Culturally and Linguistically Specific Services Behavioral Health Application

Please Note:

In order to receive enhanced payments for CLS services, a Provider must both (i) meet OHA eligibility requirements and (ii) have a contract with the specific CCO(s) whose member(s) the Provider intends to serve.

This is NOT your NPI number

If approved, this phone number will be listed on our public-facing website.

Phone

If approved, this email address will be listed on our public-facing website.

Fill in the street address.

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Do you serve children and families?*
Are you a rural provider*

Rural is defined as any geographic areas in Oregon ten or more miles from the centroid of a population center of 40,000 people or more.

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(if you are applying for eligibility as bilingual or sign language provider, please enter none)

(if you are applying for eligibility as culturally specific organization, program, or individual provider, please enter none)

Qualification Type - (Narrative element questions to follow)*

Must be able to bill for Culturally and Linguistically Specific services or bilingual services, or direct sign language services

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Organization Narrative Element Questions (OAR 309-065-0020):

A Culturally and Linguistically Specific Behavioral Health Organization means an outpatient entity or institution that is structured to provide culturally and linguistically specific behavioral health services in its entirety as evidenced by its organizational mission. OAR 309-065-0010(2).


Applicants must demonstrate the ability to serve the distinct minoritized culturally specific community identified in the application and as outlined in OAR 309-065-0020.


To ensure that these requirements are met, you must include documentation of the organization’s mission statement, vision statement, or other public-facing document that demonstrates its culturally specific focus AND answer the five questions below (OAR 309-065-0020(3)). It is strongly encouraged to keep your responses to 500 words or less to each question. In addition to the required documentation mentioned above, you may include, attach or link the following information in your answers to the five questions:


  • Your organization’s detailed policies and procedures,
  • A list of staff training requirements and any resulting certifications,


and/or


  • A narrative that details the organization’s strategic plan or history and experience, including specific examples, without identifying any individual client.


Please scan all documents including the answers to the questions below into one PDF file and attach as one document.


1. Describe how your Culturally and Linguistically Specific Services Organization is either (OAR 309-065-0020(1)(d) and (e):


(A) primarily led and staffed by people that have extensive experience working with or being immersed in the same distinct minoritized community they serve;


or


(B) has a history of at least five years primarily serving the distinct minoritized cultural community in a behavioral health setting.


2. Describe and provide examples of the diverse lived experiences held by the distinct minoritized cultural community served and its impact on the community’s collective mental health and wellbeing that your organization is aware of. This may include but is not limited to any of the following (OAR 309-065-0020(2)(a)):


  • structural racism
  • individual racism
  • minoritization
  • discrimination
  • other lived experience


3. Describe and provide examples of behavioral health inequities experienced by the distinct minoritized cultural community served which may be addressed by your culturally and linguistically specific services (OAR 309-065-0065(2)(b)). This may include but is not limited to any of the following:


  • education
  • healthcare access
  • economic stability
  • neighborhood & built environment
  • social and community context


4. Describe and provide examples of how your organization supports and affirms cultural and language practices for the distinct minoritized cultural community served (OAR 309-065-0065(2)(c)). This may include but is not limited to any of the following:


  • Health and safety beliefs, or practices
  • Positive cultural identity, pride, or resilience
  • Immigration dynamics
  • Spiritual/Religious beliefs
  • Other cultural and language practices


5. Describe and provide examples of how your organization supports and affirms clients experiencing intersectional oppression in the provision of your services (OAR 309-065-0065(2)(d)). This may include but is not limited to any of the following:


  • Established collaboration with other culturally specific providers,
  • Dedicated spaces or groups provided for clients experiencing intersectional oppression,
  • Other supportive and affirming practices.


6. Does your organization have a plan to support members of the distinct minoritized cultural community you serve who do not have insurance. If so, please describe that plan.




*Note: This answer will not impact your eligibility. This question was requested by community partners who have asked for providers to consider this.

Program Narrative Element Questions (OAR 309-065-0025)

A Culturally and Linguistically Specific Behavioral Health Program means a division or associated component of an organization that provides culturally and linguistically specific behavioral health services as evidenced by the program mission, that exists within the subset of services provided by an organization whose mission does not focus on a distinct minoritized community (OAR 309-065-0010(3)).


Applicants must demonstrate the ability to serve the culturally specific community identified in the application and as detailed in OAR 309-065-0025.


To ensure that these requirements are met, you must include documentation of the program’s mission statement, vision statement, or other public-facing document that demonstrates its culturally specific focus AND answer the five questions below. (OAR 309-065-0025(3)) It is strongly encouraged to keep your responses to 500 words or less to each question. You may include, attach or link the following information in your answers to the five questions:


  • Your program's detailed policies and procedures,
  • A list of staff training requirements and any resulting certifications,


and/or


  • A narrative that details the program’s strategic plan or history and experience, including specific examples, without identifying any individual client.


Please scan all documents including the answers to the questions below into one PDF file and attach as one document.




1. Describe how your Culturally and Linguistically Specific Services Program is either (OAR 309-065-0025(1)(d) and (e)):


(A) primarily led and staffed by people that have extensive experience working with or being immersed in the same distinct minoritized community served;


or


(B) have a history of at least five years primarily serving the distinct minoritized cultural community in a behavioral health setting.



2. Describe and provide examples of the diverse lived experiences held by the distinct minoritized cultural community served and its impact on the community’s collective mental health and wellbeing that your program is aware of. (OAR 309-065-0025(2)(a)) This may include but is not limited to any of the following:


  • structural racism
  • individual racism
  • minoritization
  • discrimination
  • other lived experience


3. Describe and provide examples of behavioral health inequities experienced by the distinct minoritized cultural community served which may be addressed by your culturally and linguistically specific services. (OAR 309-065-0025(2)(b)) This may include but is not limited to any of the following:


  • education
  • healthcare access
  • economic stability
  • neighborhood & built environment
  • social and community context


4. Describe and provide examples of how your program supports and affirms cultural and language practices for the distinct minoritized cultural community served. (OAR 309-065-0025(2)(c)) This may include but is not limited to any of the following:


  • Health and safety beliefs, or practices
  • Positive cultural identity, pride, or resilience
  • Immigration dynamics
  • Spiritual/Religious beliefs
  • Other cultural and language practices


5. Describe and provide examples of how your program supports and affirms clients experiencing intersectional oppression in the provision of your services. (OAR 309-065-0025(2)(d)) This may include but is not limited to any of the following:


  • Established collaboration with other culturally specific providers,
  • Dedicated spaces or groups provided for clients experiencing intersectional oppression,
  • Other supportive and affirming practices.


6. Does your program have a plan to support members of the distinct minoritized cultural community you serve who do not have insurance. If so, please describe that plan. If not, do intend to have a plan in the near future?




*Note: This answer will not impact your eligibility. This question was requested by community partners who have asked for providers to consider this.

Individual Provider Narrative Element Questions

A Culturally and Linguistically Specific Behavioral Health individual provider means an independently licensed and Medicaid payment eligible clinician that provides culturally and linguistically specific behavioral health services and is in private practice rather than employed by an agency/organization. (OAR 309-065-0010(4))


Applicants must demonstrate the ability to serve the culturally specific community identified in the application and as detailed in OAR 309-065-0030.


To ensure that these requirements are met, please answer the five questions below. (OAR 309-065-0030(3)) It is strongly encouraged to keep your responses to 500 words or less to each question. You may include, attach or link the following information in your answers to the five questions:


  • A resume or curriculum vitae detailing academic credentials, relevant course work or certifications


and/or


  • A narrative that details the individual applicant’s strategic plan or professional history and experience, including specific examples, without identifying clients to answer these questions.



Please scan all documents including the answers to the questions below into one PDF file and attach as one document.


1. Describe how you as an individual provider have either (OAR 309-065-0030(2)(e)):


(A) extensive experience working with or being immersed in the same distinct minoritized culturally specific community served;


or


(B) at least five years primarily serving the distinct minoritized culturally specific community.


2. Describe and provide examples of the diverse lived experiences held by the distinct minoritized cultural community served and its impact on the community’s collective mental health and wellbeing that you are aware of. (OAR 309-065-0030(2)(a)) This may include but is not limited to any of the following:


  • structural racism
  • individual racism
  • minoritization
  • discrimination
  • other lived experience


3. Describe and provide examples of behavioral health inequities experienced by the distinct minoritized cultural community served which may be addressed by your culturally and linguistically specific services. (OAR 309-065-0030(2)(b)) This may include but is not limited to any of the following:


  • education
  • healthcare access
  • economic stability
  • neighborhood & built environment
  • social and community context


4. Describe and provide examples of how you support and affirm cultural and language practices for the distinct minoritized cultural community served. (OAR 309-065-0030(2)(c)) This may include but is not limited to any of the following:


  • Health and safety beliefs, or practices
  • Positive cultural identity, pride, or resilience
  • Immigration dynamics
  • Spiritual/Religious beliefs
  • Other cultural and language practices


5. Describe and provide examples of how you support and affirm clients experiencing intersectional oppression in the provision of your services. (OAR 309-065-0030(2)(d)) This may include but is not limited to any of the following:


  • Established collaboration with other culturally specific providers,
  • Dedicated spaces or groups provided for clients experiencing intersectional oppression,
  • Other supportive and affirming practices.


6. Do you have a plan to support members of the distinct minoritized cultural community you serve who do not have insurance. If so, please describe that plan. If not, do intend to have a plan in the near future?




*Note: This answer will not impact your eligibility. This question was requested by community partners who have asked for providers to consider this.

Bilingual Services Provider

Bilingual service providers deliver direct care services in a language other than English. They may work independently or as part of a larger organization or program that is not culturally and linguistically specific. (OAR 309-065-0040(1)) Please note that only direct care services are eligible for enhanced payment. Interpreting services are not eligible. (OAR 309-065-0040(1))


Applicants must demonstrate proficiency in the language other than English that they will be providing direct care services in as detailed in OAR 309-065-0040. You must complete either 1 or 2 below.


1. Please attach certification of advanced language proficiency received within the last three years from one of the following (OAR 309-065-0040(2)(c)(A)):


  • · An OHA approved testing center for language proficiency
  • Language Line Solutions
  • Language Testing International (both Speaking & Listening)
  • ALTA Language Services


  • · OHA approved national organizations for certification
  • National Board for Certification for Medical Interpreters
  • Certification Commission for Health Care Interpreters
  • American Council on the Teaching of Foreign Languages


More information can be found here. (https://www.oregon.gov/oha/ei/pages/hci-training.aspx)


2. Currently language proficiency tests are available in more than 145 languages. If no language proficiency assessment is available for the language that you speak, you may submit a detailed narrative of how you achieved an advanced level of proficiency in that language for consideration. (OAR 309-065-0040(2)(c)(B))

Sign Language Provider

Sign language service providers deliver direct care services in sign language. They may work independently or as part of a larger organization or program that is not culturally and linguistically specific. Please note that only direct care services are eligible for enhanced payment. Interpreting services are not eligible. (OAR 309-065-0040(1))


Applicants must have demonstrate proficiency in sign language interpreter certification as detailed in OAR 309-065-0040. You must complete either 1 or 2 below.


1. Please attach sign language certification received within the last three years from an OHA approved sign language interpreter testing center. (OAR 309-065-0040(2)(d)(A)).


More information can be found here. (https://www.oregon.gov/oha/ei/pages/hci-training.aspx)


2. If you believe you have advanced proficiency in sign language and do not intend to apply for sign language certification, you may submit a detailed narrative of how you achieved an advanced level of proficiency in that language for consideration and further evaluation. (OAR 309-065-0040(2)(d)(B))

Culturally and Linguistically Specific Services Residential Substance Use Disorder Provider

A Culturally and Linguistically Specific Behavioral Health Program means a division or associated component of an organization that provides culturally and linguistically specific behavioral health services as evidenced by the program mission, that exists within the subset of services provided by an organization whose mission does not focus on a distinct minoritized community (OAR 309-065-0010(3)).


Applicants must demonstrate the ability to serve the culturally specific community identified in the application and as detailed in OAR 309-065-0025.


To ensure that these requirements are met, you must include documentation of the program’s mission statement, vision statement, or other public-facing document that demonstrates its culturally specific focus AND answer the five questions below. (OAR 309-065-0025(3)) It is strongly encouraged to keep your responses to 500 words or less to each question. You may include, attach or link the following information in your answers to the five questions:


  • Your program's detailed policies and procedures,
  • A list of staff training requirements and any resulting certifications,


and/or


  • A narrative that details the program’s strategic plan or history and experience, including specific examples, without identifying any individual client.



Please scan all documents including the answers to the questions below into one PDF file and attach as one document.



1. Describe how your Culturally and Linguistically Specific Services Program is either (OAR 309-065-0025(1)(d) and (e)):


(A) primarily led and staffed by people that have extensive experience working with or being immersed in the same distinct minoritized community served;


or


(B) have a history of at least five years primarily serving the distinct minoritized cultural community in a behavioral health setting.



2. Describe and provide examples of the diverse lived experiences held by the distinct minoritized cultural community served and its impact on the community’s collective mental health and wellbeing that your program is aware of. (OAR 309-065-0025(2)(a)) This may include but is not limited to any of the following:

  • structural racism
  • individual racism
  • minoritization
  • discrimination
  • other lived experience


3. Describe and provide examples of behavioral health inequities experienced by the distinct minoritized cultural community served which may be addressed by your culturally and linguistically specific services. (OAR 309-065-0025(2)(b)) This may include but is not limited to any of the following:

  • education
  • healthcare access
  • economic stability
  • neighborhood & built environment
  • social and community context


4. Describe and provide examples of how your program supports and affirms cultural and language practices for the distinct minoritized cultural community served. (OAR 309-065-0025(2)(c)) This may include but is not limited to any of the following:

  • Health and safety beliefs, or practices
  • Positive cultural identity, pride, or resilience
  • Immigration dynamics
  • Spiritual/Religious beliefs
  • Other cultural and language practices


5. Describe and provide examples of how your program supports and affirms clients experiencing intersectional oppression in the provision of your services. (OAR 309-065-0025(2)(d)) This may include but is not limited to any of the following:

  • Established collaboration with other culturally specific providers,
  • Dedicated spaces or groups provided for clients experiencing intersectional oppression,
  • Other supportive and affirming practices.


6. Does your program have a plan to support members of the distinct minoritized cultural community you serve who do not have insurance. If so, please describe that plan. If not, do intend to have a plan in the near future?



*Note: This answer will not impact your eligibility. This question was requested by community partners who have asked for providers to consider this.

You must answer all essay questions in full and/or upload relevant certifications.


***Reminder for programs and organizations only, in your attachment, please be sure to include the organization’s or program's culturally specific focus via mission statement, vision statement, or other public-facing document.

Drag and drop files here or

Information submitted to OHA by applicants for Culturally and Linguistically Specific Services enhanced payment eligibility is considered to be a public record under Oregon’s Public Records Law. This does not necessarily mean that all of the information you submit would be subject to disclosure if OHA received a public records request. Some of the information you submit may be protected from disclosure because it falls within the personal privacy exemption under the Public Records Law. OHA is committed to complying with Oregon’s Public Records Law, and is also committed to protecting the personal privacy of individuals that are required to submit information to OHA, to the extent permitted by the law. In addition, OHA could be required to disclose information you submit if legally required to do so by a subpoena or court order.

1. The information provided on the application is valid and complete;

2. The agency will comply with the Oregon Administrative Rules that govern these services;

3. If applicable, the agency is compliant with all other licensing or accreditation entities that apply, i.e., Department of Human Services, Drug Enforcement Administration (DEA), etc.


Check the box attesting to all submitted information in the application

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