Provider updates

CareOregon is streamlining our fee structures for specific outpatient mental health and culturally and linguistically specific (CLSS) Tier 1 services to align with Fee-for-Service rates listed in the 2025 Oregon Health Authority (OHA) Behavioral Health (BH) fee schedule. This rate adjustment is for providers who classify as Tier 1 (Primarily Non-Medicaid), who mainly serve non-Medicaid members and have less than 50% of their total revenue coming from Oregon Medicaid sources. 

We did not arrive at this decision lightly. The reality is that our current rate structure is no longer financially sustainable and with growing uncertainty at the federal level, we need take steps now to protect the long-term stability of services for our members. 

We know that this change may be difficult, and it is not a reflection of the quality of the care provided by Tier 1 providers. Our goal is to support member access while also being good stewards of Medicaid dollars. As a publicly funded organization, we must make difficult decisions to ensure that our limited resources can support the greatest needs across our communities.  

A formal notice of this change has been mailed in to impacted Tier 1 providers.  

Who is affected? 

All contracted fee-for-service outpatient mental health Tier 1 providers including routine outpatient, Culturally and Linguistically Specific Services (CLSS), applied behavior analysis (ABA), telehealth, and evaluation and management providers.  

Who is not affected? 

• CareOregon is maintaining our current rates for the additional services we cover as behavioral health benefits on our fee schedule that are not included on OHA’s fee schedule. 
• Tier 1 mental health providers paid via an alternative payment model (APM), including Level A – D Case Rates, Tier 1 substance use disorder (SUD) providers, and Tier 1 integrated co-occurring disorder (ICD) providers are not affected by this change.  
• CLSS add-on payments will not be impacted. 
• CareOregon Medicare Advantage rates will not be impacted. 

Which specific services are impacted? 

• Services that will experience a rate adjustment include, but are not limited to: 
• Routine outpatient services such as skills training, case management, individual, family and group psychotherapy, and ABA services 
• Prescriber evaluation and management services 
• Services that will not experience a rate adjustment: 
• Partial hospitalization 
• Day treatment 
• Respite 
• Transcranial Magnetic Stimulation 
• Electroconvulsive Therapy 
• Psychological testing 
• Subacute treatment 

Additional information

• Fee schedules for contracted providers are available in the provider Connect Portal/OneHealthPort: https://www.careoregon.org/providers/provider-portal
• If you believe your Medicaid revenue exceeds 50%, you may submit an attestation to be considered as a Tier 2 provider. Complete OHA’s Provider Medicaid-Focused Attestation form and send a secure email with the completed attestation form and supporting documentation to CareOregon at: BH-Attest@careoregon.org  
• If you have any additional questions, please contact Provider Customer Service 503-416-4100 or 800-224-4840, option 3. Providers can also reach out to our dedicated Provider Relations team.