Despite timely and historic investment in Oregon’s community mental health workforce and infrastructure in the past two legislative sessions, there remains a need to understand and sustainably fund the full continuum of preventative, treatment, crisis, and stabilization services to support healthy, vibrant, and safe counties across Oregon.

To do that, the Behavioral Health Transformation Workgroup led by Representative Rob Nosse (D-Portland) and Senator Kate Lieber (D-Beaverton) has broken out into four smaller workgroups during the 2022 legislative interim. Key leadership from the House speaker’s office and Senate president’s office is convening system partners and expert advocates to clarify and come together around solutions to better serve Oregon communities.

Workgroups will focus on distinct areas of the County Financial Assistance Agreement (CFAA) between the Oregon Health Authority (OHA) and the local mental health authorities for the provision of community mental health and addictions services and on system developments and roles. They will tackle both long-standing issues set aside during the COVID-19 pandemic and new federal and state level system changes, reporting back to the main workgroup in the fall with recommendations for the 2023 Legislative Session.

Mandated populations workgroup and “aid and assist” liability

Under the leadership of the speaker’s office, the mandated populations workgroup will “examine current funding and service elements through the CFAAs and develop recommendations related to the mandated caseload, calculation of cost of services included in mandated caseload, barriers to placement in appropriate level of residential care, and any other statutory or funding barriers.”

With the help of the Association of Oregon Community Mental Health Programs and local Community Mental Health Program (CMHP) directors, the OHA will restart the work begun in 2019 to establish reliable caseload forecasts and funding formulas that, per a 2019 budget note, “accurately captures the cost of community based behavioral health treatment and how caseload methodologies and use of funding incentivizes regionally and nationally recognized best practices, and outcome oriented strategies, to create a more effective system to meet the behavioral health needs of individuals in the community and prevent higher levels of care when appropriate.”

Non-Medicaid mandated populations currently in the CFAA include persons who have committed a crime and are determined “guilty except for insanity” and individuals civilly committed for court-mandated mental health treatment. A third mandated population is now being considered, those accused of a crime but found by the court unable to “aid and assist” in their own defense and ordered to receive restoration services. 

The ”aid and assist” population has historically been served at the Oregon State Hospital, but with the growing momentum to protect the civil rights and honor the treatment choices of people experiencing mental distress, state and local governments now aim to serve more of this population in their home communities in the least restrictive environment possible. This transition to community restoration and treatment is highlighting the historic lack of investment in the community mental health infrastructure and shifting new unfunded legal and financial liability to counties that so far has been neglected in state-level policy discussions.

A complementary workgroup convened by the Association of Oregon Counties will focus on the county liability issue and provide recommendations for agency and legislative action to the Behavioral Health Transformation Workgroup.

9-8-8 and crisis system expansion workgroup

Oregon’s 9-8-8 call system will go live this July. It is part of a nationwide effort to divert mental health crisis calls away from the 9-1-1 system and law enforcement response to mobile crisis response by community mental health programs. Coordinated by OHA, this workgroup is planning and adequately funding mobile crisis response expansion, including fully incorporating children and family response, communication with 9-8-8 call centers, and Coordinated Care Organization (CCO) payment. 

Certified Community Behavioral Health Clinics sustainability and expansion workgroup

Oregon was one of eight states selected in 2016 to participate in the federal Certified Community Behavioral Health Clinic (CCBHC) demonstration project. It has since received additional federal funding to expand the project to new locations. 

CCBHCs provide a comprehensive range of mental health and substance use disorder services, particularly to vulnerable individuals with the most complex needs, including crisis mental health services with 24-hour mobile crisis teams; emergency crisis intervention and crisis stabilization; screening, assessment, and diagnosis including risk management; patient-centered treatment planning; outpatient mental health and substance use services; primary care screening and monitoring; targeted case-management; psychiatric rehabilitation services; peer support; counseling services and family support services; services for members of the armed services and veterans; and connections with other providers and systems (criminal justice, foster care, child welfare, education, primary care, hospitals, etc.)

Oregon’s current CCBHC demonstration projects are Klamath Basin Behavioral Health (Klamath Falls), ​Wallowa Valley Center for Wellness (Enterprise), Deschutes County Behavioral Health (Bend), Cascadia Behavioral Health (Portland), Options for Southern Oregon (Grants Pass), Symmetry Care (Burns), Community Counseling Solutions (Heppner), Lifeworks (Portland, Hillsboro), Yamhill County HHS (McMinnville), Mid-Columbia Center for Living (Hood River), and Columbia Community Mental Health (St. Helens).

Coordinated by OHA staff, this workgroup will develop a plan for long-term sustainability of the CCBHC model in Oregon, including how they fit into the global budget and the role of CCOs. 

Administrative burden workgroup

CCOs were established in Oregon in 2012 to manage Medicaid dollars regionally for the physical, behavioral, and oral health services of their members. Ten years on, there is a need to review the administrative processes of CCOs and CMHPs to better define the distinct roles and responsibilities of each and identify areas of overlap and duplication in contract, as well as to revise the 309 rules concerning outpatient behavioral health care. The administrative burden workgroup is co-led by CCO and CMHP directors.

AOC will be at the table engaging on behalf of counties throughout the process, continuing to strengthen relationships with the state and federal agencies, legislators, and other stakeholders and supporting diverse needs of counties as service providers.

Contributed by: Jessica Pratt | Legislative Affairs Manager