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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

In November 2022, the Centers for Medicare & Medicaid Services (CMS) approved broad increases to the FFS fee schedule. These increases are retroactively effective July 1, 2022, and increase provider rates by an average of 30 percent.

View the final rate increases (XLSX)

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:

Provider Updates

Announcements:

Webinars:

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. The CLSS application should be available for providers Jan. 30.

Questions?

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Frequently Asked Questions

General questions

Rate differential for culturally and linguistically specific services