Behavioral Health Rate Increase

Background

House Bill 5202 (2022) includes a Special Purpose Appropriation by Committee recommendation for $42.5 million in state general funds for the Oregon Health Authority (OHA) to increase fee-for-service (FFS) and coordinated care organization (CCO) behavioral health provider rates by an average of 30 percent. 

This investment is anticipated to result in approximately $154.5 million total funds for Oregon's Medicaid system.

FFS Rate Increases

CCO Rate Increases

In January 2023, CMS approved OHA requiring and directing CCOs to significantly increase Medicaid behavioral health services reimbursement. Effective January 1, 2023, through December 31, 2023, the approved payment mechanism is called a “Directed Payment.” Approval of this payment mechanism is authorized through CMS regulation (42 CFR 438.6). 

The following documents provide more information about Directed Payments:

• CCO BH Directed Payment Guidance Document
  
• CCO BH Directed Payment Frequently Asked Questions
  
• CCO BH Directed Payment Attestation Form
  
• Primarily Medicaid Provider Attestation (to be eligible for 30% increases)

View each CCO's BH Directed Payment information and contacts:

• AllCare CCO
• Advanced Health
  
• Cascade Health Alliance
  
• Columbia Pacific CCO
• Eastern Oregon CCO
• Health Share of Oregon
• InterCommunity Health Network
• Jackson Care Connect
• PacificSource Community Solutions
• Trillium Community Health Plan
  
• Umpqua Health Alliance
  
• Yamhill Community Care
  

Provider Updates

Announcements:

• July 1, 2024 fee-for-service rate increase for Medicaid behavioral health services completed (7/8/2024)
  
• Fee-for-service rate increase for Medicaid behavioral health services, effective July 1, 2024 (6/12/2024)
• Fee-for-service claim adjustment pause and reprocessing to apply the October 1, 2023, behavioral health 3.4% rate increase (3/25/2024)
  
• Submitting claims to apply the October 1, 2023 rate increase (3/11/2024) 
• Fee-for-service rate increase for Medicaid behavioral health services effective October 1, 2023 (2/22/2024)
  
• Plan of care rate increases now complete, effective July 1, 2022 (1/13/2023)
• Submitting fee-for-service (FFS) claims to receive the July 1, 2022 behavioral health rate increase (1/3/2023)
• For behavioral health and substance use disorder treatment providers (12/16/2022)
• For administrative examination providers (12/14/2022)
  

Webinars:

• Fall 2023 regional webinars: Tri-county, Southwest, Northwest, Eastern Oregon
  
• Implementation update (CCO and FFS): View the slides and recording (Dec. 14, 2022) 
• Proposed rate increases: View the slides and recording (Aug. 4, 2022)
• Rate differential for culturally and linguistically specific services (CLSS): View the slides and recording (Aug. 11, 2022)
  

Timeline

August 2022

OHA submits State Plan Amendment (SPA) to CMS for approval. View OHA's submitted and approved SPAs.

November 2022

OHA receives CMS approval of the FFS rate increase. View OHA's press release.

December 2022

OHA finalizes applicable rates to be retroactively billable in MMIS, effective July 1, 2022.  

To keep informed, sign up to receive OHP Provider Updates by text or email.

January 2023

OHA receives CMS approval for CCO directed increases effective Jan. 1, 2023. View OHA's press release.

OHA finalizes the CLSS application process.

Questions?

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