Provider updates

What is changing?

As part of our efforts to ensure sustainable access for our members, we are making an important change to our standards for non-contracted behavioral health providers serving CareOregon, Jackson Care Connect, and Columbia Pacific members:

• Medicaid – Oregon Health Plan 
  • Effective October 1, 2025, CareOregon will require routine Medicaid outpatient mental health and substance use disorder services to be received by a contracted provider.    
• Medicare Advantage 
  • Effective January 1, 2026, CareOregon will require routine Medicare Advantage outpatient mental health and substance use disorder services to be received by a contracted provider.
  • Non-contracted services for Medicare Advantage will continue to be reimbursed through December 31, 2025, and services are subject to benefit limitations as detailed in the member’s Evidence of Coverage.  

What services are impacted?

The following services received by non-contracted providers will be affected by this policy change:

• Routine outpatient mental health and substance use disorder services such as:
  • Individual, family, & group therapy
  • Skills trainings
  • Case management
  • Prescriber evaluation & management services

What services are not impacted?

The following services may continue to be received by non-contracted providers, however services are subject to prior authorization/Notification of Treatment requirements:

• Applied Behavior Analysis (ABA)
• Partial hospitalization services (MH and SUD)
• Day treatment (MH and SUD)
• Intensive outpatient services (MH and SUD)
• Residential treatment (MH and SUD)
• Subacute treatment
• Respite
• Transcranial Magnetic Stimulation
• Electroconvulsive therapy
• Withdrawal Management

Why is CareOregon making this change?

As a publicly funded nonprofit organization dedicated to improving the health of our communities, we continually assess our members’ health care needs, their access to care, and our available resources now and in the future. We are navigating an incredibly challenging financial environment driven by the rising costs of health care and anticipated challenges to Medicaid funding. We must do more with less. 

With a smaller network of providers, we can streamline administrative management and focus on delivering high quality care to our members. This change is also in line with industry standards.

These changes are not a reflection of the value or importance of non-contracted providers. We value all our provider relationships and recognize the critical role they play in our health care system.

We’re here to help

There is capacity in our behavioral health provider network in all regions to serve impacted members.

Members and providers can access a list of our contracted providers online in our provider directories:

• CareOregon: https://providers.healthshareoregon.org/
• Jackson Care Connect: https://jacksoncareconnect.org/members/find-a-provider
• Columbia Pacific: https://colpachealth.org/members/find-a-provider
• CareOregon Advantage: https://www.careoregonadvantage.org/members/find-a-provider

If a member or provider are unable to find a contracted provider who is accepting new members, or have any questions, they may contact customer service (choose option 3 for provider):

• Medicaid:
  • CareOregon/Health Share of Oregon CCO: 503-416-4100 or 800-224-4840
  • Jackson Care Connect CCO: 541-500-0567 or 855-722-8208
  • Columbia Pacific CCO: 503-488-2822 or 855-722-8206
• Medicare:
  • CareOregon Advantage:  503-416-4279 or 888-712-3258

    Providers can refer high-risk and/or medically complex members for care coordination by submitting a referral to the Regional Care Coordination Team:

• CareOregon: https://www.careoregon.org/providers/support/care-coordination
• Jackson Care Connect: https://jacksoncareconnect.org/providers/care-coordination
• Columbia Pacific: https://colpachealth.org/for-providers/care-coordination
• CareOregon Advantage: https://www.careoregonadvantage.org/providers/care-coordination