FamilyCare Update for Providers

As you are probably aware, FamilyCare Health has decided not to renew its CCO contract for 2018. FamilyCare has agreed to extend its contract through January 2018, to allow for a 30-day transition period. During this time, the Oregon Health Authority will begin to transition FamilyCare members to Health Share of Oregon, Yamhill Community Care Organization and Willamette Valley Community Health.

CareOregon and our CCO partners have been working closely with the Oregon Health Authority to ensure this is a smooth transition for those who will soon become our newest members. For these members, new CCO coverage will begin February 1, 2018 or earlier.

The safety and well-being of members are our top priorities. Please encourage members to keep all previously scheduled health care appointments with you, and you should continue to provide all covered services to FamilyCare members through January 31, 2018.

CareOregon will honor FamilyCare’s prior authorizations and prescriptions from the time these members join CareOregon up to 90 days (through April 2018) to confirm a successful transition. If you have a current contract with CareOregon, your existing contract terms will apply to services for the new Health Share/CareOregon and Yamhill Community Care Organization members transitioning to us. For those providers not yet contracted with CareOregon, claims will be accepted and processed at Non Par rates until contracting is complete.

For behavioral health services, Health Share will honor prior authorizations and out-of-network providers under Health Share’s contract terms for a minimum of 180 days with potential extension to ensure appropriate care coordination and continuity.

There has been some confusion about how those who qualify for both Medicare and enrolled in Oregon Health Plan (Medicaid) with FamilyCare’s CCO fit into the transition plan, scheduled to take place February 1, 2018. In this scenario, these members may have Original Medicare or FamilyCare Community HMO SNP as primary coverage with Medicaid as secondary.

Authorization rules under Medicare fall under CMS guidelines and are quite different from OHP guidelines so we are unable to include these members in the CCO transition extension. As a result, these Medicare beneficiaries will not be eligible for a 90/180-day extension and will need to submit new prior authorizations for services and/or prescriptions (if applicable) to CareOregon Advantage should they choose to move to CareOregon Advantage Plus HMO-POS SNP.

Health Share will work with CareOregon and other health plan partners to assign the members, making the relationship between the PCP and the member a priority. Also, our clinical teams are working to identify ways to help manage the transition for the members at highest risk, and we will stay in close contact with you to ensure members are not negatively affected during this transition period.

As always, we appreciate your patience and commitment to serving OHP members. If you are interested in learning more about contracting with CareOregon or have other questions, please contact our Provider Customer Service team at 1-800-224-4840 or 503-416-4100. If you need care management support, please contact our Exceptional Needs Care Coordination team at 503-416-8055.

We will continue to keep you updated as more information is available.