Effective January 1, 2023, the Oregon Health Authority (OHA) implemented a managed care directed payment arrangement that will provide a uniform percentage increase payment to qualified network, contracted Behavioral Health (BH) providers for impacted services (described below) delivered during the 2023 contract year.
The directed payment is limited to covered services in the ACT/SE, Mental Health Non-Inpatient and Substance use disorder categories of service (COS).
EOCCO has begun work to implement this change and representatives are reaching out to contracted entities.
For more information, please review OHA's resources for the Behavioral Health Rate Increase for Medicaid Providers:
OHA has also created a standard provider attestation form that providers can use to attest to demonstrate that they are over 50% Medicaid (Primarily Medicaid) and eligible for the 30% increase.
Below are the Four Directed Payment Categories:
- Tiered Uniform Rate Increase Directed Payment
This managed care directed payment arrangement provides a uniform percentage increase payment to qualified network, contracted BH providers for impacted services (described below) delivered during the 2023 contract year. The increase is addition to the contracted rates EOCCO had in place for qualified BH providers effective January 1, 2022.
The percentage increase for Primarily Medicaid providers is 30% and the percentage increase for Primarily Non-Medicaid providers is 15%.
The payment increases have two tiers defined by whether the provider is a Primarily Medicaid or Primarily Non-Medicaid Behavioral Health Provider. The value of the percentage increase is based on whether the Provider is Primarily Medicaid (defined as having at least fifty percent (50%) of its total patient service BH revenue derived from providing Medicaid services in Contract Year 2022), or whether the provider is Primarily Non-Medicaid (defined as having less than fifty percent (50%) of its total patient service BH revenue from providing Medicaid services in Contract Year 2022). The BHDPs provide for a uniform percentage increase to a Contractor’s negotiated base rates in effect January 1, 2022 to qualified Participating Providers of ACT/SE services, MH Non-Inpatient and Substance Use Disorder services.
Please review the guidance document for additional information.
- Co-Occurring Disorder Directed Payment
The managed care directed payment arrangement provides a uniform payment increase to Participating Providers of Outpatient Behavioral Health Services approved by OHA for integrated treatment of co-occurring disorders (COD) rendered by qualified staff per the forthcoming COD Rules. The payment increase must equal:
• 10% of the Medicaid Behavioral Health Fee-For-Service fee schedule rate for covered nonresidential services provided by providers below a master’s level, including peer service providers
• 20% of the Medicaid Behavioral Health Fee-For-Service fee schedule rate for covered nonresidential services for master’s level providers
• 15% of the Medicaid Behavioral Health Fee-For-Service fee schedule rate for SUD residential services providers
The increase(s) will be in addition to the negotiated base rates in place for qualified BH providers delivering services while meeting COD standards. The billing entity must be approved under the COD rules OAR 309-019-0145.
Please review the guidance document for additional information.
- Culturally and Linguistically Specific Services (CLSS) Directed Payment
The managed care directed payment arrangement for culturally and linguistically specific services provides a uniform payment increase to:
(1) Qualified participating providers that deliver culturally and/or linguistically specific services (CLSS), and
(2) Qualified behavioral health providers that provide a direct care behavioral health service in a language other than English or in an approved Sign language.
CLSS are services that are grounded in the cultural values of minoritized communities (communities that have experienced historical and contemporary racism, trauma, and social, political, and economic injustices) in order to elevate their voices and experiences. CLSS aims are to provide emotional safety, belonging, and encourage a shared collective cultural experience for healing and recovery and are provided by a culturally and/or linguistically specific organization, program, or individual provider.
The payment increase for qualifying providers and services must be:
- 22% of the State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate for covered services provided by non-rural providers and;
- 27% of the Medicaid fee schedule rate for rural providers.
The increase(s) will be in addition to the negotiated base rates in place for qualified BH providers delivering services while meeting CLSS eligibility standards outlined in OAR 309-065-0145.
Please review the guidance document for additional information.
- Minimum Fee Schedule Directed Payment
The managed care directed payment arrangement requires EOCCO to maintain the fee schedule for SUD Residential, Applied Behavior Analysis and MH Children’s Wraparound services at no lower than the OHA State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate in effect at the date of service.
Please review the guidance document for additional information.
Questions?
If you have questions related to EOCCOs implementation of direct GOBHI contracts, please feel free to reach out to Lisa Chamness
If you have questions related to EOCCO’s implementation of the Behavioral Health Integration PCPCH payments, please feel free to reach out to Summer Prantl
