Oregon Behavioral Health Support Program

Please submit form CH-001 to refer individuals for OBHSP services, including 1915(i), non-1915(i), non-Medicaid, or State Plan Personal Care (SPPC PC 20) services.

Oregon Behavioral Health Support Program

Please submit form CH-002 when an individual moves out of an adult foster care or residential treatment program for behavioral health services.

Oregon Behavioral Health Support Program

Please submit form CH-003 to request an individually-based limitation (IBL).

Oregon Behavioral Health Support Program

Please submit form CH-006 to request a plan of care for adult foster care or residential personal care/habilitation services. For initial referrals, this form may accompany form CH-001: Referral Request for Oregon Mental Health Benefits.

Oregon Behavioral Health Support Program

Please complete form CH-007 to request prior authorization of Psychosocial Rehabilitation Services (outpatient rehabilitation).

Oregon Behavioral Health Support Program

Please complete form CH-008 to request authorization for crisis respite stays for individuals in residential and adult foster home settings. To be completed by crisis respite provider.

Oregon Behavioral Health Support Program

Please complete this form to give your consent to use and disclose your PHI. 

Oregon Behavioral Health Support Program

Please complete form CH-009 to request authorization for an individual who will be transitioning to an SRTF.

Slides from the Oregon Behavioral Health Support Program provider training webinar presented by:

• Dana Hittle — Oregon Health Authority
• Brian Sandoval, Lenora Johnson and Bennett Garner — Comagine Health