House Clears Bill Restricting CCO Service-Area Changes, But Bates Bill is Dead

At the end of the second week of the session, the Legislature is poised to pass two narrowly tailored bills corralling the actions the Oregon Health Authority took toward CCOs, but more rigorous bills are falling by the wayside.

The House unanimously voted Friday to approve legislation backed by FamilyCare that restricts the ability of the Oregon Health Authority to upend the coverage area of the state’s 16 coordinated care organizations.

Rep. Cedric Hayden, R-Cottage Grove, the chief sponsor of House Bill 4141, said the bill gives clear guidelines to the health authority about the emergency situations when it can change a CCO’s service area, gives assurances to CCOs that those situations will be limited, and most importantly, helps Medicaid patients know their healthcare will not be disrupted.

“Their doctor will not be removed in 30 days unless it’s an absolute emergency, not a political decision,” Hayden said.

Coordinated care organizations are the state’s community-focused health providers for the Medicaid program, the Oregon Health Plan; FamilyCare is the smaller of two CCOs serving the Portland metropolitan area.

During the past year, Hayden said the Oregon Health Authority changed its rules on service areas three times, creating great uncertainty. Those service changes came in an environment where the health authority was being sued by FamilyCare. In August, the state demanded that FamilyCare accept a $55 million rollback in money the state agency had already disbursed, but the CCO has refused to comply with the amended contract pushed by the Oregon Health Authority.

A vote on a second bill that aims to corral the Oregon Health Authority’s actions toward CCOs was pulled from the agenda and moved to next week.

Rep. John Davis, R-Wilsonville, told The Lund Report that he had House Bill 4107 removed so that legislative counsel could weigh in on a minor legal technicality -- and he expected the bill to pass easily next week once that’s resolved.

HB 4107 ends the agency’s ability to order clawbacks like FamilyCare had received, unless they are required to demand repayment under federal law.

But another bill that was high on the wishlist of some of the state’s CCOs -- Senate Bill 1531, which gave an automatic renewal to expiring contracts for successful CCOs -- was killed Thursday night in the Senate Health Committee.

Sen. Laurie Monnes Anderson, D-Gresham, said that some of the elements of SB 1531 could still be amended to other CCO bills -- such as HB 4141 or HB 4107 -- but there was too much controversy over SB 1531 for her to support it in its current form.

Rep. Mitch Greenlick, D-Portland, told The Lund Report he opposed SB 1531 because he wanted to have a better discussion on the future of CCOs in the 2017 Legislative session, and with the current contracts not ending until 2018, there was no need to give CCOs such a strong guarantee in 2016. Greenlick withdrew his own bill on the future of CCOs from consideration for similar reasons.

CareOregon, which participates in the operation of three CCOs, also opposed the bill.  CareOregon often acts as a rival to FamilyCare and the CCOs in the Coalition for a Healthy Oregon, which supported SB 1531.

The bill would also have demanded a quicker member enrollment process at the health authority, clearer notice about revised quality metrics and the covered benefits for the year, and more public reporting by the Oregon Health Authority.

A frustrated and exhausted Sen. Alan Bates, D-Medford, declined to comment on what further negotiations he was willing to make to achieve the goals of SB 1531. Monnes Anderson’s announcement that the bill was dead came after 6 p.m., and followed a Senate floor debate on the minimum wage that lasted several hours. Bates had been advocating for improvements in the law for CCOs and negotiating on SB 1531 through multiple meetings over several weeks.

Correction: This article has been corrected to note that FamilyCare has not complied with the Oregon Health Authority's demand that it return $55 million in alleged overpayments.

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From The Lund Report. This article has been corrected to note that FamilyCare has not complied with the Oregon Health Authority's demand that it return $55 million in alleged overpayments.

This statement is inaccurate. FamilyCare did not sign a 2015 amendment that would have require it to pay back $55 M. The OHA has no authority to demand payment because we did not sign and they have not done so. Further, Oregon Legislative Counsel has determined that Oregon law prohibits clawbacks. Lastly, the clawback was the result of a retroactive change of premiums, not alleged overpayments.