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.

• Report to Ways and Means - October 17, 2017
• Report to Ways and Means - January 12, 2018
• Report to State Emergency Board - October 31, 2018

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: 

• May 12, 2021 webinar slides
  
• January 23, 2020 webinar and slides
  
• November 19, 2019 webinar and slides
• September 30, 2019 webinar and slides

Retainer payment resources:

• Retainer Payment Request form
  
• Retainer Payment Extension Request form
  
• Retainer Payment Process fact sheet
  
• Oregon Medicaid PA Process for RTH RTF Retainer Payments - Provider Web Portal slides (updated March 2021)
  

Other resources:

• Rate Review Committee: Intensive Services Request form (11/2023)
• Year One Rate Review Questions and Responses (October 7, 2020)
  
• Year One Rate Review Template: Updated September 2020
  
• Adult Mental Health Residential FAQ: Updated September 2019
• Retainer payment and MMIS updates:  View the August 25, 2019 webinar slides
• Updates on retainer payment and capacity reporting; rate determination process and Tier 5 intensive services requests: View the July 25, 2019 webinar and slides
• Review of residential services billing; retainer payment prior authorization process; engagement and documentation; intensive services requests; capacity reporting: View the June 25, 2019 webinar and slides
• Non-OHP retainer payments and invoice tracking: View the June 24, 2019 webinar and slides
  
• Final rates, documentation and capacity reporting: View the June 6, 2019 webinar and slides
• Billing and authorization for July 1: View the May 21, 2019 webinar and slides
• Preparing for July 1 implementation: Listen to the April 17, 2019 webinar and view the slides
• Rate methodology and implementation plan: View the December 5, 2018 webinar slides
• Project status: View the June 27, 2018 webinar and slides
• Data collection: View the May 7, 2018 webinar, slides, template and fact sheet

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

Issue Date       Announcement (PDF)    4/22/2024 New customary charge for ASAM Level 3.7 R services 4/3/2024 Adult Foster Home Documentation Standards Training 3/14/2024 Request for Calendar Year (CY) 2022 and 2023 financial data 2/8/2024 Medical necessity reviews for SRTF level of care 2/8/2024 Expansion of crisis respite services effective January 1, 2023 10/19/2023 Needs assessment options for behavioral health services in the home and community 7/26/2023 Face-to-face and in-person assessments required for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant services effective Aug. 15, 2023 4/7/2023 Payment recovery planned for fee-for-service IMD residential per diem claims 3/31/2023 End of COVID-19 Residential Vacancy Payments 1/13/2023 Plan of Care rate increases now complete, effective July 1, 2022 10/4/2022 Face-to-face and in-person assessments for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant (BH PCA) services begin October 15, 2022 8/30/2021 COVID Relief Temporary Rate Increase for State Fiscal Year 2021 - Reimbursement for T1020 and T2033 7/8/2021 COVID Relief Temporary Rate Increase for State Fiscal Year 2021 5/5/2021 Provider Presentation for Year One Review of Adult Mental Health Residential Standardized Rates 5/3/2021 System of Care needs assessment and additional supports 12/9/2020 Provider collaboration and compliance with Comagine Health 10/12/2020 Certification of Need for Services for children’s Subacute treatment, effective January 1, 2020 9/11/2020 Data Requested for Year One Review of Adult Mental Health Residential Standardized Rates 6/1/2020 Transition to Comagine Health - New Independent Qualified Agent effective July 1, 2020 3/25/2020 Comagine Health is the Oregon Behavioral Health Independent Qualified Agent effective July 1, 2020 1/15/2020 Retainer Payments for Adult and Young Adult Residential Settings.pdf

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