1. Billing Strategies for ACT
Michael Oyster, LPC, CADC III
Choice Model Lead
ACT and Supported Employment Coordinator
June 11, 2019
Health Systems Division
Operations & Policy

2. Michael Oyster, LPC, CADC III
Licensed Professional Counselor (LPC)
Certified Alcohol & Drug Counselor (CADC III)
Over 20 years in community mental health and substance abuse treatment services, crisis services and program development
An explorer of billing services so that programs have the funding for sustainability

3. Learning Objectives Review eligible referrals to ACT
Identify strategies and processes to bill for ACT services based on knowledge of the funding system
Learn guidelines when billing for ACT services for a variety of insurances and other funding sources
Contribute to the discussion about challenges you face as well as develop solutions to meet those challenges

4. ACT Eligibility ACT Admission Criteria: OAR 309-019-0245 SPMI
Not a primary diagnosis of
Substance use
Intellectual developmental disability
Borderline Personality Disorder
PTSD
Autism Spectrum
Long term disability
Significant functional impairments
Practical daily living tasks (personal business, medical / legal, housing, self care, nutrition, hygiene)
Employment or homemaker role
Safe living situation

5. Exhibit M from CCO Contract 2019
In relation to ACT, CCOs must ensure:
Those with SPMI are assessed for ACT eligibility
ACT services are provided for those with SPMI
Additional ACT capacity is created to serve SPMI
When 10 or more members are on a waitlist for more than 30 days by
Increasing existing ACT team capacity
Adding additional ACT teams
Consult with OHA to develop a plan to develop additional qualified providers
Denials of ACT services are based on established criteria, recorded and compiled to accurately report denials
Provide a Notice of Adverse Benefit Determination (NOA) for all denials of ACT services

6. Strategies and Processes
ACT
Physical Health
Behavioral Health
Informal Services
The ACT billing code is a bundled code that is used by Medicaid
Other insurances do not reimburse for the ACT code

7. OSH and Medicaid
Historically, Medicaid has been suspended when clients are in Oregon State Hospital
A bill has been passed that allows participants to keep their Medicaid throughout the hospital stay
The details of how this will work is still being developed
Until the details are worked out, use other funding resources to support in-reach and coordination with OSH
Choice Model funding
County Funding through Service Elements

8. Guidelines When Billing ACT
When delivering ACT services for other insurances, unbundle the code
Informal Services
Behavioral Health
Physical Health

9. The Services of ACT Psychiatry Nursing Mental Health Therapy
Substance Use Therapy
Case Management
Supported Employment
Supported Education
Peer Delivered Services

10. Discussion problem Solving

11. Contact
Michael Oyster LPC, CADC III Choice Model Lead ACT and Supported Employment Coordinator Office: (503)
Health Systems Divisions
Operations & Policy