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2023 Medicaid Behavioral Health Provider Directed Payment Increase
What is the directed payment increase?
Effective January 1, 2023, the Oregon Health Authority (OHA) is implementing four behavioral health directed payments (BHDPs) within the CCO contracts that will further the goals and priorities of the Medicaid program.
Trillium Medicaid Behavioral Health/Substance Abuse providers will receive a minimum of a 15% rate increase with possible additional increases based on the four health directed payments below:
- Tiered Uniform Rate Increase Directed Payment
- Co-Occurring Disorder Directed Payment
- CLSS Directed Payment
- Minimum Fee Schedule Directed Payment
What actions do I need to take?
- Step 1: All contracted Behavioral Health Providers need to fill out the information requested on all tabs in this OHA form: "Primarily Medicaid Provider Attestation (to be eligible for 30% increases)" (Excel)
Please note: Trillium is requesting all contracted Behavioral Health Providers complete the form in Step 1 even if they qualify for the 15% minimum increase and not the 30% rate increase according to OHA criteria.
- Step 2: If you have questions or need additional information, please review OHA’s CCO BH Directed Payment Guidance Document (PDF) and OHA’s CCO BH Directed Payment Frequently Asked Questions (PDF).
- Step 3: Email your completed attestation form to Trillium at OR_prov_reps@trilliumchp.com
How do I learn more?
- Visit OHA’s Behavioral Health Rate Increase webpage for additional resources
- View the recorded video (YouTube) and slides (PDF) from OHA’s Implementation Update Webinar (12/14/22)
- Download OHA’s CCO BH Directed Payment Frequently Asked Questions (PDF)
- Download OHA’s CCO BH Directed Payment Guidance Document (PDF)
Who can help me if I have questions?
Please contact your assigned Health Plan Provider Relations Representative. We are happy to help guide you through this process!
Prior Authorization Forms
- Medicaid BH PA Form - Inpatient (PDF)
- Medicaid BH PA Form - Outpatient (PDF)
- OR Medicaid Certificate of Need Form (CON) (PDF)
For behavioral health services only: Discharge information is required within 24 hours of discharge from IP or RTC levels of care. Please fax discharge clinicals to: 833-505-1300.
Note: Effective July 1, 2021, Prior Authorization requirements for some Behavioral Health (BH) codes have changed.
Codes described below will no longer require Prior Authorization for services when provided by a Participating Provider. Non-Participating Providers still require a Prior Authorization for all services.
Prior Authorization requirements for all codes can be verified on our Pre-Auth Check Tool - Just visit https://www.trilliumohp.com/providers/preauth-check.html.
|Code||Procedure||PA Requirement / Units allowed prior to PA|
|90832, 90833, 90834, 90836 90837, 90838, 90846, 90847, 90849, 90853, H0004, H0005, H0006, H0036, T1006||Behavioral Health Outpatient Therapy||No Prior Authorization is required for Participating Providers. Non-participating providers always require prior authorization.|