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Behavioral Health

2026 Medicaid Behavioral Health Payment Guidance

Trillium Community Health Plan (“Trillium”) reimburses behavioral health services in alignment with guidance issued by the Oregon Health Authority (“OHA”) for the Oregon Health Plan (“OHP”). This includes the OHP Behavioral Health Fee‑for‑Service Fee Schedule and OHA‑approved Behavioral Health Directed Payments (also referred to as Qualified Directed Payments).

OHA establishes payment methodologies, eligibility criteria, and recognition requirements for enhanced payments. These requirements may change annually and are subject to federal approval. Trillium administers reimbursement in accordance with current OHA guidance.

Visit the OHA website to learn more about OHA behavioral health rate and directed payment guidance.

For covered behavioral health services, Trillium aligns reimbursement with the OHA Oregon Health Plan Behavioral Health Fee‑for‑Service Fee Schedule, as published and updated by OHA.

The OHP Behavioral Health Fee Schedule includes applicable procedure codes and maximum allowable rates and may be updated by OHA without notice. Trillium incorporates applicable updates consistent with OHA guidance.

OHA Behavioral Health Fee Schedule

OHA has established Behavioral Health Directed Payments to support access to outpatient behavioral health services for OHP members. Directed payments apply to specific behavioral health services identified by OHA, when delivered by providers that meet OHA eligibility criteria.

Beginning in Calendar Year 2026, enhanced BHDP payments are primarily focused on providers that qualify as Team‑Based High Acuity Medicaid Providers, as defined by OHA.

OHA BHDP guidance is available on the OHA website.

Behavioral Health Directed Payments are subject to ongoing CMS approval and OHA guidance and may be modified or discontinued if required by federal or state authorities.

Provider Eligibility

Eligibility for BHDP is determined solely by OHA and requires providers to meet all applicable criteria established by OHA such as:

  • Holding an OHA Certificate of Approval (COA);
  • Meeting OHA‑defined Medicaid revenue thresholds; and
  • Delivering integrated, team‑based care as defined by OHA.

Providers are responsible for reviewing OHA guidance and submitting any required attestations or documentation to establish or maintain eligibility.

If a provider does not meet OHA eligibility criteria, services are reimbursed under standard reimbursement methodologies.

BHDP eligibility and payment are not guaranteed by contract and are administered by Trillium in accordance with current OHA guidance.

OHA has established enhanced directed payments for Culturally and Linguistically Specific Services (CLSS) to support culturally responsive behavioral health care for OHP members. CLSS payments are separate from BHDP eligibility and require specific OHA recognition.

CLSS Recognition Requirements

To qualify for CLSS‑related directed payments:

  • Providers must be approved by OHA as a CLSS provider; and
  • Services must meet OHA CLSS service criteria.

Only providers recognized by OHA as CLSS providers are eligible for CLSS‑related enhanced payments.

OHA CLSS Approved Providers List (PDF)

OHA CLSS Billing Guide (PDF)

For more information, visit OHA's webpage on Culturally and Linguistically Specific Services.

OHA has established enhanced directed payments for providers delivering Integrated Co‑Occurring Disorder (COD) services to individuals with co‑occurring mental health and substance use disorders. COD payments are administered separately from standard BHDP eligibility and require OHA program recognition.

COD Recognition Requirements

To qualify for COD‑related directed payments:

  • The provider or program must be recognized by OHA as an Integrated Co‑Occurring Disorder (ICD/COD) program; and
  • Services must meet OHA‑defined COD program standards.

Only programs recognized by OHA are eligible for COD‑related enhanced payments.

OHA Integrated Co‑Occurring Disorder (COD) Program List (PDF)

OHA Integrated Co‑Occurring Disorder (COD) Billing Guide (PDF)

For more information, visit OHA's webpage on Integrated Co‑Occurring Disorder (COD) Services.

Residential behavioral health services, including residential mental health and residential substance use disorder (SUD) treatment, are reimbursed using OHA‑established residential rate methodologies.

Residential services are generally excluded from outpatient Behavioral Health Directed Payment minimum rate requirements, unless explicitly identified by OHA as eligible for directed payments.

Residential rates and methodologies are published by OHA and incorporated by Trillium in accordance with OHA guidance.

OHA Behavioral Health Fee Schedule

OHA retains sole authority to define:

  • Behavioral Health Directed Payment eligibility;
  • CLSS and COD recognition;
  • Covered services; and
  • Payment methodologies.

Providers are responsible for monitoring OHA guidance and maintaining applicable approvals and recognitions. Trillium administers payment in accordance with OHA guidance as updated.

OHA Reference Links

2025

What is the directed payment increase?

Effective January 1, 2025, the Oregon Health Authority (OHA) is implementing the annual attestation process required for qualified BH providers for three behavioral health directed payments (DPs) within the CCO contracts that further the goals and priorities of the Medicaid program. All Trillium Medicaid Behavioral Health/Substance Abuse providers who submitted Tier 2 Primarily Medicaid OHA attestations in 2024 are required by OHA to resubmit 2025 attestations to CCOs in order to continue qualifying for BHDP rate tier increases.

For 2025, providers will want to review the criteria for each category as OHA has updated the DP program this year and limited qualifying providers to those in the Primarily Medicaid, COD and CLS categories listed below:

  1. Behavioral Health Primarily Medicaid Directed Payment: attestation to CCO required for this DP
  2. Integrated Co-Occurring Disorder (COD) Directed Payment: OHA approval required for this DP
  3. Culturally and Linguistically Specific Services (CLS) Directed Payment: OHA approval required for this DP

What actions do I need to take?

How do I learn more?

Who can help me if I have questions?

Please contact your assigned Health Plan Provider Engagement Administrator (PEA). We are happy to help guide you through this process! You can locate your assigned PEA on Trillium’s Regional Rep Contact webpage.

2023

What is changing  

As of July 1, 2023, Trillium Community Health Plan (Trillium) will add Behavioral Health (BH) Board Registered Associates to the BH provider types that the CCO can enroll as a part of credentialing for BH group practices. 

As a CCO and partner with our BH provider network, Trillium values a whole-person approach to overall wellness and access to healthcare services for our members. That includes working with our BH provider network on strategies that support the best access to high quality and effective BH treatment services. In collaboration with our BH provider partners, we received feedback that adding BH associates registered with state clinical boards as allowed under the 410 OARs will enable improved access to BH services and support building the BH workforce of clinicians that serve Oregon Health Plan (OHP) members across our CCO regions. 

What is remaining the same

The following BH practitioner types require the below state clinical board license or OHA certification:

  • Credentialing Independent BH Practitioners: Individual BH practitioner credentialing requires an active license in good standing with a state clinical board in OR to practice independently without supervision.
  • Credentialing BH Practitioners certified through the Mental Health and Addictions Certification Board of Oregon (MHACBO): QMHPs, QMHAs, CADCs, CGACs and other BH practitioner types allowable under the 309 OARs require a provider/agency to hold a COA with OHA in order to enroll and credential these BH practitioner types. 

Where to send questions or updates to your Trillium BH roster template  

Behavioral Health Resource Networks

Lane County Behavioral Health Resource Network Information (PDF)

Behavioral Health Policies

To view and download our Behavioral Health Policies, please visit the Policy section of our website.

Prior Authorization Forms

Medicare

Medicaid

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.

Prior Authorization requirements for all codes can be verified on our Pre-Auth Check Tool.

Helpful Resource: Authorization Tip Sheet for Behavioral Health Providers (PDF)