Behavioral Health Qualified Directed Payment (QDP/BHDPs) overview
Effective January 1, 2023, the Oregon Health Authority (OHA) implemented a statewide rate increase for Medicaid Behavioral Health providers. As a partner with Health Share of Oregon CCO, we must increase our rates through four Behavioral Health Directed Payments (BHDPs) to improve equitable access to quality services for CareOregon/Health Share enrollees through a more sustainable behavioral health workforce.
These BHDPs are:
- Tiered Uniform Rate Increase Directed Payment
- Integrated Co-occurring Disorder (ICD) Directed Payment
- Culturally & Linguistically Specific Services (CLSS) Directed Payment
- Minimum Fee Schedule Directed Payment
Click on the arrow next to the sections below to see more information about what each behavioral health directed payment entails.
Culturally & Linguistically Specific Services (CLSS) Directed Payment
A uniform payment increase to qualified behavioral health participating/contracted providers who deliver culturally and/or linguistically specific services (CLSS) as defined by the Oregon Administrative Rules (OARs). This increase is in addition to CCO contracted rates already in place and any tiered payment and/or ICD QDP rate increases. Payment increases are available based on “Rural” and “Non-Rural” classifications.
Which Providers Qualify?
- CLSS organizations and programs, individuals, and bilingual service and sign language providers enrolled as a Medicaid provider and meet criteria defined in OAR Chapter 309, Division 65 and provide the following services:
- Assertive Community Treatment (ACT)
- Supported Employment Services (SE)
- Applied Behavior Analysis (ABA)
- Wraparound
- Outpatient Mental Health Treatment and Services (OP MH)
- Outpatient Substance Use Disorder Treatment and Services (OP SUD) and non-Inpatient withdrawal management
How Do Providers Get Paid the Increased Rate?
For providers designated as follows by the OHA (per their online approved-provider list):
- CLSS Programs (459)
- CLSS Organizations (460)
- CLSS Individual Providers (461)
- Individual Bilingual Providers (462)
- Individual Sign Language Provider (463)
- You do not need to notify us of your CLSS designation.
- CLSS claims must include CLSS modifiers as appropriate. Please refer to the CareOregon Fee Schedule and OHA’s CLSS Billing Guidefor these details. Please note: Care Oregon’s claim processing system cannot accurately process CLSS claims when two lines of modifier are billed a stated in the OHA Billing Guide. Please bill your CPT code and CLSS modifier on one line.
- U9: Culturally and Linguistically Specific Services for non-rural providers
- TN: Culturally and Linguistically Specific Services for rural providers
Noncontracted providers
Noncontracted providers may only be eligible for the “Minimum Fee Schedule Directed Payment.” Noncontracted providers do not qualify for the other BHDPs listed above and should not submit a Primarily Medicaid Provider Attestation form, nor a quarterly report related to CLSS or ICD reimbursement. Please review details for the Minimum Fee Schedule Directed Payment under the heading above to see if this applies to you.
You can find our Noncontracted BH & SUD fee schedule here, or on our Metro BH provider page.
For more information on how to contract with CareOregon, please review requirements and our submission form on our Provider Support page.
Questions or additional support? Please contact your Provider Relations Specialist at MetroBHPRS@careoregon.org
Provider Updates & FAQs
The following documents provide more information about Directed Payments:
Forms & Additional Resources
- Primarily Medicaid Provider Attestation is provided by the OHA and is available on the Oregon.gov website
- Completed Primarily Medicaid Provider Attestation forms and supporting documentation must be submitted through a secure email to CareOregon at: BH_attest@careoregon.org.
