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Behavioral Health

2026 Medicaid Behavioral Health Provider Directed Payment Program Update

In preparation for annual changes to OHA’s BH Directed Payment Program (BHDP), Trillium updates our website each January to ensure our network of contracted behavioral health providers has timely access to updated details, guidelines and resources. Please review the current status of OHA’s 2026 BHDP program below.

What is the status of the 2026 BHDP rate increases?

  • Per OHA’s 2026 BHDP guidance, the 2026 directed payment structure is not final until approved by CMS. As of late December, CMS has not provided that approval. Trillium will update our website upon hearing from OHA on next steps for 2026.

What steps do providers need to take?

  •  For additional questions and to stay updated, OHA’s 2026 BHDP program guidance document and other resources can be found on OHA’s  Behavioral Health Rate Increase webpage.
  • For Trillium contracted providers, Trillium will continue reimbursing at our contracted rates and will adhere to all OHA reimbursement guidelines. While providers may no longer qualify for BHDP rates as of 1/1/26, reimbursement will not automatically revert to 100% of DMAP unless contractually specified. We regularly review reimbursement methodologies in alignment with OHA expectations and will notify providers in advance of any changes.

Who do I contact at Trillium if I have questions?

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.

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.

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.

Behavioral Health Codes

CodeProcedurePA Requirement / Units allowed prior to PA
90832, 90833, 90834, 90836 90837, 90838, 90846, 90847, 90849, 90853, H0004, H0005, H0006, H0036, T1006Behavioral Health Outpatient Therapy No Prior Authorization is required for Participating Providers.  Non-participating providers always require prior authorization.