1. (1) A Certified Community Behavioral Health Clinic (CCBHC) submitting a claim or other request for payment to Oregon Health Authority (Authority) or a Coordinated Care Organization (CCO) must meet the requirements in Oregon Administrative Rules (OAR) 410-153-0010, OAR 410-120-1280 and OAR 410-120-1300.
2. (2) Only one CCBHC daily encounter is permitted to be paid per Oregon Health Plan member per calendar day, regardless of the number of services rendered.
3. (3) Covered services provided by a CCBHC or Designated Collaborating Organization via telehealth may qualify as encounters if the services meet federal and state telehealth standards and are documented appropriately. Services within the scope of CCBHC delivered via telehealth must be billed at the daily encounter rate and are not eligible to be billed separately.
4. (4) Ancillary services (for example, laboratory tests, basic imaging) provided in connection with a same-day CCBHC service are included in the CCBHC daily encounter and not separately billable.
5. (5) CCBHCs must list all applicable billing modifiers on the claim.
6. (6) Before billing the Authority or a CCO, a CCBHC must make reasonable efforts to obtain payment first from other resources as required under OAR 410-120-0080.

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