Hundreds of Oregon House and Senate bills quietly died last week, with the March 29 deadline passing for legislation to be scheduled for a work session or get shelved.
The casualties included an Oregon Senate bill whose death has dismayed backers. They include officials at the National Alliance on Mental Illness of Oregon, who say Senate Bill 137 would have improved the state’s response to mental health crises by forcing coordinated care organizations to assume more responsibility for their subcontracted behavioral health service providers.
The shelving of SB 137 on Friday following a March 25 public hearing on the bill effectively ends efforts to place strict language into state laws prohibiting coordinated care organizations from fully delegating their financial risk for behavioral health benefits to subcontracted service providers in their communities, which supporters say leads to higher instances of denials of care.
SB 137 also would have required the Oregon Health Authority to set statewide prior authorization policies determining when a physician must receive approval from an insurer to provide certain medications.
“Behind the scenes in particular, there have been entities that, without bothering to show up to register open opposition, have been trying to kill the bill because it’s asking them to do things they maybe don’t want to be required to do,” said Chris Bouneff, executive director of the National Alliance on Mental Illness of Oregon.
It’s widely acknowledged that the Oregon Health Plan has failed the mental health needs of its clients. https://www.thelundreport.org/content/oregon-mental-health-patients-are-left-lurch-medicaid-system
The state ranked 49, followed by Idaho and Nevada, in a nationwide scorecard that includes Washington D.C. The ratings, developed by the nonprofit Mental Health America, were based on the prevalence of mental illness and access to treatment. In mental illness alone, Oregon was the worst in the country.
In hearing before the Senate Committee on Health Care last week, Bouneff and several supporters testified in favor of SB 137. No one spoke in opposition, but written testimony from Health Share, Oregon’s largest coordinated care organization; the Association of Oregon Community Mental Health Programs and officials with some of the state’s most populous counties show intense pushback to the statutory changes supporters wanted. Those organizations argued that they’re already working to improve mental health responses as part of Oregon’s preparation for the next Medicaid round, an effort the state calls “CCO 2.0.”
“We are concerned (SB 137) will impede our ability to achieve the state’s goals around both improving the behavioral health system and cost containment,” Maggie Bennington-Davis, interim CEO and chief medical officer for Health Share of Oregon, the coordinated care organization that represents about 315,000 Oregon Health Plan patients in Multnomah, Washington and Clackamas counties, said in written testimony to the Senate health care committee.
The Oregon Health Authority “is currently in the midst of a procurement process for CCOs that will accomplish many of the goals outlined in SB 137,” Bennington-Davis wrote. “It would be disruptive to that process to change the course of OHA’s CCO contracting policy in the middle of the procurement process.”
Officials from Washington, Clackamas and Lane counties also submitted written testimony that called the bill cumbersome and disruptive to their efforts to manage behavioral health care services.
Health Share, like many of Oregon’s 15 coordinated care organizations, contracts with the counties for mental health services. In turn, the counties often subcontract with the actual service providers that administer the care.
SB 137 supporters say the lack of direct accountability for coordinated care organizations in behavioral health care makes the system even more difficult for people in crisis to navigate, delaying critical care.
Sen. Laurie Monnes Anderson, D-Gresham, who chairs the Senate Committee on Health Care, declined to schedule a work session on SB 137. She shelved the bill after discussions with Multnomah County officials and representatives with Health Share of Oregon and Eugene-based Trillium Community Health Plan, she told The Lund Report.
“They all came to me with real concerns about the bill. That’s why it’s not moving forward,” Monnes Anderson said. She noted that behavioral health system improvements are one of four key target areas in Medicaid reform discussions. In 2017, Oregon Gov. Kate Brown tasked the Oregon Health Policy Board with improving mental health care delivery under the coordinated care model.
But giving coordinated care organizations flexibility to improve their care networks and make changes in future contracts is preferable for now to the mandates SB 137 backers were hoping to place in Oregon Health Authority statutes, Monnes Anderson said.
“I’m still hopeful that all these things that NAMI brought forward are possibly incorporated by some CCOs,” she said. “But I just don’t want to do a mandate yet.”
Bouneff said it’s a mistake to think coordinated care organizations will make large strides in their mental health delivery models without statutory changes to how the state regulates them.
“There’s this belief these new contracts are going to solve everything,” Bouneff told The Lund Report. “Our history shows contracts may make some incremental improvements, but by and large you don’t see the systemic changes happen rapidly enough to actually save people’s lives.”
He said he was discouraged by the process”We have these problems we’ve elaborated time after time after time after time, and we’re told, ‘Trust us, we’re going to do something about it,’” Bouneff said. “It’s frustrating because nothing gets done.”
You can reach Elon Glucklich at [email protected].
Priorities, people!