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Oregon Behavioral Health Support Program Providers

The Oregon Behavioral Health Support Program ensures that adults in Oregon with severe and persistent mental illness (SPMI) are actively involved in directing their treatment through person-centered care planning.

We work with eligible individuals to create person-centered service plans. We follow up with them quarterly to determine how their plans are working and if they’re receiving the services and supports they need.

This work also includes:

  • Providing needs assessments and person-centered service planning for individuals transitioning from secure residential treatment facilities or the Oregon State Hospital
  • Supporting the Behavioral Health Personal Care Attendant (State Plan Personal Care) program by conducting a similar assessment and service planning process, while enrolling State Plan personal care attendants to assist individuals in this program
  • Performing continued stay reviews for people in the Oregon State Hospital and secure residential treatment facilities
  • Providing authorizations for fee-for-service individuals in crisis respite settings


Providers, please submit your prior authorization (PA) requests via MMIS.

If needing to locate a nurse/medical program to assist with RN delegations, please click here.

Provider Forms

CH-002: Discharge Notification for Behavioral Health Services
Please submit when an individual moves out of an adult foster care or residential treatment program for behavioral health services.

Form Instructions

CH-003: Individually-Based Limitation
An individually based limitation (IBL) is based on specific assessed need and only implemented with the informed consent of the individual or, as applicable, the legal representative of the individual, as described in OAR 411-004-0040. The complete rule can be found here. IBLs are only for individuals in home and community-based settings.

Form Instructions

CH-006: Plan of Care Request for Behavioral Health Residential or Personal Care Services
This form to be used to request 1915(i) assessments for anyone living independently, in an adult foster home or residing in residential programs.

Form Instructions

CH-007: PA-Rehab — Psychosocial Rehabilitation Services (PRS)
Complete this form to request prior authorization of Psychosocial Rehabilitation Services. The CH-007 should be uploaded to the prior authorization request in the Medicaid Management Information System (MMIS).

Form Instructions

CH-008: Crisis Respite Request
Please complete form CH-008 to request authorization for crisis respite stays for individuals in residential settings. To be completed by crisis respite provider.

Form Instructions

CH-009: SRTF Criteria Checklist
Please complete this form to request an authorization for the individuals who will be transitioning to an SRTF. The Independent and Qualified Agent (IQA) will review this request and process it for the individual staying at the identified facility.

Form Instructions

CH-010: BH PCA Referral
This form may be used to refer an individual for OBHSP Behavioral Health Personal Care Attendant (BH PCA) services (reference OAR 410-172-0790).

Form Instructions

CH-011: Nurse (RN) Delegation Form 

Nurse (RN) delegation(s) are to be submitted to Comagine Health for individuals who require additional supportive services to assist with their ongoing care. RN delegations are to be submitted every 6 months in alignment with the RN reassessments, or more frequently if applicable.

Form Instructions

Consent for Release of Information and Participation in the Oregon Behavioral Health Support Program
Please complete this form to give your consent to use and disclose your PHI.

Click here for the Spanish version of this form.

Form Instructions

Form CH-012 OSH Initial Determination for 1915(i) Services

This form is intended for 1915(i) assessment requests by the Oregon State Hospital only.

Form Instructions

CH-013: Post-Acute Intermediate Treatment Services (PAITS) Authorization Form 

Please submit with supporting documentation via MMIS to request initial 90-day authorizations and 30-day continued stay authorizations.

Form Instructions

IQA 1915(i) Assessment Reconsideration Request

Please use this form for any reconsideration related to the Level of Service Inventory (LSI), Level of Care Utilization System (LOCUS) or person-centered care plan (PCSP).

Form Instructions

Form Instructional Videos

OBHSP Provider Form Download Instructions

OHA Policies and Tools

Contract Transition

Starting July 1, 2020, Comagine Health has assumed responsibility for assessments from the current contractor, KEPRO.

Providers, our Provider Training webinar was held on Thursday, June 25, 2020.

Contact Us

We look forward to working with you. Please contact us with any questions.

  • Call us at 888-416-3184.
  • Fax us at 877-575-8309.
  • If you use TTY/TDD, you can call us by dialing 711 and then our phone number: 888-416-3184.
  • Send an email to
  • Send us a message by using our contact form.