Traditional MedicareAdministrativeHigh impact
Medicare is the primary payer for some outpatient behavioral health services for Medicare-Medicaid members, effective January 1, 2024
Oregon Health Plan·OR · Psychiatry·Plan contract
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Effective January 1, 2024, Medicare became the primary payer for behavioral health services provided by Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs), as well as Intensive Outpatient Programs (IOP). Medicare-Medicaid dual eligible members must now have Medicare billed first, with Medicaid covering cost-sharing as secondary payer.
Action Required
Immediately: Billing team must verify all MFTs, Licensed Marriage and Family Therapists, Licensed Professional Counselors, and IOP providers are enrolled in Medicare (may take up to 60 days). Update billing system to bill Medicare as primary for dual eligible members with BMM or BMD benefit packages, verifiable in MMIS Provider Portal. For Medicare Advantage members, contact plans for authorization requirements before services. Claims will automatically crossover to CCOs/OHA for cost-sharing coverage.