As you may/may not have heard, FamilyCare has decided not to accept a contract with the Oregon Health Authority, as the current contract offer would bankrupt FamilyCare by June.
As of today, FamilyCare has agreed to stay open through 1/31/2018 to help clients transfer to other OHP “CCOs” and transition their care. There is still a tiny, tiny, chance that ongoing demands to Tina Kotek and Paul Courtney may push the legislature into a special session to intervene and keep FamilyCare alive. If you would like to advocate, do it TODAY by calling:
- Tina Kotek (Speaker of the House) (503) 449-9767
- Peter Courtney (Senate President) (503) 986-1600
- Tawna Sanchez (State Representative) (503) 986-1443
- Lew Frederick (State Senator) (503) 986-1722
Ask them to convene the legislature for a special one day session to come in and fix the rates in the FamilyCare contract. #specialsession.
What Does This Mean?
All people with FamilyCare insurance will no longer have that CCO as of 1/31/18—they have extended their close date by 1 month to help clients and providers transition. Clients WILL retain their OHP coverage.
What Is A CCO?
CCOs are the managing organizations of OHP funds. FamilyCare covered mental, medical, and dental health under one umbrella. Other CCOs split management between mental and medical health. HealthShare is the other major metro CCO and manages mental health. CareOregon, Kaiser, Providence, and Tuality are medical CCOs that work in collaboration with HealthShare. Rural CCOs (Yamhill, Columbia, etc) often split the management too. OpenCard is the actual state (Oregon Health Authority) that manages a small pool of funds.
How Do I Get A New CCO?
Most people will be automatically transferred to a new CCO, such as HealthShare/CareOregon, or OpenCard. You may also contact OHP member services yourself at (800) 273-0557 and request to be switched to CareOregon. CareOregon is the only other Medicaid CCO that contracts with independent clinics like Hands On Medicine.
Do I Get To Keep Seeing My Providers?
You will be able to keep seeing your Primary Care Provider. We are also working as fast as we can to contract our behavioral health providers with HealthShare so that you can continue to see your behavioral health provider. OHA has provided all behavioral health providers already seeing FamilyCare patients a 180 day extension, so we hope HealthShare will have your behavioral health providers contracted by that time.
What Will This Change Affect?
- Surgery or Medical Procedure Referrals: If you’re waiting for a surgery or procedure, call those providers to tell them that you have requested a new CCO. They may have to resubmit authorizations for upcoming surgeries or procedures, which may create a delay in care. This is especially relevant to people with a consult or surgery in January or February.
- Prescriptions: Your prescriber/pharmacy will need to submit prescriptions to the new CCO, which may create a delay. Try to get a refill before 1/31 if you can.
- Mental Health: HealthShare currently contracts mostly with community mental health providers, who practice under a “case rate” contract. This means that you have fewer options of providers, and they are required to provide time-limited therapy, with only a certain number of visits allowed. You may experience a delay in getting in with a provider.
- Dental: FamilyCare contracts with all of the same DCOs that Health Share does (including CareOregon Dental), so there should be no disruption to dental care providers.
- Other Services: you may be told you’re not eligible for medical transport, pharmacies, language interpretation, or other services that bill insurance. If this happens, inform them that you have a new CCO and ask them to search for your coverage. This should help them update and cover your care.
My Provider Isn’t Contracted With Other CCOs. How Can They Get Contracted?
Please know that many providers are working hard to get contracted with other CCOs, and the CCOs are determining how to absorb the increase in clients. If you would like to advocate for your provider, call the member services number of HealthShare at (503) 416-8090. Tell them that your behavioral health provider is a specialist and provides high quality care, and should be contracted with their CCO. You can share how a transition in provider will disrupt your care if you desire.