and is the largest care provider for Health Share of Oregon, a Portland-area CCO.

Taylor also criticized the for-profit structure of some CCOs, asking how the Medicaid system, designed to help raise low-income people out of poverty, could possibly be a source of capitalist profit. “A lot of people are making a lot of personal wealth,” he said.

But Rep. Brian Clem, D-Salem, defended the for-profit structure of his home CCO, Willamette Valley Community Health, noting that the organization can both gain capital and lose investments, which it risks as the cost of doing business.

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Anything done in secret will sooner or later lead to abuse.

History repeats itself, first as tragedy, second as farce
We are moving toward farce.