CareOregon Policy Changes (2025)
A lot has been changing following the policy
enacted by CareOregon in December.
Background on the Policy Changes
On Dec 5th, CareOregon/Oregon Health Plan announced a policy revision that would strip access for all CareOregon members from working with Associate-level clinicians in private practice. The policy is set to go into effect in July of this year.
Client Migration Plan
Because of this, Present Beings will be transitioning to a cash-only practice and my current CareOregon clients will travel (on paper) with me to my partner organization, Dian’s Well Counseling. What does this mean for you?
From a session-standpoint, very little will change for us in our work together. Some changes that will happen include: new paperwork, possible schedule changes, and a revised treatment plan after migrating to DWC.
I will be reaching out to each of you individually about the timeline for this, as we will migrate clients over in a period of several weeks.
All of my current OHP clients in individual therapy will NOT face an interruption in services during this transition.
Conjoint Treatment (Couples & Families) at DWC
Image description: two fat queerdos talk in bed over a cup of tea. They are engaged in eye contact and both have a slight smile.
After conferring with the owner of the group practice about this, I've been given the very unfortunate news that I will not be able to bill OHP clients for conjoint treatment, either in the short or long term. Below is an excerpt of the instructions I received:
"The long of the short of it is, we can't provide them on-going family therapy. [...] The main concern is that billing for marriage or couples counseling is considered fraud, waste, and abuse under Medicaid guidelines. Medicaid doesn’t expect to see billing for couples therapy for adults, [and] we can't provide long-term family therapy unless it's kids or adolescents. The only exception is for SUDs clinics, which is why some clinicians working for SUDs teams or agencies are so convinced all therapists are covered for it. While all other group practice owners warm vehemently against it."
As the above indicates, each clinic is going to have its own idea of what's allowed, but my work with the group practice requires I follow the strictest adherence to the CareOregon policy. Other clinicians who are not bound by COA-standards may still be offering these slots until the July cut-off date (when all Associate-level clinicians in Private Practice will stop being able to bill CareOregon independently).
I realize this is disappointing news for many of us, and I hope this blog post gives you some context to empower your decision making in next steps.
Wishing you well in the next steps of your journey!
- Ernest
