MedicaidReimbursementHigh impact
Per member, per day reimbursement changes effective Jan. 1, 2023
Oregon Health Plan·OR · Psychiatry·Provider
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Effective January 1, 2023, Oregon's Medicaid program now processes only one Prospective Payment System (PPS) payment per member per day for Certified Community Behavioral Health Clinics (CCBHCs), regardless of how many different services (substance use, mental health, or primary care) are provided on the same day. CCBHCs must revise their cost reporting to count multiple service types per member per day as a single encounter rather than multiple encounters.
Action Required
By July 14, 2023: CCBHCs must review all encounters reported in Demonstration Year 4 cost reports to ensure accuracy and reflect only one encounter per service user per day instead of multiple encounters for multiple services. Submit any necessary corrections to Katie Rosenthal at Katie.M.Rosenthal@oha.oregon.gov. Continue reporting all services provided but adjust internal counting methodology for cost reporting purposes.