oregon health authority

FamilyCare and Health Authority Plan More Mediation over 2015 Rate Dispute

Mediation talks on Tuesday did not reach a conclusive outcome, requiring the Health Authority and the Portland-based CCO to call for a second round of discussion. The outcome of the mediation may determine whether FamilyCare will be able to continue as a CCO.

The feud between the Oregon Health Authority and FamilyCare will continue for another week after binding mediation talks over its 2015 reimbursement rates failed to produce a resolution on Tuesday.

Stakeholders Want Basic Health Option on Exchange for 2018

A legislature-commissioned workgroup has found a compromise solution that insurers, brokers and providers will be more likely to support, setting a highly-regulated and standardized basic health insurance plan on the exchange, provided by multiple companies and paying providers rates similar to Medicare, while still offering lower premiums and eliminating deductibles and coinsurance for consumers under 200 percent of poverty.

The Oregon Health Authority is putting the finishing touches on the state’s revised designs for a  Basic Health Plan, breaking considerably from earlier proposals that would have simply expanded the coordinated care organizations to cover more working-class adults.

Lawmakers Skeptical of State’s Demand that CCOs Return $100 Million

Sen. Alan Bates plans to meet with Gov. Kate Brown as a controversy has erupted over the revised 2015 payments to coordinated care organizations that cut the Medicaid program rather than give the organizations the 3.4 percent increase promised. The state’s order to FamilyCare that it return 9 percent of its current revenues -- $55 million -- would wipe out its profit for the year, and put it on rocky footing going forward. Rep. Mitch Greenlick agreed with some of the calculations but argued that the rates for the Medicaid expansion were more arbitrary and could threaten the CCOs’ ability to innovate and transform the delivery system.

The Oregon Health Authority is demanding that six coordinated care organizations that operate the state’s Medicaid program pay back nearly $100 million for alleged overpayments in the first eight months stemming from two wildly different but equally controversial rate calculations.


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