Jeff Heatherington finds himself confronted by some of the same coordinated care organizations he brought together under the Coalition for a Healthy Oregon as its founder and former chairman. Now two of its members are eager to take over his territory in Marion County -- Trillium Community Health Plan and Willamette Valley Community Health. .And those are the same CCOs that Heatherington asked to object to the Oregon Health Authority's decision to call for new letters of intent.
After Heatherington refused to sign the 2015 contract amendment with the Health Authority, claiming he would not return the $55 million in supposed overpayments, and hadn’t indicated whether he’d sign the 2016 contract, which now he says he will, Lynne Saxton took preemptive action, asking the other 15 CCOs if they were interested in filling the gap left by FamilyCare, which has 128,000 members in Multnomah, Clackamas, Washington and Marion counties.
Six CCOs jumped at the chance – sending binding letters of intent on Wednesday – PacificSource, Trillium, Health Share, Willamette Valley Community Health, Eastern Oregon CCO and Columbia Pacific CCO.
The Health Authority insisted it was only taking a “precautionary step to ensure continuity of coverage," and it’s unknown whether the agency will move forward with its emergency plan.
In the latest developments, meanwhile, the Legislative Counsel appears to have sided with Heatherington about the Health Authority’s demand that he return the $55 million in overpayments in a legal opinion following a request by Sen. Chip Shields, D-Portland.
That opinion could also affect the clawback the Oregon Health Authority demanded of several other CCOs, including All-Care Health Plan, Umpqua Health Alliance and Jackson Care Connect, which is administered by CareOregon.
The Health Authority does not have the statutory authority to reclaim those dollars, according to Dexter Johnson, legal counsel. “However,” he wrote, “these questions may be at issue in pending litigation between FamilyCare and the OHA, and facts or arguments may be revealed during the course of that litigation that might lead a court to a different conclusion.”
Johnson's opinion does leave open the possibility that the Legislature could require FamilyCare to return those dollars.
In response, Heatherington said in a written statement, “This opinion follows the same legal reasoning our attorneys gave us in the first place. We hope the OHA will do the right thing and give the funds back to the CCOs who did sign the amendment.”
The FamilyCare litigation referenced in the opinion is not related to the retroactive payments, according to Cindy Becker, vice president of community and government relations, who told The Lund Report, “Our suit was filed in May and we were notified about the retroactive payments in August.”
Diane can be reached at [email protected].
