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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 starting January 1, 2020. For an overview of CCO coverage in 2020, view the service area map.

New CCOs:

  • PacificSource Community Solutions to add CCOs in Lane, Polk and Marion counties.
  • Trillium Community Health Plan to start service in Multnomah, Clackamas and Washington counties.

OHA is informing members in these counties about the new CCOs coming to their area, and how to choose the CCO that works best for them.

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.

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 January 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 will get a mailing from OHA in mid-September and a letter with the CCO choices in mid-October. Members will have two opportunities to make decisions about which CCO works best for them:

  1. From October 16 to November 17, and
  2. From January 1 to March 31.

Let your patients know which CCOs you work with so they can make a choice by November 17.

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 November 17 (and between January 1, 2020 and March 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. 
  • 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 January 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 in 2020:

CCOs in other areas currently served by PrimaryHealth and WVCH:

 

Resources

Member resources:

 

Provider resources:

Fact sheets

Sample member letters

Communications toolkit

Quick links

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