Driven by concerns for the rising cost of medical care and the growing number of people remaining uninsured, the Oregon legislature passed a series of laws from 1989 through 1993 which came to be known collectively as the Oregon Health Plan (OHP). Fueled by a federal Medicaid waiver, eligibility for the OHP has more than doubled since 1994. In May 1995, chemical dependency treatment was included in the OHP benefit for all Medicaid-eligible citizens. Since that time, twelve to fifteen pre-paid health plans have received state substance abuse agency approval to serve as managed care organizations (MCOs), administering the chemical dependency benefit to the Medicaid population across the state. The current study is both a qualitative and quantitative investigation of the evolution of policies, procedures and services of the state-approved MCOs over the past five years in Oregon. Extant data available from state agencies evidences a significant increase in participation in treatment , with significant differences across Medicaid eligibility categories and managed care organizations. Key variations in pre-authorization, utilization monitoring, risk-sharing and reimbursement procedures with treatment providers across the state are highlighted. Their impact on penetration rates and service patterns of these MCOs are discussed.
Learning Objectives: 1. Participants will learn about the different operating characteristics that managed care organizations (MCOs) employ to manage the chemical dependency benefit of the Oregon Health Plan (OHP). 2. Participants will learn about OHP managed care organization's financial arrangements, risk sharing mechnaisms, and other managment techniques with treatment providers and how these mechanisms may create the differences found in chemical dependency treatment rates of OHP recipients among the different MCOs
Keywords: Managed Care, Substance Abuse Treatment
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.