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CCO Quality Assurance

About Quality Assurance

Quality Assurance (QA) is a continuous cycle of evaluation. To achieve this, we must:

  • Assess or evaluate quality using a variety of data sources
  • Identify problems or shortcomings in the delivery system
  • Make recommendations to overcome these deficiencies
  • Monitor to ensure the effectiveness of the corrective steps
Health System Division's CCO Quality Assurance team is focused on compliance specifically related to the federal regulations, managed care requirements, Oregon Administrative Rules (OARs) and our CCO Contracts.
Questions? Please contact HSD.QualityAssurance@odhsoha.oregon.gov.

Projects & Activities


Oregon's Medicaid Quality Strategy
Learn more about how Oregon monitors its coordinated care model and its goals of access, equity, quality and outcome improvement in the health care delivery system.
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.

  • Health Share of Oregon

    • Oct. 19, 2019 Initial notice related to non-emergent medical transportation services


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.

Grievance and Appeal System

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

Legislative reports

Notice templates

​Member Materials

For general guidance, please see the Material Submissions and Reviews page.

NOABD, NOAR templates

Please see templates below for Notice of Adverse Benefit Determination and Notice of Appeal Resolution. These templates were updated in September 2022.

Notice Workgroup



Network Adequacy

​OHA works to develop Network Adequacy Standards that are in alignment with 42 CFR 438.68(c), 42 CFR 438.206 and 438.207, OAR 410-141-3515, and Exhibit G in the CCO Contract. 



External Quality Reports

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.

  • OHA's EQRO is Health Services Advisory Group (HSAG). HSAG helps determine the Managed Care Entities' compliance with federal (42 CFR 438) and state requirements related to access, structure and operations, and quality measurement and improvement.
  • 42 CFR §438.358 identifies mandatory and optional EQR activities to be performed.