The Oregon Health Authority has finalized the 2021 capitation rates for coordinated care organizations (CCOs). These rates are the per-member-per-month amounts the state pays CCOs to coordinate health care for Oregonians who are members of the Oregon Health Plan (OHP). The rate increase represents a 3.4% rate of growth for 2021.
“As this public health emergency wears on, we are working to ensure we have the necessary funding to provide quality care to more than 1.2 million Oregonians,” said David Baden, OHA chief financial officer. “Improving care while controlling costs is as important as ever, as more of our neighbors need access to health coverage through the Oregon Health Plan.”
The average net payment in 2021 is $467, which is approximately 3.4% more than the comparable average per-member-per-month payment in 2020.
Due to the passage of HB 2267 in the Legislature’s 2019 session, 2020 rates were recalculated this summer and were applied retroactively to January 2020. The recalculation accounts for changes to CCO member enrollment during the transition from 2019 to 2020 contracts, as well as the unexpected increase in the OHP population due to the public health emergency and the limits the federal government put on Medicaid disenrollment.
There are 12 rate categories for CCOs, which take into account the average cost for members in these specific categories. For example, the state pays CCOs more for members who have disabilities than it does for children because members with disabilities generally have higher health care costs. The rates are also based on average provider rate costs in each region.
A full breakdown of final amended 2021 CCO rates can be found on OHA’s website.