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2020 coordinated care organization changes for providers

  Get provider updates and resources about 2020 CCO changes by text or email

What is changing?

Changes are coming to the Oregon Health Plan in 2020. Based on the CCO 2.0 contract awards, providers will see the following changes to CCO service areas. For an overview of CCO coverage in 2020, view the service area map.

New CCOs and 2020 provider network changes:

  • PacificSource Community Solutions will serve members in Lane, Polk and Marion counties starting Jan. 1, 2020.
  • Trillium Community Health Plan will serve Multnomah, Clackamas and Washington counties no sooner than Apr. 1, 2020.

On Nov. 12, 2019, OHA announced that members in Clackamas, Multnomah, Washington, Jackson and Lane counties will be reassigned to different CCOs on Jan. 1, 2020, due to provider network changes.

  • Clackamas, Multnomah and Washington counties: Trillium Community Health Plan does not have a 2020 contract with any Portland-area hospitals, so Health Share of Oregon members will stay with Health Share for 2020. Trillium will be ineligible to enroll members in these counties until at least Apr. 1, 2020.
  • Jackson County: Members have been matched with the CCO that works their current providers. This means some AllCare CCO members will move to Jackson Care Connect to preserve their current relationships with Primecare medical providers. AllCare CCO does not have a 2020 contract with Primecare.
  • Lane County: Trillium Community Health Plan does not have a 2020 contract with PeaceHealth clinics and Oregon Medical Group, so members who use these providers for primary care will move to PacificSource Community Solutions for 2020.

OHA will notify all affected members of these changes in mid-December.

Special populations and CCO closures:

The following special populations will not need to choose a 2020 plan, unless their plan is closing and there is more than one plan choice in their area:

  • Members who are dually eligible for Medicare and Medicaid 
  • Members enrolled with the Office of Developmental Disability Services
  • Children and youth enrolled in Child Welfare programs
  • Children and youth enrolled in Oregon Youth Authority programs

CCO closures:

  • PrimaryHealth will no longer serve Josephine, Jackson and Douglas counties.
  • Willamette Valley Community Health will no longer serve Marion, Polk, Linn, Benton, Yamhill and Clackamas counties.

In November, OHA informed PrimaryHealth and WVCH members of the closures and their new CCO for 2020.

Benefits and covered services

Benefits and covered services will remain the same. Each CCO’s specific policies may differ, but coverage must include all benefits defined in the Oregon Health Plan benefit package and cover these benefits for funded conditions on or above Line 469 of the Prioritized List of Health Services.

Contact the CCO to learn about each CCO's specific coverage policies and procedures.

Continuity of care

Starting Jan. 1, 2020:

  • CCOs will honor all existing service authorizations (physical, oral, behavioral health and prescription drugs) from the member’s 2019 CCO for up to six months.
  • Members will be able to see their current primary care provider for up to 90 days.
  • Members will be able to see their current behavioral health provider for up to 180 days.

This is true even if the member’s current providers do not join the network of the member’s new CCO for 2020.

Read OHA's fact sheet about continuity of care»

What providers can do

Your patients may start asking which CCOs you will be working with next year. Members in areas with changes to their CCO choices got a letter with the CCO choices in mid-October. The "Pick Your Plan" choice period ended Nov. 17, but members in choice areas can still choose a different CCO from Jan. 1 to Mar. 31, 2020.

View the slides from OHA's Nov. 21 provider webinar»

Supporting member choice

We have received questions from providers who are in areas where OHP members are likely to be served by multiple CCOs. Providers have asked how to respond to OHP members seeking guidance on how to make their CCO selection:

  • Do: Let OHP members know which CCOs you work with so they can make their choice prior to Nov. 17 (and between Jan. 1, 2020 and Mar. 31, 2020). 
  • Don’t: Encourage OHP members to sign up with a specific CCO. OHP members will weigh a variety of factors in making their selections, including other provider relationships. Any provider communications intended to encourage members to sign up with a specific CCO must be reviewed by the CCO and if needed, by OHA. To learn more, read our fact sheet.
  • Do: Encourage members to learn about their choices and get help by calling the dedicated Pick Your Plan phone line at 877-647-0027 (TTY 711) or from a local community partner organization. You can review all the information members have received at our “Pick Your Plan” website.

Continuing care

Starting Jan. 1, 2020, please be sure to continue serving all OHP members, regardless of their specific CCO enrollment.

Read OHA's fact sheet about continuity of care»

Engaging your local CCOs

Contact the CCO to ask about their:

  • Provider enrollment/credentialing requirements and timelines
  • Billing, authorization and coverage policies and procedures
  • Point of sale, billing, eligibility and other electronic health care transactions
  • Other requirements such as reporting and member notification

Credentialing information

To learn about each CCO’s credentialing and provider participation requirements, contact the CCO.

Areas with new CCOs:

CCOs in other areas currently served by PrimaryHealth and WVCH:

 

Resources

Member resources:

 

Provider resources:

Nov. 21 webinar

Fact sheets

Sample member letters

Communications toolkit

Quick links

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