Medicaid §1115 Demonstration Waiver
In 1994, CMS approved the state’s §1115 Demonstration Waiver, known as the Oregon Health Plan (OHP) §1115 Demonstration. The driving forces behind the OHP demonstration were: expanding Medicaid eligibility; prioritizing the list of health services; and managed care. (Source: Oregon Demonstration Fact Sheet, 8/30/2013)
In July 2012, CMS approved an amendment to the OHP §1115 Demonstration waiver, extending the demonstration through June 30, 2017; and allowing Oregon to launch Coordinated Care Organizations (CCO’s) in the state’s Medicaid program. CCO’s are managed care entities that operate regionally, with enhanced local governance and provider payment structures promoting transparency and accountability. As of June 2014, Oregon has fifteen coordinated care organizations in operation around the state; and the majority of Oregon Medicaid recipients now receive care through a CCO. (Source: Press Release, link no longer available 5/3/2012; Oregon Demonstration Fact Sheet, 8/30/2013; State Coordinated Care Organization website, link no longer available)
Application for Amendment and Renewal (3/1/2012)
Current Approval Document (7/5/2012)
On August 7, 2014, CMS informed Oregon of several fundamental issues with the state’s CCO rate development process. CMS also proposed a path forward toward approval of the state’s 2014 rates. CMS’ letter indicates that the state must adhere to a number of core Medicaid requirements, including reporting encounter data and ensuring accuracy of the rate-setting process. CMS stated that it is particularly concerned about the methods used to develop the rates for the ACA expansion population, which is 100% Federally funded. (Source: Letter from CMS (8/7/2014)
State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)
In May 2012, Oregon submitted a duals demonstration proposal to CMS for a capitated payment demonstration model. In October 2012, the state decided not to pursue the demonstration because the demonstration was not financially viable for Oregon’s CCO’s and their affiliated Medicare Advantage plans. The state may consider a modified, non-financial alignment demonstration that focuses on CCO delivery system reforms and Medicare/Medicaid administrative alignments. (Source: State Duals Demonstration website, link no longer available; Letter to Coordinated Care Organizations and Stakeholders, link no longer available10/30/2012)
Demonstration Proposal (5/2012)
Section 1915(i) HCBS State Plan Option
As of May 2014, CMS has approved the state’s §1915(i) HCBS State Plan Amendment; and the state is currently participating in the HCBS State Plan Option. (Source: Kaiser HCBS State Plan Option website, 5/2014)
Section 1915(k) Community First Choice Option
On July 1, 2013, CMS approved the state’s Community First Choice Option SPA, known as the K Plan, which will provide the state approximately $100 million to expand person-centered and community-based services for eligible individuals. (Source: Press Release, link no longer available 7/1/ 2013)
State Plan Amendment (7/1/2013)
Health Homes
In March 2012, CMS approved Oregon’s Health Home State Plan Amendment for Health Homes targeting individuals statewide with two chronic conditions; one chronic condition and a risk of developing another; or one serious mental illness. (Source: Kaiser Brief on Medicaid Health Homes for Beneficiaries with Chronic Conditions, 8/2012) Approved Health Home State Plan Amendment, link no longer available (3/13/2012)