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:
-
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
| 5/18/2026 | Changes to SRTF concurrent stay authorization timeframes effective June 1, 2026 | | 3/13/2026 | Children’s Psychiatric Residential Treatment Facility emergency admission procedure | | 8/26/2025 | OHA does not cover the fee-for-service per diem rate for days youth are not in residential care | | 2/7/2025 | Adult mental health residential rates, effective Jan. 1, 2025 | | 1/30/2025 | Feb. 3, 2025 webinar about adult mental health residential rates | | 12/24/2024 | Pause: 2025 adult mental health residential rates | | 5/30/2024 | Secure residential treatment facility approval and reauthorization timeframes | | 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 | Expansion of crisis respite services effective January 1, 2023 | | 2/8/2024 | Medical necessity reviews for SRTF level of care | | 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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