Oregon Health Authority’s redeveloped rates receive approval from the Centers for Medicare and Medicaid Services

The Oregon Health Authority (OHA) received notice from the Centers for Medicare and Medicaid Services (CMS) that its 2015 redeveloped rates for coordinated care organizations (CCOs), submitted in an actuarial certification dated August 28, 2015, meet all federal requirements. This is good news for Oregon Health Plan members, CCOs and Oregon.

Oregon’s CCOs voiced concern that the original 2015 rates were flawed and were not created transparently. The state also received extensive questions from CMS. As a result of this feedback, OHA worked with CCOs and its actuarial contractor Optumas to redevelop 2015 rates. 

Because continued health system transformation requires a stable and actuarially sound rate methodology that is supported by CMS, OHA engaged in a transparent and intensive process that included more than 100 meetings between CCOs, OHA and Optumas to successfully redevelop its rates. OHA used the same rate methodology to calculate 2016 rates. 

“OHA’s successful process leading to fair, actuarially sound rates is the direct result of communication, partnership and transparency between OHA’s staff and Oregon’s CCOs,” said Lynne Saxton, OHA Director. To date, 15 of 16 CCOs have signed their 2015 rate amendments.