2020 Important updates about CCO 2.0 and Health Share

IMPORTANT NOTE: Changes related to CCO 2.0 and Health Share’s re-structure DO NOT AFFECT our Medicare patients. Please see more information below.

Frequently asked questions

Download an overview of this information

Q: I heard Health Share is making some changes to its physical health plan partners. What does this mean for OHP members in the tri-county region?

A: All of the Health Share partners have been working closely to create a community-based CCO model that is prepared to further the CCO 2.0 goals put forth by Governor Brown and the OHA. Starting on January 1, 2020, Health Share is streamlining its health service offerings under five plans. A member’s provider network will depend on which plan they’re assigned to. Plan options are:

  • OHSU Health
  • Legacy-PacificSource
  • Kaiser Permanente
  • Providence Health & Services
  • CareOregon
Plan Name  Members will have access to primary care providers at:
OHSU Health  OHSU, Adventist or Tuality’s Provider network (some members will be assigned to Virginia Garcia and Hillsboro Pediatrics through the
OHSU Health network)
Legacy-PacificSource  Legacy Medical Group
 Kaiser Permanente  Kaiser Permanente
 
Providence Health & Services 
Providence Medical Group (approximately half of Children’s Health Alliance members will be assigned to Providence)
 
CareOregon 
Any provider group that is currently in the CareOregon network, including community-based, FQHCs and other provider groups such as Childrenregon network, including’s Health Alliance (approximately half of members). It will specifically exclude the PCP services now on the OHSU Health, Legacy-PacificSource, Kaiser Permanente and Providence Medical Group network. (Health Share is also contracting with CareOregon to manage the dental, specialty behavioral health and NEMT benefits)

Q: What does this mean for OHP members?

A: Members will be assigned to their physical health plans based on their current primary care providers. The primary objective is to ensure patient safety and to maintain continuity of care. Except as noted above, all of the members assigned to primary care physicians associated with FQHCs and Children’s Health Alliance will be assigned to CareOregon. All members assigned to primary care providers associated with one of the other health plans will be assigned to that plan.

For example, if a member is currently assigned to a Legacy primary care physician under a CareOregon contract, in 2020, they will be assigned to Legacy. If a member is currently assigned to Virginia Garcia through Providence, that member will be assigned to Virginia Garcia through CareOregon in 2020. If members are not engaged with a primary care provider, they will be assigned to one of the plans based on the same algorithm Health Share uses today.

Q: How will members know which plans they have been assigned to and what to do if they want to make changes?

A: Health Share is beginning to send out member handbooks and temporary member IDs cards the week of November 18. The cards will indicate the member’s physical health plan, primary care provider and dental plan assignment. It will also show CareOregon as the contact for all mental health and substance use disorder treatment benefit questions. The assignments are effective January 1, 2020.

If members want to switch their physical or dental health plans, they can do that by calling Health Share Customer Service at 503-416-8090 or toll-free 888-519-3845.

Q: How will this impact physical health specialists?

A: CareOregon’s specialist network will not change. We will continue to contract with specialty providers from OHSU, Legacy, and Providence. However, in order for specialty providers to care for members assigned to OHSU Health and Legacy-PacificSource, they will need to contract with those organizations. Call the provider relations teams at OHSU and Legacy-PacificSource for more information.

To ensure there is no disruption in service for members and payment to providers, all of the health plan partners will honor existing service authorizations: 90 days for physical health and pharmacy and 180 days for specialty behavioral health services.

Q: What’s changing with the member’s mental health and substance use disorder treatment benefits?

A: Health Share is delegating the management of these benefits to CareOregon. However, CareOregon is continuing to contract with the same specialty behavioral health network of providers to ensure continuity on January 1, 2020. Members will continue to have access to the same providers they see today.

  • Starting December 18th, 2019, CareOregon will begin the processing of specialty behavioral health authorizations, grievances and appeals for the Heath Share members within CIM. The process will occur the same as it does today until January 1, 2020. Check out the behavioral health landing page on our website for more information: careoregon.org/bhproviders
  • Beginning on January 1, 2020, members and providers will call CareOregon instead of the counties for all questions related to their mental health and substance use disorder treatment benefits.

Providers can contact our Provider Relations team at 503-416-4100 and press 3 for provider.
Members can reach our Customer Service team at 503-416-4100 or toll-free 800-224-4840.

Q: What’s changing with the member’s dental health benefits?

A: Health Share is delegating the management of these benefits to CareOregon. However, CareOregon is continuing to contract with the same five dental plans. Members will continue to have access to the same providers they see today.

  • Starting January 1, 2020, CareOregon will manage the dental benefit on behalf of Health Share. CareOregon will continue to work with the same five dental plans that Health Share works with today:
    • Advantage Dental Services
    • CareOregon Dental
    • Kaiser Permanente
    • ODS
    • Willamette Dental Group
  • Members engaged in dental care will keep their current dental plan and provider. Members who are not engaged with a dental provider, may be assigned to a different dental plan based on their physical plan assignment — to further align services for better member experience
  • Members will continue to call Health Share to change their dental plan and will continue to call their dental plan with questions related to their dental benefits and provider.

Q: What is changing with non-emergent medical transportation (NEMT) services

A: Starting in 2020, Health Share will phase in a new model for its NEMT benefits. The goal is to improve the service delivery for members. Under the new model, Health Share will delegate responsibility to administer the NEMT benefit to CareOregon, who will manage sub-contractors to deliver services.

Ride to Care will continue to be the name of the program, and members and providers will call the same number as they do today to request transportation options. The benefit itself (the NEMT services that OHP enrollees are entitled to, as defined by OHP rules) will not change. CareOregon plans to stabilize the program to provide greater member access to services and a more reliable transportation experience.

Members can contact Ride to Care at 503-416-3955, Toll-free: 855-321-4899 or online at ridetocare.com

Q: How will these changes with Health Share assignments affect our Medicare/dual patients?

A: These changes will NOT affect Medicare/dual patients. The Health Share restructure is for OHP/Medicaid only. There are no changes to a Medicare member’s PCP or their Medicare plan. This means that our CareOregon Advantage (Medicare) members with Legacy, Providence, or OHSU PCPs will still remain with those PCPs. Health Share will then assign the secondary Medicaid/OHP plan to align with the primary Medicare coverage to create a more integrated, seamless system of care for our dual members.

If you have questions about your ability to see CareOregon Advantage patients, please contact our Provider Relations team at 503-416-4100 and press 3 for provider.