Reference

Behavioral Health Glossary

Definitions of essential regulatory and operational terms for behavioral health and substance use disorder treatment programs in Oregon.

42 CFR Part 2

The federal regulation governing the confidentiality of substance use disorder patient records. Stricter than HIPAA in several important ways: it requires specific patient consent for redisclosure of SUD records to most parties. Any organization providing SUD treatment must manage 42 CFR Part 2 consent separately from standard HIPAA authorizations. Your EHR must support Part 2 consent management.

ASAM Criteria

The American Society of Addiction Medicine Patient Placement Criteria — the most widely used clinical framework for determining the appropriate level of care for substance use disorder treatment. ASAM evaluates patients across six dimensions: acute intoxication and withdrawal potential, biomedical conditions, emotional/behavioral/cognitive conditions, readiness to change, relapse potential, and recovery environment. Oregon payers and OHA use ASAM criteria to evaluate medical necessity for SUD treatment.

ASAM 1.0 (Outpatient)

The least intensive ASAM level of care — fewer than 9 clinical service hours per week. Appropriate for clients who can maintain stability with weekly or bi-weekly contact and whose clinical severity does not warrant more intensive programming. Oregon OHA licenses outpatient SUD programs under OAR 309-018.

ASAM 2.1 (Intensive Outpatient / IOP)

Intensive Outpatient requires a minimum of 9 structured clinical service hours per week across at least 3 days. Programming is predominantly group-based. IOP serves clients who need more support than standard outpatient but whose severity does not require residential or near-daily PHP-level contact. Licensed under OAR 309-018 in Oregon.

ASAM 2.5 (Partial Hospitalization / PHP)

Partial Hospitalization requires a minimum of 20 structured clinical service hours per week, typically delivered 5 days per week. PHP serves clients who need near-daily clinical contact but not 24-hour residential structure. Access to medical and psychiatric services is required. Prior authorization is required from most payers.

ASAM 3.1 / 3.5 / 3.7 (Residential)

The residential ASAM levels, each representing increasing intensity of clinical and medical support: 3.1 is clinically managed low-intensity residential (24-hour structure, overnight stays), 3.5 is clinically managed high-intensity residential (24-hour clinical support), and 3.7 is medically monitored intensive inpatient (24-hour nursing and medical oversight). All residential levels are licensed under OAR 309-019 in Oregon.

CAQH ProView

An online platform for healthcare providers to centralize and manage their credentialing information. Most Oregon CCOs and commercial payers require a current CAQH ProView profile as part of the credentialing process. Providers must keep their CAQH profile updated and re-attest quarterly.

CARF

Commission on Accreditation of Rehabilitation Facilities — an international accreditation organization with a strong presence in behavioral health and addiction treatment. CARF accreditation involves an announced survey conducted by CARF surveyors against CARF standards. CARF offers specific program-level certifications including ASAM Level of Care Certification.

CCO (Coordinated Care Organization)

Coordinated Care Organizations are regional managed care organizations that contract with the Oregon Health Authority to administer Oregon Health Plan benefits — including behavioral health — for OHP-enrolled members in specific geographic areas. Behavioral health providers must credential with each CCO individually. As of 2025, CCOs serve the majority of OHP members statewide.

Certificate of Approval (COA)

The OHA license issued to organizations providing substance use disorder treatment services in Oregon. Issued by the OHA Office of Licensing and Regulatory Oversight following application review and on-site survey. The COA specifies the licensed program type, level of care, and capacity. Required before serving OHP members or credentialing with CCOs for SUD services.

Clean Claim

A claim submitted to a payer that contains all required information, uses correct codes and modifiers, and requires no additional information before adjudication. Clean claim rate — the percentage of submitted claims accepted without rejection on first submission — is a key revenue cycle performance metric. A high clean claim rate reduces denial management costs and accelerates payment.

COA (Certificate of Approval)

See Certificate of Approval. The foundational OHA license for SUD treatment programs in Oregon.

Concurrent Review

The payer process for evaluating whether authorized services should continue — typically required at regular intervals (every 5 to 14 days depending on payer and level of care) for authorized residential, PHP, and sometimes IOP services. Documentation submitted for concurrent review must demonstrate ongoing medical necessity against ASAM criteria or the applicable payer standard.

DMAP (Division of Medical Assistance Programs)

The Oregon division that administers the fee-for-service Oregon Health Plan for OHP members not enrolled in a CCO, and publishes the OHP fee schedule for covered services. Providers billing fee-for-service OHP must comply with DMAP billing rules and submit through the Oregon Medicaid portal or an approved clearinghouse.

HIPAA

The Health Insurance Portability and Accountability Act — federal law governing the privacy and security of protected health information (PHI). All behavioral health providers must comply with HIPAA Privacy Rule and Security Rule requirements. For SUD treatment providers, 42 CFR Part 2 imposes additional, stricter confidentiality requirements on SUD treatment records.

IOP (Intensive Outpatient Program)

See ASAM 2.1. A level of care providing 9 or more structured clinical service hours per week across at least 3 days. Typically group-therapy-focused. Requires separate OHA COA certification in Oregon.

Joint Commission

The Joint Commission (formerly JCAHO) — a national accreditation organization that evaluates behavioral health organizations against its Behavioral Health Care and Human Services (BHC) manual. Joint Commission surveys are unannounced after initial accreditation. Strong recognition among hospital systems and many commercial payers. Three-year accreditation cycle.

MAT (Medication-Assisted Treatment)

The use of FDA-approved medications — buprenorphine, methadone, naltrexone — in combination with counseling and behavioral therapies to treat substance use disorders. Also referred to as MOUD (Medications for Opioid Use Disorder) when specifically addressing opioid use disorder. The clinical evidence base strongly supports MAT as an effective, life-saving treatment approach.

MOUD (Medications for Opioid Use Disorder)

Medications used to treat opioid use disorder — primarily buprenorphine (Suboxone, Subutex), methadone (through OTP-licensed programs), and naltrexone (Vivitrol). MOUD is the preferred term in many clinical and regulatory contexts. Oregon Health Plan covers MOUD for eligible members. Programs serving opioid use disorder clients should have a clear MOUD policy.

NARR (National Alliance for Recovery Residences)

The national organization that sets quality standards for recovery housing and provides accreditation for recovery residences. NARR defines four levels of recovery housing (1–4) based on structure and services. NARR accreditation is increasingly required for programs to receive referrals from licensed treatment providers and OHP CCOs in Oregon.

OAR (Oregon Administrative Rules)

The administrative rules that govern regulated activities in Oregon. Behavioral health programs operate under OAR Chapter 309 (mental health and SUD), OAR 309-016 (definitions), OAR 309-018 (outpatient programs), OAR 309-019 (residential programs), and OAR 415-012 (opioid treatment programs), among others. OAR requirements are the specific compliance standards OHA surveys against.

OHA (Oregon Health Authority)

The Oregon state agency responsible for overseeing behavioral health licensing and regulation, administering Oregon Medicaid (OHP), and setting behavioral health policy. OHA's Behavioral Health Division administers the Certificate of Approval program for SUD treatment programs and conducts licensing surveys under OAR Chapter 309.

OHP (Oregon Health Plan)

Oregon's Medicaid program, administered by the Oregon Health Authority. OHP covers behavioral health services including SUD treatment, mental health, and co-occurring treatment for eligible Oregon residents. The majority of OHP members are enrolled in Coordinated Care Organizations (CCOs). OHP fee schedule rates are published by DMAP.

OTP (Opioid Treatment Program)

A federally licensed program authorized to dispense methadone for opioid use disorder treatment. OTPs must obtain SAMHSA certification in addition to OHA licensure under OAR 415-012. OTPs are the only settings where methadone may be legally dispensed for OUD treatment on a take-home basis.

PHP (Partial Hospitalization Program)

See ASAM 2.5. A level of care providing 20 or more structured clinical service hours per week, typically 5 days per week. Requires access to medical and psychiatric services. Prior authorization is required from most payers. Often used as a step-down from residential treatment.

Prior Authorization

A payer requirement to obtain approval before delivering certain services in order for those services to be covered. Required by most payers for residential, PHP, and detox behavioral health services. Managing prior authorizations requires a real-time tracking system, concurrent review documentation workflow, and defined accountability. Expired or missing authorizations are a primary cause of behavioral health revenue loss.

QAPI (Quality Assurance and Performance Improvement)

A required operational component for OHA-licensed behavioral health programs and a core accreditation standard for both Joint Commission and CARF. A QAPI program involves systematically measuring quality indicators, identifying improvement opportunities, implementing changes, and evaluating results — documented in a continuous cycle. QAPI is not a report written annually; it is an ongoing operational process.

SUD (Substance Use Disorder)

The clinical term for a condition in which the use of a substance — alcohol, opioids, stimulants, or other drugs — causes significant impairment or distress. SUD treatment is regulated separately from general mental health services in Oregon, requiring specific OHA licensure under OAR Chapter 309 and 42 CFR Part 2 compliance.

UR (Utilization Review)

The payer process for evaluating whether medical services are medically necessary, appropriate, and efficiently delivered. In behavioral health, UR includes pre-authorization review (before services begin), concurrent review (during ongoing services), and retrospective review (after services are delivered). Documentation aligned to ASAM criteria is the most effective tool for successful UR outcomes.

VOB (Verification of Benefits)

The process of confirming a patient's insurance coverage and benefit details before services begin. A thorough VOB confirms: active eligibility on the date of service, in-network or out-of-network status, applicable behavioral health benefit levels, prior authorization requirements, patient financial responsibility (deductible, out-of-pocket, copay), and the payer's timely filing window. VOB errors at intake create downstream claim denials across the entire episode of care.

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