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.
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.
Webinar updates, questions and answers:
Retainer payment resources:
- Rate Review Committee: Intensive Services Request form (12/2021)
- 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 and 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