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 on the OHP fee schedule page

Providers may also apply to receive an enhanced FFS rate for:

• Providing Culturally and Linguistically Specific Services (CLSS), and
  
• Providing Integrated Co-occurring Disorders (ICD) treatment services.
  

Learn how to complete the CLSS application process

Complete the CLSS application

Frequently asked questions about the application

CLSS Billing Guide

To learn more about becoming eligible to provide ICD treatment, visit OHA's Integrated Co-occurring Disorders page. You can also view OHA's list of approved ICD programs by county.

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:

• 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:

• 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?

Please email us