1. It's a "quality of care" issue. 

What they say: 

CareOregon has stated that they have observed a difference between the quality of care between associate providers working in private practice vs. associate providers working under contracted organizations or those with a Certificate of Approval (COA). They argue that supervision and oversight is better at these organizations compared to supervision given in private practice or in group practices without a contract or COA. 

What we say: 

The HB 2235 workgroup was assembled by the Oregon Health Authority (OHA) last year to study major barriers to workforce recruitment and retention in Oregon’s publicly financed behavioral health (BH) care system. In their report published in January 2025, it states, “Often within the public BH system, there is a lack of internal resources to offer consistent, high-quality supervision” (pg. 12). Anecdotal evidence and this 2022 report prepared for OHA demonstrates that these settings lead to more cases of provider burnout, resulting in more turnover and less consistency for clients and associate providers who require supervision. Community mental health programs (CMHPs) provide crucial mental health care for individuals across the state and deserve more support. They often have more resources to serve high-acuity clients or clients with complex behavioral health care needs. However, this rule change will not translate to associate providers gaining access to better and more consistent supervision to ensure quality of care. In fact, it may do the opposite, especially for associate providers with marginalized identities. In private practice or in some group practices, associate providers have the choice to choose their supervisor, which allows them the agency to select a supervisor who has particular expertise in their client population and preferred therapy modalities, which can lead to better client outcomes. 

Most of all, we have yet to see any data that demonstrates that associate clinicians provide a lesser quality of care in private practice and small group practice settings. 

2. It's a "workforce" issue.

What they say: 

According to CareOregon, there has been a "significant exodus" of behavioral health providers "particularly from safety net organizations" in the past five years due to the COVID-19 pandemic and workforce burnout. Both CareOregon and OHA express concern that counselors are not filling and staying in these positions; therefore, these rulings will encourage associate providers to do so. 

What we say: 

CareOregon’s decision and OHA’s proposed rulemaking fail to ignore the widely understood reasons why associates and licensed clinicians alike are not filling those positions, which are extremely high (and unsafe) caseloads, low pay, lack of support, and emotional exhaustion. Research indicates that burnout within a provider population can compromise the quality of client care. With this proposed rulemaking, we are returning to a strained system in which “individual providers with the least experience may be paired with the most complicated and high-need populations. This phenomenon has generated enormous barriers to retaining workers, with provider groups citing an average turnover period of 6-8 months” (Behavioral Health Workforce Report, pg 30). We believe that more efforts should be directed towards supporting these organizations to alleviate workforce burnout, rather than pushing associate providers back into these settings without first addressing these widely known challenges.