Provider updates

For more FAQs about this change, visit our Behavioral health contracting and networking change FAQ page.

If you want to learn more about how this change could impact you, CareOregon will be hosting information sessions to help minimize disruptions and ensure continuity of care. Sign up for more details.

What is changing? 

• Currently, board registered associate providers who are unlicensed and non-contracted may be reimbursed for providing certain types of clinical services to CareOregon members.  
• As of July 31, 2025, CareOregon will be closing our network to unlicensed board registered associate providers who do not have a contract with CareOregon or are not employed by a group with a Certificate of Approval from the state. 
• CareOregon will no longer accept claims for member care with a date of service later than July 31, 2025 from non-contracted and unlicensed providers without a Certificate of Approval (unless they are part of a group with a Certificate of Approval from the state).
  

Why is this change being made?  

• Providers who are fully supported in upholding standards in safety, clinical care, credentialing, and oversight are best able to serve our members and fulfill our duty of care.
• Our goal is to ensure members can access high quality, clinically effective care.
  • This change supports member choice and access to care from a range of providers, including those who provide culturally responsive care.
    
  • Over the next eight months, we’ll work with providers to minimize disruptions and ensure continuity of care for our members.
• Our network needs to be able to offer comprehensive services, including crisis care and after-hours services for member with high acuity or complex cases. This is part of our commitment to health equity.
  • Behavioral health groups with a Certificate of Approval (COA) from the state operate with regular reviews of safety standards and quality of care.
  • We use standardized quality assurance practices to ensure the integrity of our network. Our credentialing committee, peer review process, and other parts of the credentialing process are key components of how we support providers no matter their specialization or experience level.
  • Requiring a contract allows us to verify the qualifications of our providers, assess their backgrounds, and ensure they have appropriate training, certification, license, and experience to provide care to our members.

What will CareOregon do next?

• We will continue to support a strong and diverse provider network that uniformly provides high quality care.
• We will continue to assess the breadth of services provided in our network to identify network needs and ensure members can access the care that suits them best, including that which is culturally responsive.
• We will continue to use a variety of information sources to assess members’ access to care, including geographic distribution of providers and access to culturally responsive programs and providers.
• We will continue to monitor for effective clinical care as well as fraud, waste and abuse in order to make sure members can access the services they need.

What should providers do next? 

• This change may impact: 
  • Board registered clinical associates
  • Board registered marriage and family associates 
  • Board registered professional counselor associates  
• This change does not impact:
  • Licensed, non-contracted providers
  • Unlicensed providers working in an organization with a Certificate of Approval (contracted or non-contracted)
  • Psychology residents who are part of an approved program and working toward eventual licensure under Oregon Board of Psychology guidelines
• Providers who are unlicensed, non-contracted, and working independently of an organization that holds a contract or Certificate of Approval with CareOregon should follow these instructions to avoid a claim denial:
  • Do not take on new members after December 1, 2024.
  • Develop a transition plan and coordinate the member’s care to an in-network provider of the member’s choice by July 31, 2025.
• You may refer any high-risk members for care coordination services by submitting a referral to the Regional Care Coordination Team to assist in transitioning to a new in-network provider.
• CareOregon will continue to allow claims from groups operating with a Certificate of Approval. If you are a non-contracted group with a Certificate of Approval, please contact Provider Customer Service to update your billing information by calling 800-224-4840 and choosing option 3.