Salem Hospital in Oregon Sues Local Coordinated Care Organization
Statesman Journal report.
Coordinated care organizations like WCVH are a key part of Oregon's Medicaid overhaul. The CCOs consist of a network of providers that deliver comprehensive mental, medical and dental care for low-income Oregon residents.
Before WCVH was established, Marion Polk Community Health Plan managed the care of Oregon Health Plan, or Medicaid, patients through contracts with providers, including Salem Hospital, according to the report. WCVH later replaced MPCHP.
Salem Hospital claims that in October, WCVH Chairman Jim Russell declared Salem Hospital would only be paid as a "non-participating provider" by the CCO, which is a lower reimbursement rate.
In its suit, Salem Hospital asked the court to declare the hospital has a valid and enforceable contract with WCVH, after the CCO's board unanimously approved its contract with Salem Hospital in June, according to the report.
If the court rules in favor of WVCH, the hospital would receive 64 percent of the Medicare rate if the hospital provides services to more than 10 percent of the organization's enrollees, compared with a 68 percent rate for hospitals that contract with a managed care organization, according to the report.
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