Office of Inspector General’s Audit of CCO Compliance
The U.S. Department of Health & Human Services Office of Inspector General (OIG) interviewed four of Oregon’s 15 CCOs and audited their compliance with federal Medicaid managed care regulations for calendar years 2016 and 2017. The Oregon Health Authority (OHA) agreed with the audit’s findings. As noted in the response, the agency has made changes to program oversight and through its CCO 2.0 contracts that address the audit’s compliance concerns.
External Quality Review
The Oregon Health Authority contracts with an external quality review organization (EQRO) to perform external quality review of the Medicaid managed care services delivered to Oregon Health Plan members. These annual reports are listed below.
Corrective Action Plans
When a CCO is found to be out of compliance with state or federal requirements, the Oregon Health Authority issues a notice of noncompliance. The CCO must develop and implement a corrective action plan to correct the issues outlined in the notice of noncompliance.
- Trillium Community Health Plan:
Initial notice (Aug. 14, 2020);
- Health Share of Oregon: Initial notice related to non-emergent medical transportation services, issued October 14, 2019
- Cascade Health Alliance:
Initial notice related to Hepatitis C treatment, issued May 20, 2019; with recent findings issued August 27, 2019