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As contract negotiations between addiction treatment providers stall, some say residents will suffer

Representatives with a St. Helens-based recovery center say a contract dispute with the county's mental health provider could leave residents without options for treatment.SPOTLIGHT PHOTO: COURTNEY VAUGHN - Tana Howtopat and Pam Daniel, founders of Medicine Wheel Recovery Services, review contract documents in the midst of a dispute over fees with Columbia Community Mental Health.

Tana Howtopat and Pam Daniel, founders of Medicine Wheel Recovery Services, say Columbia Community Mental Health offered a contract renewal with Medicine Wheel that financially undercuts Medicine Wheel, offering only a fraction of the cost of services the center provides to clients on behalf of CCMH.

Medicine Wheel offers addiction treatment programs, DUII education and rehabilitation, 24-hour mental health crisis counseling and assists veterans with obtaining housing, among other services.

CCMH began contracting with Medicine Wheel in 2016 to provide some of those services to county residents, on behalf of CCMH.

When contract renewal discussions came up in November 2017, CCMH offered less money to Medicine Wheel, and the two entities have yet to reach an agreement. The previous contract has since lapsed, and attempts at negotiation for a renewed partnership have failed.

An attorney for CCMH says Medicine Wheel "rejected all offers that CCMH put on the table," but had agreed to come back with a counter offer." That has yet to happen.

"The ball is currently in Medicine Wheel's court," Henry O'Keeffe, an attorney with Greater Oregon Behavioral Health Inc., speaking on behalf of CCMH, stated Wednesday. "CCMH is still awaiting that counter offer, and looks forward to continuing the conversation with Medicine Wheel."

Contract documents show CCMH proposed to reimburse Medicine Wheel $45 per week for outpatient substance use disorder services, with a requirement that clients attend sessions twice a week.

That amounts to a fraction of the cost of staff time, and far less than what Medicaid— which offers the lowest reimbursement rates in the state— pays out for the same services.

"What they offered was literally about 17 percent of what the fee for service is," Howtopat said.

Despite CCMH's indication that it awaits another meeting with Medicine Wheel, Howtopat and Daniel say CCMH never indicated it was willing to negotiate.

"They had a solid offer and there appeared to be no room for movement in that," Howtopat said Wednesday.

O'Keeffe said in short, CCMH receives an allotment of dollars for each Oregon Health Plan member it serves, which doesn't match up with Medicine Wheel's fee for services asking rate. He claims CCMH simply doesn't have the funding to cover the same contract amounts it did previously.

"The way it turned out, the small part of the population Medicine Wheel serves used a disproportionately large share of CCMH's budget, making it very difficult for CCMH to fulfill its duty to meet the rest of its population's needs," O'Keeffe explained via email Wednesday.

Howtopat and Daniel question those claims, noting CCMH gets funding from Columbia Pacific Coordinated Care Organization, which manages OHP members in Columbia County and surrounding areas. That funding covers every health plan member for all services, regardless of whether they use them. That means CCMH likely receives funds that never get used by many members.

"The truth of the matter is, we've continued to do more research and we've found that there's almost 30,000 members in the CCO," Howtopat notes. "If they serve 250 members in a year, they've still collected the capitation rate for all those 30,000 people. The work that we're doing deserves to be reimbursed."

Medicine Wheel estimates about 73 percent of its clients come to the center through CCMH. Howtopat and Daniels say their center provides a different treatment approach that many clients have success with. Without more than one treatment provider in the county, the women say residents in need are at risk.

"In rural communities, there may be only one provider and people don't get a choice, but the key is, we are another provider," Howtopat said. "We are a new provider and they're trying to run us out."

"We have a lot of people who have told us they will stop receiving services if we close," Daniel added.

O'Keeffe, says that's not the case, rather, he refers to a "chronic underfunding of substance use disorder treatment" from the state.

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