OHA announces coordinated care organizations will establish service areas based on counties for next round of contracts

The Oregon Health Authority says all new and existing applicants for coordinated care contracts will have to define their service areas by county for the 2020-2024 contract period. A service area is where people have to live to be members of a coordinated care organization (CCO). A service area does not impose limits on the location of a CCO’s provider network.

Currently 15 CCOs operate in service areas defined in 2012 through the state’s request for applications (RFA) process. Of those, nine have boundaries that do not follow county lines.

As the Oregon Health Authority (OHA) develops contracts for the next five years of coordinated care, also known as “CCO 2.0,” the agency sought public comment on how to best define service areas for current and potential new applicants. Public comment received by OHA supported establishing service areas based on county boundaries.

CCO applicants will be allowed to seek exceptions to county-wide coverage. Those applicants will need to demonstrate how their proposed service area would do a better job of achieving the transformation priorities of CCO 2.0, the benefit to members and the community, how it addresses patient travel and referral patterns, and that the proposal is not designed to minimize financial risk and does not create adverse selection.

This announcement comes as OHA officially closes public comment today on policymaking related to the next round of CCO contracts.

On November 19 OHA held public input sessions on member enrollment and rate setting for CCO 2.0. OHA needs to develop a process for how members will enroll in CCOs when there is a change in CCO availability, and to develop an auto-assignment process for members who do not select a CCO in areas with multiple CCOs. OHA shared multiple proposals for this process. The agency also sought public comment on how to set the capitation rates (amount paid to CCOs per member per month) used to build global budgets, and draft rate methodology adjustments to the current rate development process.

Decisions on member enrollment and rate setting will be announced with the release of the RFA in January.

OHA will continue to provide updated information about the CCO 2.0 RFA process and answers to frequently asked questions on the CCO 2.0 page on the OHA website.

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This press release was provided by the Oregon Health Authority.