OHSU Surplus Note Doesn’t Come Due Until 2024

Meanwhile, mental health providers have raised concerns about the slow claim payments processed by Moda.

Now that Oregon Health & Science University has officially announced it’s not moving forward with an ownership stake in Moda Health, there’s a lingering question – what’s the status of the $50 million surplus note and back interest payments?

OHSU signed a nonbinding letter of intent in November 2015 allowing the University to acquire up to a 25 percent equity position in Moda. Their intent was to create a joint board committee to explore future collaborations.

That surplus note remains in full force until 2024, according to Jonathan Nicholas, vice president of Moda, who said a recapitalization plan needs to be completed in advance.

“The federal government’s decision to delay payments owed to Moda under the ‘risk corridor’ program resulted in our health plan losing money in the individual market,” Nicholas added. “That prompted a recapitalization plan to replace the amounts owed to us under that program, a plan that will be complete in 2017.”

Moda continues to partner with OHSU on a wide range of initiatives, including its close alliance on health insurance exchange products for the individual market this year and beyond, he said. None of the existing arrangements with OHSU have been “called off,” he added.

OHSU also is eager to continue its collaboration with Moda, according to Tamara Hargens-Bradley, spokeswoman. “As we all prepare for a new administration and the likely upcoming repeal and subsequent replacement of the Affordable Care Act, OHSU will continue to partner with both payers and providers to improve the health of Oregonians and secure their access to our state’s only academic health center,” she said.

Claims delay

Moda’s also been criticized for its delay in paying claims, at times up to six months after claims have been submitted, according to several mental health providers who contacted The Lund Report and requested anonymity.

In response, Nicholas said, “The timing for paying claims varies depending on the time of year, the amount of time it may take for us to receive the claim, and the complexity of the claim. We usually see an increase in claims activity in the 4th quarter, which can increase payment times.

We also typically see a delay in the ACA market in the 1st quarter of each year due to the time it takes to verify members’ eligibility.

“These issues have been exacerbated this year [in 2016] because of all the uncertainty around the individual market and concerns about whatever changes might be in store for 2017. In the meantime, if any Moda provider or member has a question about a specific claim, we will be happy to help him or her in any way that we can. The number to call is 1-888-217-2363.”

Diane can be reached at [email protected].

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