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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

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.

  • Columbia Pacific CCO

    • Feb. 16, 2022 Initial notice related to Intensive In-Home Behavioral Health Treatment (IIBHT)

  • Jackson Care Connect

    • Feb. 16, 2022 Initial notice related to Intensive In-Home Behavioral Health Treatment (IIBHT)

  • Health Share of Oregon

    • Oct. 19, 2019 Initial notice related to non-emergent medical transportation services
    • Feb. 16, 2022 Initial notice related to Intensive In-Home Behavioral Health Treatment (IIBHT)

  • Trillium Community Health Plan

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 January 2024.

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. 

Oregon is changing its rules for time and distance to providers. Learn more about proposed change and how to give your feedback on the Time and Distance Rules page.

Model Member Handbook

The Quality Assurance team creates a handbook template for CCOs to use called the Model Member Handbook. The model handbook and the handbook evaluation criteria is updated every year in June.

Learn more about the Model Member Handbook.

CCO Contract Deliverables

​The CCO Quality Assurance team is coordinating efforts to examine CCO Contract Deliverables and find opportunities to reduce administrative burden, reduce duplication, and improve the overall process.

Part of these efforts included surveying CCO and OHA staff about their experiences and their opinions regarding restructuring deliverables.

CCO Contract Deliverables Portal

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.