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Provider Digest | Volume 216

Date: 05/13/26

Frequently Asked Questions: Medicaid Behavioral Health Utilization Management Guidelines

Trillium recognizes that changes to prior authorization (PA) requirements can require workflow adjustments, and we appreciate the partnership of our provider community as we implement these updates that went into effect April 1, 2026.

To help clarify what to expect and how best to navigate the transition, you'll find a list of Frequently Asked Questions on Trillium's Prior Authorization webpage. You may also like to review this Authorization Tip Sheet for Behavioral Health Providers (PDF) for additional information about the PA process.

If you have any questions, please contact your assigned Provider Engagement Account Manager or email ORProviderExperience@TrilliumCHP.com.

Thank you for your partnership!

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Cards for Connection™ Training

Join Dr. Amy King, psychologist, and her team for an in-person "Cards for Connection" training on brief intervention strategies to bridge mental health gaps and strengthen relational health. This training is geared toward professionals in healthcare, child welfare, and behavioral health.

  • October 9 and October 23, 2026
  • 8:30 a.m.-4:30 p.m.
  • Downtown Athletic Club, 999 Willamette Street, Eugene, OR 97401
  • OHSU School of Medicine designates this live activity for a maximum of 14 AMA PRA Category 1 Credits™.
  • Free for professionals serving children and families in Lane County
  • View the flyer (PDF)
  • Register for Cards for Connection

If you have any questions, please email certify@doctoramyllc.com.

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Reminder: OHA Appointment Access Requirements for Trillium Medicaid Providers

To ensure access to care and improved health outcomes, Trillium Medicaid providers are contractually obligated to comply with the Oregon Health Authority (OHA) access requirements. Please review the below access requirements and contact your assigned health plan Provider Engagement Account Manager if you have any questions. Thank you for your partnership in helping our members stay healthy.
 
Important Note: Trillium is accredited by the National Committee for Quality Assurance (NCQA). NCQA measures additional appointment access timeframes that OHA does not, including non-life threatening emergency care for behavioral health services. Trillium Medicaid providers must comply with both the OHA and NCQA access requirements. 

Physical Health (Primary Care and Specialists) Appointment Access Standards

  • Emergency: Immediate or referred to an emergency department depending on the member’s condition
  • Urgent: Within 72 hours or as indicated in initial screening and in accordance with OAR 410-141-3840
  • Well Care (Routine): Within 4 weeks, or as otherwise required by applicable care coordination rules including OAR 410-141-3860 and 410-141-3870
  • After-hours: 24 hours/7 days a week

Behavioral Health (Non-Specialty/Non-Priority Populations) Appointment Access Standards

  • Urgent behavioral health care (all populations): Within 24 hours
  • Routine behavioral health care (non-priority populations): Assessment within seven (7) days of the request, with a second appointment occurring as clinically appropriate
  • Non-Life-Threatening Emergency: 6 hours (NCQA)

Specialty Behavioral Health (Priority Populations) Appointment Access Standards:

In accordance with the timeframes in OAR 410-141-3515 for assessment and entry, terms are defined in OAR 309-019-0105, with access prioritized per OAR 309-019-0135.

Priority access order for entry per OAR 309-019-0135:

  1. Individuals who are pregnant and using substances intravenously
  2. Individuals who are pregnant
  3. Individuals who are using substances intravenously; and
  4. Individuals or families with dependent children.

If a timeframe cannot be met due to lack of capacity, the member must be placed on a waitlist and provided interim services within 72 hours of being put on a waitlist. Interim services must be comparable to the original services requested based on the level of care and may include referrals, methadone maintenance, HIV/AIDS testing, outpatient services for substance use disorder, risk reduction, residential services for substance use disorder, withdrawal management, and assessments or other services described in OAR 309-019-0135.
 
Specialty Behavioral Health (Priority Populations)

  • Urgent Care: Within 24 hours
  • Non-Life-Threatening Emergency: 6 hours (NCQA)
  • Capacity limits / waitlist: If a timeframe cannot be met due to lack of capacity, members must be placed on a waitlist and provided interim services within 72 hours of being put on a waitlist.
  • Opioid use disorder: Assessment and entry within 72 hours
  • Medication assisted treatment: As quickly as possible, not to exceed 72 hours for assessment and entry
  • IV drug users including heroin: Immediate assessment and entry. Admission for treatment in a residential level of care is required within fourteen (14) days of request, or, if interim services are necessary due to capacity restrictions, admission must commence within 120 days from placement on a waitlist.
  • Children with serious emotional disturbance: Any limits that the Authority may specify in the contract or in sub regulatory guidance
  • Pregnant women, veterans and their families, women with children, unpaid caregivers, families, and children ages birth through five years, individuals with HIV/AIDS or tuberculosis, individuals at the risk of first episode psychosis and the I/DD population: Immediate assessment and entry. If interim services are necessary due to capacity restrictions, treatment at appropriate level of care must commence within 120 days from placement on a waitlist.

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Trillium Provider Orientation Sessions: Choose the Date that Works Best for You

Please join our Provider Engagement team for a hosted virtual orientation session for all new contracted providers and currently contracted providers who would like updates for 2026.

All sessions will contain the same content and will cover the following topics important to providers, including:

  • Trillium website – tips and tour of resources  
  • Introduction to provider portals      
  • Credentialing     
  • Claims submission     
  • Prior authorization check tool   
  • Interpreter services     
  • Family planning and women’s healthcare services   
  • Population Health case management services      
  • Behavioral Health services    
  • Free clinical trainings      
  • Access and availability provider appointment standards     
  • How to connect with your dedicated Provider Engagement Account Manager 

Note: If you need accommodations or would like to schedule an individual session for your team/provider group, please contact ORProviderExperience@TrilliumCHP.com.

We look forward to connecting with you!

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