OHA approves Trillium application to serve OHP members in Portland metro area

The Oregon Health Authority (OHA) has approved updated application materials from Trillium Community Health Plan to expand its Oregon Health Plan (OHP) service area to include Clackamas, Multnomah and Washington counties. Trillium will be able to start enrolling OHP members in those areas on September 1. Trillium Community Health Plan currently serves OHP members in Lane, Douglas and Linn counties.

On November 8, 2019, the Oregon Health Authority notified Trillium Community Health Plan that the coordinated care organization (CCO) would have until June 30, 2020, to contract with a hospital and meet other network requirements. If not, the CCO would lose its ability to serve the tri-county region over the next five years.

 

 

All CCOs are required to show they have a provider network that is adequate to serve their members. Trillium submitted updated provider network information to OHA in June and presented it to OHA in July. Based on the resubmission, which includes a hospital system under contract, OHA is giving Trillium a notice to proceed enrolling members beginning September 1.

As part of the notice to proceed in enrolling members, OHA has remaining questions about the quality of Trillium’s network, especially in the area of behavioral health. Trillium’s proposed network also shows a lack of language access capacity and OHA has other concerns about Trillium’s ability to demonstrate that it meets contract requirements around health equity and community engagement.

In order to continue to work on these issues, OHA will be issuing a Corrective Action Plan to address these concerns over the next few months.

Over the course of the CAP timeline, Trillium will need to demonstrate network growth and adequacy and that other CCO 2.0 priority areas are adequately addressed to OHA’s satisfaction through the remainder of 2020. Failure to meet CAP terms could lead to additional sanctions, including monetary penalties, membership freeze and potential contract termination.

As of September 1, members in the tri-counties will be able to choose Trillium as their coordinated care organization at the time of enrollment. Members are also allowed to change CCOs once per year and when they renew their OHP. Renewals are currently paused during this national emergency to ensure members maintain access to health coverage.

This press release was provided by the Oregon Health Authority.