A temporary restraining order issued on Monday by Marion County Circuit Court Judge Channing Bennett allows FamilyCare to continue serving its 134,000 Medicaid members pending a preliminary injunction hearing or further court order, according to CEO and President Jeff Heatherington.
That hearing is expected to be held sometime next week.
In an effort to avoid the restraining order, OHA filed papers just hours before the hearing indicating - for the first time - that it intended to give FamilyCare a contested case administrative hearing and appeal rights before taking action to terminate FamilyCare's contract, according to Heatherington.
OHA's attorney, Assistant Attorney General Sarah Weston, argued that because it could take "months and months or even years and years" before a final decision was made to terminate, there was no need for a restraining order. Judge Bennett disagreed, commenting that OHA's notice of default did not contain any mention of an administrative hearing and essentially was a "hold-up." He said that OHA was "using heavy handed tactics" to force FamilyCare to sign the retroactive amendment. The judge granted the TRO so that FamilyCare can continue its business as usual until the court could hold a hearing to determine whether to grant the preliminary injunction requested by FamilyCare. "We hope this will encourage the OHA to finally sit down and work with us. We've still not received documents we requested in 2015; after a year of delaying, it's time to settle this," said Cindy Becker, vice president for public affairs. "We appreciate the Judge's ruling in this matter and believe it is in the best interest of our members, providers, and staff."
When asked to comment on the court proceedings, Alissa Robbins, MPA, health system transformation communications manager at the OHA issued the following statement: “The judge’s decision will allow both sides to move forward to resolve this dispute through the appropriate administrative process. OHA has a responsibility to protect coverage and benefits for OHP members, maintain federal participation in Oregon’s Medicaid program and treat all our CCO partners is an equitable way. We will continue to pursue a resolution of Family Care’s 2015 rate overpayment that is consistent with these principles.”
In late March, the OHA and FamilyCare were close to resolving their dispute over a contract amendment from 2015 and its contract for 2016 and 2017. But mediation failed to produce a favorable outcome.
At that time, Heatherington told The Lund Report:
“Under today's proposal, FamilyCare's payment rates for the ACA population are still less than the other tri-county CCO, amounting to approximately $46 million less for 2015 and $32 million less in 2016. FamilyCare has operated in good faith to reach a resolution, but OHA has consistently thrown up barriers and refused to provide information. Heatherington said FamilyCare, which has been in business for more than 30 years, has exceeded the state's incentive metrics for the past two years, and has been designated a top workplace for the past four years.
“OHA's actions have had and will continue to have a negative impact on thousands of members, providers, staff, and community programs,” he added. “OHA has a fair proposal in front of them, and they're putting the state at financial risk every day they don't act on it.”
In response, OHA Director Lynne Saxton told The Lund Report her agency would be carefully reviewing the proposal with their attorneys, while remaining hopeful an agreement can be reached with FamilyCare later this week.
“We hope to bring this matter to a conclusion so FamilyCare can continue serving its members and taxpayer dollars respected,” she said. “Our interest is in getting this matter resolved in a financially sustainable manner, that’s always been our goal. We’re open to discussion and always have been. If a counter proposal is in order, we’re happy to pursue every avenue.”
Diane can be reached at [email protected].
