OAR 309-065 establishes the qualifications and application processes for outpatient behavioral health providers and residential substance use disorder (SUD) providers to receive enhanced Medicaid (Oregon Health Plan) reimbursement for delivering culturally and linguistically specific behavioral health services to minoritized cultural communities. Eligible providers—organizations, programs, or individual clinicians—must demonstrate cultural competency, community immersion or experience, and enrollment as outpatient Medicaid behavioral health providers. The rule also covers enhanced payments for bilingual and sign language direct care providers. Federally Qualified Health Centers, Rural Health Clinics, and Indian Health Care Providers are generally excluded from the enhanced fee schedule.
View official sourceOregon Health Authority Health Systems Division: Behavioral Health Services - Chapter 309 Division 65 CULTURALLY AND LINGUISTICALLY SPECIFIC BEHAVIORAL HEALTH SERVICES(CLSS) 309-065-0000 Purpose and Scope (1) These rules establish processes and procedures for outpatient behavioral health providers and residential substance use disorder (SUD) providers, delivering services that are culturally and linguistically specific, to receive enhanced payment for patients on the Oregon Health Plan. Organizations, programs and individuals that are reimbursed outside OHP's fee schedule for behavioral health services such as but not limited to Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Indian Health Care Providers (IHCPs) are not eligible for enhanced fee schedule reimbursement because these services are reimbursed at a clinic-specific encounter rate. There is a small subsection of services that are outside of this clinic-specific encounter rate that are eligible to receive the enhanced payment. (2) Whether or not an organization, program or individual qualifies for enhanced payments through this program, all providers of behavioral health services are encouraged to provide culturally and linguistically specific services if they have that expertise. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: HB 5202 (2021) History: BHS 2-2025, amend filed 02/27/2025, effective 03/01/2025 BHS 13-2023, adopt filed 05/23/2023, effective 05/30/2023 BHS 21-2022, temporary adopt filed 12/02/2022, effective 12/02/2022 through 05/30/2023 309-065-0010 Definitions (1) “Culturally and linguistically specific behavioral health services” means quality mental health, substance use, problem gambling, and other behavioral health prevention, treatment, and recovery supports and services that are designed specifically for a distinct minoritized cultural community, developed based on the languages used and cultural values of the distinct minoritized cultural community and designed to elevate their voices and experiences, and that have the aim of enhancing emotional safety, belonging, and a shared collective cultural experience for healing and recovery among the distinct cultural community served. (2) “Culturally and linguistically specific behavioral health organization “means an outpatient entity or institution that is structured to provide culturally and linguistically specific behavioral health services in its entirety as evidenced by its organizational mission. (3) “Culturally and linguistically specific behavioral health program” means a division or associated component of an organization that provides culturally and linguistically specific behavioral health services as evidenced by the program mission, that exists within the subset of services provided by an organization whose mission does not focus on a distinct minoritized community. (4) “Culturally and linguistically specific behavioral health individual provider” means an independently licensed and Medicaid eligible clinician that provides culturally and linguistically specific behavioral health services, and is in private practice rather than employed by an agency. (5) “Minoritized cultural community” is a community that has experienced historical and contemporary discrimination and oppression primarily on the basis of race, ethnicity, gender identity, sexual and affectional orientation, ability status, and/or migration history. (6) “Substance Use Disorders Treatment and Recovery Services” means outpatient, intensive outpatient, and residential services and supports for individuals with substance use disorders. (7) “Indian Health Care Provider (IHCP)” means a health care program operated by the Indian Health Service (IHS) or by an Indian Tribe, Tribal Organization, or Urban Indian Organization (otherwise known as an I/T/U) as those terms are defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. § 1603). (8) “Rural area” is an area greater than 10 miles from the center of an urban area. County with extreme access considerations: County with a population density of 10 or fewer people per square mile. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: HB 5202 (2021) History: BHS 2-2025, amend filed 02/27/2025, effective 03/01/2025 BHS 13-2023, adopt filed 05/23/2023, effective 05/30/2023 BHS 21-2022, temporary adopt filed 12/02/2022, effective 12/02/2022 through 05/30/2023 309-065-0020 Culturally and Linguistically Specific Services Organization & Program Qualifications (1) In order to qualify for culturally and linguistically specific behavioral health services enhanced payments as an organization, the organization must: (a) Be enrolled as an outpatient Medicaid Behavioral Health provider with the Oregon Health Authority (OHA) that is not prohibited by law from receiving the enhanced payment ; (b) Submit a complete application to the Oregon Health Authority (OHA); (c) Demonstrate the ability to serve a distinct minoritized cultural community; and (d) Be primarily led and staffed by people that have extensive experience working with or being immersed in the same minoritized cultural community they serve; or (e) Have a history of at least five years primarily serving the specified minoritized cultural community in a behavioral health setting. (2) To demonstrate the ability to serve a distinct minoritized cultural community under section (1) (c) of this rule an organization must provide information that shows the following: (a) Comprehensive knowledge of diverse lived experiences held by the minoritized cultural community being served including, but not limited to, their experiences of structural and individual racism, minoritization or discrimination that may have an impact on the community’s collective mental health and wellbeing. (b) Knowledge of specific behavioral health inequities documented in the minoritized cultural community being served, which may be addressed by the culturally and linguistically specific service organization. (c) A practice of supporting and affirming cultural and language practices for the community being served, such as but not limited to: (A) Health and safety beliefs, or practices; (B) Positive cultural identity, pride, or resilience; (C) Immigration dynamics; or (D) Religious beliefs. (d) A demonstrated ability to support and affirm clients experiencing intersectional oppression in the provision of services. The ability to support and affirm the unique needs of clients experiencing intersectional oppression may be evidenced through details of established collaboration with other culturally specific providers, details of dedicated spaces or groups provided for clients experiencing intersectional oppression, or any other supporting information. (3) The information required to be provided under section (1)(b) through (e) and (2) of this rule must include documentation of the organization’s culturally specific focus demonstrated in a mission statement, vision statement, or other public-facing document. Supporting information can also include but is not limited to: (a) Documentation detailing policies and procedures. (b) Documentation of staff training requirements and any resulting certifications. (c) A narrative that details the organization or program’s strategic plan or history and experience, including specific examples, without identifying any individual clients. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: HB 5202 (2021) History: BHS 13-2023, adopt filed 05/23/2023, effective 05/30/2023 BHS 22-2022, temporary adopt filed 12/05/2022, effective 12/05/2022 through 05/30/2023 309-065-0025 Culturally and Linguistically Specific Services Program Qualifications (1) In order to qualify for culturally and linguistically specific behavioral health services enhanced payments as a program, the program must: (a) Be enrolled as an outpatient Medicaid Behavioral Health provider with the Oregon Health Authority (OHA) that is not prohibited by law from receiving the enhanced payment; (b) Submit a complete application to the Oregon Health Authority (OHA). (c) Demonstrate the ability to serve a distinct minoritized cultural community: and (d) Be primarily staffed and render services provided by people that have extensive experience working with or being immersed in the same minoritized cultural community being served; or (e) Have a history of at least five years primarily serving the specified minoritized cultural community in a behavioral health setting. (2) To demonstrate the ability to serve a distinct minoritized cultural community under (1) (c) of this rule , a program must provide information that shows the following: (a) Comprehensive knowledge of diverse lived experiences held by the minoritized cultural community being served including, but not limited to, their experiences of structural and individual racism, minoritization or discrimination that may have an impact on the community’s collective mental health and wellbeing. (b) Knowledge of specific behavioral health inequities documented in the minoritized cultural community being served, which may be addressed by the culturally and linguistically specific service program. (c) A practice of supporting and affirming cultural and language practices of the minoritized cultural community being served, such as but not limited to: (A) Health and safety beliefs, or practices; (B) Positive cultural identity, pride, or resilience; (C) Immigration dynamics; or (D) Religious beliefs. (d) A demonstrated ability to support and affirm clients experiencing intersectional oppression in the provision of services. The ability to support and affirm the unique needs of clients experiencing intersectional oppression may be evidenced through details of established collaboration with other culturally specific providers, details of dedicated spaces or groups provided for clients experiencing intersectional oppression, or any other supporting information. (3) The information required to be provided under section (1)(b) through (e) and (2) of this rule must include documentation of the organization’s culturally specific focus demonstrated in a mission statement, vision statement, or other public-facing document. Supporting information can also include but is not limited to: (a) Documentation detailing policies and procedures. (b) Documentation of staff training requirements and any resulting certifications. (c) A narrative that details the organization or program’s, strategic plan or history and experience, including specific examples, without identifying any individual clients. Statutory/Other Authority: 413.042 Statutes/Other Implemented: HB 5202(2021) History: BHS 13-2023, adopt filed 05/23/2023, effective 05/30/2023 309-065-0030 Culturally and Linguistically Specific Services Individual Qualifications (1) In order to qualify for culturally and linguistically specific behavioral health services enhanced payments, individual behavioral health providers must: (a) Be enrolled as an outpatient Medicaid Behavioral Health provider with the Oregon Health Authority (OHA). (b) Submit a complete application to the Oregon Health Authority (OHA). (c) Demonstrate the ability to serve a distinct minoritized cultural community. (2) To demonstrate the ability to serve a particular minoritized community under (1) (b) of this rule , an individual behavior health provider must provide information that shows the following: (a) Comprehensive knowledge of diverse lived experiences held by the minoritized cultural community being served including, but not limited to, their experiences of structural and individual racism, minoritization or discrimination that may have an impact on the community’s collective mental health and wellbeing. (b) Knowledge of specific behavioral health inequities documented in the minoritized cultural community being served, which may be addressed by the culturally and linguistically specific service provider; (c) A practice of supporting and affirming cultural and language practices for the minoritized cultural community being served, such as but not limited to: (A) Health and safety beliefs or practices; (B) Positive cultural identity, pride, or resilience; (C) Immigration dynamics; or (D) Religious beliefs. (d) A demonstrated ability to support and affirm clients experiencing intersectional oppression in the provision of services. The ability to support and affirm the unique needs of clients experiencing intersectional oppression may be evidenced through details of established collaboration with other culturally specific providers, details of dedicated spaces or groups provided for clients experiencing intersectional oppression, or any other supporting information ; and (e) Have extensive experience working with or being immersed in the same minoritized cultural community being served, or, if not immediately immersed in the same community served, have5 or more cumulative years of service provision to the identified minoritized cultural community they are serving. (3) The information required to be provided under section (1)(c) and (2) of this rule can include, but is not limited to: (a) A resume or curriculum vitae detailing academic credentials, relevant course work or certifications; or (b) A narrative that details the individual’s professional history and experience, including specific examples, without identifying clients. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: HB 5202 (2021) History: BHS 13-2023, adopt filed 05/23/2023, effective 05/30/2023 BHS 21-2022, temporary adopt filed 12/02/2022, effective 12/02/2022 through 05/30/2023 309-065-0040 Bilingual Service and Sign Language Provider Qualifications (1) Individual providers who deliver direct care services in a language other than English or in sign language may be eligible to receive enhanced payments for direct care services delivered in a language other than in English, or in sign language. Oral or sign language interpretation is not eligible for this enhanced payment. (2) In order to qualify for enhanced payment, a direct care behavioral health provider must: (a) Be enrolled as a Medicaid Behavioral Health provider with the Oregon Health Authority (OHA); (b) Be a Bilingual service provider and identify the language(s) other than English that the provider uses in providing direct care services to clients that speak the language(s); (c) For bilingual service providers, provide: (A) Proof of having passed a language proficiency assessment by an OHA approved language proficiency testing center in the last three years for the language(s) identified; or (B A narrative detailing how proficiency in the language was acquired, such as growing up in a home where this language was the primary language used if no language proficiency assessment is available in a particular language. (d) For providers using Sign Language, provide: (A) Proof of current sign language interpreter certification from an OHA approved sign language interpreter testing center; or (B) A narrative detailing how proficiency was acquired in sign language, such as growing up in a home where sign language was the primary language used. (3) Nothing in this rule is intended to exempt a health care provider from complying with ORS 413.559 and OAR 950-050-0160. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: HB 5202 (2021) History: BHS 13-2023, adopt filed 05/23/2023, effective 05/30/2023 BHS 21-2022, temporary adopt filed 12/02/2022, effective 12/02/2022 through 05/30/2023 309-065-0050 Culturally and Linguistically Specific Residential SUD Provider Qualifications (1) Except as provided in subsection (4) below, i n order to qualify for culturally and linguistically specific behavioral health services enhanced payments as a residential SUD provider, they must: (a) Be enrolled as a residential SUD Medicaid Behavioral Health provider with the Oregon Health Authority (OHA) that is not prohibited by law from receiving the enhanced payment; (b) Submit a complete application to the Oregon Health Authority (OHA); (c) Demonstrate the ability to serve a distinct minoritized cultural community; and (d) Be primarily led and staffed by people that have extensive experience working with or being immersed in the same minoritized cultural community they serve; or (e) Have a history of at least five years primarily serving the specified minoritized cultural community in a behavioral health setting. (2) To demonstrate the ability to serve a distinct minoritized cultural community under section (1) (c) of this rule an organization must provide information that shows the following: (a) Comprehensive knowledge of diverse lived experiences held by the minoritized cultural community being served including, but not limited to, their experiences of structural and individual racism, minoritization or discrimination that may have an impact on the community’s collective mental health and wellbeing. (b) Knowledge of specific behavioral health inequities documented in the minoritized cultural community being served, which may be addressed by the culturally and linguistically specific service organization. (c) A practice of supporting and affirming cultural and language practices for the community being served, such as but not limited to: (A) Health and safety beliefs, or practices; (B) Positive cultural identity, pride, or resilience; (B) Immigration dynamics; or (C) Religious beliefs. (d) A demonstrated ability to support and affirm clients experiencing intersectional oppression in the provision of services. The ability to support and affirm the unique needs of clients experiencing intersectional oppression may be evidenced through details of established collaboration with other culturally specific providers, details of dedicated spaces or groups provided for clients experiencing intersectional oppression, or any other supporting information. (3) The information required to be provided under section (1)(b) through (e) and (2) of this rule must include documentation of the organization’s culturally specific focus demonstrated in a mission statement, vision statement, or other public-facing document. Supporting information can also include but is not limited to: (a) Documentation detailing policies and procedures. (b) Documentation of staff training requirements and any resulting certifications. (c) A narrative that details the organization or program’s strategic plan or history and experience, including specific examples, without identifying any individual clients. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: HB 5202 (2021) History: BHS 2-2025, adopt filed 02/27/2025, effective 03/01/2025