1. (1) Certified Community Behavioral Health Clinics (CCBHC) are subject to audits and other reviews by the Oregon Health Authority (Authority) under Oregon Administrative Rules (OAR) chapter 410, division 120.
2. (2) The CCBHC must submit true, accurate, and complete claims. The Authority treats the submission of a claim or encounter, whether on paper or electronically, as certification by the CCBHC.

3. (3) The CCBHC must maintain complete and accurate service and financial records supporting:

   1. (a) All encounters billed to Medicaid and Medicare;
   2. (b) Cost reports submitted to the Authority;
   3. (c) Supplemental Coordinated Care Organization (CCO) wraparound payment reports;
   4. (d) All services provided and payments received.
4. (4) The Authority may at any time conduct audits, desk reviews, or on-site inspections of the CCBHC and any Designated Collaborating Organization, to verify CCBHC compliance with these rules, OAR chapter 410, division 120, and OAR chapter 410, division 141.
   (5) CCBHCs must cooperate fully with audits and investigations conducted by the Authority, Centers for Medicare and Medicaid Services, Medicaid Fraud Control Unit, or other authorized federal and state agencies as required under OAR 410-120-1395, OAR 410-120-1396, and OAR 410-120-1510.
   (6) If a CCBHC determines that a submitted claim, cost report, or wrap payment received from the Authority or a CCO is an overpayment, the CCBHC must refund the amount of the overpayment to the Authority or the CCO, as required under OAR 410-120-1280 or the CCBHC’s contract with the CCO.

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