MedicaidCoverageMedium impact
Request for Comment - Draft Medicaid State Plan Amendment to Align MH and SUD Services - Comments due Feb. 21, 2020
Oregon Health Plan·OR · Psychiatry, Internal Medicine, Family Medicine +1 more·Public notice
We identified it
Aug 19, 2026
Summary
Oregon Health Authority is proposing a Medicaid State Plan Amendment to expand Substance Use Disorder (SUD) treatment services to align with mental health coverage. This will add new CPT/HCPCS codes to the fee schedule for SUD services including residential treatment, recovery support services, and transitional housing support. Billing teams must monitor for the finalized code list once CMS approves the waiver.
Action Required
By February 21, 2020: Oregon-based billing teams should review this public notice to understand upcoming changes to SUD coverage. After CMS approval of the 1115 Waiver and State Plan Amendment: (1) Monitor oregon.gov/OHA/HSD for follow-up notices announcing specific CPT/HCPCS codes that will be added to the Oregon Medicaid fee schedule for SUD services; (2) Billing team must update billing software and fee schedules once specific codes are published; (3) Providers must update claim submission workflows to use new SUD codes for residential treatment (>16 beds), recovery support services, and transitional housing services; (4) Train billing and clinical staff on new service components and proper code application. The policy explicitly states 'Additional notices will be posted for providers once those have been determined.' No immediate billing changes are required until specific codes are published.