Update From The CEO
Happy winter season! While this can be a busy and hectic time in the behavioral health field, I wish you positive vibes and space for relaxation and reflection.
Below is a word cloud to celebrate many of the widely recognized winter holidays.
Thank you for your steadfast work serving Eastern Oregon’s vulnerable and priority populations. I look forward to addressing the needs of our community members alongside you, now and in the months ahead.
Karen Wheeler, MA CEO, GOBHI / Tribal Liaison, EOCCO
BH Provider Direct Payments
The Oregon Health Authority is implementing a tiered payment increase for behavioral health providers that meet certain criteria. GOBHI has begun the work to implement this beginning January 1, 2023. The plan still needs to be approved by CMS but that is expected anytime.
The four categories for the increased payments are summarized below:
Tiered Uniform Rate Increase - This is two tiers of payments for all contracted Behavioral Health providers. Providers eligible are outpatient mental health and substance use.
30% increase for Medicaid Dominant (at least 50% of revenue)
15% increase for Medicaid non dominant (less than 50% of revenue)
Co-Occurring Disorders - Payments to providers certified by OHA for integrated treatment of co-occurring disorders. All co-occurring providers are eligible. All providers must be recertified via the state website application process.
20% for Master’s, 10% for non-Master’s and 15% for Residential
Culturally & Linguistically Specific Services - Payment increase for providers of culturally and/or linguistically specific services. Eligible providers are outpatient mental health and substance use. All providers must be certified via the state website application process.
22% for Non-Rural
27% for Rural
Minimum Fee Schedule - Maintain fee-schedule rates for SUD Residential, ABA and Mental Health Children’s Wraparound services.
It is a complicated program, but GOBHI has structured a work group and sub-groups to ensure we are working with providers to obtain the documents needed to identify the correct payments for services. GOBHI is also working with Moda to implement the new payment arrangements. Lisa Chamness, CFO, is the lead on the implementation; please reach out with further questions at firstname.lastname@example.org.
Early & Periodic Screening, Diagnosis and Treatment
EPSDT is a benefit that provides comprehensive and preventive health care services for children and youth under age 21 who are enrolled in Medicaid and the Children’s Health Insurance Plan (CHIP).
Early: Assessing and identifying problems early
Periodic: Checking children’s health at periodic, age-appropriate intervals
Screening: Providing physical, mental, developmental, dental, hearing, vision and other screening tests to detect potential problems
Diagnostic: Performing diagnostic tests to follow up when a risk is identified and
Treatment: Control, correct or ameliorate (make more tolerable) health problems found.
EPSDT’s goal is to ensure individual children on Medicaid get the health care they need when they need it – the right care to the right child at the right time in the right setting. These benefits include comprehensive preventive health care services from birth until they turn age 21, such as:
Age-appropriate medical exams, screening and diagnostic services and
Medically necessary Medicaid-covered services (defined in Section 1905 (a) of the Social Security Act) to treat any physical, dental, developmental and mental health conditions discovered.
Covering EPSDT services for children from birth until their 21st birthday will increase access to the full breadth of preventive, developmental, dental, mental health, and specialty services so that Oregon’s children and youth are supported holistically in their education, growth, development, and health.
Beginning January 1, 2023, OHP must cover any medically necessary and medically appropriate services for enrolled children and youth until their 21st birthday, regardless of:
The location of the diagnosis on the Prioritized List of Health Services.
Whether it pairs or is a non-pairing service.
Whether it is a historically non-covered ancillary service.
Whether it is covered under the State Plan.
The Prioritized List remains a guidance tool for identifying services that may require documentation of medical necessity and medical appropriateness (and dental appropriateness, if applicable) for members under age 21. The Prioritized List cannot, however, be used as the basis for denying services under EPSDT. It is important that providers:
Do not refuse to render service or refer care based on Prioritized List placement, and
Know that medically necessary and medically appropriate services must be covered, regardless of pre-set limits or guidelines.
Materials and additional information are posted to OHA’s EPSDT webpage at www.oregon.gov/EPSDT.
EPSDT Policy Change Memo for OHP providers
EPSDT Guidance for OHP Providers
EPSDT Fact Sheet for OHP members
Problem Gambling Services
Problem Gambling services are coming to CCOs and CMHPs.
Currently, there is at least one program in each county that is contracted for non-Medicaid with OHA for problem gambling services in Eastern Oregon. Each of them should have at least a certified person or individuals working toward certification for problem gambling. The providers that currently have been identified as having COAs in Eastern Oregon are:
Wallowa Valley Center for Wellness - Wallowa County
New Directions NW- Baker County
Center for Human Development - Union County
Community Counseling Solutions in Umatilla, Grant, Wheeler, Morrow, Gilliam counties
Mid-Columbia Center for Living - Sherman
Symmetry - Harney County
Lake Health District - Lake County
Lifeways - Malheur County
A complete list of current non Medicaid contractors/providers can be found at www.OPGR.org under the help for gamblers tab and then search by location. OHA hopes that the expansion into Medicaid will allow for more providers, a choice of providers, and more professionals getting certification to provide problem gambling services.
OHA, in collaboration with its partners:
Administers a comprehensive problem gambling system of services that meets the needs of individuals, families, and communities across the continuum of care.
Ensures system wide access to culturally-responsive services that are respectful and empowering.
Provides free prevention and treatment services for individuals with gambling problems and
OHA is offering resources to assist with the certification process.
309-018-0165 Residential Problem Gambling Services
309-019-0170 Outpatient Problem Gambling Services
Problem Gambling Helpline
Call 1-877- My Limit (1-877-695-4648) or
Get help by Instant Messaging/Chat/Email
Help is free, confidential, and it works.
EOCCO/GOBHI is currently reviewing the list of CPT codes associated with problem gambling and will be sending a letter to all providers on the codes.
BH Education Campaign Update
This year, GOBHI and partners embarked on a public education campaign in Eastern Oregon; the focus is centered on behavioral health workforce development.
In spring 2023, the campaign will use a wide variety of multimedia tools in order to convey the efficacy of BH services and draw in professionals to join in this crucial work.
We are pleased to announce the campaign development – in partnership with our contractors, CFM (and subcontractors ZPP Productions and Birdee Media) - has moved into the material development stage.
The vendor’s team traveled throughout Eastern Oregon during October to record video testimonials from a diverse group of real BH professionals. Now, the intensive process of video editing has begun.
Also, the campaign steering committee, partners, and vendor collaborated to develop a logo and tagline for the product: Come Care with Us.
During January and February, stay tuned for updates from staff leads Lindsay Gordon and Pat Mulvihill. We will be inviting feedback from recruitment/HR professionals in our provider network to test the materials and offer feedback on the key marketing stage of the campaign.
GOBHI seeks applications for housing funds
Reminder: GOBHI recently announced a request for applications from organizations engaged in new affordable housing development projects in Eastern Oregon. This is a key opportunity to address the housing crisis our region is experiencing.
The housing stability project is a component of the EOCCO Comprehensive Behavioral Health Plan. For this effort, GOBHI has $100,000 available. Funds may be used for pre-development costs associated with new affordable housing units and must contemplate how units will be accessible to people with behavioral health needs.
We seek to fund four projects in total, and we will consider them in a quarterly schedule. We have moved past the first quarter and into the second in this process.
Application due dates:
For 2nd quarter: Received by Noon, Wednesday, March 15, 2023
For 3rd quarter: Received by Noon, Thursday, June 15, 2023
For 4th quarter: Received by Noon, Friday, September 15, 2023
Priority will be given to new projects in the pre-development phase. If you have questions, please contact Marci McMurphy at GOBHI: email@example.com, 541-298-2101. The application is posted on our website.
SUD Waiver reminder
Background: The Centers for Medicare & Medicaid Services (CMS) approved Oregon’s Substance Use Disorder 1115 Demonstration waiver, effective April 8, 2021, through March 31, 2026. This SUD specific waiver helps build a full continuum of care for Medicaid members with substance use disorders. The following is part of a series of updates from GOBHI helping to keep you informed about the waiver and its related requirements.
As Of Jan. 1, 2022 OHA has opened up several new SUD reimbursement codes. OHA has updated the Medicaid Management Information System (MMIS) with these changes. Providers can now bill for these new rates and services for dates on or after Jan. 1, 2022.
Please refer to this link to the CMS approval letter: https://www.google.com/url?q=https://www.oregon.gov/oha/HSD/Medicaid-Policy/Documents/PHE-Risk-Mitigation-Approval.pdf&sa=D&source=docs&ust=1668204031486600&usg=AOvVaw3bpZuKbE-hkqZiUzrPA_cQ
For more information, visit our SUD 1115 Waiver Website, which is updated on an ongoing basis. For questions, contact Michelle Brandsma at GOBHI, firstname.lastname@example.org.
Program highlight - Foster Care
Foster homes for youth are greatly needed in Eastern Oregon!
The GOBHI Therapeutic Foster Care program provides full-time/part-time services and care to youth in foster homes with foster parents certified and trained by GOBHI. Youth are involved with the Oregon Department of Human Services (DHS), Child Welfare Division.
Please visit our website to learn more about the program and how you can help by sharing information, promoting the importance of foster care, and referring individuals who are able to support this critical effort.
Help us build a network of caring homes to support youth across our state. For more information about referral incentives and how you can support foster home recruitment efforts, see this flyer or contact a member of our Foster Care Team.
Invitation: County Highlights
This newsletter is published on the last Monday of each month.
One of our ongoing sections is a “spotlight” of each county. Each month, we invite updates from the 12 counties in our service area. We invite content from you for this section: 3-4 sentences (or ~150-300 words) about news in your county, such as staff, building, and success story content. Please contact Pat Mulvihill to sign up for one of the 12 months. Aside from sign-ups, we will reach out to you to help gather the content. Thank you for your support.
Submission due dates for comments and submitted write-ups: the second Friday of each month, at 4 p.m. Next due date is Jan. 13.