The Oregon Health Authority has finalized the 2022 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). In 2022, the rates will be 4.2% higher than in 2021.
The rate increase for 2022 begins with the legislatively budgeted 3.4 percent baseline growth rate combined with additional funding for a program enhancement (+0.8 percent) to improve service delivery for members with substance use disorders, resulting in a 4.2 percent total growth for 2022 from 2021.The program enhancement is related to an approved 1115 Demonstration waiver regarding substance use disorders, which was effective April 8, 2021.
The waiver allows OHA to expand the continuum of care for people with substance use disorders, including access to care. Other improvements include outreach, initiation, and treatment and recovery. At a critical time during the pandemic, this expansion reduces the use of emergency departments and inpatient hospital settings for treatment. Among the many benefits the SUD waiver offers, housing support services are included in the treatment care plan. For more information, please click here.
The pandemic has impacted Oregon’s healthcare system and this impact is expected to continue, particularly in behavioral health service needs (substance use and mental health). Behavioral health annual trends have typically been around 2.5% – 3.0% year-over-year increases in the capitation rates; however, because of increased prevalence related to the pandemic, it has now increased to 3.0 % – 3.5% for 2022 capitation rates. The 0.5% increase in annual trend is being driven by an anticipated 15%-20% increase in prevalence of behavioral health disorders.
“The 2022 base rate increase with the addition of funding for services relating to substance use disorders represents an investment by OHA, the legislature and the Governor to support our members and the CCOs that serve them. These rates continue to meet our financial targets to keep Medicaid costs down, while helping us accomplish our vision to achieve health equity by improving access to services for everyone who needs them and to help them sustain long-term recovery,” said Oregon Health Authority CFO David Baden.
The average net per-member per-month payment in 2022 will be $485.84, which is approximately 4.2 percent more than the comparable average per-member-per-month payment in 2021.
There are 12 rate categories for CCOs, which take into account the average cost for members in these specific categories. To learn more about those categories, click here to review the full 2022 capitation rate certification. Rates are also based on average provider rate costs in each region.
A full breakdown of final amended 2022 CCO rates can be found on OHA’s website.