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Behavioral Health Services Rules and Guidelines

Resources related to provider reimbursement for behavioral health services to Oregon Health Plan (OHP) members.

 Receive rule updates by text or email

Current Oregon Administrative Rules

Please refer to the Oregon Secretary of State website. OHA no longer maintains the administrative rulebooks. 

  • Click the program name, then click the rule you want to view.
  • The current rule will display. To view previous revisions of the rule, click the revision date(s) at the bottom of the rule page. Revisions are available back to 2017.
  • If you need older revisions, please email Adminrules.Archives@oregon.gov. 
  • If you have problems accessing older revisions not available on the SOS website, please email HSD.Rules@oha.oregon.gov. 

Recent Rule Filings

Supplemental Information and Guidelines

Announcements

Issue Date   
  
Announcement (PDF)
  
Applies To
  
7/31/2026Reimbursement for nitrous oxide during in-office medical procedures effective Aug. 1, 2026All Providers, Family planning clinics, CCOs
7/30/20261915(i) Home and Community Based Services (HCBS) Referral Documentation Standards UpdateCommunity Mental Health Programs, 1915(i) HCBS referring and rendering providers, community partners
6/25/2026Clarification about billing for S0109 (Methadone, 5 mg) effective July 1, 2025Substance use disorder treatment providers
6/25/2026Behavioral Health Fee Schedule rate adjustments effective April 1, 2026Substance use disorder treatment providers
5/18/2026Changes to SRTF concurrent stay authorization timeframes effective June 1, 2026Community Mental Health Programs, Secure Residential Treatment Facility providers; Oregon State Hospital
3/26/2026Due date update for MOU reportAll Providers, CCOs
3/17/2026 New process for non-response to licensing information requests, effective June 1, 2026Behavioral health providers, Mental health providers, Substance use disorder treatment providers
2/17/2026Young Adults with Special Health Care Needs eligibility changes effective Jan. 1, 2026All Providers
2/10/2026Behavioral Health Fee Schedule rate adjustments effective Jan. 1, 2026Substance use disorder treatment providers
11/14/2025Substance Use Disorder Assessment Codes: Fee Schedule UpdateSubstance use disorder treatment providers
11/7/2025Waiver of select CY 2026 Value Based Payment requirementsAll Providers, CCOs
10/29/2025Ensuring Oregon Health Plan coverage of medical grade formulaAll Providers, CCOs
9/17/2025Oregon Health Plan adoption of the West Coast Health Alliance guidance on respiratory vaccinesAll Providers, CCOs
8/26/2025OHA does not cover the fee-for-service per diem rate for days youth are not in residential careCommunity Mental Health Programs, Youth psychiatric residential treatment providers
7/30/2025Reconciling of The ASAM Criteria, Third Edition and The ASAM Criteria, Fourth Edition – Updated TimelineSubstance use disorder treatment providers
6/27/2025Substance Use Disorder Behavioral Health Fee Schedule Update: Place of Service 15 (Mobile Unit)Substance use disorder treatment providers
6/27/2025Substance Use Disorder Behavioral Health Fee Schedule Update: S0109 Methadone AdditionSubstance use disorder treatment providers
6/25/2025Policy Clarification for HRSN and HUD Housing Supports_All Providers, CCOs
6/18/2025Fee-for-service coverage of directly observed therapy, effective Oct. 1, 2024All Providers
5/5/2025Substance Use Disorder Behavioral Health Fee Schedule Update: H0031 AdditionSubstance use disorder treatment providers
5/5/2025Substance Use Disorder Behavioral Health Fee Schedule Update: J0570 DeletionSubstance use disorder treatment providers
5/5/2025Substance Use Disorder Behavioral Health Fee Schedule Update: Q9991 and Q9992 Rate UpdatesSubstance use disorder treatment providers
4/25/2025Federal comment period now open for Oregon’s Substance Use Disorder 1115 waiver application: Please comment by May 10, 2025All Providers, Behavioral health providers, CCOs, Community Mental Health Programs
2/7/2025Adult mental health residential rates, effective Jan. 1, 2025Adult mental health residential providers
1/30/2025Feb. 3, 2025 webinar about adult mental health residential ratesAdult mental health residential providers
12/24/2024Pause: 2025 adult mental health residential ratesAdult mental health residential providers
12/19/2024Young Adults with Special Health Care Needs benefits effective Jan. 1, 2025All Providers
7/19/2024SB 1557 Access to Healthcare (Section 5) for children up to 21 with Intellectual or Developmental Disability to Mental Health Assessment, Treatment, ServicesHospitals, Mental health providers, CCOs, Community Mental Health Programs, Licensed professional boards
7/8/2024July 1, 2024 fee-for-service rate increase for Medicaid behavioral health services completedBehavioral health providers, Substance use disorder treatment providers
6/12/2024Fee-for-service rate increase for Medicaid behavioral health services, effective July 1, 2024Behavioral health providers, Substance use disorder treatment providers
5/16/2024New option for verifying substance use disorder treatment appointmentsNon-emergent medical transportation brokerages, Substance use disorder treatment providers
4/22/2024New customary charge for ASAM Level 3.7 R servicesCCOs, Substance use disorder residential treatment providers
4/3/2024Adult Foster Home Documentation Standards TrainingMental health residential providers
3/25/2024Fee-for-service claim adjustment pause and reprocessing to apply the October 1, 2023, behavioral health 3.4% rate increaseBehavioral health providers, Substance use disorder treatment providers
3/14/2024Request for Calendar Year (CY) 2022 and 2023 financial dataAdult mental health residential providers
3/11/2024ASAM Foundational TrainingsSubstance use disorder treatment providers
3/11/2024Submitting fee-for-service claims to receive the 3.4% rate increase for Medicaid behavioral health services effective October 1, 2023Behavioral health providers, Substance use disorder treatment providers, Community Mental Health Programs
2/22/2024Fee-for-service rate increase for Medicaid behavioral health services effective October 1, 2023Substance use disorder treatment providers, Community Mental Health Programs, Behavioral health programs
2/14/2024Prior authorization required for Secure Residential Treatment Facility placement starting March 1, 2024Community Mental Health Programs, Oregon State Hospital; acute care psychiatric settings
2/8/2024Expansion of crisis respite services effective January 1, 2023Licensed mental health residential treatment providers
2/8/2024Medical necessity reviews for SRTF level of careCommunity Mental Health Programs, Secure residential treatment facilities
1/9/2024Reporting SUD residential treatment facility admissions and dischargesSubstance use disorder treatment providers
12/28/2023Changes in coordinated care organization (CCO) enrollment timeframesAll Providers, CCOs
12/18/2023OHP coverage of gender-affirming treatment, effective January 1, 2024All Providers, CCOs
11/9/2023Billing for covered fall prevention programs with updated telehealth billing requirements All Providers, CCOs
10/19/2023Needs assessment options for behavioral health services in the home and communityPersonal care attendants, Mental health residential providers
7/26/2023Face-to-face and in-person assessments required for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant services effective Aug. 15, 2023Personal care attendants, Community Mental Health Programs, Behavioral health residential facilities; behavioral health Adult Foster Home providers
6/29/2023H0039 restricted to certified Assertive Community Treatment providers beginning July 1, 2023Community Mental Health Programs, Assertive Community Treatment providers
6/14/2023Inappropriate fee-for-service payments for some E&M codes and Medicare crossover claimsAll Providers, CCOs
5/31/2023PHE Authorities and Flexibilities MemoAll Providers, CCOs
5/30/2023Mental health assessments required for all individuals seeking services through a community mental health programBehavioral health providers, Community Mental Health Programs
5/30/2023PHE Authorities and Flexibilities on and after May 11, 2023All Providers, CCOs
4/7/2023Payment recovery planned for fee-for-service IMD residential per diem claimsSubstance use disorder residential treatment providers
3/10/2023Fee-for-service reprocessing for certain Home and Community-Based Services claims starting March 3, 2023Behavioral health providers, Home health agencies, School-Based Health Services providers, Targeted Case Management providers, AMH-Licensed Adult Foster Homes
1/31/2023Fee-for-Service Fidelity Wraparound expansion, effective November 30, 2022Behavioral health providers, Community Mental Health Programs
1/27/2023Fee-for-service reprocessing of Citizenship Waived Medical Plus postpartum professional and dental claimsAll Providers
1/13/2023Plan of Care rate increases now complete, effective July 1, 2022Adult mental health residential providers
1/3/2023Submitting fee-for-service claims to receive the July 1, 2022 behavioral health rate increase Behavioral health providers, Substance use disorder treatment providers
12/16/2022Fee-for-service rate increase for Medicaid behavioral health services, effective July 1, 2022Behavioral health providers, Substance use disorder treatment providers
12/1/2022Provider guide regarding services to OHP Children and Youth: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)All Providers
11/2/2022Two new dental-only Oregon Health Plan programs open January 1, 2023All Providers, CCOs
10/18/2022Coverage of community integration services effective January 1, 2022Substance use disorder treatment providers, CCOs
10/7/2022Oregon Health Plan coverage for bivalent COVID-19 booster vaccinations and seasonal flu vaccinesAll Providers, CCOs
10/4/2022Face-to-face and in-person assessments for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant (BH PCA) services begin October 15, 2022AMH-licensed residential treatment providers, Personal care attendants, AMH-Licensed Adult Foster Homes
9/15/2022Changes to daily limits for fee-for-service SUD treatment codes, effective January 1, 2019Substance use disorder treatment providers
8/25/2022Billing for diabetes self-management and prevention programsAll Providers, CCOs
8/22/2022OHP coverage of hMPXV (human monkeypox virus) vaccines and testingAll Providers, CCOs
8/16/2022Billing for covered fall prevention programsAll Providers, CCOs
7/26/2022Fee-for-service reimbursement for self-administered COVID-19 test kits supplied by non-pharmacy providers, effective April 4, 2022 Clinical labs, Federally Qualified Health Centers, Home health agencies, Hospitals, Indian Health Service (IHS) clinics, Medical practitioners, CCOs, Opioid treatment programs
6/22/2022Mobile Opioid Treatment Programs, effective May 1, 2022Oregon Opioid Treatment Programs
4/7/2022New SUD treatment reimbursement codes and rate changes effective January 1, 2022Substance use disorder treatment providers, CCOs
1/11/2022Medicaid Coverage of Crisis Respite Services and Respite CareAMH-Licensed Adult Foster Homes
1/7/2022Change to mental health assessment timeline for Wraparound referralsCCOs, Community Mental Health Programs
11/19/2021Update to fee-for-service COVID-19 home testing coverage effective December 1, 2021All Providers
11/4/2021CAWEM coverage of COVID-19 home tests and flu vaccinations during the COVID-19 Public Health EmergencyAll Providers
10/29/2021Fee-for-service coverage of COVID-19 home testing effective November 8, 2021All Providers
9/30/2021SUD treatment code and rate changes effective January 1, 2022Substance use disorder treatment providers, CCOs
9/22/2021“No Wrong Door” for Oregon Health Plan providers billing for covered monoclonal antibody (mAb) servicesAll Providers
9/2/2021Oregon Health Plan coverage for third dose of COVID-19 vaccineAll Providers
8/30/2021COVID Relief Temporary Rate Increase for State Fiscal Year 2021 - Reimbursement for T1020 and T2033AMH-licensed residential treatment providers
8/26/2021Oregon Health Plan monoclonal antibody coverage for COVID-19 treatmentAll Providers
7/8/2021COVID Relief Temporary Rate Increase for State Fiscal Year 2021AMH-licensed residential treatment providers
7/6/2021Additional payment for in-home COVID-19 vaccine administration, effective June 8, 2021All Providers, CCOs
6/3/2021PCA reimbursement for transportation to COVID-19 vaccination sitesPersonal care attendants, Community Mental Health Programs
5/18/2021Add-on fee for interpreter services extended for fee-for-service paymentAll Providers
5/5/2021Provider Presentation for Year One Review of Adult Mental Health Residential Standardized RatesAMH-licensed residential treatment providers
5/3/2021System of Care needs assessment and additional supportsBehavioral health providers, CCOs, Children's psychiatric residential treatment providers, Community Mental Health Programs
2/3/2021Eliminating Barriers to Care for People with Disabilities during the COVID-19 PandemicAll Providers, CCOs
1/25/2021Help Oregon complete Phase 1a of the COVID-19 Vaccine Sequencing Plan All Providers, CCOs
12/31/2020Add-on fee for interpreter services now open for fee-for-service paymentAll Providers
12/9/2020Provider collaboration and compliance with Comagine HealthCommunity Mental Health Programs, AMH-Licensed Residential and Outpatient Providers, AMH-Licensed Adult Foster Homes
10/7/2020Transition of Personal Care Attendant service authorizations to Comagine HealthBehavioral health providers, Community Mental Health Programs, Behavioral health case managers
9/11/2020Data Requested for Year One Review of Adult Mental Health Residential Standardized Rates AMH-licensed residential treatment providers
8/3/2020Short-term Medicaid stability loans for providers with reduced business caused by COVID-19 All Providers
6/1/2020Transition to Comagine Health - New Independent Qualified Agent effective July 1, 2020AMH-licensed residential treatment providers, Behavioral health providers, Community Mental Health Programs, AMH-Licensed Residential and Outpatient Providers, AMH-Licensed Adult Foster Homes
5/11/2020Providing Culturally and Linguistically Appropriate Services During the COVID-19 EmergencyAll Providers, CCOs
5/5/2020Temporary expansion of CAWEM-only coverage during the COVID-19 emergency.pdfAll Providers
3/31/2020New dates for OHA Intensive In-Home Behavioral Health Treatment Webinars.pdfAll interested parties, Behavioral health providers, Indian Health Service (IHS) clinics, Tribal 638 clinics, CCOs, Community Mental Health Programs
3/30/2020How to bill for COVID-19 services to OHP members effective immediately.pdfAll Providers, CCOs
3/25/2020Comagine Health is the Oregon Behavioral Health Independent Qualified Agent effective July 1, 2020AMH-licensed residential treatment providers, Behavioral health providers, Community Mental Health Programs, AMH-Licensed Adult Foster Homes
3/20/2020Avoid processing delays by submitting claims and prior authorization requests electronically.pdfAll Providers
3/20/2020Expanded telehealth coverage for behavioral health services.pdfBehavioral health providers, CCOs, Community Mental Health Programs
2/21/2020Oregon Health Plan coverage of behavioral health treatment for trauma and relationship diagnoses.pdfCCOs, Community Mental Health Programs
2/19/2020Join the OHA Intensive In-Home Behavioral Health Treatment webinar series.pdfAll interested parties, Behavioral health providers, Indian Health Service (IHS) clinics, Tribal 638 clinics, CCOs, Community Mental Health Programs
2/7/2020Join OHA for an Intensive In-Home Behavioral Health Treatment webinar on February 13 2020.pdfBehavioral health providers, CCOs, Community Mental Health Programs
2/3/2020ASD and Wraparound Eligibility Effective January 1, 2020.pdfCCOs, MHOs, Community Mental Health Programs
1/15/2020Retainer Payments for Adult and Young Adult Residential Settings.pdfAMH-licensed residential treatment providers
9/27/2019Request for Comment - State Plan Amendment to increase fee-for-service SUD ratesAll interested parties, Behavioral health providers, Substance use disorder treatment providers, Community Mental Health Programs


Policy Quick Links

Rules and Guidelines by Program

Temporary Rule Filings

Permanent Rule Filings

Notices of Proposed Rulemaking

Behavioral Health Quick Links

Applied Behavior Analysis

ABA resource list

For OHP families - Steps to ABA treatment

How to enroll as an Oregon Medicaid provider

Prior authorization resources

State Plan Personal Care

IQA website and request forms

OHP 531 - 20-Hour Service Plan for Mental Health Services

Oregon Home Care Commission 

Office of Developmental Disabilities

Residential Services

1915(i) rules and guidelines

IQA website and request forms

Rate standardization project - Webinars, forms and other resources

Retainer Payment PA process

Frequently asked questions

Other Resources

Addictions and Mental Health rules and statutes

Behavioral Health fee schedule

Behavioral Health rate increases

Community Mental Health Programs 

Culturally and Linguistically Specific Services

Provider Web Portal resources

Who to Call for Help

For information about authorizing services for CCO members, contact the CCO.

Applied Behavior Analysis

For fee-for-service authorizations, email OR1915i@kepro.com.

For other questions, contact Provider Services.

Other Services

For authorizations of 1915(i), Adult Foster Home, Residential Treatment, and Personal Care Attendant services, email ORBHSupport@comagine.org.

For other questions, email bhpocp.auths@oha.oregon.gov.

Provider Services

 800-336-6016 or  email us

 Address and telephone contacts