This article is a working checklist for program directors, clinical supervisors, and compliance leads. It is general information, not legal advice. Confirm the current text on the Oregon Secretary of State OAR pages and the permanent order PDF before you change policy.
What changed, in plain terms
BHS 18-2026 rewrote staff qualifications and personnel documentation for outpatient mental health, substance use, and problem gambling programs under Division 019. Two themes matter most for day-to-day operations.
First, program staff who render or bill services under the outpatient certificate must meet updated Oregon presence, credential, and supervision rules. Board-registered associates (including professional counselor associates, marriage and family therapist associates, clinical social work associates, and related associate statuses listed in the rule) are called out with their own subsection.
Second, personnel records and the organizational chart are no longer a soft expectation. OAR 309-019-0130 now requires a hierarchical chart or a spreadsheet that names every person who renders or bills services, or who has access to protected health information tied to the certificate. The spreadsheet must show reporting structure. Each row needs full legal name, license or credential, position title, full-time or part-time status, and whether the person works remote, in office, or hybrid.
The July 1, 2027 COA line for Medicaid
Across several staff categories, including board-registered associates and substance use and problem gambling treatment staff pathways in the amended OAR 309-019-0125, the rule states that effective July 1, 2027 the person must be under the outpatient (OAR 309, Division 019) Certificate of Approval if providing services to individuals under Medicaid.
That is not a renewal reminder. It is a billing and employment structure rule. If your associates currently render Medicaid services outside a Division 019 COA setting, you have until July 1, 2027 to bring them under a certified outpatient program or stop Medicaid billing for that work. Solo or group practices that never applied for a COA and that use associates for OHP or other Medicaid lines should treat this as a licensing project, not an HR tweak.
Physical presence in Oregon at the time of providing services or supports under the outpatient certificate is repeated throughout the amended rule for associates, QMHAs, QMHPs, peers, and many supervisors. Remote work across a state line does not erase that requirement when the service is tied to the certificate.
What belongs in each personnel file
OAR 309-019-0130(2) lists the documents providers must keep for each program staff member:
- Criminal records check results for the current position or title. Mental health staff, or anyone with access to mental health protected health information such as charts or billing data, must use the Oregon Criminal Records Check processes in OAR 943-007-0001 through 0501. Staff who render only substance use disorder treatment, or who have access only to SUD protected health information, must use national and statewide criminal records check processes.
- A current job description that includes applicable competencies
- Copies of relevant licensure, certification, registration, diploma, or certified transcripts that show the person meets qualifications
- Employment Eligibility Verification (Form I-9)
- Documentation of suicide risk screening, assessment, treatment, and management training of at least two hours every two years or three hours every three years
- Periodic performance appraisals
- Program orientation documentation
- Disciplinary documentation
- Documentation of other trainings required by these or other applicable rules
- Documentation of clinical supervision
Missing I-9s, expired background checks for the current title, and thin supervision logs are the findings that turn into Plans of Correction. Update the file when someone changes title, moves from associate to licensed status, or shifts from SUD-only to mental health access.
Orientation inside 30 days
Unless another rule sets a different clock, orientation for staff who provide or supervise services must be documented within 30 days of hire. At minimum it covers crisis prevention and response, emergency evacuation, program policies (including ASAM level-of-care procedures for SUD staff), individual rights, mandatory abuse reporting, confidentiality, fraud waste and abuse, care coordination, and agreement to the Code of Conduct. Substance use treatment staff and SUD clinical supervisors must complete ASAM Criteria training within the first three months of rendering SUD services, or show it was completed in the most recent two years. Enhanced Care Services staff also need positive behavior support training.
Supervision hours that match the new text
Clinical supervision is required for all program staff providing direct services or supports. Documentation must show the date, time spent, and a brief description of topics. For full-time non-licensed staff, including board-registered associates, the minimum is two hours per month, with at least one hour of individual face-to-face contact. The other hour may be group. Mental health interns and student interns need one hour of individual clinical supervision per week. Part-time staff get no less than half the full-time minimum. Individual face-to-face contact may include real-time two-way audio or audio-visual conferencing.
Staff licensed by an Oregon board must be clinically supervised by another person licensed by an Oregon board. Unlicensed staff must be supervised by a board-licensed person who is physically present in Oregon at the time of supervision, or by a QMHP who qualifies as a clinical supervisor and who is physically present in Oregon when services are provided and while providing supervision.
When available, a qualified Peer Delivered Services Supervisor should provide one of the two monthly hours for staff who deliver peer services, with the rest from a qualified clinical supervisor.
A practical sequence before July 2027
- Inventory every board-registered associate, QMHA, QMHP, CADC pathway staff member, and peer who touches Medicaid.
- Confirm each person sits under a current Division 019 COA for the service site, or start the COA application path now. OHA's outpatient program page is the starting point for certificate questions.
- Rebuild the organizational chart or spreadsheet with the five required fields and a clear supervisor for every row.
- Audit personnel files against the ten-item list in OAR 309-019-0130(2), including I-9 and suicide training dates.
- Reset supervision calendars so associates get two documented hours per month with one individual hour, and so interns get weekly individual supervision.
- Put July 1, 2027 on the leadership calendar as a hard stop for Medicaid billing that depends on associates outside a COA.
Programs that treat BHS 18-2026 as a document refresh will still scramble next summer. Programs that treat it as a staffing and certificate project will have cleaner files, clearer supervision, and a defensible Medicaid structure when the date arrives.
Easton Hallock is Managing Partner of Saint Health Group, which helps behavioral health and addiction treatment organizations with licensing, compliance, payer contracting, revenue cycle operations, and compliance and risk.
