State recommends extended mental health transition
The Oregon Health Authority has recommended a longer transition period for moving Jackson County Mental Health patients to other providers.
A contract between the county and AllCare Health — which coordinates physical, mental and dental health coverage for many Oregon Health Plan patients — is set to expire March 31 after the two sides were unable to come to an agreement. Jackson County Mental Health has been providing mental health care to AllCare clients.
The state is recommending a 90-day transition period, according to a Friday letter Oregon Health Authority Director Lynne Saxton and Chief Health Systems Officer Varsha Chauhan sent to AllCare and the county.
AllCare had sought the extension, while Jackson County had hoped for a much longer transition period stretching through December 2018, saying AllCare would not be able to line up enough providers in the community to handle the patient load.
"Some staff had hoped for a recommendation for a longer transition," said Jackson County Health and Human Services Director Mark Orndoff.
He said Tuesday that the county and AllCare are in discussions about the state recommendations.
With so much uncertainty, the county has already lost 85 employees, with about 80 of those in mental health, Orndoff said.
"That encumbers our ability to enter into a long-term agreement," he said.
The Oregon Health Authority is also recommending the two sides hold weekly meetings to ensure a smooth transition of AllCare members, including those with high needs.
AllCare and the county should collaborate on communication with stakeholders and the community about progress on the transition. They should monitor the stability of the provider network in the community and jointly address any gaps, the letter said.
The state also wants AllCare to submit weekly reports about treatment capacity and patients' ability to access care. AllCare — which is a coordinated care organization, or CCO — will be required to submit a mitigation plan if members' needs can't be met at an appropriate level, the letter said.
"Throughout the process, OHA will continue to monitor concerns and critical issues such as CCO capacity and consumer access to necessary behavioral health services," the letter said. "Through both its administrative rules and its contract with CCOs, OHA has the ability to take regulatory action against a CCO if OHA determines members are being denied timely access to vital health services."
In response to the letter, AllCare Vice President of Government Relations and Health Policy Josh Balloch said, "We embrace the support of OHA in this transition, and we appreciate their call for improved collaboration and communication with JCMH. We’ll continue to work hand-in-hand with OHA to monitor our progress and ensure our members are getting the care they need."
AllCare says the county was not able to see enough patients, and waiting times for appointments were too long. The CCO says it could not meet state quality and access requirements by relying on the county alone — and was in danger of losing funding from the state for mental health care.
Jackson County had been receiving $13 million per year from AllCare for mental health services and rejected an $8 million offer. AllCare says it planned to use the $5 million to provide an array of additional mental health services and boost the number of providers in other settings, such as schools and doctors' offices where people are already going.
AllCare says it plans to invest $14.5 million in mental health services in Jackson County this year and is not pulling back on care.
A second CCO serving Jackson County residents on OHP, Jackson Care Connect, began an 18-month process to transition its patients away from county services in January.
The original target was to transfer 150 county clients per month, Orndoff said.
An updated transition plan calls for transferring 95 clients this month, 103 in April, 109 in May, 67 in June, 83 in July, 61 in August, 134 in September, 119 in October and up to 164 in November and December combined.
Jackson County Mental Health therapists are warning that disruptions to the local mental health system could lead to spikes in homelessness, unemployment, domestic violence, child abuse, crime, addiction, hospitalizations and suicides.
They contend Jackson Care Connect and AllCare cannot line up enough alternate providers to handle the client load.
AllCare is doing everything it can to create a smooth transition, according to Balloch.
AllCare's mental health partners include Options of Southern Oregon, Family Solutions and more than 35 private therapists. AllCare also plans to work with La Clinica, Rogue Community Health, and Care and Counseling, Balloch said.
Jackson Care Connect has turned to ColumbiaCare and other providers.
One in three Jackson County residents receives government-subsidized health coverage, which made them eligible to receive county mental health services if needed.
Jackson County is maintaining some mental health services, including crisis services and care for the indigent and patients with certain specialized needs.