1. (1) Certified Community Behavioral Health Clinics (CCBHCs) must bill the applicable CCO for services provided to members enrolled in a CCO. CCOs are not required to pay CCBHCs at their bundled daily rate.
2. (2) CCBHCs may receive supplemental Medicaid wraparound payments to ensure that total reimbursement for CCBHC daily encounters for CCO-enrolled members and dual-eligible members meets the bundled daily rate.
3. (3) Oregon Health Authority (Authority) calculates the supplemental payments on a quarterly basis using the “CCBHC Wraparound Data Template” and “CCBHC Wraparound Guide” found on the CCBHC website. Calculations are based on:
   (a) Costs incurred during the settlement period;
   (b) Amounts received during the settlement period;
   (c) Costs less amounts received.

4. (4) CCBHC must submit wraparound reports within 12 months of close of quarter being reported. Exceptions to the 12-month requirement that are permitted to be submitted to the Authority are as follows:

   1. (a) When Oregon Department of Human Services (ODHS), the Authority, or the member’s branch office makes an error that causes the provider not to be able to bill within 12 months of the date of service, the report is permitted to be filed up to six (6) months after the error is discovered. The Authority must confirm the error.
   2. (b) When a court or an Administrative Law Judge orders the Authority to make payment.
5. (5) The Authority must issue supplemental payments within 90 days of receipt of complete and accurate quarterly reports.
6. (6) CCBHCs must retain supporting documentation for all CCO encounters and payments for a minimum of 10 years for audit purposes.

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