Medicaid Behavioral Health Qualified Directed Payments

The four categories for the increased payments are summarized below:

1. Tiered Uniform Rate Increase: This is two tiers of payments for all contracted Behavioral Health providers.

   • Providers eligible are outpatient mental health and substance use.

     Greater of 110% of 2025 DMAP or reasonable inflation factor over 2024 rates increase for Medicaid Dominant (at least 50% of revenue)

   • NO increase for Medicaid non dominant (less than 50% of revenue)

2. Co-Occurring Disorders: Payments to providers certified by OHA for integrated treatment of co-occurring disorders.  All co-occurring providers are eligible.  All providers must be recertified via the state website application process. Specific codes and modifiers required. See guidance for correct billing codes.

   • 115% of DMAP for SUD Residential services, 120% of DMAP for mental health non-inpatient services and 110% of DMAP for SUD services 

3. Culturally & Linguistically Specific Services: Payment increase for providers of culturally and/or linguistically specific services. Eligible providers are outpatient mental health, substance use and now including traditional healthcare workers.  All providers must be certified via the state website application process. Specific modifiers apply.

   • 22% for Non-Rural

   • 27% for Rural

4. Minimum Fee Schedule: Maintain fee-schedule rates for SUD Residential, ABA and Mental Health Children’s Wraparound services

 

This is an additive payment structure, meaning providers can be eligible for more than one payment category.

 

Provider attestations are currently available. Please find it in the resources section on this page below.

 

To learn more about becoming eligible to provide ICD treatment, visit OHA's Integrated Co-occurring Disorders page.

 

If you have questions related to EOCCO’s implementation of the Behavioral Health Integration PCPCH payments, please feel free to reach out to Summer Prantl (summer.prantl@modahealth.com)