State guidelines may lead to reduced health care access
Published 2:13 pm Thursday, September 25, 2025
CareOregon curtails behavioral health options
Columbia Pacific Coordinated Care Organization, the health insurance agency that provides coverage in Clatsop, Tillamook and Columbia counties, will be reducing their coverage scope come Oct. 1.
CareOregon, of which Columbia Pacific is a subsidiary, will no longer reimburse non-contracted providers for routine outpatient behavioral health services — including mental health counseling, substance use disorder treatment, and prescriber evaluation and management visits.
The change comes as CareOregon seeks to align its guidelines with expected changes to Oregon Health Authority regulations come the end of the year.
“With the change, CareOregon is really aligning with industry standards,” Rachel Paczkowski, Columbia Pacific director of behavioral health, said at the Sept. 17 Clatsop County Commission meeting. “Nowhere in the country outside of Oregon are individual unlicensed mental health providers allowed to bill Medicaid or commercial insurance directly … they need to be working under another organization.”
The policy change is two-pronged.
First, on Aug. 1, certain provider types became ineligible for reimbursement for providing mental health and substance use disorder services as an individual or under a non-certificate group.
Second, on Oct. 1, outpatient mental health and substance use disorder services will be required to be provided by a contracted licensed provider.
For example, this means that individuals who receive services for substance use disorder treatment via an out-of-state telehealth provider without a license to operate in Oregon, will no longer be able to work with that clinician.
“They represent care for 8% of outpatient services to members in Clatsop County,” Paczkowski said, roughly equivalent to 202 people, 191 adults and 11 youths.
According to a one-pager provided to county commissioners by CareOregon, “this change is also in line with industry standards and helps us prepare for sweeping federal Medicaid budget cuts.”
Commissioners Mark Kujala and Lianne Thompson both voiced their concerns about the changes during the Sept. 17 meeting.
Thompson shared her first-hand experience with the difficulties surrounding becoming a licensed health provider in Oregon.
Kujala said the changes may, for a time, limit access to necessary behavioral health services.
“I have had conversations with owners of private counseling services here in Clatsop County, Shoreline Counseling being one of them, and I know they are very concerned about the process, about how long it will take to get folks a COA (Certificate of Authority),” Kujala said. He added that the new requirements also place an additional administrative burden on providers.
Speaking after the meeting, Kujala said that if it takes six months or longer for a provider to get approval, that is a long time to go without reimbursement or to go without being able to provide service.
Commissioner Pamela Wev said she found the changes to be concerning.
“This is very, very upsetting to me. I hear from providers that they have trouble hiring people because the process is so difficult,” Wev said.
Paczkowski said the changes have been precipitated by communication and dialogue between providers and Columbia Pacific.
“A huge part of our effort has been engaging with our key partners,” Paczkowski emphasized. “We are putting processes in place to assess for and fill gaps in our current network.”