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2023 Medicaid Behavioral Health Qualified Directed Payment Increase

The Oregon Health Authority is implementing a tiered payment increase for Behavioral Health providers that meet certain criteria.  Greater Oregon Behavioral Health (GOBHI) has begun the work to implement this beginning January 1, 2023. 

The four categories for the increased payments are summarized below:

  1. Tiered Uniform Rate Increase: This is two tiers of payments for all contracted Behavioral Health providers. Providers eligible are outpatient mental health and substance use.

    • 30% increase for Medicaid Dominant (at least 50% of revenue)

    • 15% increase for Medicaid non dominant (less than 50% of revenue)

  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.

    • 20% for Master’s, 10% for non-Master’s and 15% for Residential

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

    • 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.

 

It is a complicated program but GOBHI has structured a work group to ensure we are working with each provider to obtain the documents needed to identify the correct payments for services.  We are also working with Moda to configure their claims system for the new payment structure.

 

GOBHI will be sending attestation forms beginning next week for your organization to complete to begin receiving the increased payments.  For more information, please review OHA's webpage about the Behavioral Health Rate Increase for Medicaid Providers.

 

If you have any questions related to GOBHI's implementation of these payments, please feel free to reach out to Lisa Chamness at lchamness@gobhi.org.

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