Behavioral Health Qualified Directed Payments

Behavioral Health Qualified Directed Payment (QDP/BHDPs) overview

Effective January 1, 2026 the Oregon Health Authority (OHA) has made changes to the qualified directed payments (QDP) framework. This is narrowing the scope of the QDP payments to ensure limited Medicaid resources are prioritized for OHP members with the most complex behavioral health (BH) needs, who require more advanced, coordinated care. CareOregon has adjusted our BH fee schedule to align with OHA’s fee schedule and the updated QDP framework for 2026.

New definitions and rate structures for 2026

• “Tier 2 Provider” will become “Team-Based High Acuity Medicaid Provider” (TBHA Medicaid Provider) 
• Criteria to be a TBHA Medicaid Provider for outpatient (OP) BH and substance use disorder (SUD) services (excludes SUD residential and applied behavior analysis (ABA) services): must meet new standards; has a COA, at least 50% of revenue comes from Medicaid, and offers integrated, team-based care (TBC). 
• “Tier 1 Provider” will become “Non-Team-Based High Acuity Medicaid Provider” (non-TBHA Medicaid Provider) (excludes SUD residential and ABA services) 

Providers who were previously Tier 2 and have a COA, excluding ABA and SUD residential services, will be paid 2025 rates until OHA releases attestation guidance. All other QDPs will remain in effect, including Culturally and Linguistically Specific Services (CLSS) and Integrated Co-occurring Disorders (ICD). We will align with the new definition of team-based care and provide new rates for providers that don’t meet the new criteria.  

Under OHA’s 2026 Qualified Directed Payment Program, only providers that meet the following criteria are eligible for enhanced rates:

• Be a Community Mental Health Program offering one or more of the following: 
  • Assertive Community Treatment (ACT)  
  • Early Assessment and Support Alliance (EASA)  
  • Intensive In-Home Behavioral Health Treatment (IIBHT)  
• Or meet all of the following: 
  • Hold a Certificate of Approval from OHA;  
  • Derive at least 50% of annual behavioral health revenue from services to OHP members (previous year); and  
  • Provide integrated, team-based care that includes the following, as clinically indicated:  
    • Psychiatric Services and/or Addiction Medicine Services  
    • Peer-Delivered Services (CRM, PWS, PSS) 
    • Case Management Services
    • Individual, Group and Family Therapy – community based as needed

For further definitions of provider groups that qualify for enhanced payment, we invite you to visit the OHA provider announcements page on their website. CareOregon will continue to follow these updates closely and communicate as more information is available.

ABA and SUD residential services will be reimbursed at 100% of OHA’s fee schedule.

OP mental health (MH) and OP SUD groups who meet the above criteria to become a Team-Based High Acuity Medicaid Provider and receive QDP payments will not experience a rate change. All other OP MH and OP SUD groups will be paid at 90% of DMAP rates.  

• The OHA fee schedule is available here.  
• For codes not on the DMAP fee schedule, CareOregon maintains fee schedules that can be found for each CCO:  
  • Health Share fee schedule can be found here.  
  • Jackson Care Connect fee schedule can be found here. 
  • Columbia Pacific CCO fee schedule can be found here.  

ABA and SUD residential services will be reimbursed at 100% of OHA’s fee schedule.