House bill

House bill would strengthen behavioral health workforce

Behavioral healthcare providers in Oregon can get state grants to recruit and retain employees thanks to a bill aimed at easing industry labor struggles.

House Bill 4004, heard Thursday before the House Behavioral Health Committee, would provide grants to behavioral health care providers across Oregon. The measure is intended to provide short-term relief and prevent the system from collapsing as the state works on a long-term solution that will likely result in higher Medicaid reimbursement rates for providers.

“The workforce crisis is ongoing,” said Rep. Rob Nosse, D-Portland and chairman of the House Behavioral Health Committee. “We cannot afford to ignore it. If we don’t fix that, we’re going to consider closing programs. »

The industry’s 24,000 employees are facing headwinds on several fronts. Low Medicaid rates make it difficult for providers to pay competitive salaries, especially for entry-level positions that routinely pay less than $20 an hour. Meanwhile, the pandemic has exacerbated problems in the behavioral health system over the past two years. Residential facilities have been forced to reduce beds to comply with capacity restrictions. Outpatient programs and group therapy shifted to online communication instead of in-person communication. Staff are exhausted and suppliers are competing for the same employees.

Twenty percent of behavioral health providers said it takes an average of six months or more to fill a position, according to a June 2021 survey by the Oregon Council for Behavioral Health, an industry trade group. Another 18% said they had permanent job offers due to a lack of applicants.

The bill comes after the 2021 Legislature approved a series of landmark investments in the behavioral health system, including greater capacity for residential programs, workforce incentives to diversify the manpower and money to set up programs for Measure 110, which decriminalizes low-level drug possession. . Including matching federal dollars, the price of these items was $1 billion.

The catch: These programs take time to set up and are largely not yet in place, even as the pandemic continues to drive up the overall demand for behavioral healthcare systems.

“I don’t want the doors to be closed because we don’t provide the resources that these programs need,” Nosse said.

Unlike the 2021 legislation, this bill runs on a tighter timeline. The Oregon Health Authority would be required to distribute the funding by May 31. Suppliers are expected to use the money by June 30, 2023 or return it.

Under the bill, suppliers would have to spend 75% of subsidies directly on workers’ wages. The remaining 25% should be spent on other recruitment and retention efforts, such as childcare allowances for employees.

The health authority and lawmakers are still working to figure out how much the bill will cost. Current estimates range from a low of $54 million to a high of $132 million. This is based on providing an average additional salary of $2,000 to $4,000 to each worker. However, the bill does not dictate the amount each employee receives.

Due to staffing shortages, Oregon’s residential systems that serve children and adults have lost 383 beds statewide, said David Baden, chief financial officer of the Oregon Health Authority.

This includes homes that offer a range of different treatments and options, including psychiatric homes, substance use disorder, and adult foster homes.

“It’s a real crisis,” Baden said.

Providers and advocates have encouraged lawmakers to pass the measure.

Amy Baker, executive director of Clatsop Behavioral Healthcare, said she had three positions she had been trying to fill for over a year.

When she tells potential employees the starting salaries, she says, “they often laugh at us.”

It’s an image that applies to the entire industry. Colleagues are worried, especially after two tough years, Baker said.

“I hear fear in their voices,” Baker said. “None of us have ever seen anything like this before.”

She said she would spend the money on increases while lawmakers work on a long-term solution.

“I’m ready to take this chance to increase the salaries of my organization’s employees,” Baker said.

“You’re extending a lifeline,” Baker told committee members. “You give a sense of hope to every behavioral health care provider.”

The bill also requires the health authority to contract emergency nurses and healthcare workers to help affected residential programs during the pandemic. Currently, there are 77 emergency nursing staff at facilities across the state. It costs $700,000 a week for this service, Baden said. Officials expect the Federal Emergency Management Agency to reimburse those costs. If not, the health authority will seek financial assistance from the Centers for Medicare & Medicaid Services with contract costs.

As these funds flow to providers, state officials plan to work on higher Medicaid reimbursement rates, which this bill does not provide. That’s partly because it’s a complex process that requires approval from the federal government, which provides matching funds.

It is unclear how the pricing structure may change. Current state estimates have 10%, 20% and 30% rate increase scenarios.

A 10% increase would cost the state about $18 million and provide a total of $68 million in matching state and federal dollars.

A 20% increase would cost $39 million in public funding and $106 million in federal funding, or $145 million in total. At the high end, a 30% increase would cost about $61 million in state dollars and $169 million in federal dollars — $230 million in total.

These estimates include combined increases for the fee-for-service model and managed care organizations.

You can reach Ben Botkin at [email protected] or through Twitter @BenBotkin1.