CareOregon/Columbia Pacific CCO says new policy will shift Medicaid outpatient behavioral‑health billing to contracted providers; about 500 members affected

CareOregon and Columbia Pacific CCO representatives told Clatsop County commissioners that two policy changes—one already effective and one due Oct. 1—will limit routine outpatient Medicaid reimbursement to contracted providers and to organizations that hold required approvals.

"Effective August 1, the following provider types ... are no longer eligible for reimbursement for routine outpatient mental health and substance use disorder services when billing as an individual provider or under a non contracted or non certificate of approval group," Rachel, a presenter for CareOregon/Columbia Pacific CCO, said during the county meeting.

CCO staff said the changes were intended to align reimbursement rules with industry norms, enable credentialing and oversight, and concentrate resources on providers able to deliver a full continuum of services, including crisis care. Rachel said the policy "impacts about 19 percent of our outpatient behavioral health providers, but only 6 percent of our outpatient utilization," and that the change was…