April 23 2017
PORTLAND, Oregon - FamilyCare Health is disappointed to report that the Oregon Health Authority's (OHA) rate dispute with FamilyCare is no closer to final resolution. OHA continues to reject FamilyCare's comprehensive settlement proposals for the 2015 and 2016 rates. Additionally, OHA has rejected FamilyCare's offer to resume mediation and conclusively settle the matter in a single-day session. And, contrary to OHA's statements in the press, there is no agreement to resolve 2015 rates on a stand-alone basis.
It is unfortunate that OHA is using termination of FamilyCare's contract as a way to end the lawsuit and force FamilyCare to consent to an unlawful contract amendment. According to Oregon Legislative Counsel, OHA's 2015 contract amendment violates Oregon's law. Combined with FamilyCare's 2016 rates set by OHA, the amendment will reduce FamilyCare's reserve to below minimum requirements.
CMS's stated position is that it will approve any contract that falls within the actuarially approved rate ranges. Despite multiple attempts by FamilyCare to negotiate rates for 2015-2016 that fall within these guidelines, OHA has not budged an inch: OHA will not agree to rates for this period that allow FamilyCare to operate in the black.
Because of OHA intransigence and brinkmanship, FamilyCare has no choice but to protect its members, and its contract rights, in the face of OHA's threat to terminate FamilyCare as of April 5. To that end, FamilyCare has filed a complaint and a motion for a temporary restraining order against OHA to preserve the status quo until a court can review the legality of OHA's claim that FamilyCare has breached and is in default of the 2015 contract and may be terminated.
FamilyCare regrets that it must again take legal action to protect its members. OHA's continuing stubbornness is puzzling, considering FamilyCare's longstanding commitment to healthcare transformation, a fact recognized by providers across the region. In response to these events, one provider has called FamilyCare, "one of the most innovative CCO's in Oregon, and leaders in integrating physical and behavioral health." Another provider sent a letter to Legislators stating: [No insurance company] "...compares with FamilyCare in efficiency, quality, breadth of service, and human compassion. They have provided unparalleled service to their clients and the tax payers of Oregon. They should be the model by which all others are judged."