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 Joanna Johnson, Substance Use Systems Coordinator and SUD 1115 Waiver Manager.
Oregon 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. Right now:
- Oregon cannot 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 is 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.
SUD treatment code and rate changes effective January 1, 2022
Effective January 1, 2022, OHA will implement fee-for-service reimbursement for:
- Treatment provided within SUD facilities with more than 16 beds, and
- Community integration services (housing and employment support services) for members with SUD.
OHA is working to identify applicable CPT and HCPCS procedure codes and develop rates commensurate to these services. To learn more and view the preliminary list of services effective on or after Jan. 1, 2021, please view the announcement from OHA.
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
- Large print
- Audio and other formats
If you need help or have questions, please contact
Joanna Johnson at 503-753-6160 (711 TTY) at least 48 hours before the meeting.