Portland, Oregon-based nonprofit managed care organization CareOregon is limiting its networks for “non-contracted behavioral health providers.”
On Friday, the organization announced that its Medicaid and Medicare Advantage (MA) members would be required to get routine mental health and substance use disorder treatment from in-network providers.
Further, MA-covered behavioral health services provided by non-contracted providers will be subject to limitations after the end of the year, according to the announcement from CareOregon.
“We are navigating an incredibly challenging financial environment driven by the rising costs of health care and anticipated challenges to Medicaid funding. We must do more with less,” the announcement states. “With a smaller network of providers, we can streamline administrative management and focus on delivering high-quality care to our members. This change is also in line with industry standards.”
Specifically, the following services will be impacted:
— Individual, family & group therapy
— Skills trainings
— Case management
— Prescriber evaluation and management services
CareOregon specified that services such as applied behavior analysis (ABA), day treatment, partial hospitalization and intensive outpatient programing (PHP and IOP) and several other services would not be impacted by the new out-of-network mandate.
CareOregon maintains that its present network has the capacity to serve all impact members. The organization operates two distinct entities within the Oregon Medicaid program: Jackson Care Connect and Columbia Pacific. Its Medicare entity is called CareOregon Advantage.
The Portland Business Journal reports that CareOregon is the largest managed care organization within the state’s Medicaid program and announced the elimination of 150 filled and vacant roles to stem losses and prep for coming challenges in implementing changes to the Medicaid program.
The Journal further reports that out-of-network providers were paid 40% to 95% more than contracted providers and that the move reestablishes a pre-COVID era policy.
