Alternative Headline: CareOregon Tightens Behavioral Health Network
[MM Curator Summary]: CareOregon will require Medicaid and MA members to use in-network providers for most behavioral health services starting next year.
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3 things to know summary – GPT
Suggested new headline:
CareOregon, Oregon’s largest Medicaid managed care organization, will limit routine behavioral health services to in-network providers for both Medicaid and Medicare Advantage members starting next year. Impacted services include therapy, skills training, case management, and prescriber visits, while intensive programs like ABA, day treatment, PHP, and IOP will remain unaffected.
The move aims to cut costs amid rising healthcare expenses and anticipated Medicaid funding challenges. Out-of-network providers have been paid 40%–95% more than contracted ones, and CareOregon says its existing network can meet demand. The change aligns with pre-COVID policies and follows a decision to cut 150 positions to manage financial pressures.
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5BF Summary – GPT
- Summary: CareOregon will require Medicaid and MA members to use in-network providers for most behavioral health services starting next year.
- Key Points:
- Affected services include therapy, skills training, case management, and prescriber visits.
- Intensive services like ABA, PHP, and IOP remain unaffected by the policy change.
- Move follows 150 job cuts and aims to address higher out-of-network costs (40%–95% more).
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BEGIN ORIGINAL ARTICLE
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.
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General item, but important. Gets at main point of article= YELLOW
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A specific topic that seems to be different than other topics = BLUE