Behavioral Health Provider Resources

Effective Jan. 1, 2023, the Oregon Health Authority will implement a managed care-directed payment arrangement that will provide a uniform percentage increase payment to qualified network contracted behavioral health providers for services delivered during the contract year. The increase will be in addition to the contracted rates IHN-CCO had in place for qualified behavioral health providers effective Jan. 1, 2022.

The payment increases have two tiers defined by whether the provider is a “Medicaid dominant” or “non-Medicaid dominant” behavioral health provider.

• 30% increase for Medicaid-dominant: defined as having at least 50% of its total patient service revenue derived from providing Medicaid services in the prior contract year.
• 15% increase for Medicaid non-dominant: defined as having less than 50% of its total patient service revenue from providing Medicaid services in the prior contract year.

Who Is Eligible?

Qualified participating providers of ACT/SE services, MH non-inpatient and substance abuse services.

What Should You Do?

1. All eligible providers will default to an increase equivalent to the Medicaid Non-dominant tier (15%). No further action is required.  

2. If you feel you or your provider group meets the definition of eligibility for Medicaid-dominant tier (30%), providers should gather financial information* to demonstrate their distribution of prior contract year patient services revenue between Medicaid and non-Medicaid payors and submit it to IHN-CCO prior to March 31, 2023, or as soon as eligibility is met. Initiate the process with IHN-CCO and select “Behavioral Health Directed Payment” in the “Request Type” field.   

*Please track your gathered financial information on the OHA fillable form available at the Oregon Health Authority website by selecting the “Primarily Medicaid Provider Attestation Form” listed under the CCO Rate Increases section.

3. IHN-CCO contracts contain “lesser of billed charges” language. Providers should bill at a rate that takes into account any of the behavioral health-directed payment rate increases they expect to be eligible for to ensure payments can be applied correctly and reduce the need for claim resubmission.

Effective Jan. 1, 2023, the Oregon Health Authority will implement a directed payment arrangement that will provide a uniform payment increase to participating providers of outpatient behavioral health services certified by OHA for integrated treatment of co-occurring disorders (English), also known as COD, rendered by qualified staff per the forthcoming COD rules. The payment increase(s) equals:

• 10% of the State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate effective Jan. 1, 2023, for covered non-residential services provided by providers below a master’s level, including peer service providers.
• 20% of the Medicaid fee schedule rate in effect on Jan. 1, 2023, for covered non-residential services for master’s level providers.
• 15% of the Medicaid fee schedule rate in effect on Jan. 1, 2023, for residential services providers.  

The increase(s) will be in addition to your negotiated base rates currently in place for qualified providers delivering services while meeting COD certification standards. The billing entity must be certified under the forthcoming COD rules established by OHA.

The directed payment is limited to services on the Medicaid Fee-For-Service Behavioral Health Rate Increase Fee Schedule and in the A&D Residential, Mental Health Non-Inpatient, Mental Health Children’s Wraparound and SUD categories of service.  

What Should You Do?

1. Become certified by applying for Certification of Approval through your assigned licensing and certification specialist at OHA. Programs will need to have previous and current Behavioral Health Certification of Approval and meet requirements that OHA will add to Oregon Administrative Rule  309 019 0145 . OHA has advisory and information groups formed to discuss revisions to this rule. To get involved or receive ongoing information and updates, contact David Corse.  

2. Provider staff rendering services will meet staff training and certification requirements per COD rules.  

3. Certified providers should bill using the appropriate payment modifier when a service is provided to a member with qualifying diagnoses.

• Master’s level provider: use modifier HO for eligible services to receive the additional 20%.
• All other providers: use modified HH for eligible services to receive the additional 10%.  

4. For residential providers: To receive the 15% of the Medicaid fee schedule rate increase, a residential CPT code from the following table must be present.

CPT	Modifier	Other Conditions
H0010	HH	Certified SUD program
H0011	HH	Certified SUD program
H0018	HH	Certified SUD program
H0019	HH	None
H2013	Not HK	None

5. Providers who obtain COD certification at the organization and rendering provider level should notify IHN-CCO and provide supporting documentation. Initiate the process with IHN-CCO and select “BH Directed Payment” in the “Request Type” field.

6. IHN-CCO contracts contain “lesser of billed charges” language. Providers should bill at a rate that takes into account any of the behavioral health-directed payment rate increases they expect to be eligible for to ensure payments can be applied correctly and reduce need for claim resubmission.  

Effective Jan. 1, 2023, the Oregon Health Authority will implement a directed payment arrangement that will provide a uniform payment increase to qualified participating providers when they deliver culturally and/or linguistically specific services, also known as CLSS, direct services in a language other than English or in an approved sign language.

CLSS are services that are centered on the cultural values of ethnic and minority communities in order to elevate the voices and experiences of those who have been historically oppressed. Their aims are to provide safety, belonging and encourage a shared collective cultural experience for healing and recovery, and are provided by a culturally and/or linguistically specific organization, program or individual provider. The payment increase(s) equals:  

• 22% of the State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate in effect on Jan. 1, 2023, for covered services provided by non-rural providers.
• 27% of the Medicaid fee schedule rate in effect on Jan. 1, 2023, for rural providers.  

The increase(s) will be in addition to your negotiated base rates currently in place for qualified behavioral health providers delivering services while meeting CLSS certification standards.

Who Is Eligible?

1. CLSS Organization Program or individual provider and bilingual service or sign language providers deemed eligible through OHA application process providing the following services:

• Substance used disorder (non-inpatient).
• Mental health (non-inpatient).
• Mental Health Children’s Wraparound.
• Assertive Community Treatment and Supportive Employment, also known as ACT and SE.
• Applied Behavioral Analysis, also known as ABA.

2. Once approved as an eligible provider/billing entity by OHA, providers should contact IHN-CCO to submit approval and request for rate enhancement.
3. Providers/billing entities should use the linked template to comply with the required reporting details and must submit a complete template for interpreter services provided to IHN-CCO within 30 days following the end of each calendar quarter starting in 2023. Completed templates can be delivered to [email protected].  

What Should You Do?

1. Providers who deliver a CLSS service, a service in a language other than English or a service in an approved sign language and have met eligibility requirements should bill using the appropriate payment modifier.

To receive the enhanced payment, each eligible service on the claim must be billed in two separate detail lines. The first detail line is billed following current billing practice for the service, including any required modifiers, and reimburses at the OHA FFS rate. The second detail line is a duplicate of the first and must also include either the modifier U9 or TN.

• U9: For non-rural providers will reimburse at 22% of OHA’s fee for service rate.
• TN: For rural providers (as confirmed by OHA during the application process) will reimburse at 27% of OHA’s fee for service rate.

To receive CLSS enhanced payments for previously submitted claims for services provided on or after July 1, 2022, providers can adjust eligible claims as follows:

• For each eligible service on a paid detail line, add a second detail line including either the U9 or TN modifier and adjust the claim.

For additional information, please reference the CLSS Billing Guide (English).

2. IHN-CCO contracts contain “lesser of billed charges” language. Providers should bill at a rate that takes into account any of the behavioral health directed payment rate increases they expect to be eligible for to ensure payments can be applied correctly and reduce need for claim resubmission.

3. Initiate the process to submit information and supply approval with IHN-CCO and select “BH Directed Payment” in the “Request Type” field.

Effective Jan. 1, 2023, the Oregon Health Authority will implement a directed payment arrangement that will require CCOs to maintain the fee schedule for A&D Residential, Applied Behavior Analysis and Mental Health Children’s Wraparound services at no lower than the OHA State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate in effect at the date of service.

Impacted Services

The directed payment is limited to services on the Medicaid Fee-For-Service Behavioral Health Rate Increase Fee Schedule and in the A&D Residential, Applied Behavior Analysis and Mental Health Children’s Wraparound Categories of Services.

What Should You Do?

1. No additional action will be required from providers. IHN-CCO will adopt/maintain the fee schedule for A&D Residential, Applied Behavior Analysis and Mental Health Children’s Wraparound services at no lower than the OHA State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate in effect at the date of service.
2. IHN-CCO contracts contain “lesser of billed charges” language. Providers should bill at a rate that takes into account any of the behavioral health directed payment rate increases they expect to be eligible for to ensure payments can be applied correctly and reduce need for claim resubmission.

The Measures and Outcomes Tracking System, also known as MOTS, is a comprehensive electronic data system required to be used by Oregon’s behavioral health service providers to support:

• Improved care.
• Controlled costs.
• Shared information.

For more information on MOTS or on who is required to report, refer to the reference manual (English) and/or this Health System Division policy (English).

The Oregon Health Authority intends ROADS to be the single, web-based data submission and reporting solution for behavioral health partners and OHA. OHA expects ROADS to eventually replace the current Measures and Outcomes Tracking System. Featured improvements include:

• Online data submission to replace submissions via emails and spreadsheets.
• Flexibility for OHA to adjust data collection requirements and features without highly technical resources or outsourcing.
• Advanced reporting capabilities that allow users to customize reports for their specific administrative needs.

For additional questions regarding MOTS or the ROADS project, please contact: [email protected]

Training & webinars available:

oregon.gov/oha/HSD/COMPASS/Pages/Client-Entry-Online-Training.aspx
oregon.gov/oha/HSD/COMPASS/Pages/Communications.aspx

Covered services can be found on Provider Connect, the provider website or by calling Customer Service. We strongly encourage providers to sign up for Provider Connect access due to the abundant amount of information available

Samaritan Health Plans offers several plans:

• Samaritan Advantage Health Plans (HMO Medicare plans).
• InterCommunity Health Network Coordinated Care Organization (Medicaid plan).
• Samaritan Employer Group Plans (commercial plans).
• Samaritan Choice Plans (self-funded plans for Samaritan employees).
• Samaritan Exclusive Provider Organization Plan.

Mental health providers that want to contract with Samaritan Health Plans should complete the Join Our Network form located on our website. 

Yes, when adding a provider to a solo/individual practice, you are no longer a solo/individual practice but become an organization. The new provider will need to complete the credentialing or validation process and the organization will need to supply a Type 2 NPI (English) that identifies the practice as an organization rather than an individual. To begin this process, complete the Add a Provider to Your Group and you will be contacted with information on requirements.

Providers are required to inform Samaritan Health Plans when their panel availability changes. If you are unable to take more patients, complete the Panel Availability Change Form (English) we can reflect the change in the Provider Directory. Remember to complete the form again when you are ready to open your panel availability.

When reviewing your Provider Remittance Advice, also known as PRA, there will be an amount listed as “member responsibility”. These are charges that may be passed on to the member. If you feel a code was denied in error, contact Customer Service so a review can be conducted.

Note: IHN-CCO members should never be billed for services.

Telehealth outpatient mental health services should be coded as follows:

Plan	Place of Service	Modifiers
InterCommunity Health Network	Use either 02 or 10.	GT modifier is accepted, but not required.
Samaritan Employer Group Plans	Use either 02 or 10.	Modifiers not required.
Samaritan Choice Plans	Use either 02 or 10.	Modifiers not required.
Samaritan Advantage	Use either 02 or 10.	Modifier 95 required.

Samaritan Health Plans Care Management team offers assistance to members who are experiencing immediate and on-going medical conditions, have barriers to care or are experiencing needs related to social determinants of health. To refer a member for these services, complete the Case Management Member Referral Form (English) located on the Provider website for review and consideration of service eligibility. 

We encourage providers to utilize electronic methods, but paper claims are acceptable. For information on billing addresses and processing tips please see Billing & Claims Submission Process for Providers on the provider website.

Provider Connect is a secure provider portal utilized by Samaritan Health Plans contracted providers. Through Provider Connect you can view eligibility, benefits, claim status and submit prior authorizations. To obtain access to Provider Connect, you will need to register your organization with OneHealthPort. A registration guide is available on the OneHealthPort page to assist you. 

Each provider who bills for IHN-CCO must have a current Medicaid enrollment number. If you fail to renew your enrollment, SHP will be notified by OHA and will begin denying claims. Once you are reenrolled, the effective date will be retroactive and any denied claims will be reprocessed. If you need assistance with enrollment, please contact Customer Service.

Yes, there are several. The list below is not inclusive so if a provider type isn’t listed, please contact Samaritan Health Plans Provider Relations at [email protected].

Provider Type	Requirements	Restrictions	Resources
Associates (formerly known as Interns)	– Must be part of a contracted group. – Have a valid NPI. – Complete credentialing/ validation process. – Have an active Medicaid number for IHN-CCO.	Can only submit claims for IHN-CCO.	OAR 858–010–0037 OAR 858–010–0038 OAR 833–050–0011
CADC, QMHP, QMHA, Peer Support Specialist	– Must be part of a contracted group. – Have a valid NPI. – Complete validation process. – Have an active Medicaid number for IHN-CCO.	Can only submit claims for IHN-CCO.	Mental Health & Addiction Certification Board of Oregon (MHACBO).
LPC, LMFT	– Must be licensed or certified by the state where you provide services. – Have a valid NPI. – Credentialing approval. – Have an active Medicaid number for IHN-CCO.	Not an eligible provider type for Medicare.	Medicare Mental Health Medicare Learning Network booklet (cms.gov) (English).
Physician, Psychologist	– Must be licensed or certified by the state where you provide services. – Have a valid NPI. – Credentialing approval. – Have an active Medicaid number for IHN-CCO.
LCSW	– Must be licensed or certified by the state where you provide services. – Have a valid NPI. – Credentialing approval. – Have an active Medicaid number for IHN-CCO.

When providing care to InterCommunity Health Network members, you can find covered CPT codes on the Oregon Health Plan Behavioral Health Fee Schedule.  For other plans, please refer to the appropriate Medicare fee schedule listed on your agreement.

Please refer IHN-CCO and/or Samaritan Advantage members to Cascade West Ride Line, Monday through Friday, 8 a.m. to 5 p.m. at 541-924-8738, toll free 866-724-2975 (TTY 711). Review the Non-emergent Medical Transportation Program Guide (English) for more information.