Behavioral Health Provider Directed Payment Increase
The 2025 CCO contract with OHA requires that each CCO reassess its Medicaid-Primary behavioral health providers status using each provider’s revenue data from CY 2024. Medicaid-Primary providers are required to re-attest to qualify and maintain their Tier 2 – Medicaid-Primary practice status.
Effective January 1, 2025 OHA has implemented changes to tiered increase directed payment as follows:
- OHA has eliminated Tier 1. Affected providers will be moved from 138% of 2022 DMAP behavioral health rates to 100% of current DMAP behavioral health rates. These rates are roughly equivalent. Due to DMAP fee schedule increases since 2022, most previously-Tier 1 providers will not experience an increase or decrease.
- Tier 2 reimbursement rates have received an inflation adjustment, bringing reimbursement rates to 160% of the 2022 DMAP Behavioral Health Rates for services rendered in 2025. We had hoped to move this group to a multiple of current DMAP; however, the 2025 CCO contract requirement requires that we apply an inflation adjustment to 2024 pricing if such an adjustment exceeds 110% of current DMAP rates.
***Update: As of January 1, 2025, the Tier 1 non-Medicaid primary rate has been changed to 110% of the Current BH Rates published by OHA.
As you may be aware, we requested re-attestation of your Medicaid-Primary vs. Non-Primary status back in August for the time frame of January 1 – June 30, 2024. However, the 2025 CCO contract requires providers to attest to Medicaid-Primary status based on calendar year 2024 revenue.
At this time, we are requesting each BH provider to re-attest and provide financial breakdown by payor for CY 2024 (January 1 – December 31, 2024). As soon as we receive and validate your re-attestation we will retroactively adjust any claims for dates of service in 2025 for Medicaid-Primary providers beginning the first date of the quarter in which the attestation is received.
Going forward, please mark your calendars each year to ensure timely submission of your annual re-attestation and financial report showing payor breakdowns. In adherence to your Network Provider Agreement, it is each BH provider’s responsibility to re-attest annually (by December 31st of each year) in order to receive any changes in current rates for the next year. If no re-attestation is received, rates will convert to the Non-Primary rate published by OHA for the coming year.
Please submit your re-attestations as soon as possible so that we can update your rates and reprocess any 2025 claims for Medicaid-Primary providers. You will find the current re-attestation form attached to this email. However, soon you will find the re-attestation form and supporting information on our website at www.advancedhealth.com/providers and it will be your responsibility to submit the form annually and in a timely manner.
All Tier 2 Medicaid-Primary providers are required to re-attest by December 31st of each year to allow their Tier 2 status of reimbursement to continue into the next year. If a re-attestation is not received by December 31st, reimbursement will default to the Non-Primary rate published by OHA for the coming year until a re-attestation is received. Once the re-attestation is received, the Tier 2 reimbursement will be effective the 1st day of the quarter in which the re-attestation is received.
For more information related to QDP implementation and CMS regulations, please visit OHA’s website: https://www.oregon.gov/oha/HSD/OHP/Pages/BH-Rate-Increase.aspx
Thank you to those of you that have already submitted your full annual re-attestation and financial breakdowns for CY2024.
For those that have not yet submitted your full CY2024 documents, Please submit your completed attestation and financial breakdown to karen.gannon@advancedhealth.com.
For more information, please review OHA’s webpage about the Behavioral Health Rate Increase for Medicaid Providers.
For attestation form, please download here: BHQDP 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