The Oregon Health Authority (OHA) has released the 2018 capitation rates for Oregon’s coordinated care organizations (CCOs). Oregon’s 16 CCOs contract with the state to manage and deliver health care to Oregonians on the Oregon Health Plan (OHP), the state’s Medicaid insurance program. OHA pays a per-member-per-month fee to CCOs to manage OHP members’ physical, behavioral and oral health care.
The average rate increase among Oregon’s CCOs is 3.3 percent. As part of its federal waiver with the Centers for Medicare & Medicaid Services (CMS), Oregon has pledged to contain rate increases to 3.4 percent per year or less.
“These rates show that Oregon can contain costs while at the same time improving quality and transforming health care in the state,” said Patrick Allen, director of the Oregon Health Authority. “One in four Oregonians now receives health care through our innovative coordinated care model. That’s something all Oregonians should be proud of.”
Rate setting takes into account several factors, including differences in regional costs, population disease risk and hospital reimbursement. The state contracts with Optumas, an actuarial consulting firm, to assist in the rate development. The 2018 capitation rates have been certified by Optumas as actuarially sound.
OHA gives CCOs an opportunity to review the rates before they are submitted to CMS. It also works with the CCOs and the actuary to ensure that the methodology behind the rate setting is rigorous, equitable and compliant with federal requirements.
CMS has approved Oregon’s CCO rates for the past three years. OHA is taking extra steps this year to ensure the rate-setting process is fully transparent and independently verified. This will include two additional reviews, by a second Medicaid-qualified actuary and an independent law firm.