Overview
The Centers for Medicare & Medicaid Services (CMS) approved Oregon’s Substance Use Disorder 1115 Demonstration waiver, effective April 8, 2021, through March 31, 2026. A central part of the waiver focuses on enhancing residential treatment services as a crucial component in the continuum of substance use addiction benefits. It accomplishes this by permitting Oregon to receive federal funding for Medicaid services for individuals with a substance use disorder in residential treatment facilities with more than 16 beds.
This new federal funding, added to the resources provided in the Governor’s Budget for 2021-23, allows for greater investment in Oregon’s vision to prevent, identify, and treat people with substance use disorder and help them sustain long-term recovery.
The other major component of this waiver increases the service array for Oregon Health Plan (OHP) members with substance use disorders, including Community Integration services composed of housing and employment support.
At the guidance of CMS, the proposed Recovery Support Services were separated out from this waiver. This means peer-delivered services outside of a treatment episode will be considered for further conversation and development in the future.
For additional information or inquiries,
please contact Sarah Adelhart, SUD 1115 Waiver Policy Analyst.
Current Demonstration
This waiver has the potential to profoundly change Oregon’s substance use disorder treatment system.
We believe substance use disorder is a chronic condition that needs long-term comprehensive care and support. Oregon envisions a person-centered and recovery-oriented system that supports prevention, treatment and ongoing support for sustained recovery. Before this demonstration:
- Oregon could not use Medicaid funds to pay for residential treatment in facilities with more than 16 beds. Most of Oregon’s residential treatment facilities are more than 16 beds and solely state-funded.
- Only treatment was eligible for Medicaid funding (not prevention, outreach, or recovery support).
The SUD 1115 waiver would allow Oregon to pay all residential facilities using Medicaid funds. OHA will use these new funds to also provide the supports needed to prevent substance use disorder, identify substance use disorder and sustain long-term recovery.
New substance use disorder (SUD) treatment reimbursement codes and rate changes effective Jan. 1, 2022
OHA published the fee-for-service Behavioral Health Fee Schedule effective Jan. 1, 2022, to include the following changes for SUD treatment services:
- New customary charge structure and rate increase for SUD residential facilities. OHA will contact each Medicaid-enrolled SUD residential program to confirm their specific customary charge.
- New codes and rates for community integration services (housing and employment services) to help members with SUD transition from hospital or residential settings back into the community.
- New codes and rates for crisis services, intervention, care coordination and case management.
- Increased rates for select outpatient SUD services and supports.
OHA has updated the Medicaid Management Information System (MMIS) with these changes. Providers can now bill for these new rates and services for dates on or after Jan. 1, 2022.
Learn more by reading the memo from OHA.
2022 Public Health Emergency Risk Mitigation Amendment
OHA requested and received approval for this amendment upon advisement from CMS on how to modify a risk mitigation arrangement with coordinated care organizations after the applicable rating period has begun in order to make appropriate equitable payments during the COVID-19 Public Health Emergency.
Meeting Accommodation
Everyone has a right to know about and use Oregon Health Authority (OHA) programs and services. OHA provides free help. Some examples of the free help OHA can provide are:
- Sign language and spoken language interpreters
- Written materials in other languages
- Braille
- Large print
- Audio and other formats
If you need help or have questions, please contact Sarah Adelhart at 503-621-8455 (711 TTY) at least 48 hours before the meeting.