Overview of the Public Mental Health System in Oregon

History of Public Mental Health in Oregon

• Introduction
• Recent Developments
• Deinstitutionalization
• System Care for Children
• Expenditures for Public Mental Health Services

The Current Mental Health System

• Guiding Principles
• Population to Receive Available Services
• Array of Services
• Access to Services
• Adequate Linkages Between Services, Programs, and Agencies
• Stakeholder Participation in Policy-Making and Oversight
• Quality of Services

Mental Health Administration

• Organization
• Management Information Systems

In 1961, the Mental Health Division, hereafter referred to as the Division, was established. During the 1960s, fueled by the national effort to begin treating people with mental illness in communities and the Community Mental Health Centers Act, Oregon began contracting with Community Mental Health Programs.

In 1973, the Comprehensive Community Mental Health Program Act was passed. The Act integrated the three state hospitals with community programs into a regional system. In an effort to encourage counties to expand basic mental health services and to develop alternatives to hospitalization, the Act also granted one-to-one matching state funds to cover the cost for most services, with up to 100% state funding for defined alternatives to state hospital care.

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Recent Developments

Through a flourish of initiatives in the late 1980s and early 1990s, Oregon's public mental health system developed to its current capacity. The most notable achievements, highlighted below, include the Oregon Health Plan, deinstitutionalization, development of a system of care for children, and improved funding for all mental health services. The following chart demonstrates the evolution of Oregon's Medicaid-funded health care system. Throughout the 1980s, an increasing amount of state General Fund was used to leverage federal Medicaid dollars. This allowed for considerable expansion of the public physical and mental health care systems. However, escalating health care costs necessitated new strategies to provide cost effective and appropriate public health care. The Oregon Health Plan was developed in the late 1980s by Oregon lawmakers to provide a rational method for allocating public resources for health care. The basic tenets of the plan were to devote resources to services that had the greatest impact on the lives of consumers, to develop an alternative incentive structure to promote cost effective and appropriate service provision, and to provide coverage for all who needed it.

The Health Services Commission, comprised of physicians, service providers, and consumers, was formed in 1989 and charged with prioritizing medical conditions and associated treatments. Condition and treatment pairs are ranked according to the state of medical technology, the effectiveness and cost of treatment, public values, and advice from medical specialists and ethicists. In 1993, Legislators provided for the integration of mental health conditions and treatments into the prioritized list.  

Beginning February 1994, Oregon's Medicaid Authority began contracting physical health service delivery to managed care organizations and paying for services on a prepaid, capitated basis. Administered in this manner, providers no longer have the incentive to increase revenues by delivering costly and inappropriate services. At the same time, Medicaid eligibility criteria were expanded to provide health care coverage to a larger proportion of the population. In addition to the traditional Medicaid eligibility categories, all persons with family incomes below 100% of federal poverty level (FPL) and children under age 6 and pregnant women with family incomes below 133% FPL became eligible for the Oregon Health Plan. The 1997 Legislature increased the income limitation for children and pregnant women to 170% of FPL and added children age 6 to 11 to this group.

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In July 1995, mental health services were added to the Oregon Health Plan benefit package for contractors providing coverage in 20 of Oregon's 36 counties. In January 1997, the Division released a Request for Proposals to provide capitated mental health services on a statewide basis under the Oregon Health Plan. As of July 1, 1997, the Oregon Health Plan will include an expanded mental health benefit that will cover all Oregon Health Plan eligibles. Beginning October 1997, services will be provided through managed mental health organizations statewide.

Deinstitutionalization. The chart below demonstrates the shift from institutionalization towards a continuum of intensive community placements, short-term acute psychiatric care, and state hospital services when necessary. Since 1987, the number of adults served in state hospitals has declined 9.8% annually. During 1995, Dammasch State Hospital was closed and a 68-bed Oregon State Hospital-Portland campus was established to enhance accessibility and coordination with local community programs. In addition to budget savings, this also resulted in improved staffing at the state hospitals.

 Since 1987, the number of adults served in acute care units and intensive community and residential programs has increased at an annual rate in excess of 50%. This has assured stabilization of consumers nearer their homes with less disruption in their lives.

 
The Extended Care Management Unit (ECMU), created in 1995, is responsible for individual placement approvals and service utilization reviews for adults in need of extended mental health care. ECMU staff's efforts to monitor and coordinate the intensive service system have been instrumental in reducing the number of people requiring treatment in state hospitals, and have allowed nearly 400 people to leave state hospitals. Since 1995, 62% of those people have lived in the community without needing any form of emergency hospitalization for psychiatric conditions. Only 80 people have returned to state hospitals for extended stabilization and treatment. Of the 80, 38 returned to the community.

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System of Care for Children. Historically, Oregon's state and county mental health services were focused primarily on the needs of adults. From 1987 to 1992, Oregon received funds through the federal Child and Adolescent Service System Program (CASSP) to design and implement a system of care for children with mental health treatment needs. The program provided a set of values and principles, including early intervention, family involvement, and minimal restriction of freedom, to guide system development. Implementation of the federal Early and Periodic Screening Diagnosis and Treatment Program (EPSDT) expanded mandate resulted in expanded funding for children's mental health services. In fiscal year 1996-97, an estimated 28,000 children received public mental health services compared to 10,239 in fiscal year 1987-88.

 In addition to serving an increasing number of children, Oregon has also modified services and added new components to the system of care. Mental health services for children are currently provided in settings that were not previously used or were under-utilized, including homes, schools, and other community settings. In 1991, responsibility and funding for other state-funded treatment services, such as day and residential treatment, were transferred to the Division from the state's child welfare agency (formerly called Children's Services Division, now named Children, Adults and Families). For children needing intensive treatment, a system of residential and community-based programs has been developed and jointly managed between the division, Services for Children and Families, Oregon Youth Authority, and the schools. The number of children served in such programs has increased from 44 in fiscal year 1987-88 to 1,743 in fiscal year 1996-97, a 51% annual growth rate.

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Oregon completed a two year managed mental health care demonstration for 25% of the state's population in July 1997. The Child and Adolescent Plan (CAP Care) implemented in Multnomah County in April 1996 provided outpatient and acute care for an additional 25% of the state's children under a 1915(b) waiver. Like the Oregon Health Plan demonstration, CAP Care was also funded on a prepaid capitation basis.

Expenditures for Public Mental Health Services. As the following chart illustrates, growth in nominal expenditures for mental health services has outpaced growth in numbers served, particularly for children. While the number of children served in the public mental health system increased at an annual rate of 11.8% from 1987 through 1997, expenditures for children's rose 33.1%. As indicated earlier in the section, this is primarily the result of both the EPSDT mandate and the expansion of intensive services for children and adolescents in the custody of the state. Expenditures for adult programs rose at an 8.0% annual rate, slightly greater than the 5.9% annual growth in numbers served.

 
Resources have been shifted from state hospitals to community programs as a result of deinstitutionalization. The proportion of dollars expended on adult and children's community mental health services relative to state hospitals was 71.3% in fiscal year 1996-97, compared to 37.2% in fiscal year 1987-88.  Back to top

The Current Mental Health System

Guiding Principles

Population to Receive Available Services

Traditionally, adults have been prioritized for publicly funded mental health services based on risk of hospitalization and/or posing a hazard to the health and safety of themselves or others. Oregon, like other states, has been required under federal law to provide Medicaid-covered services to eligible children assessed with a condition by an EPSDT screen. Prioritization for non-Medicaid resources, if available, is based on risk factors associated with a psychiatric disorder. Oregon's Medicaid managed care demonstration, allowed through a Federal waiver of part 1115 of Title XIX of the social Security Act, entitled the "Oregon Health Plan", has changed how this client population is determined in two important ways. First, eligibility for Medicaid has traditionally been restricted to people who met eligibility for other welfare programs and then only for a subset with average family incomes around 58% of Federal Poverty Level.

The Oregon Health Plan established expanded criteria for Medicaid eligibility, beyond the requirement for categorical eligibility and resulting in coverage for all persons whose income falls at or below the federal poverty level. Second, for the Medicaid population, eligibility for mental health services is no longer determined by risk factors. The Oregon Health Plan Medicaid benefit package integrates health services for dental, chemical dependency, mental and physical conditions. Coverage is based on a prioritized list of integrated condition/treatment pairs. Assessments needed to diagnose a condition are always covered. Thus, an individual with an approved condition can receive appropriate mental health treatment, including educational and preventative programs, before the condition deteriorates to a critical stage.

Not all individuals requiring public mental health services will meet Medicaid eligibility criteria. Services continue to be made available to persons not eligible for the Oregon Health Plan according to statutorily defined risk criteria. In addition, various federal grants, local funds, and private insurance payments provide additional sources of revenue for Community Mental Health Programs to serve people who have not been identified as having serious mental illness. Back to top

Array of Services

Outpatient Services. Regardless of funding mechanism, clients are provided with an array of outpatient services, including assessment and evaluation, individual and group therapy, medication management, case management, and daily support and skills training. A range of services is available for clients experiencing psychiatric conditions including 24-hour crisis assistance, community-based respite care, and sub-acute psychiatric care. A promising feature of the Oregon Health Plan is the flexibility providers have to develop individualized treatment and intervention strategies. Allowable treatments for covered mental health conditions include both traditional treatments and alternative services suggested by contractors, allowing for less costly, more effective service delivery when appropriate. Intensive Services for Adults. In addition to the services outlined above, Oregon maintains a comprehensive system of intensive community-based, residential, and inpatient programs for clients requiring extended treatment and supervision. As of June 1997, 264 extended care placements located in secure residential, foster care, and supported-living programs were available for adults. An additional 126 placements were maintained in nursing homes or other facilities funded jointly with the State Senior and Disabled Services Division for clients requiring nursing care and added psychiatric treatment. A statewide system of regional acute care units provides 109 beds for short-term inpatient psychiatric services. For adults in need of long-term, secure treatment, 188 state hospital beds are available in two state psychiatric hospitals. Back to top

Intensive Services for Children. A variety of intensive service options are available to children and adolescents. Psychiatric Day Treatment (DARTS) programs provide 384 placements for children and adolescents who cannot attend regular school programs due to a mental or emotional condition. Therapeutic Foster and Proctor Care, and Therapeutic Group Home services offer approximately 50 additional placements of community-based treatment as an alternative to psychiatric residential and hospital levels of care.

Three types of residential psychiatric treatment services are available in JCAHO-accredited treatment facilities: 47 placements for assessment and brief treatment, 58 "step-down" beds for children discharged from psychiatric care, and 167 placements for residential psychiatric treatment services. Access to non-emergency inpatient care in psychiatric residential treatment facilities accredited by the Joint Commission on the Accreditation of Healthcare Organizations requires approval from a statewide Certificate of Need for Services Committee. Certificate of Need for Services (CONS) screening procedures require that a child's need for psychiatric residential treatment be determined by a psychiatrist prior to admission. This process assures that admissions are made according to the treatment needs of referred children and assures that less restrictive levels of care have proven ineffective or are inappropriate to meet these needs. The Certificate of Need for Services process preserves high level treatment options for those children who are most in need of these services and prevents inappropriate placements for other children.

Residential Medicaid (RES-MED) programs provide mental health services in State Office for Services to Children and Families (SCF) and Oregon Youth Authority (OYA) contracted programs. The mental health services are co-funded and managed by these agencies. Placements numbered 207 as of June 1997. Treatment is directed by an individualized treatment plan, which is regularly evaluated and adjusted for effectiveness. Staff deliver mental health treatment focused on symptoms, behavior, feelings and perceptions the child presents in the treatment/living milieu. Treatment includes regularly scheduled curriculum-based group therapy, group and individual skills training, and individual and family therapy. Most RES-MED programs provide on site education for enrolled children.

Psychiatric inpatient services are available in local acute care units for children in crisis. Sixty beds were available as of June 1997. Services include psychiatric assessment, diagnostic testing, medication administration and stabilization. The Child and Adolescent Treatment Program, located within Oregon State Hospital, provides 60 beds of extended inpatient care for children suffering from severe functional impairment. This program is JCAHO accredited and children's treatment is financed through federal Medicaid reimbursement to the state. Families are encouraged to participate in their child's hospital treatment and aftercare planning.

The Psychiatric Security Review Board (PSRB) maintains jurisdiction for individuals adjudicated "Guilty Except for Insanity". The PSRB reports to the Governor and has successfully utilized a variety of resources to manage people under its jurisdiction. In 1996 none of the people under the jurisdiction of the PSRB re-offended. The Division, in close coordination with the PSRB, provides mental health services to such individuals. Besides State Hospital services, the Division provides assessment of persons for the PSRB and court to determine whether treatment in the community is appropriate, determination of the supervision requirements of each placement, and treatment for persons conditionally released into the community. Community treatment includes evaluation, supervision, case management, psychotherapy, and medication management.

Access to Services

The Oregon Health Plan Mental Health Benefit. The comprehensive nature of the benefit package available to Oregon Health Plan enrollees is expected to improve access to mental health treatment for a significant proportion of Oregonians afflicted with mental illness. Contractors that demonstrate integration and coordination of necessary physical and mental health care and social support services are given preference in the selection process. Enrollees will also be able to access mental health treatment at earlier stages given that individuals are no longer required to be at risk of hospitalization or a safety hazard in order to receive priority for services. Oregon lawmakers have expanded Medicaid eligibility criteria twice since the Plan's inception, increasing the number of Oregonians eligible for Medicaid approximately 80%. As of July 1, 1997, all persons whose income falls below federal poverty level (FPL), pregnant women and age-12-and-under children with family incomes below 170 percent of FPL, and some full-time college students will be eligible for the Oregon Health Plan in addition to persons meeting traditional Medicaid criteria. Back to top

Access for Persons Residing in Remote Regions. Access to mental health services in rural areas of the state is comparable to that in urban areas. In addition to local programs, all persons have access to appropriate statewide resources such as acute psychiatric hospitalization, state hospital programs, and intensive community and residential programs.

An early Federal Community Mental Health Center Construction Grant was awarded to rural Eastern Oregon counties to develop an integrated community mental health service delivery system. The consortium of eastern counties has evolved over time. A new quasi-public benefit corporation, the Greater Oregon Behavioral Healthcare, Inc. (GOBHI), recently emerged to purchase and manage mental health care in rural Oregon counties under the Oregon Health Plan mental health demonstration. Through the pooling of resources, the fifteen counties that comprise GOBHI are able to provide mental health services across an area that makes up more than half of the landmass of the state. GOHBI's base of coverage will expand to include at least two rural counties in western Oregon as a result of the Oregon Health Plan expansion.

In an effort to better serve rural children, Treatment Foster Care was developed in 1992-93 through a joint funding initiative with the State Office for Services to Children and Families. Considered the least restrictive of the residential treatment options for children in child welfare custody, Treatment Foster Care provided by trained foster parents, employed and supervised by the local Community Mental Health Program is a particularly viable treatment option for children in rural counties. Of the thirteen Treatment Foster Care contracts awarded, eight are in rural communities.

While individuals in rural areas have access to services through manage care organizations and community mental health providers, access to some services, notably psychiatric evaluation, extended care and acute care, requires travelling long distances to reach the nearest provider. One solution has been the development of psychiatric evaluations delivered via teleconference. A majority of Oregon's rural counties have received federal designation as mental health professional shortage areas. This designation appears to be helpful in recruiting psychiatrists for areas that lack coverage by physicians without regard to specialty. Organizations in these counties are eligible to apply for repayment of student loans on behalf of a newly recruited psychiatrist, increasing the likelihood that that a full range of services can be developed.

Medicaid Authorization Specialists (MAS) authorize services for all children who receive more than 15 hours of Medicaid reimbursable services per month or who receive mental health treatment services from more than one provider. The MAS develop plans of care that prescribe necessary services, including medical, dental, protective services, and housing and identifies the providers responsible for providing them. They facilitate entry into higher levels of care for those children who need more intensive services than outpatient treatment or who require authorizations for extended stays greater than seven days in local hospitals. The Medicaid Authorization Specialists also facilitate access to statewide resources such as residential treatment or the Oregon State Hospital. These functions will become the responsibility of the Mental Health Organizations under the Oregon Health Plan.

Access for Persons Who Are Homeless. Access to available services is most problematic for the homeless. The Federal Plan to Break the Cycle of Homelessness was authorized under presidential authority in 1993. A survey conducted by the federal department of Housing and Urban Development (HUD) in that same year indicated that federal, state, and local planners consistently rated mental health treatment needs among their highest priorities in planning for services to people who are homeless.

Since 1988, the State has received Federal McKinney Mental Health Services for Homeless (MHSH) Block Grant funds, currently titled Projects to Aid in the Transition from Homelessness (PATH), to establish specialized services in the two counties with significant homeless populations: Marion and Multnomah. Both counties provide outreach services to engage those individuals who are seriously mentally ill and who use emergency shelters or live outdoors. Once engaged, other services may include intensive case management, medication stabilization and management, referral for primary health care problems, transitional and supported housing options, dual diagnosis services and treatment, money management, referral for job training and/or education, and linkage to ongoing community mental health services. Back to top

The Division supports a number of programs that provide housing opportunities to homeless persons with mental illness: (1) the Housing Authority of Portland's Shelter Plus Care program providing rent subsidies combined with support services; (2) Northwest Human Services' Safe Haven program for five persons from Marion County who are transitioning from homelessness to permanent housing; (3) Lane County's Safe Haven program for 12 persons who are transitioning from homelessness to permanent housing; and (4) Mental Health Services West's "Royal Palm" program that provides a dormitory and single rooms for 45 of the most persistently homeless persons with mental illness in downtown Portland.

In Oregon, the majority of children and adolescents who are homeless reside in the Portland metropolitan area. A limited array of services are available through a small number of private nonprofit social service agencies including Portland Impact, Human Solutions, Outside-In, and the Green House youth shelter. These agencies provide housing, case management and related social services, and operate a drop-in center and youth shelters for runaways and street youth. Advocates sponsored a bill in the 1997 Legislature to address the problems of homeless adolescents. The bill, which would have directed additional resources toward this population as a delinquency prevention measure, did not pass.

The remaining counties in the State also serve homeless persons with serious mental illness, largely through their crisis services. Specific services provided include limited outreach, psychiatric and physical health stabilization, emergency and short-term housing, assistance with entitlements, and linkage to ongoing community mental health services.

Screenings Delivered in Non-Mental Health Settings. Identifying that an individual suffers from mental illness is paramount to connecting them with necessary services. Mental health screening programs for adults are delivered in a variety of settings, including nursing facilities, correctional facilities, and as part of the precommitment process. Medicaid eligible children receive a mental health developmental assessment as part of the EPSDT screening process and as part of the Oregon Health Plan focus on prevention and early intervention. Also, in preparing children's individualized education plans required through the Individuals with Disabilities Education Act (IDEA), children can receive mental health assessments to determine whether they have serious emotional or neurobiological impairments which would affect their ability to learn.

Access for Minorities. The Division has worked to promote access to culturally appropriate and responsive services. The Division routinely requires Community Mental Health Programs to address cultural factors in organizational planning. To improve access to appropriate services, the Division has developed Administrative Rules, which require that cultural factors be included as one of the domains of comprehensive clinical assessments for all persons enrolled in state-funded mental health treatment services. Further, Mental Health Organizations and other Medicaid providers are required to provide appropriate translation services for adults, children, and families who require them. Back to top

Adequate Linkages Between Services, Programs, and Agencies

Mental health services are most effective when delivered in concert with other social supports, including housing and income assistance, health care, and vocational and educational programs. The Division is committed to developing the linkages necessary to give persons with mental illness the opportunity for independent and meaningful lives. The Oregon Health Plan. Oregon Health Plan contractors are required to establish linkages with support services, including established Community Mental Health Programs, for services that are not covered by the capitation payment. Thus, enrollment in an Oregon Health Plan managed care organization will serve as a single access point for all necessary social services available to persons eligible for Medicaid, more than half a million individuals in fiscal year 1996-97.

Housing Issues. The Division provides technical assistance to local agencies in the development of housing resources, financing packages, and applications for federal Department of Housing and Urban Development (HUD) awards. In addition, since 1989, the Division has awarded small grants used to leverage funds to complete financial packages and develop housing for persons with mental illness. As of July 1997, a total of $2,077,485 has been awarded to 80 housing projects throughout Oregon to create or preserve housing, accompanied by various levels of support, for 982 persons with psychiatric disabilities. This program has taken on increased importance as the Portland Metropolitan Area has become the second least affordable housing market in the nation.

Children in State Custody. Children in the care, custody and supervision of the State's Services to Children and Families Division comprise more than half of children receiving mental health treatment services. The Division has Interagency Agreements to co-finance and co-manage much of the out-of-home treatment services provided to these children.

Children in the Juvenile Justice System. Historically, youth in the juvenile justice system have experienced difficulty gaining access to mental health treatment services. In 1995, the State Legislature established the Oregon Youth Authority, which has responsibility for incarceration of and services for adjudicated youth. In establishing the Oregon Youth Authority, approximately 50% of the child welfare-contracted mental health treatment beds in Oregon were transferred from the State Office for Services to Children and Families to the Oregon Youth Authority. As a result, these beds are now designated for serving youth that are involved in the juvenile justice system. The Division and the Oregon Youth Authority are working in close collaboration to expand the system of care and to further develop appropriate mental health treatment resources for adjudicated youth. Back to top

The Division Maintains State Hospital and Community Mental Health Program Linkage Agreements to assure effective case management of persons treated in and discharged from state hospitals. Similar agreements are in effect between regional acute care units and Community Mental Health Programs. These agreements will require greater involvement in screening, admission, treatment, discharge planning, and aftercare on the part of Community Mental Health Programs.

Persons in the Extended Care System. The Division's Extended Care Management Unit manages placements in state hospitals, acute care units, and extended care placements. The ECMU is also responsible for coordinating transition between settings and from extended care to lower levels of care (case management and supported-living programs).

Seniors. The Division co-finances and co-manages services to seniors with mental illness who require 24-hour care in Adult Foster Homes and specialized Enhanced Care Facilities.

Persons in Correctional Facilities. The 1995 Legislature gave the State Department of Corrections responsibility for developing and providing a full range of mental health services for inmates in correctional facilities. The Division's Mental Health Corrections Program retains quality assurance responsibility, conducting reviews and providing technical assistance to insure adequate and appropriate service delivery. Back to top

Stakeholder Participation in Policy-Making and Oversight

Planning and Management Advisory Council. The Division provides administrative resources and staff to the Mental Health Planning and Management Advisory Council (PAMAC). The Council consists of representatives from consumers, family advocacy organizations, State hospitals, State agencies, Community Mental Health Programs, and provider organizations and serves as a forum for stakeholders to make recommendations on major policy changes and initiatives. Equal representation is maintained for both adults and children. Regional Planning Councils. The Division maintains six regional planning councils. Representatives from acute care units, mental health administration, community providers, and advocacy organizations give direction to both inpatient and community-based services related to each of the local acute care facilities.

Director of Consumer Advocacy. The Division has historically provided accommodations and administrative resources for a statewide Director of Consumer Advocacy, a full-time position funded through a CMHS Service System Improvement Grant to serve as an independent advocate for consumer issues. Outstationed in the Division, the Director has been intimately involved in state policy development and decision-making. As discussed under Requirement 1 of the adult plan, the status of this position will change during the coming fiscal year.

Oregon Family Support Council. The Division participates in the Oregon Family Support Council. The Council provides assistance in the development of family support policy for all of the agencies in the Department of Human Resources. Family members will comprise at least 50% of the Council membership. Policy makers, advocates, and service provider representatives are also included among the Council membership.

State Target Planning and Consultation Committee. The Division participates as a member of the State Office for Services to Children and Families Target Planning and Consultation Committee. It is the responsibility of this committee to approve and fund individualized treatment plans for children in state custody who would otherwise be placed out of state or in the state hospital for treatment.

Oregon Health Plan. Oregon Health Plan managed care organizations are required to maintain consumer, advocate, and family member involvement in monitoring and quality assurance processes for managed behavioral health services. Back to top

Quality of Services

Training. The Division sponsors and coordinates a variety of educational workshops, conferences, and training programs. Events are held in a variety of formats, including on-site programs throughout the state, closed circuit and satellite broadcasts, and videotape distribution. The Division administers recertification workshops for Professional Assault Response Training (PART) Trainers. The Division sponsors training for professionals in the Oregon Youth Authority, Juvenile court system, and local agencies to provide mental health screenings. Training is provided for commitment investigators and law enforcement personnel to insure compliance with statutory requirements and appropriate police response to persons in crisis. Quality Assurance. The Office of Mental Health Services' Quality Assurance Unit is responsible for licensing Residential Care Facilities and Adult Foster Homes serving persons with mental illness. Additionally, certification programs are administered for Community Mental Health Programs and sub-contracted providers, Day Treatment and JCAHO-accredited residential programs for children, acute care units, privately-funded non-inpatient mental health providers, and providers utilizing hold rooms. Unit staff conduct site reviews of community programs and acute care facilities to insure compliance with contract conditions and state regulations.

Oregon Health Plan contractors are required to develop comprehensive quality assurance plans. A Mental Health Organization's plan provides for the systematic collection of utilization, performance, and outcome data. This information is compared to established performance standards for access to services, quality of care, education, outreach, preventative care, and coordination of available social services. The plan describes how findings are communicated to all stakeholders, including practitioners, enrollees and family members, and Division staff. A quality assurance committee representing all stakeholders is authorized to identify and implement changes in the delivery of services.

Abuse and Critical Incident Reporting. Under Oregon Statute and associated Administrative Rules, private or public officials must report potential instances of abuse of an adult with mental illness to the Division. The Quality Assurance Unit is responsible for logging reports of abuse, monitoring the progress of investigations and when necessary, conducting investigations and writing reports.

Oregon Administrative Rules. The body of Oregon Administrative Rules (OARs) governs all services and activities administered by State agencies. The Division continually reviews and updates rules regarding the delivery of mental health services to reflect state-of-the-art practices and insure consistency with federal regulations. In fiscal year 1996-97, the Division adopted revisions for children's community treatment services. Work continued on rule revisions pertaining to Residential Care Facilities and the commitment process. Back to top

Mental Health Administration

Organization (July 1, 1997)

In state fiscal year 1996-97, the public mental health system was in transition. In twenty "demonstration" counties, provision of Medicaid-covered outpatient and acute inpatient services were contracted through managed care organizations under the Oregon Health Plan. Approximately 28% of Medicaid-eligible public mental health clients received services in these counties. In addition, Medicaid-eligible children in Multnomah County received services through CapCare, a managed care initiative funded on a prepaid capitation basis through a 1915b waiver. An additional 25% of child and adolescent mental health recipients received services through CapCare. Medicaid mental health services in the remaining counties were contracted through Intergovernmental Agreements with counties and direct contracts and reimbursed on a fee-for-service basis. For individuals not eligible for Medicaid, Community Mental Health Programs continued to deliver mental health services prioritized according to statutorily mandated criteria based on risk of hospitalization and dangerousness. Back to top

The Division maintains detailed population estimates. This information is used to derive estimates of prevalence for serious mental illness in adults and serious emotional disturbance in children. Racial, age, and geographic distributions are compared to those of the client population to identify potential variations in access and appropriateness of services across groups. Back to top