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Reports and Findings

External Quality Reports

States that use Medicaid managed care must have an external quality review organization (EQRO) determine the state's Managed Care Entities' compliance with federal and state requirements related to:

  • Member access to care, 
  • Managed care structure and operations, and 
  • Quality measurement and improvement.

Health Services Advisory Group, is Oregon's EQRO. 42 CFR §438.358 identifies mandatory and optional activities the EQRO may perform.

Other Reports

​​The CCO Operational Snapshot Report (April 2025) provides insight into five topics of focus: 

  • Access to care, 
  • Service delivery, 
  • Member rights and health equity, 
  • Program integrity, and 
  • Financial performance.  

The report shows where development is needed. It is not a comprehensive review of CCO performance or part of the CCO procurement process. 

Individual CCO profiles from the CCO Operational Snapshot are below.

​When a CCO is found to be out of compliance with state or federal requirements, OHA 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.

Co​​​lumbia Pacific CCO

  • Feb. 16, 2023 Initial ​notice related to Intensive In-Home Behavioral Health Treatment (IIBHT)

Jackson C​are Connect

  • Feb. 16, 2023 Initial notice related to Intensive In-Home Behavioral Health Treatment (IIBHT)

Health Share of Or​egon

  • Oct. 19, 2019 Initial notice related to non-emergent medical transportation services
  • Feb. 16, 2023 Initial notice related to Intensive In-Home Behavioral Health Treatment (IIBHT)
  • Feb. 7, 2025 Initial notice related to Fraud, Waste, and Abuse noncompliance.

Trillium Community Hea​​lth Plan

Cascade Hea​​​lth Alliance

​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. OHA agreed with the 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.

House Bill 2517 (2021) requires OHA to post annual compilations of CCO-reported information about prior authorizations received. This report contains aggregate CCO data, including:
  • Total PA requests received, 
  • Total requests initially denied and the reasons for the denials, and
  • Total denials reversed on appeal. 

View the reports:

All Grievance and Appeal System​ evaluation criteria and templates are posted on the CCO Contract Forms page.