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Quality Assurance & Contract Oversight

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.

  
2020 EQR Technical Report
2019 EQR Technical Report
2018 EQR Technical Report
2017 EQR Technical Report
2016 EQR Technical Report
2015 EQR Technical Report
2014 EQR Technical Report
2013 EQR Technical Report

CCO and DCO evaluations

The Oregon Health Authority also requests other evaluations as needed to determine compliance with state and federal requirements.

  
2020 CCO Behavioral Health Report - Measures of Behavioral Health Service Delivery
2020 CCO Delivery System Network Evaluation
2020 Dental - DCO Delivery System Network Evaluation
2019 CCO Delivery System Network Evaluation
2017 CCO Delivery Systems Network Capacity Report

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.

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