Section 413.NEW - [Newly enacted section not yet numbered](1) The certified community behavioral health clinic program is established in the Oregon Health Authority for the purpose of certifying community behavioral health clinics that meet criteria adopted by the authority by rule to receive prospective fixed cost-based rates, as provided in subsection (4) of this section, for services provided to medical assistance enrollees.(2) The authority shall appoint an advisory committee, as described in ORS 183.333, to advise the authority in the adoption of rules to carry out this section. The Director of the Oregon Health Authority shall appoint to the advisory committee 15 individuals who represent a diverse constituency and are knowledgeable about certified community behavioral health clinic delivery systems, patient-centered primary care home delivery systems, integrated health care or health care quality. At least five members of the advisory committee must be current or former consumers of the type of behavioral health services that are typically provided by certified community behavioral health clinics or family members, representatives or advocates for such consumers. Rules adopted by the authority:(a) Must be consistent with the criteria adopted by the United States Department of Health and Human Services for certified community behavioral health clinics; and(b) Shall ensure that certified community behavioral health clinics provide, either directly or by referral through formal relationships with other providers, all of the services required by the criteria adopted by the United States Department of Health and Human Services for certified community behavioral health clinics.(3) If the authority adopts requirements for certified community behavioral health clinics that are in addition to the criteria described in subsection (2)(a) of this section, the authority shall: (a) Provide funding to the clinics sufficient to reimburse the costs of the additional requirements; or(b) Have a process for granting allowable variances to one or more of the requirements.(4)(a) A certified community behavioral health clinic shall complete the federally required cost report for the authority to review and approve the clinic's prospective fixed cost-based rate for a patient encounter.(b) The authority shall regularly adjust the prospective fixed cost-based rate at intervals consistent with federal guidance. A certified community behavioral health clinic may request a rate adjustment if a clinic changes the clinic's scope of services.(c) The authority shall adopt and provide to certified community behavioral health clinics guidance on the development of fixed rates and billing. The fixed rate must include but is not limited to: (A) An estimate of the projected cost of anticipated expansions of the certified community behavioral health clinic program or the populations served by the program; and(B) The cost of the technology and data systems needed by each clinic to track and measure outcomes and other data that the authority requires to be tracked or measured.(d) The authority shall review federal guidance on rate setting for clinics that are dually certified as federally qualified health centers, as defined in 42 U.S.C. 1396d(l)(2), and as certified community behavioral health clinics and provide recommendations to such dually certified clinics about how the clinics can best bill for services.(5) In any geographic region of this state that is served by both a certified community behavioral health clinic and a community mental health program:(a) Before the authority may approve the certification of a certified community behavioral health clinic, the certified community behavioral health clinic and the community mental health program shall enter into a written agreement concerning collaboration between the clinic and the program in the coordination of services that are provided by both the clinic and the program.(b) The authority shall develop a plan to ensure: (A) Coordination of services between the clinic and the program to minimize service redundancies; and(B) Financial efficiencies to maximize financial benefits.(6) This section does not require a clinic that is eligible for certification under this section to apply for certification. Participation in the certified community behavioral health clinic program is voluntary.Added by 2024 Ch. 70,§ 14, eff. 4/1/2024.