OAR 410-153-0050: Scope of Service Changes

(1) A Certified Community Behavioral Health Clinic (CCBHC) may submit a written request to the Oregon Health Authority (Authority) for an adjustment to its bundled daily rate if there is a documented scope of service change that results in at least a five (5) percent change in cost per encounter. (2) A CCBHC scope change request must include for each change for which the CCBHC is requesting an adjustment: (a) A detailed description of the change in services, staffing, or operations; (b) Supporting financial data showing the projected cost impact of each change; (c) Documentation of the implementation date of the change. (3) If approved by the Authority, the rate adjustment is effective on the first day of the calendar quarter following the date of the Authority’s approval. (4) A CCBHC may request a scope of service adjustment no more than once per calendar year, unless the Authority determines that multiple unrelated changes have occurred. (5) The Authority will begin its review of a CCBHC scope change request when all data and information required by section (2) above has been received by the Authority. The Authority may also request additional data or information from the CCBHC in the course of its review, as the Authority deems necessary. All such requests will be provided in writing to the CCBHC. (6) CCBHC scope changes may include but are not limited to: (a) Changes in the type, intensity, or duration of covered services required under the CCBHC; (b) Expansion or reduction of operational hours for services; (c) Changes in staffing models that affect service delivery capacity; (d) Changes in cost resulting from state or federal regulatory or statutory requirements. (7) CCBHC changes that do not generally qualify as a scope of service change include: (a) Routine fluctuations in encounter volume; (b) Changes in payer mix without associated scope changes; (c) Changes solely in administrative structure without service delivery impact.