Health Share staff have been busy working on preparations for the 2022 Compliance Review. Each year, CCOs are audited by an External Quality Review Organization that is contracted with the Oregon Health Authority. These audits are based on Medicaid standards developed by CMS.
As part of the review process, Health Share has to address findings from the previous audit in 2021. The 2021 Compliance Review was focused on provider-related standards, such as network adequacy, availability of services, and provider selection. To address related findings, Health Share has chartered a new Network Adequacy Workgroup. This workgroup will bring together Health Share staff as well as representatives from all five of Health Share’s Plan Partners to provide oversight and monitoring of Health Share’s provider network. This will include ensuring that members have access to all covered benefits and that the network is providing these services in a linguistically and culturally appropriate manner.
For 2022, the review focus is on operational standards, including health information systems, enrollment and disenrollment and quality assessment and performance improvement. Different departments have worked to gather needed reports, policies, and other documentation to show Health Share’s compliance with the standards. Health Share is also working to expand its internal reporting and build on current reporting processes.