OAR 410-153-0030: Eligibility for Payment

(1) Certified Community Behavioral Health Clinics (CCBHC) must bill the clinic-specific bundled daily rate when at least one qualifying CCBHC service, as these services are described in Oregon Administrative Rules (OAR) 410-153-0020, is provided by the CCBHC or Designated Collaborating Organization to an Oregon Health Plan member (OHP). (2) Only one bundled daily rate is permitted to be paid per OHP member per calendar day, regardless of the number of services or provider contacts. (3) Services rendered by Designated Collaborating Organizations must be included within the CCBHC’s bundled daily rate and billed by the CCBHC, not separately by the Designated Collaborating Organization. (4) Only services provided at approved CCBHC facilities are eligible the bundled daily rate. (5) Telephone CCBHC daily encounters qualify as a valid CCBHC daily encounter for services provided in accordance with OAR 410-120-1990. (6) Claims must include ICD-10-CM and CPT/HCPC codes as required by OAR 410-120-1280.