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Rate Standardization Project

Overview

As required by the budget note in House Bill 5026-A (2017), the Oregon Health Authority established a plan for standardization of Oregon's reimbursement rates for adult mental health residential services. This page provides information about that plan, also known as the Rate Standardization Project.

The following reports to the Oregon Legislature provide an overview of the project and its timelines.

Background

Historically, OHA negotiated provider rates on an individual basis, based upon provider-submitted costs, with little connection to resident acuity. In 2007, a partial rate standardization effort resulted in two groups of providers, each paid according to a different rate methodology.

  • 50 percent had their individually negotiated rates rebased.
  • The remaining 58 providers continue under a bundled personal care (PC)/habilitation rate from pre-2007.

Neither rate methodology is risk-adjusted nor tied to patient acuity. Meanwhile, some providers get biennially updated operating budgets through the OHA county pass-through contracts, which may include cost of living adjustments.

Resources

Webinar updates, questions and answers: 

Retainer payment resources:

Other resources:

Also visit the OHP Behavioral Health Policy page for guides, forms and other resources specific to Oregon Medicaid coverage and reimbursement; and the Mental Health Rules page for other requirements.

Updates for facilities

  
  
8/30/2021COVID Relief Temporary Rate Increase for State Fiscal Year 2021 - Reimbursement for T1020 and T2033
7/8/2021COVID Relief Temporary Rate Increase for State Fiscal Year 2021
5/5/2021Provider Presentation for Year One Review of Adult Mental Health Residential Standardized Rates
5/3/2021System of Care needs assessment and additional supports
12/9/2020Provider collaboration and compliance with Comagine Health
10/12/2020Certification of Need for Services for children’s Subacute treatment, effective January 1, 2020
9/11/2020Data Requested for Year One Review of Adult Mental Health Residential Standardized Rates
6/1/2020Transition to Comagine Health - New Independent Qualified Agent effective July 1, 2020
3/25/2020Comagine Health is the Oregon Behavioral Health Independent Qualified Agent effective July 1, 2020
1/15/2020Retainer Payments for Adult and Young Adult Residential Settings.pdf

Project timeline

April 2018

Develop interim rate review process

June 2018

Gather rate standardization data from providers

September 2018

Complete preliminary rate analysis and modeling

November 2018

Review and approve rates

December 2018

Plan phased roll-out to include early adopter testing

Questions?

Email the Rate Standardization Project Team