Oregon Health Authority (OHA) has received federal approval to significantly increase Medicaid behavioral health services reimbursement paid through coordinated care organizations (CCOs).
The federal approval requires CCOs to increase pay to providers for behavioral health services provided on or after Jan. 1, 2023.
This approval and the additional funding will enable OHA to invest Medicaid funds to improve access to services, support the behavioral health workforce, incentivize culturally and linguistically specific services, and increase support for integrated treatment of substance use and mental health (co-occurring) disorders.
“This historic federal approval is a game-changer that enables us to consistently increase reimbursement across both CCO provider networks and OHA’s fee-for-service program for behavioral health services. This also develops a sustainable funding stream to rebuild Oregon’s pandemic-depleted behavioral health system at a time of spiking demand and service challenges,” said OHA Chief Financial Officer Dave Baden.
“Getting more people access to behavioral health services is a top priority for Governor Kotek and for OHA. This rate increase will help stabilize service providers and expand care for people in Oregon who need it,” said OHA Director James Schroeder.
The legislature allocated $42.5 million state funds through House Bill 5202 (2022). These state funds are projected to yield approximately $112 million in matching federal Medicaid funds for increases across by fee for service providers and for CCOs.
The combined $154.5 million in rate increases, plus additional funds available in the CCO budget, resulted in an increase of approximately $221 million funds over this calendar year.
CCOs are receiving this increase as of Jan. 1. OHA expects the increases to be retroactively effective to that date for providers.
The estimated impact on CCO capitation rates — the per-member-per month amounts the state pays to CCOs to coordinate care for Oregonians through the Oregon Health Plan — is projected to be about $221.3 million.
About $175 million will go toward providing behavioral health services across a broad spectrum of services:
- Providers will receive a 30-percent increase to reimbursement when compared to January 2022 if they have more than 50 percent service revenue from Medicaid.
- Providers will receive a 15-percent increase to reimbursement when compared to January 2022 if they have less than 50 percent service revenue from Medicaid.
- Differentials are also available for providers who deliver culturally and linguistically specific services and serve members who have co-occurring disorders.
There are 12 rate categories for CCOs, which consider the average cost for members in these specific categories. Rates are also based on average provider rate costs in each region.
Part of the funding requires CCOs to create publicly available websites to help providers understand the rate increases. Providers will also be required to produce records showing the distribution of patient service behavioral health care between Medicaid payers and non-Medicaid payers.
More information can be found here.
Last November, the Centers for Medicare & Medicaid Services approved the fee-for-service portion of the increase, retroactively to July 1, 2022.
