|
July 13, 2023
Media Contact: Elizabeth Gharst, elizabeth.a.gharst@oha.oregon.gov, 971-666-2476
Agency takes steps to improve access to behavioral health and substance use services for Oregon Health Plan members.
PORTLAND, Ore. – In response to an Oregon Health Authority (OHA) Ombuds Program report released in May that underscored key Oregon Health Plan (OHP) member concerns and issues from 2022, the agency is taking steps to address concerns and employ solutions.
The OHA Ombuds Program, which advocates for OHP members, publishes a yearly report to summarize key areas where OHP services are most frequently brought to the Ombuds Program by members. The report uses Ombuds Program data, OHA claims data, coordinated care organization (CCO) financial reporting data, member stories and experiences and other statewide data sources to elevate and document the system barriers experienced by many OHP members.
In addition to issues with access to non-emergency medical transportation and pharmacy concerns, conclusions from the 2022 Ombuds Program report include:
-
Residential capacity is low. OHA must work to ensure that OHP members have timely access to appropriate substance use disorder (SUD) treatment, expand statewide service capacity for all residential treatment providers and address the lack of facilities accepting OHP members or lack of providers enrolled to accept OHP members. There are only 47 SUD residential facilities statewide, of which 36 are contracted to be OHP providers.
-
A lack of Emergency Department (ED) support endangers unhoused members. Members with certain health conditions are likely to miss opportunities to obtain care coordination and community-based supports and frequently use EDs as avenues to primary care. Data show that OHP members with mental health or substance use disorders visited EDs an average of two times during 2022; however, because discharge planning is required only in an in-patient setting, most individuals seeking ED care for an SUD or mental health diagnosis were not fully connected to care.
-
Home and community-based services need improved screening processes. Individuals with mental health disabilities encountered significant barriers in being referred for screening, qualifying for services and obtaining approved services by providers. By fixing issues related to home and community-based services access, Oregon will be better able to support housing stability, reduce the “Aid & Assist” population, and follow the Americans with Disabilities Act to provide services to individuals with disabilities in the most integrated setting appropriate to their needs.
“I have great deal of gratitude for the Ombuds Program and their help every day in assisting OHP members,” said Dana Hittle, Oregon’s Medicaid director. “As part of OHA’s commitment to eliminating health inequities, it’s essential for OHA to listen and learn from individual concerns. Continued work by the Ombuds Program to identify needed fixes in our Medicaid program will help improve the health of those who rely on OHP.”
OHA treats the Ombuds report as an audit and will create a full action plan to address the findings. OHA’s Health Systems Division responded to the 2022 Ombuds Report and outlined steps the agency is taking to improve member experiences, including:
-
Increase SUD residential capacity and access. The agency is reviewing CCO and fee-for-service claims to identify trends in how OHP members are currently accessing care and to improve oversight of treatment allowances by providers. The Behavioral Health Workforce Initiative is also working to provide incentives to help retain behavioral health professionals.
-
Expand home and community-based services utilization. In January 2023, OHA established a 1915(i) Implementation Project Team which began working with internal and community partners to identify service needs. The team focuses on establishing rate reviews and standardizing service codes to make it easier for providers to bill for these services. The goal is to implement services by 2024.
-
Non-Emergency Medical Transportation (NEMT). OHA established a Technical Advisory Committee for NEMT consisting of members, providers and others in the medical community to better understand NEMT challenges and identify solutions.
“This report highlights long-standing gaps in care coordination and links to critical supports, especially for Oregonians facing challenges with mental health and substance use who utilize emergency departments,” said OHA Behavioral Health director Ebony Clarke. “It is critical that we work towards more flexible and collaborative solutions with our partners in the health system,” Clarke said.
“It’s great to see forward progress, but we’re still a long way from where we need to be, particularly with community-based supports,” said Sarah Dobra, OHA’s Ombuds Program manager. “Significant, transformative, person-centered work – including member outreach and support for our providers who work with high-risk populations – is needed to connect people with vital supports that will help them live independently and reduce risk of being unhoused.”
The Ombuds Program will release a six-month report in August focused on children’s behavioral health. The report will include updates on progress made from prior recommendations.
###
 You are subscribed to Oregon Health Authority News Releases. View all OHA news releases.
|
