A few weeks ago, Tiffany Kettermann received a notice: Owing to a state policy change, her therapy practice of 36 clinicians would soon get paid less for many of its services—if it didn’t make certain changes fast.

Kettermann had already moved to make some of the required shifts, which included applying for a rigorous certification process with the state. But, dealing with a glut of similar applications, the Oregon Health Authority was taking a long time to process her application, filed months ago. It was becoming clear her practice would not satisfy the updated requirements by the new year, when the new payment policy is set to take effect.

Recently, Kettermann says, she announced temporary pay cuts to her staff.

Kettermann’s East Portland-based practice, Health Allies Counseling, is

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