What is happening?
Over the next year or so, people served by the Oregon Health Plan will get care through a new type of health care organization. The new groups are called Coordinated care organizations (CCOs). They are being formed by existing health plans and groups in local communities.
When it's happening
The change to coordinated care organizations is not happening everywhere at once. The first CCOs started in August, 2012. OHP clients are moving into CCOs as they are created in local communities.
If you are served by the Oregon Health Plan and are moving into a coordinated care organization, you will receive mail notifications from the Oregon Health Authority in advance.
Your Oregon Health Plan benefits will not change.
You will have the same benefits you do today.
What you should do and when you will learn more
You do not have to do anything. This change will happen automatically. Your medical ID will stay the same.
You will get a letter before any change happens. The notice will tell you the effective date and the name of your new organization. You will also get a second notice from the Oregon Health Authority when the change has happened. And you will also receive information from your new coordinated care organization.
There will be no break in your care
Most providers will be part of your Coordinated Care Organization. It is likely that you can still see your current provider under the new plan. And you will have the same benefits you do today. But some providers may not be covered under the new plan. We will work with you so there is no break in your care.
Why this change is happening
Most OHP members, including open card clients, are moving into coordinated care organizations. CCOs are set up so that anyone who provides your care — doctors, nurses, counselors — can focus on prevention and improving care.
Instead of just treating you when you get sick, they can work with you to keep you healthy and help you manage existing health conditions.
For example, there may be added services for OHP clients who have chronic conditions like diabetes, asthma or other health needs. CCOs can also help prevent unnecessary trips to the hospital or emergency room.
- CCOs will offer more team-based care
- They can better share information to avoid repeat or unnecessary testing
- You will get the tools and support you need to stay healthy
- Your care and the advice you get will be easy to understand and follow
- CCOs will help all of your providers work together to improve your health and health care
"Open card" clients
Clients with an "open card" are those not in a health plan now. Most open card clients will be automatically enrolled in a CCO by November 1, 2012 for physical and addictions and mental health care.
Some communities have more than one coordinated care organization. Clients may choose a different CCO based on the ZIP code service area where you live. You may want to talk to your doctor or other providers to find out which CCO he or she works with. Here is the list of organizations for each Oregon county.
If you would like to change your enrollment to a different CCO, you can do so for up to 30 days after you are moved into a CCO. Call the Oregon Health Authority at 1-855-226-6170 to make the change or if you have any questions at all.
"Open card" clients with special health needs
If you have special health needs and you won’t be moved to a CCO automatically on November 1, 2012.
This includes people enrolled in Disease Management or Care Coordination programs. Others include people in in breast or cervical cancer treatment and those who receive services for HIV/AIDs through CareASSIST, people with end stage renal disease, and medically fragile children.
Individuals with special health needs will move to a CCO when a safe transition plan is in place for their particular needs. The CCO they move to will be notified of that member’s care needs (including prior authorized services, prescriptions, equipment, providers and specialists) so they are prepared to facilitate care coordination.
In addition, The Oregon Health Plan and CCOs will work with special needs members individually through care conferences to ensure a smooth transition if needed.
If you have special health needs and have questions about coordinated care organizations, please call the Oregon Health Authority at 1-855-226-6170.
People who will not change plans
- Tribal members who do not wish to be enrolled in a health plan
- People who have both Medicare and Medicaid coverage and do not wish to be enrolled in the new plans
- People who are also covered through an individual, entity, insurance, or other program that is responsible to pay for health care services (known as third-party liability clients)
- Pregnant women who request a third-trimester exemption. This option is available to pregnant OHP clients until January 2013
American Indians and Alaska Natives
If you are an American Indian or an Alaska Native you are not required to move into the Coordinated Care Organization. You may ask to change your enrollment at any time by calling 1-855-226-6170.
Medicare benefits and coverage will not change because of Coordinated Care Organizations.
Clients new to the Oregon Health Plan
Children and adults who join the Oregon Health Plan after August 1, 2012 will be enrolled automatically in a coordinated care organization. If more than one CCO is available, you may choose which one you want to join.
If you have any additional questions, please call us. We want to make sure that you have the information you need.
Call the help line for questions about plan changes or CCOs: 1-855-226-6170. Let us know if you need information in another language or format, such as large print, Braille, audio recordings, web-based communications, or other electronic formats.