CCO Plan Comparison Guide · CCO plan’s health care providers, pharmacies, hospitals and extra services. • Except for the extra services and pharmacy options, all CCOs offer you

Pick Your Plan

CCO Plan Comparison

Guide2020

2

This guide is for OHP members who live in areas where choices of CCO plans have changed. If you are looking for information about a CCO and don’t see it in this guide, go to OHP.Oregon.gov.

New health plan choices are coming to the Oregon Health Plan (OHP) in 2020.

OHP has local health plans that help you use your benefits. These plans are called coordinated care organizations or CCOs.

This guide will help you Consider, Compare and Choose your plan.

Why is OHP asking members to pick a plan?You count on the Oregon Health Plan for your health care. Your benefits are not changing, but the health plans or CCOs that help you use your benefits are changing. In some areas of the state, there will be new CCO plans. In other areas, CCO plans are closing. You get to compare the plans in your area and decide what works best for you and your family. New plans will start January 1, 2020.

CCO Plan Comparison Guide: Introduction

http://OHP.Oregon.gov

3

How did I get matched with a plan?OHP matched you with a CCO plan based on the mental health and primary care providers you have seen in the past 24 months. We heard from members and health care providers that OHP’s main goals during this transition should be:

• Keeping members with providers they see now and

• Not disrupting their care.

OHP values your choice. You do not need to keep the CCO plan OHP matched you with. You can compare that plan with other plans in your area. You have two chances to pick a different plan:

1. Between October 16 and November 17, 2019, you can choose another plan. If you don’t choose another CCO plan by November 17, your matched plan will start January 1, 2020.

2. Between January 1 and March 31, 2020, you can try out your CCO plan and change it for any reason.

If you’re happy with your matched plan, you don’t have to do anything.

Help is availableCall: OHP has a special phone number to answer your questions and help you make your choice. The number is 877-647-0027 (TTY 711).Regular business hours: 7 a.m. –5 p.m. Monday-FridayOctober 16-November 17, 2019: 7 a.m.–8 p.m. Monday-FridayIf you need an interpreter, ask for one when you call.

Ask a trusted community partner: Find a person trained to help guide you through this process at OHP.Oregon.gov.

Go online: Compare plans and find links to more CCO information at OHP.Oregon.gov.

CCO Plan Comparison Guide: Introduction



4

Your OHP letterImportant information you will need to pick your plan is in your letter from OHP.

Statewide Processing CenterPO Box 14015Salem, OR 97309

10/16/2019

Letter ID: XXX123

John A. Doe123 First Ave.Somewhere, Oregon 90000

There are more health plan choices coming to your areaDear John,

Thank you for being a part of the Oregon Health Plan. There are new health plan choices coming to OHP in January. OHP has local health plans that help you use your benefits. These plans are called coordinated care organizations or CCOs.

Starting in January, you will have more CCO plan choices in your area. You get to compare the plans and decide what works best for you and your family.

We started by matching you with a CCO plan based on your doctors and the care you get now:John Doe: CCO Example Name 1Mary: CCO Example Name 1Amy: CCO Example Name 2

How to get help:

Call 877-647-0027(TTY 711)

Ask a local community partner. Find one at: ohp.oregon.gov

Learn more at: ohp.oregon.gov

You can get this letter in another language, large print, or another way that is best for you. Call 877-647-0027 (TTY 711) 19-129 073019

What you need to know:

• Your OHP benefits are not changing.

• More CCO plans are coming in January.

• You can choose a CCO plan.

• If you don’t choose, you will be enrolled in a plan based on the care you get now.

• New plans will start January 1, 2020.

If you are happy with the CCO plan(s) listed, you don’t have to do anything. Your CCO plan will start January 1, 2020. You will get a welcome letter and ID card close to January 1.

You can choose a different CCO plan.If you don’t like the CCO plan(s) listed, that’s okay. You can choose any of these plans: CCO Example Name 2, CCO Example Name 3

Compare the CCO plans, consider what each plan offers, and then choose.You can learn more about the plans in the guide sent with this letter or at OHP.Oregon.gov. Look at each plan’s health care providers, pharmacies, hospitals, and services.

Tell us if you want a different CCO plan by November 17.If the plan(s) listed will not work for you, go to http://bit.ly/CCOchoice and tell us your choice. Please use your Letter ID to login: XXX123. You can also call us at 877-647-0027. This special phone number is set up to help you with your 2020 CCO plan choice. You can also get help in person. Find a trusted community partner near you at OHP.Oregon.gov.

Don’t worry. You can also change your CCO plan after January 1.Try out your CCO plan. If you are happy with your plan, you won’t have to do anything. If you want a different CCO plan after January 1, you can tell us at that time. You can change plans for any reason until March 31, 2020.

About the OHP benefits and services you get now

Your OHP benefits are not changing.You still have the same OHP physical, dental, and mental health benefits. Some CCO plans have extra services, like health classes. Check with your CCO plan about what extra services it offers. If you need to renew your OHP before January 1, your eligibility may change.

Choosing a new plan? You can still use the CCO plan you have now until January 1.Many doctors or providers work with all the CCO plans in your area. But if you need a different provider, your new CCO plan will help you pick one. Your new plan will help you get the prescriptions and treatments you need.

You can keep scheduled appointments and fill your prescriptions.Your current CCO plan will honor your appointments and prescriptions until January 1. If you have a new plan, it will help you make appointments and get prescriptions after January 1. If you have appointments scheduled after January 1 or need to fill a prescription, tell your new plan.

Need help? You can call 877-647-0027 or get help in person. Find a trusted community partner in your area at OHP.Oregon.gov.

Thank you,Oregon Health Plan

CCO Plan Comparison Guide: Instructions

Letter ID

Your matched plan(s)

Your other plan choice(s)

5

Follow these steps to pick your plan1. Consider:

• In your letter, find the CCO plan that we matched you with as well as any other options.

• In this guide, find the CCOs in the alphabetical list, which starts on page 10.

2. Compare: • Read about other CCO plans in your area. Make sure you check which ZIP

Codes are served. Some CCOs serve only part of a county. Look at each CCO plan’s health care providers, pharmacies, hospitals and extra services.

• Except for the extra services and pharmacy options, all CCOs offer you the same benefits.

• Each CCO has a provider directory on its website. Look for a list of doctors and providers that work with that CCO plan.

• Learn more about other services offered by the CCO.• You may want to use the Pick Your Plan Worksheet on the next two

pages to help you compare.

3. Choose: • After comparing your options,

choose a plan. If you’re happy with your matched plan, you don’t have to do anything! If you want to choose a different CCO plan, tell OHP your choice:

• Online at http://bit.ly/CCOchoice

• By phone at 877-647-0027

• Through a trusted community partner. You can find one at OHP.Oregon.gov.

To pick your plan online:

Use the CCO plan choice form online. It’s the fastest way to pick a plan.

1. Go to http://bit.ly/CCOchoice.

2. Use your unique Letter ID to login. You’ll also need your OHP ID number from your OHP or CCO card.

3. Choose a plan for yourself and other members of your household.

4. Save your plan choice and get a confirmation email.

CCO Plan Comparison Guide: Instructions

http://bit.ly/CCOchoice



6

Pick Your Plan Worksheet Picking your health plan can be easy. Use this worksheet to help you choose the best CCO plan for you and your family. Each CCO plan has different doctors, hospitals and pharmacies. In three simple steps, you will have all the information you need to make the best health plan choice and enroll.

Step 1 Consider

Review your letter, or this guide or go online to OHP.Oregon.gov to find the CCO plans in your area, including the one you’ve been matched with. List the plans you can choose from.

Your plan choices

Option 1

Option 2

Option 3

Important due dates: If you don’t choose another CCO plan by November 17, your matched plan will start January 1, 2020.

Between January 1 and March 31, 2020, you can try out your CCO plan and change it for any reason.

CCO Plan Comparison Guide: Pick Your Plan Worksheet

Nov17

Mar31

7

Step 2 Compare

List the doctors, hospitals and pharmacies that are most important to you. For each CCO plan, find out whether the doctor or facility is in the plan’s network. You can do this by calling your doctor’s office or the CCO plan, or by visiting the plan’s website. Go to OHP.Oregon.gov or look in this guide to find the health plan’s contact information.

Doctors, hospitals and pharmacies that are important to you

Which CCO they participate in

To narrow your choice, you may want to consider extra services listed in this guide or at OHP.Oregon.gov.

Step 3 Choose Name of the plan that is best for you:

If you agree with the plan OHP matched you with, you don’t need to do anything. If you want to choose another option, do ONE of the following:

Fastest option: Change your health plan ONLINE.

1. Go to http://bit.ly/CCOchoice. 2. Use your unique Letter ID to login. You’ll also need your OHP ID number

from your OHP or CCO card.3. Choose a plan for yourself and other members of your household.4. Save your plan choice and get a confirmation email.

PHONE: Call 877-647-0027

TRUSTED COMMUNITY PARTNER: You can find one at OHP.Oregon.gov.

Do not fax or mail this form. It is a tool to help you, not an enrollment form.

CCO Plan Comparison Guide: Pick Your Plan Worksheet



8

CCO plan choices

The following list only includes CCOs in areas where the choice of CCO plans has changed for 2020. If you are looking for information about other CCO plans, please go to OHP.Oregon.gov.

Clackamas Health Share of OregonTrillium Community Health Plan Inc.

DouglasUmpqua Health Alliance LLC (97441, 97467 and 97473 excluded)AllCare CCO Inc. (97410, 97442 only)Trillium Community Health Plan Inc. (97424, 97436, 97441, 97467, 97473, 97493 only)

Jackson AllCare CCO Inc.Jackson Care Connect

Lane PacificSource Community Solutions — LaneTrillium Community Health Plan Inc.

Multnomah Health Share of OregonTrillium Community Health Plan Inc.

Polk PacificSource Community Solutions — Marion PolkYamhill Community Care Organization (97101, 97304, 97347, 97371, 97378, 97396 only)

Washington Health Share of OregonTrillium Community Health Plan Inc. Yamhill Community Care Organization (97119, 97123, 97132, 97140 only)

Please note: Information in this guide is current as of August 30, 2019. Many CCOs expanding to new areas are setting up their network of doctors, hospitals and other providers. The information in this guide was provided by the CCOs and is subject to change.

For the most complete and up-to-date information on a CCO plan, go to the plan’s website or call its customer service number.

CCO Plan Comparison Guide: CCO plan choices


9

Extra servicesAll CCO plans are required to provide the same OHP-covered mental, physical and dental care services. These are your core benefits.

Some CCOs provide extra services. These are items or services to support your health or manage a condition. This guide provides examples of each CCO plan’s extra services. Some extra services are available to all members. Others are provided on a case-by-case basis or by special request. You can contact each CCO to learn about a full list of services and how to access them.

Extra services may include:

• Child and family: Parenting classes, childbirth classes and other supports for children, new parents and pregnant women

• Wellness: Supports for healthy living, such as gym memberships, cooking classes, other training and education; rides to access wellness resources, or incentives to complete appropriate preventive care

• Chronic condition support: Classes, programs and resources to support people living with diabetes, chronic obstructive pulmonary disease, and other conditions

• Housing support: Temporary housing, shelter, home repair and other services to help members stay housed or live in a healthy environment

Did you know?CCO benefits include physical, dental and mental health care. Behavioral health care means treatment for mental health conditions or substance use disorders.


10

Contracted hospitals• Ashland: Asante Ashland Community Hospital • Crescent City: Sutter Coast Hospital • Gold Beach: Curry General Hospital • Grants Pass: Asante Three Rivers Medical Center • Medford: Providence Medford Medical Center; Asante Rogue Regional

Medical Center

Primary care provider locations • Curry County: Brookings, Coos Bay, Crescent City, Gold Beach, Port Orford • Douglas County: Coos Bay, Eagle Point, Grants Pass, Medford, Rogue

River, Shady Cove • Jackson County: Ashland, Butte Falls, Central Point, Eagle Point, Gold Hill,

Jacksonville, Medford, Prospect, Rogue River, Shady Cove, Talent, White City • Josephine County: Cave Junction, Grants Pass, Selma • United Indian Health Services in Del Norte County: Crescent City,

Arcata, Klamath, Smith River

Dental care networks• Curry County: Advantage Dental Services • Douglas County: Advantage Dental Services, Willamette Dental Group • Jackson County: Advantage Dental Services, Capitol Dental Care,

La Clinica, ODS Dental Plan, Willamette Dental Group


AllCare CCO Inc.

Curry, Jackson, Josephine, and partial Douglas (97410, 97442 only) counties

541-471-4106 or 888-460-0185 or TTY 800-735-2900, language access line: 888-260-4297

www.allcarehealth.com

Dear <Member Name>

Below this letter is your AllCare CCO/OHP membership card. Please review the card

Detach this card and carry it with you.

You have physical health, mental health and dental coverage with AllCare CCO. Your Primary Care Provider (PCP) is listed on the card. Your PCP coordinates all of your medical care. Please contact your PCP if you are in need of any medical services. This isnot required for mental or dental services, or in true emergencies.

If you have any questions or concerns regarding your AllCare CCO/Oregon Health Plan benefits, or if you need an AllCare CCO Member Handbook and or Provider Directory,

or TTY at (800) 735-2900.

Sincerely, AllCare Health Member Services

You have 24-hour HealthcareSee membership card for details

allcare cco1701 NE 7th St. Grants Pass, OR 97526Phone (541) 471-4106Toll free (888) 460-0185TTY (800) 735-2900AllCareHealth.com/Medicaid

allcare cco

AllCareHealth.com/Medicaid

Page | 1 of 2OHP-ALL-17-114

Name: <FN> <MI> <LN>ID: <MEMBERID>Dental Plan: <DCO>Dental Plan Phone: <(XXX) XXX-XXXX>PCP: <PCP NAME>PCP Phone: <(XXX) XXX-XXXX>

Member Services (541) 471-4106TTY (800) 735-2900 Toll free (888) 460-0185

<FIRSTNAME> <MI> <LASTNAME><STREET><STREET2><CITY>, <STATE> <ZIP>

<MM/DD/YYYY>ID: <MEMBERID>

Non-Emergency Medical Transport: ReadyRideCall to schedule between 8 a.m.-6 p.m., Monday through Friday at (541) 479-7920 or (800) 479-7920. Rides available 24 hours a day, 7 days a week.

Pharmacy: Must be a MedImpact ProviderPCN # 00000 BIN # 000000

11

• Josephine County: Advantage Dental Services, Capitol Dental Care, ODS Dental Plan, Willamette Dental Group

Behavioral health networksFor a full list of behavioral providers, call Member Services or visit: www.AllCareHealth.com/CCO/Behavioral-Health • Curry County: Curry Community Health • Douglas County: Options for Southern Oregon, Adapt, Choices

Counseling, Grants Pass Treatment Center, OnTrack Rogue Valley• Jackson County: Options for Southern Oregon, Addictions Recovery

Center, Allied Health Services, OnTrack Rogue Valley, Phoenix Counseling For Mental Health Crisis – Jackson County Mental Health

• Josephine County: Options for Southern Oregon, Adapt, Choices Counseling, Grants Pass Treatment Center, OnTrack Rogue Valley

Pharmacies Many area pharmacies. Find a pharmacy online at www.AllCareHealth.com/CCO/Find-Pharmacy.

Medicare plan AllCare Advantage www.AllCareHealth.com/Medicare

Provider directory www.AllCareHealth.com/CCO/Find-Doctor

Member handbookwww.AllCareHealth.com/CCO/Member-Handbook

Extra servicesGym memberships, tobacco-cessation programs, rides to health-related services, weight-loss programs for adults and children, and wellness programs such as managing chronic pain. Also offers a “Babe Store” (items for pregnant women, babies, and new parents), meal delivery, help applying for Social Security Disability, programs to manage chronic health conditions, help finding housing, and home repair More information: Call the Care Coordination team or go to www.AllCareHealth.com/CCO/Coordination.


http://www.AllCareHealth.com/CCO/Behavioral-Health

http://www.AllCareHealth.com/CCO/Find-Pharmacy

http://www.AllCareHealth.com/Medicare

http://www.AllCareHealth.com/CCO/Find-Doctor

http://www.AllCareHealth.com/CCO/Coordination

12

Clackamas, Multnomah and Washington counties

503-416-8090 or 888-519-3845, TTY 711

www.HealthShareOregon.org

Contracted hospitals• Clackamas: Kaiser Sunnyside Medical Center• Gresham: Legacy Mt. Hood Medical Center• Hillsboro: Kaiser Westside Medical Center, Tuality Community Hospital• Milwaukie: Providence Milwaukie Hospital• Oregon City: Providence Willamette Falls Medical Center• Portland: Adventist Medical Center, Doernbecher/OHSU, Legacy Emanuel,

Legacy Good Samaritan, Providence Portland Medical Center, Providence St. Vincent Medical Center, Unity Center for Behavioral Health

• Tualatin: Legacy Meridian Park Medical Center

Primary care provider locations • Clackamas County: Canby, Clackamas, Damascus, Estacada, Gladstone,

Gresham, Happy Valley, Keizer, Lake Oswego, Milwaukie, Molalla, Mt Angel, Oregon City, Portland, Sandy, Silverton, Tualatin, Welches, West Linn, Wilsonville, Woodburn

• Multnomah County: Beaverton, Clackamas, Gresham, Happy Valley, Hillsboro, Milwaukie, Portland, Tualatin

• Washington County: Aloha, Beaverton, Forest Grove, Hillsboro, North Plains, Sherwood, Tigard, Tualatin


Health Share of Oregon

13

Dental care networksAdvantage Dental Services, CareOregon Dental, Kaiser Permanente Dental, ODS Community Dental Plan, Willamette Dental Group

Behavioral health networks CareOregon, Kaiser Permanente, OHSU Health, Legacy Health PacificSource, Providence Health & Services

Pharmacies Many area pharmacies. See a complete list on the CCO’s website.

Medicare plans CareOregon Advantage, Kaiser Senior Advantage, PacificSource Medicare, Providence Medicare Dual Plus (HMO SNP)

Provider directory www.healthshareoregon.org/members/my-health-plan

Member handbook www.healthshareoregon.org/members/my-health-plan/member-handbook

Extra services Dental programs for young children and pregnant women; infant and toddler programs (Baby Day); summer camps and classes; cooking classes; cleaning services; clothing and shoes; food delivery; gym and community center memberships; meal service; personal care kits; prepaid cell phones or minutes; self-help support services; sensory items; weight management; chronic disease management and prevention classes; eviction prevention; home equipment and repairs; hotel/motel (short-term); household furniture and furnishings; identification documentation replacements; legal help to address housing barriers; recovery housing programs (Clean and Sober); recuperative care; rental assistance; shelter; supportive moving and hauling; utility assistance.

More information: 503-416-8090 or www.HealthShareOregon.org.


http://www.healthshareoregon.org/members/my-health-plan

http://www.HealthShareOregon.org

14

Contracted hospitals• Ashland: Asante Ashland Community Hospital• Grants Pass: Asante Three Rivers Medical Center• Medford: Providence Medford Medical Center,

Asante Rogue Regional Medical Center• Portland: Adventist Medical Center, Doernbecher/OHSU, Legacy Emanuel,

Legacy Good Samaritan, Providence Portland Medical Center, Providence St. Vincent Medical Center, Providence Willamette Falls Medical Center, Providence Milwaukie Hospital

Primary care provider locations Ashland, Butte Falls, Central Point, Eagle Point, Jacksonville, Medford, Phoenix, Rogue River, Shady Cove, Talent, White City

Behavioral health networks Jackson County Mental Health, ColumbiaCare Services, Kairos, OnTrack Rogue Valley, Addictions Recovery Center, Albertina Kerr, Family Solutions, Hearts with a Mission, Integrated Health Services, Juniper Ridge, Redemption Ridge, Trillium Family Services, Compass House, Options for Southern Oregon, Kolpia, Phoenix Counseling, Allied CRC, multiple private therapists

Dental care networks Advantage Dental Services, Capitol Dental, ODS Dental Plan, Willamette Dental Group


Jackson county

855-722-8208, TTY 800-735-2900

www.jacksoncareconnect.org

Jackson Care Connect

15


Medicare plans CareOregon Advantage

Provider directory www.jacksoncareconnect.org/for-members/provider-search

Member handbook www.jacksoncareconnect.org/for-members/member-handbook

Extra services Diapers, car seats and other gear, care coordination, social support, and lactation support for caregivers of children under 4 years; childcare and enrichment programs for eligible members; local gym memberships; weight management and cooking classes for adults and children; rides to wellness and prevention programs (including 12-step and other recovery support communities), WIC appointments, Starting Strong, YMCA, mental health peer support, and other activities; oral hygiene supplies; other supports depending on member needs, such as sensory items, clothing and shoes; support and incentives to complete appropriate preventive care; chronic disease management and prevention classes; housing supports for qualified members. More information: www.jacksoncareconnect.org/for-members/wellness-benefits/strong-families


http://www.jacksoncareconnect.org/for-members/provider-search

http://www.jacksoncareconnect.org/for-members/wellness-benefits/strong-families

16 CCO Plan Comparison Guide: CCO plan choices

Contracted hospitals• Crook County: St. Charles Prineville• Deschutes County: St. Charles Medical Center Bend, St. Charles Medical

Center Redmond• Grant County: Blue Mountain Hospital• Harney County: Harney District Hospital• Hood River County: Providence Hood River Memorial Hospital• Jefferson County: St. Charles Madras• Lane County: McKenzie-Willamette Medical Center, PeaceHealth Cottage

Grove Community Medical Center, PeaceHealth Sacred Heart Medical Center University District, PeaceHealth Peace Harbor Medical Center, PeaceHealth Sacred Heart Medical Center at RiverBend

• Marion County: Legacy Silverton Medical Center• Multnomah County: Legacy Emanuel Medical Center, Legacy Good

Samaritan Medical Center, Legacy Mount Hood Medical Center, Oregon Health & Science University, Shriners Hospitals for Children

• Wasco County: Mid-Columbia Medical Center• Washington County: Legacy Meridian Park, Providence St. Vincent

Medical Center• California: Stanford Children’s Health — Lucile Packard Children’s

Hospital Stanford• Washington state: Skyline Hospital

Lane county

503-210-2515 or 800-431-4135 or TTY 800-735-2900

www.communitysolutions.pacificsource.com

Member Name: [Member Name] OHP ID #: [OHP ID #] Member ID #: [Member ID #] Primary Care Provider: [Provider Name]Dental Plan: [Dental Plan Name]

If you have a medical emergency, call 911 or go to the

nearest emergency room. If you are not sure if you have a true

dental emergency, please call your dentist.

Customer Service: [(800) 431-4135]TTY Line: (800) 735-2900Hours: 8 a.m. to 5 p.m., Monday - Friday Online: Electronic Claims Payor ID#: [ insert number]

Pharmacists: (541) 330-4999 or (888) 437-7728 RxBin [012114] RxGroup [RX6156] RxPCN [COBSEGADV]

Keep your ID card with you at all times. Please show your ID

card to your provider at each visit.

PacificSource Community Solutions: Lane

17CCO Plan Comparison Guide: CCO plan choices

Primary care provider locations Cottage Grove, Creswell, Eugene, Florence, Junction City, Oakridge, Springfield, Veneta

Dental care networks Advantage Dental Services, Capitol Dental Care, Oregon Dental Service


Medicare plans Multiple Medicare Advantage plans.

Behavioral health networks Review the provider directory to find behavioral health providers in the network. If you have questions about any particular provider’s participation in PacificSource’s network, contact customer service at 800-431-4135.

Provider directory www.communitysolutions.pacificsource.com/Tools/ProviderDirectory

Member handbook www.communitysolutions.pacificsource.com/Member

Extra services Training and education for health improvement or management, home and living environment items or improvements, and transportation needs. Examples include, but are not limited to, gym passes, swim passes, exercise equipment, temporary transitional housing, air purifiers, and water filtersMore information: Contact customer service at 800-431-4135.


Contracted hospitals• Crook County: St. Charles Prineville• Deschutes County: St. Charles Medical Center Bend, St. Charles Medical

Center Redmond• Grant County: Blue Mountain Hospital• Harney County: Harney District Hospital• Hood River County: Providence Hood River Memorial Hospital• Jefferson County: St. Charles Madras• Lane County: McKenzie-Willamette Medical Center, PeaceHealth Cottage

Grove Community Medical Center, PeaceHealth Sacred Heart Medical Center University District, PeaceHealth Peace Harbor Medical Center, PeaceHealth Sacred Heart Medical Center at RiverBend

• Marion County: Legacy Silverton Medical Center• Multnomah County: Legacy Emanuel Medical Center, Legacy Good

Samaritan Medical Center, Legacy Mount Hood Medical Center, Oregon Health & Science University, Shriners Hospitals for Children

• Wasco County: Mid-Columbia Medical Center• Washington County: Legacy Meridian Park, Providence St. Vincent

Medical Center• California: Stanford Children’s Health — Lucile Packard Children’s

Hospital Stanford• Washington state: Skyline Hospital

Marion and Polk counties

503-210-2515 or 800-431-4135 or TTY 800-735-2900

www.communitysolutions.pacificsource.com

PacificSource Community Solutions: Marion Polk Member Name: [Member Name]

OHP ID #: [OHP ID #] Member ID #: [Member ID #] Primary Care Provider: [Provider Name]Dental Plan: [Dental Plan Name]

If you have a medical emergency, call 911 or go to the

nearest emergency room. If you are not sure if you have a true

dental emergency, please call your dentist.

Customer Service: [(800) 431-4135]TTY Line: (800) 735-2900Hours: 8 a.m. to 5 p.m., Monday - Friday Online: Electronic Claims Payor ID#: [ insert number]

Pharmacists: (541) 330-4999 or (888) 437-7728 RxBin [012114] RxGroup [RX6156] RxPCN [COBSEGADV]

Keep your ID card with you at all times. Please show your ID

card to your provider at each visit.


Primary care provider locations Marion: Salem, Keizer, Aumsville, Mount Angel, Monmouth, Silverton, Stayton, Sublimity, WoodburnPolk: Dallas, Salem, Monmouth, Grand Ronde

Dental care networks Advantage Dental Services, Capitol Dental Care, Oregon Dental Service


Medicare plans PacificSource is in the process of affiliating with other plans to serve Marion County and Polk County.

Behavioral health networks Review the provider directory to find behavioral health providers in the network. If you have questions about any particular provider’s participation in PacificSource’s network, contact customer service at 800-431-4135.

Provider directory www.communitysolutions.pacificsource.com/Tools/ProviderDirectory

Member handbook www.communitysolutions.pacificsource.com/Member

Extra services Training and education for health improvement or management, home and living environment items or improvements, and transportation needs. Examples include, but are not limited to, gym passes, swim passes, exercise equipment, temporary transitional housing, air purifiers, and water filters More information: Contact customer service at 800-431-4135.


Contracted hospitalsCedar Hills Hospital (psychiatric), ColumbiaCare Services (psychiatric), Legacy Emanuel Hospital, Looking Glass Youth and Family Services (psychiatric), Lower Umpqua Hospital, McKenzie Willamette Hospital, Oregon Health & Science University, Peace Harbor Hospital, Sacred Heart Medical Center University District, Sacred Heart Medical Center Riverbend

Primary care provider locations • Clackamas, Multnomah and Washington: Beaverton, Canby, Estacada,

Gresham, Hillsboro, Milwaukie, Oregon City, Portland, Tigard, Wilsonville• Lane, Douglas and Linn: Albany, Blue River, Coburg, Cottage Grove,

Creswell, Curtin, Dexter, Eugene, Florence, Glide, Junction City, Lebanon, Myrtle Creek, Oakridge, Pleasant Hill, Reedsport, Roseburg, Springfield, Sutherlin, Veneta, Winston

Dental care networks Advantage Dental, Capitol Dental, Oregon Dental Service, Willamette Dental

Behavioral health networks Go to providersearch.trilliumhealthplan.com or call 541-485-2155 or 877-600-5472 or TTY 877-600-5473 to learn about options for mental health and substance use disorder treatment.

Clackamas, Multnomah and Washington and Lane, partial Douglas (97424, 97436, 97441, 97467, 97473, 97493 only) and partial Linn (97446 only) counties

541-485-2155 or 877-600-5472 or TTY 877-600-5473

www.TrilliumCHP.com

Medical Dental Behavioral Health

Name: <JOHN SMITH>

PCP Start Date: <12/05/2016> RX: Envolve RxDoctor (PCP): <Dr. Jane Doe> RXBIN: 004336

PROVIDER INFORMATIONPHARMACY

INFORMATION

Oregon Health Plan#: <123456789101112>

RXPCN: MCAIDADVDCO: <DCO Name>RXGRP: RX5461DCO Phone: <(555) 555-1234>

Trillium Community Health Plan Inc.

http://providersearch.trilliumhealthplan.com



Medicare plans Trillium Medicare Advantage www.trilliumadvantage.com

Provider directory www.trilliumohp.com/members/oregon-health-plan/for-members/benefit-information.html

Member handbook www.trilliumohp.com/members/oregon-health-plan/for-members/handbooks-forms.html

Extra services • Clackamas, Multnomah and Washington: Start Smart for Your Baby

(extra benefits and support during and after pregnancy); caregiver support; 24/7 nurse advice line; online search for free or low-cost assistance programs; digital scale, air conditioner, medical bracelets, aquatic classes; help applying for Supplemental Security Income (SSI) benefits; online health and life coaching programs for conditions including asthma, diabetes, back pain, congestive heart failure, heart disease, hyperlipidemia, hypertension, weight management and others; flexible funds to attend specific wellness programs (such as the Diabetes Prevention Program)

• Lane, Douglas and Linn: Start Smart for Your Baby (extra benefits and support during and after pregnancy); caregiver support; tobacco prevention programs for children and pregnant women; parenting support services and education; 24/7 nurse advice line; online search for free or low-cost assistance programs; digital scale, air condition, medical bracelets, aquatic classes; wellness incentives (gift cards) for Medicare members and adolescents; help applying for Supplemental Security Income (SSI) benefits; Intensive Community Care Management clinics; diabetic care program; online health and life coaching programs for various conditions; flexible funds to attend specific wellness programs (such as the Diabetes Prevention Program); Sheltercare Medical Recuperation; Trillium Produce Plus (access to no cost fresh fruit and vegetables in some clinics and public settings)

http://www.trilliumadvantage.com

http://www.trilliumohp.com/members/oregon-health-plan/for-members/benefit-information.html

http://www.trilliumohp.com/members/oregon-health-plan/for-members/benefit-information.html

http://www.trilliumohp.com/members/oregon-health-plan/for-members/handbooks-forms.html

http://www.trilliumohp.com/members/oregon-health-plan/for-members/handbooks-forms.html


Contracted hospitalsRoseburg: Mercy Medical Center

Primary care provider locations Canyonville, Glide, Myrtle Creek, Roseburg, Sutherlin, Winston, Drain

Dental care networks Advantage Dental Services

Behavioral health networks Adapt, Compass, Serenity Lane, Umpqua Health- Newton Creek, UCHC, Douglas CARES, Valley View, Second Wind Mental Health, Cow Creek, Jessica Blake LLC, Evergreen Family Medicine, other independent providers.

Pharmacies Most Douglas County pharmacies

Medicare plans ATRIO plans

Partial Douglas (excludes 97441, 97467 and 97473) county

541-229-4842 or 866-672-1551 or TTY 888-877-6304 or 541-440-6304

www.umpquahealth.com/ohp

Member Name:«first_name» «last_name»

Member ID: «member_number»

Member Services:541-229-4UHA or 541-229-4842

TTY Users: 541-440-6304Website: www.UmpquaHealth.com

C

M

Y

CM

MY

CY

CMY

K

Umpqua Health Alliance LLC


Provider directory www.umpquahealth.com/ohp

Member handbook www.umpquahealth.com/ohp

Extra services Support for pregnant women (New Day) and families with young children (New Beginnings) who are experiencing barriers to health, training and education; Quit for Life tobacco cessation program, some non-medical rides, diabetes education classes, intensive case management. More information: www.umpquahealth.com/ohp/programs

http://www.umpquahealth.com/ohp/programs

24

Contracted hospitals• McMinnville: Willamette Valley Medical Center• Newberg: Providence Newberg Medical Center• Portland: OHSU including Tuality, Legacy, Providence• Salem: Salem Health

Primary care provider locations • Yamhill County: McMinnville, Newberg, Sherwood, Tualatin• Polk County: Falls City, Monmouth, Salem• Washington County: Aloha, Beaverton, Forest Grove, Hillsboro,

Sherwood, Tigard, Tualatin

Dental care networks Capitol Dental Care

Behavioral health networks Yamhill County Health and Human Services


Yamhill county, partial Polk (97101, 97304, 97347, 97371, 97378, 97396) and partial Washington (97119, 97123, 97132, 97140) counties

503-488-2800 or 855-722-8205 or TTY 800-735-2900

www.yamhillcco.org

Yamhill Community Care Organization


http://www.yamhillcco.org

25

Medicare plans Contact the CCO for details.

Provider directory yamhillcco.org/for-members/find-a-provider

Member handbook yamhillcco.org/for-members/member-handbooks

Extra services Childbirth classes; Quit for Life tobacco cessation program; some non-medical rides; other services to help with housing, accessing healthy foods and non-medical transportation services; diabetes prevention program; other services to help with housing


26

Key termsUse this list to help you understand some of the words in OHP letters and documents.

Benefits: The services that your health care plan pays for. CCO benefits include physical, dental and mental health care.

Behavioral health care: Treatment for mental health conditions or substance use disorders.

Community partner: A person or organization that helps people apply for health coverage. Community partners are local. Help is free.

Coordinated care organization (CCO): A CCO is a health care plan that has a local group of providers: doctors, counselors, nurses, dentists and others who work together in your community. CCOs help make sure OHP members stay healthy.

Health plan or plan: A company that arranges and pays for health care services.

Medicaid: A state-run program that helps with health care costs for people with low incomes. In Oregon, it’s part of the Oregon Health Plan.

Medicare: A federal health care program for people 65 or older. It also helps people with disabilities of any age.

Primary care provider or primary care physician (PCP): The medical professional who takes care of your health. This is usually the first person you call when you have health issues or need care. Your PCP can be a doctor, nurse practitioner, physician’s assistant, osteopath or sometimes a naturopath.

Provider: A licensed person, group or facility that offers a health care service. Examples are a doctor, dentist, therapist, or a hospital.

CCO Plan Comparison Guide: Key terms

27

Rights and responsibilitiesYou have the right to:

• Be treated with dignity and respect, the same as other patients.• Choose your health care providers.• Tell your provider about all your health concerns.• Have a friend or helper come to your appointments.• Get an interpreter if you want one.• Get information on all your covered and noncovered treatment options.• Help make decisions about your health care, including refusing treatment.• Not have people hold you down or keep you away from others as a way to:

• Make you do something you don’t want to do.• Make caring for you easier for your providers.• Punish you for something you said or did.

• A referral or second opinion, if you need it.• Get care when you need it, any time of day or night.• Mental health care and family planning services without a referral.• Help with addiction to cigarettes, alcohol and drugs without a referral.• Get handbooks and letters you can understand.• See and get a copy of your health records, unless your doctor thinks it

would be bad for you.• Limit who can see your health records.• A Notice of Action letter if you are denied a service or your service

level changes.• Information and help to appeal CCO denials and/or ask for a hearing.• Make complaints and get a response without bad treatment from your

plan or provider.• Get free help from the OHA ombudsperson.

You have the right to understand information from OHP. You can ask for:

• An interpreter.• Information in other languages.• Information in Braille, large print and other formats.

Tell your CCO if you need help. (continued on next page)

CCO Plan Comparison Guide: Rights and responsibilities

(continued from previous page)

You have a right to be treated fairly.OHP, its providers and its CCOs must follow state and federal civil rights laws. It cannot treat people unfairly in any of its programs or activities because of a person’s:

• Age• Color• Disability• Gender identity

• Marital status• National origin• Race• Religion

• Sex • Sexual orientation

Tell us if you are not treated fairly.If you feel you were treated unfairly for any of the above reasons, tell us. Contact the civil rights manager in one of these ways:

• Web: www.oregon.gov/OHA/OEI• Email: [email protected] • Phone: 844-882-7889, TTY 711• Mail: OHA Office of Equity and Inclusion

421 SW Oak St., Suite 750, Portland, OR 97204

You can get this document in other languages, large print, braille or a format you prefer. Contact the Oregon Health Plan

at 877-647-0027. We accept all relay calls or you can dial 711.OHA 2832C (09/2019)

Call: OHP has a special phone number to answer your questions and help you make your choice. The number is 877-647-0027 (TTY 711).Regular business hours: 7 a.m.–5 p.m. Monday-FridayOctober 16-November 17, 2019: 7 a.m.–8 p.m. Monday-FridayIf you need an interpreter, ask for one when you call.

Ask a trusted community partner: Find a person trained to help guide you through this process at OHP.Oregon.gov.

Go online: Compare plans and find links to more CCO information at OHP.Oregon.gov.

http://www.oregon.gov/OHA/OEI

mailto:[email protected]



CCO Plan Comparison Guide · CCO plan’s health care providers, pharmacies, hospitals and extra services. • Except for the extra services and pharmacy options, all CCOs offer you

Documents