1. (1) Oregon Health Authority (Authority) performs reconciliation following the establishment of a new bundled daily rate by comparing payments made under previous bundled daily rate to newly established bundled daily rate.
2. (2) If the payments made to a Certified Community Behavioral Health Clinic (CCBHC) provider exceed the newly established bundled daily rate, the Authority must recoup the overpayment for period following the close of the cost reporting period and establishment of new rate.
3. (3) If the payments made to a CCBHC provider are less than newly established bundled daily rate, the Authority may issue a settlement payment to the CCBHC for the period following the close of the cost reporting period and establishment of a new bundled daily rate.
4. (4) All settlements are subject to audit and final determination by the Authority. The CCBHC may appeal the Authority’s determination, as outlined in Oregon Administrative Rules 410-153-0090.
5. (5) Settlements are completed by the Authority within 18 months of the close of the cost report year, unless delayed by circumstances beyond the Authority’s control.
   (6) Payment or settlement by the Authority does not restrict or limit the Authority or any state or federal oversight entity’s right to review or audit a claim before or after the payment. Claim payment may be denied or subject to recovery if medical review, audit, or other post-payment review determines the service was not provided in accordance with applicable rules or does not meet the criteria for quality of care or medical appropriateness of the care or payment.

Statutory/Other Authority

​ORS 413.042 & 414.065

Statutes/Other Implemented

​ORS 414.065

History

DMAP 73-2025, adopt filed 09/26/2025, effective 10/01/2025