Behavioral Health Qualified Directed Payments

A uniform percent increase in reimbursement rates to qualified behavioral health participating/contracted providers. This increase is in addition to CCO contracted rates already in place effective in January 2022 and limited to the following covered services: Assertive Community Treatment (ACT), Supported Employment Services (SE), Outpatient Mental Health Treatment and Services (OP MH), and Outpatient and Non-inpatient Detox Substance Use Disorder Treatment and Services (OP SUD). All rate increases received in 2022 will count towards the total 15% or 30% tiered increase effective January 1, 2023. This increase is in addition to any other COD and/or CLSS QDP rate increases.

The increased percentage has two tiers based on the details of a provider’s total patient service revenue:

• 30% increase for “Primarily Medicaid” – defined as having at least 50% of its total patient service revenue derived from providing Medicaid services in the prior calendar year.
• 15% increase for “Primarily Non-Medicaid” – defined as having less than 50% of its total patient service revenue from providing Medicaid services in the prior calendar year.

Which Providers Qualify?

Qualified participating providers of:

• Assertive Community Treatment (ACT)
• Supported Employment Services (SE)
• Outpatient Mental Health Treatment and Services (OP MH)
• Outpatient Substance Use Disorder Treatment and Services (OP SUD)
  • This includes non-inpatient withdrawal management

How Do Providers Get Paid the Increased Rate?

• All qualified participating providers who held a contract on or after January 1, 2022, will automatically receive the “Primarily Non-Medicaid” rate increase of 15% (over the 1/1/22 rates) effective January 1, 2023. This will be applied retroactively once implemented. This means that providers who did not hold a contract on 1/1/22 will not be penalized and will have comparable rates as the rest of the network.
• If a qualified participating provider meets criteria for the “Primarily Medicaid” rate increase of 30%, the provider must provide documentation demonstrating criteria is met based on the BH revenue from Medicaid services provided in calendar year 2022.
• Fill out the OHA’s Primarily Medicaid Provider Attestation form, available on the Oregon.gov website.  Completed forms are to be submitted through a secure email to Jackson Care Connect at BH_attest@careoregon.org.
  • DOCUMENTATION:
    • If documentation is received by March 31, 2023, the 30% rate increase (over 1/1/22 rates) will be retro-effective January 1, 2023.
    • If documentation is received after March 31, 2023, the 30% rate increase (over 1/1/22 rates) will be retroactively implemented to the first day of the calendar quarter of which the documentation was submitted.  For example, if the documentation is received May 31, 2023, then the rate will be retro-effective April 1, 2023.

All qualified non-contracted BH providers will be reimbursed at rates that are no less than OHA’s Medicaid Fee-for-Service (FFS) Behavioral Health Fee Schedule in effect on the date of service. Effective date will be announced soon.

A uniform payment increase for qualified behavioral health providers certified by OHA for integrated treatment of Co-Occurring Disorders (COD) rendered by qualified staff per OAR 309-019-0145. This increase is in addition to CCO contracted rates already in place effective January 2022 and any other tiered payment and/or CLSS QDP rate increases.

The following payment increases are available to qualified participating providers of:

• BH participating/contracted providers of Non-residential COD services per OAR 309-019-0105:
  • Add on payment that is 10% of OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service for:
    • Qualified Mental Health Associate (QMHA)
    • Peer
    • Substance Use Disorders (SUD) Treatment Staff
  • Add on payment that is 20% of OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service for:
    • Qualified Mental Health Professional (QMHP)
    • Licensed Health Care Professional (LHCP)
    • Mental Health Intern
• BH participating/contracted providers of SUD Residential and Non-inpatient Detox COD services per OAR Chapter 309, Division18:
  • Add on payment that is 15% of OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service.

Which Providers Qualify?

• To qualify for the COD rate increase, providers must meet the following criteria:
  • Provider Organization will possess a current OHA HSD Approval to provide integrated Co-Occurring Disorders services per COD Rules and published process.

How Do Providers Get Paid the Increased Rate?

• Providers need to notify the contracted CCO(s) of their OHA HSD Approval to provide COD services and include supporting documentation.

A uniform payment increase to qualified behavioral health participating/contracted providers who deliver culturally and/or linguistically specific services (CLSS) as defined by the Oregon Administrative Rules (OARs). This increase is in addition to CCO contracted rates already in place effective January 2022 and any tiered payment and/or COD QDP rate increases.

The following payment increases are available based on “Rural” and “Non-Rural” classifications:

• Add on payment for “Rural” CLSS Providers: add on payment of 27% of OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service.
• Add on payment for “Non-Rural” CLSS Providers: add on payment of 22% of OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service.

Which Providers Qualify?

• CLSS organizations and programs, individuals, and bilingual service and sign language providers enrolled as a Medicaid provider and meet criteria defined in OAR Chapter 309, Division 65 and provide the following services:
  • Assertive Community Treatment (ACT)
  • Supported Employment Services (SE)
  • Applied Behavior Analysis (ABA)
  • Wraparound
  • Outpatient Mental Health Treatment and Services (OP MH)
  • Outpatient Substance Use Disorder Treatment and Services (OP SUD) and non-Inpatient Detox

How Do Providers Get Paid the Increased Rate?

• Providers need to notify the contracted CCO(s) of their OHA HSD Approval to provide CLSS and include supporting documentation.
• Please note: Jackson Care Connect is working with OHA to finalize process tracking which may include the addition of a new modifier. 
  

Regardless of a provider’s contract status with a CCO, effective January 1, 2023, the Oregon Health Authority requires CCOs to reimburse qualified providers of Substance Use Disorders (SUD) Residential services, Applied Behavior Analysis (ABA), and Mental Health Children’s Wraparound services at rates that are no less than OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service.

Which Providers Qualify?

• The directed payment is limited to Medicaid covered SUD Residential, Applied Behavior Analysis, and MH Children’s Wraparound services.

How Do Providers Get Paid?

• All qualified providers will receive payment no less than OHA’s Medicaid FFS Behavioral Health Fee Schedule in effect on the date of service.