- Early Discussion and Resolution Bill Headed to the Governor's Desk (March 12, 2013)
- Oregon Senate Passes Early Discussion and Resolution Legislation (March 5, 2013)
- Senate Judiciary Committee Approves Early Discussion and Resolution Bill (Feb. 14, 2013)
- Review and Comment on Draft CCO Documents by Noon on March 13 (March 6, 2012)
- Oregon Legislature Passes Health System Transformation Bill (Feb. 28, 2012)
- Oregon Senate Passes CCO Bill (Feb. 15, 2012)
- House Sends HB 4010 to Rules Committee (Feb. 10, 2012)
- OMA President Carla McKelvey, MD, Appointed to OHPB (Feb. 3, 2012)
- Oregon Health Policy Board Sends CCO Proposal to Lawmakers for Approval (Jan. 25, 2012)
- Oregon Health Policy Board Releases Revised CCO Proposal (Jan. 10, 2012)
Make Your Voice Heard on Health System Transformation
Make sure your voice is heard as health system transformation continues in Oregon. The Oregon Health Authority is asking for public input on the draft Coordinated Care Organization (CCO) application and model contract. Comments and concerns must be submitted by no later than noon next Tuesday, March 13.
On March 2, Governor Kitzhaber signed SB 1580, which will implement Coordinated Care Organizations to better serve Oregon Health Plan members. CCOs will integrate behavioral, physical and ultimately oral health care with a focus on improved wellness and prevention. The aim is to bring better health, better care and lower costs to the more than 600,000 Oregonians served by the Oregon Health Plan.
The Oregon Health Authority is now preparing to take applications from interested organizations that wish to be certified by the state to become CCOs, and it is important that physicians and PAs give their input on documents that will shape the way the new delivery model is implemented.
New information is now available from the OHA at www.health.oregon.gov. Interested stakeholders can review draft documents explaining each step of the CCO application and implementation process and submit comments. These documents include the draft Request for Applications, a draft CCO sample contract, draft temporary administrative rules and the draft proposal for Oregon's Medicare-Medicaid Alignment Demonstration that will be submitted to CMS. The site also contains Oregon's request to the federal government for additional federal flexibilities. This Request for Amended Waiver was submitted to CMS on March 1.
Be sure your concerns are heard! The OHA is accepting public comments on the RFA, draft CCO sample contract, temporary administrative rules and draft proposal for Oregon's Medicare-Medicaid Alignment Demonstration now through noon on March 13 athttp://cco.health.oregon.gov/Comment/Pages/Home.aspx.
You can also submit your comments directly to the OMA, and we will incorporate your concerns into OMA’s comments on these documents and the CCO implementation process; to do so, e-mail your comments toOMA@theOMA.org. More information from the OMA on CCOs and Health System Transformation in Oregon is available at www.theOMA.org/transformation.
The Oregon House of Representatives passed SB 1580, the bill that implements Coordinated Care Organizations for the Oregon Health Plan, with a bipartisan vote of 53-7 on Feb. 23. The Senate has already approved the bill, and the Governor is expected to sign it into law soon.
Under the legislation, CCOs will be local entities that coordinate and deliver physical, mental and dental health care to OHP patients. They will be expected to meet criteria that call for a high standard of health outcomes and support prevention, early intervention, and patient-centered care.
The new coordinated delivery model is expected to improve health outcomes and reduce costs. An analysis by Health Management Associates projects that CCOs could save the state $3.2 billion over five years by reducing waste and inefficiency and improving prevention.
Passage of the bill allows the state to submit a state plan waiver to the federal government to allow greater flexibility on how Oregon Health Plan dollars are used for care in CCOs. The state will also apply for additional federal investments of up to $2.5 billion over the next five years to fund innovation in health care delivery.
In the coming months, OHA will write the administrative rules and regulations that set the criteria and expectations for CCOs, establish an arbitration process for when a dispute arises regarding participation in a CCO, and detail how the Authority and the Department of Consumer and Business Services will share financial information about CCOs.
Simultaneous to the rule writing process, the Oregon Health Authority will review and approve the first CCO applications. The OHA will begin accepting proposals from prospective CCOs in April.
While the final CCO legislation does not include medical liability reform language, it does call for the creation of a Governor-appointed Patient Safety and Defensive Medicine Work Group, which will craft and propose liability reform legislation for the 2013 Legislative Session.
More information about CCOs and the Health System Transformation from the Oregon Health Authority is available at www.health.oregon.gov. Information and analysis from the OMA is available atwww.theOMA.org/transformation.
The Oregon Senate passed SB 1580, the state’s ‘Health System Transformation’ legislation and the implementation vehicle for Coordinated Care Organizations, in a vote of 18-12 on Feb. 14.
The bill moved quickly last week from the Policy committee to the Ways and Means Human Services Subcommittee. Legislators cited a need to pass the bill quickly in order to qualify for Federal grant dollars that will help pay for CCO implementation and to achieve savings in the delivery system that will help mitigate deeper cuts to the Oregon Health Plan. The Subcommittee held two evening public hearings and adopted a set of amendments that include the creation of a Patient Safety and Defensive Medicine Workgroup among other clarifications. The Workgroup is directed to craft and propose liability reform legislation for the 2013 Legislative Session.
On Feb. 10, the Full Ways and Means committee attempted to adopt an amendment to the bill, inserting a delayed version of the Oregon Tort Claims Act (OTCA) that would have covered CCOs. The amendment was intended to act as a “backstop” to force action from the Patient Safety and Defensive Medicine Workgroup. The amendment failed and the bill was sent to the Senate floor.
During the debate on the bill, Sen. Ted Ferrioli (R-John Day) moved to amend the bill on the floor to include the OTCA amendment that had earlier failed in Ways and Means. The amendment failed on a party line vote. Following that motion, Sen. Dave Nelson (R-Pendleton) made a motion to send the bill back to Ways and Means Committee to attempt to add liability reform language. The motion failed, again on a party line vote. After the bill passed the chamber, Sen. Jeff Kruse (R-Roseburg) made an attempt to bring another liability reform bill directly to the floor for a vote. This motion also failed on a party line vote.
During the debate, members discussed a set of memos that had been authored by the Department of Justice and OHSU citing legal concerns with the planned extension of the OTCA over CCOs.
While medical liability reform language was not in the final bill passed in the Senate, the bill does call for the creation of a Governor-appointed Patient Safety and Defensive Medicine Work Group, which would develop liability reform legislation for the 2013 session.
The bill now moves to the House for a floor vote as early as this week.
Join Us for a Free CCO Discussion Webinar Next Tuesday, Feb. 21
OMA General Counsel and Vice President of Health Policy Gwen Dayton, JD, will host an honest discussion on CCOs in Oregon for physicians, PAs, practice managers and other practice staff next Tuesday, Feb. 21 from 11:30 am to 12:30 pm. Discuss the new order of health care in our state, and learn how to better position yourself and integrate your practice within a coordinated care model. This webinar is free to OMA members and their staff; pre-registration is required.
HB 4010, which would require insurers to reimburse nurse practitioners at the same rate as physicians for the same services, was heard on Feb. 3 before the House Health Care Committee. Despite opposing testimony from nine organizations, including the OMA, the bill passed out of committee with a do pass recommendation in a 6-2 vote.
In response, the OMA called on members to contact their state representative urging them to oppose the bill. While this legislation was brought forward to address a legitimate problem: insurance companies’ unexplained reductions in reimbursements to psychiatric mental health nurse practitioners and primary care nurse practitioners, HB 4010 is not the right solution to this problem. Mandating equal pay for all nurse practitioners, regardless of specialty or practice type, as this bill does, will actually increase costs at a time when Oregon is seeking to reduce health care expenditures and will likely exacerbate the state’s physician workforce shortage and further limit access to quality care in many parts of the state.
The OMA and other stakeholders met with many members of the House to discuss the bill, and on Feb. 9, the House voted 33 to 26 on a motion to refer the bill to the House Rules Committee.
Throughout this process, the OMA has met with the sponsors of HB 4010 on behalf of Oregon’s physicians, PAs and medical students and has offered amendments to HB 4010 seeking to rectify the reimbursement rate reduction initiated by commercial insurance companies by reinstating the reimbursement rate at or above the 2009 rates. We will continue to work with lawmakers and stakeholders to find a resolution to this issue that is satisfactory for all.
Governor Kitzhaber has appointed OMA President Carla McKelvey, MD, to the Oregon Health Policy Board. On Feb. 3, the Governor announced his nominees for service on several state boards and commissions. These nominations are subject to Senate confirmation; the Senate Rules Committee will hold confirmation hearings on Feb. 10.
A press release from the Governor's office is available at http://governor.oregon.gov/Gov/media_room/press_releases/p2012/press_020312a.shtml.
On Jan. 24, the Oregon Health Policy Board voted to send their Coordinated Care Organization implementation proposal to state lawmakers for approval. This action is the latest step in Oregon’s health system transformation laid out in HB 3650, which the legislature passed in 2011. Under the legislation, CCOs will be local entities that deliver physical, mental and dental health care to Oregon Health Plan patients. The OHPB proposal lays out the governance, global budget and criteria for coordinated care organizations.
According to third-party analysis, the state could realize substantial cost savings through CCOs, with an estimated $3 billion in savings over five years.
The Oregon legislature must now consider the Board’s proposal for approval in the February session. If approved, CMS will review the CCO plan, and the first CCOs could begin operations by July 2012.
The OMA submitted comments on two rounds of draft CCO proposals, and we appreciate our members taking the time to do the same. Links to the OHPB proposal, OMA analysis and more are available atwww.theOMA.org/transformation.
In mid-December, the Oregon Health Policy Board rolled out a preliminary Coordinated Care Organization proposal based on the recommendations of four workgroups created by HB 3650 to plan different aspects of CCO creation. The 133 governor-appointed members of these work groups, including several OMA members, represent government, the public, insurers, hospitals and physicians from health care sectors and communities across the state. The OHPB’s draft proposal makes preliminary recommendations for the criteria for establishing a Coordinated Care Organization, how it should be governed and how the budget should be established.
The OMA submitted comments on the CCO proposal to legislators and asked members to do the same. We appreciate the input of physicians and PAs who made their voices heard to help shape CCO implementation in their local communities.
At the Jan. 10, 2012 Oregon Health Policy Board meeting, the Board rolled out a revised draft CCO Implementation Proposal, and they’re accepting public comments through Jan. 18, 2012 at 5:00 pm. The revised proposal lays out the governance for Coordinated Care Organizations, the criteria to apply, details of how a global budget will work, and the methodology for the quality metrics that will hold CCOs accountable for better health.
It is important that physicians and PAs make their voices heard during this process and help shape CCO implementation in their local communities. Links to the OHPB proposal, an OMA summary and more are available below. Review the proposal and visit www.oregon.gov/OHA/OHPB/health-reform/get-involved.shtml to submit comments by Jan. 18. Please copy OMA@theOMA.org on any comments you submit to help us keep track of members' comments and concerns.
If approved by state lawmakers, the proposal would be sent to CMS for review and approval. If accepted, the first CCO could potentially begin enrolling clients in the summer of 2012.
More information and resources from the OMA, including a summary and analysis of the draft CCO plan, a transformation timeline and OMA comments to legislative leadership are available at www.theOMA.org/transformation.