Behavioral Health Provider Directed Payment Increase
Effective January 1, 2023, the Oregon Health Authority (OHA) implemented four behavioral health-directed payments (BHDP’s) within the CCO contracts that will further the goals and priorities of the Medicaid program.
- Tiered Uniform Rate Increase Directed Payment based on % of Medicaid revenue received.
- Rate increase will be in addition to the rates in place for CCOs for qualified BH providers providing ACT/SE, MH Services Non-Inpatient and Substance Abuse effective January 1, 2022.
- Tier 1 = 15% of negotiated rate effective Jan 1, 2022, for providers with less than 50% of BH service revenue derived from providing Medicaid services in the prior CY
- Tier 2 = 30% of negotiated rate effective Jan 1, 2022, for providers with greater than 50% of BH service revenue derived from providing Medicaid services in the prior CY
- Rate increase will be in addition to the rates in place for CCOs for qualified BH providers providing ACT/SE, MH Services Non-Inpatient and Substance Abuse effective January 1, 2022.
- Co-Occurring Disorder Directed Payment – requiring certification by the state. For application and ICOD policy and procedures please visit www.oregon.gov/icd
- Rate increases will be structured as follows for those providing A&D Residential, MH services Non-inpatient, MH Children’s Wraparound and/or Substance Abuse.
- 10% of the FFS State Plan Fee schedule for providers treating members with COD
- 20% of the FFS state plan fee schedule for providers with a Master’s degree in BH field treating members with COD
- 15% for FFS State Plan fee schedule for Residential providers treating members with COD.
- Rate increases will be structured as follows for those providing A&D Residential, MH services Non-inpatient, MH Children’s Wraparound and/or Substance Abuse.
- CLSS Directed Payment – requiring certification by the state.
- Rate increases will be structured as follows for those providing ACT/SE, Applied Behavior Analysis, MH Services Non-Inpatient, MH Children’s Wraparound and/or Substance Abuse.
- 22% of the FFS State Plan Fee schedule for Non-Rural qualifying providers
- 27% of the FFS State Plan Fee schedule for Rural qualifying providers
- Rate increases will be structured as follows for those providing ACT/SE, Applied Behavior Analysis, MH Services Non-Inpatient, MH Children’s Wraparound and/or Substance Abuse.
- Minimum Fee Schedule Directed Payment
- The directed payment will require BH providers in A&D Residential, Applied Behavior Analysis, MH Children’s Wraparound to be paid at least the FFS State Plan fee schedule rate for services delivered during the contract year.
For more information, please review OHA’s webpage about the Behavioral Health Rate Increase for Medicaid Providers.
For attestation form, please download here: BHPDP Attestation Form
For direct assistance please contact Kera Hood – kera.hood@advancedhealth.com
For more information on Culturally and Linguistically Specific Services (CLSS) Behavioral Health Provider please click here: CLSS Behavioral Health Provider
Please email all attestation and certification documents to Karen Gannon – karen.gannon@advancedhealth.com