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Medicaid Behavioral Health Qualified Directed Payments

The four categories for the increased payments are summarized below:

  1. For 2026, there has been a revision with additional requirements for a provider to qualify to receive at least 110% of current FFS rates effective on 1/1/26. Providers can meet the requirement in one of two ways:

    1. CMHPs that provide ACT/SE, IIBHT and/or EASA automatically qualify and do not need to submit an attestation to qualify.  

      ​OR

    2. Providers must meet all three of the following criteria to be eligible:

      1. Hold a certificate of approval from OHA; 
        ​and

      2. At least fifty percent (50%) of their total patient service BH revenue derived from providing services to OHP Members in the prior Contract Year; 
        and 

      3.    Can deliver team-based care to include all the following, as clinically indicated

        • Psychiatric services and/or addiction medicine services

        • Peer delivered services (CRM, PWS, PSS)

        • Case management services

        • Individual, group and family community-based services. 

  2. Co-Occurring Disorders: Payments to providers certified by OHA for integrated treatment of co-occurring disorders.  All co-occurring providers are eligible.  All providers must be recertified via the state website application process. Specific codes and modifiers required. See guidance for correct billing codes.

    • Services provided by a QMHP or higher will receive 120% of DMAP provided the services are being provided to someone identified as dealing with and being treated for co-occurring disorders

    • Services provided by non-QMHP will receive 110%. 

    • Residential and IOP will receive 115% because there is a variety of education levels providing services under one service code

  3. Culturally & Linguistically Specific Services: Payment increase for providers of culturally and/or linguistically specific services. Eligible providers are outpatient mental health, substance use and now including traditional healthcare workers.  All providers must be certified via the state website application process. Specific modifiers apply.

    • 22% for Non-Rural

    • 27% for Rural

  4. Minimum Fee Schedule: Maintain fee-schedule rates for SUD Residential, ABA and Mental Health Children’s Wraparound services

 

This is an additive payment structure, meaning providers can be eligible for more than one payment category.

 

Provider attestations are currently available. Please find it in the resources section on this page below.

 

To learn more about becoming eligible to provide ICD treatment, visit OHA's Integrated Co-occurring Disorders page.

 

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 (summer.prantl@modahealth.com)

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