What types of policy changes does Oregon Health Plan issue?

Oregon Health Plan regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Oregon Health Plan update its policies?

Oregon Health Plan typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Oregon Health Plan policy changes are tracked here?

This page currently tracks 50 documented Oregon Health Plan policy changes. New items are added as they are identified.

What should I do when Oregon Health Plan changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

PAYER POLICY CHANGES

Oregon Health Plan Policy Changes & Prior Auth Updates

We track 50 documented policy changes from Oregon Health Plan across OR. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Oregon Health Plan notice. Use the related links below to narrow results by specialty or state, or create a free alert to get new Oregon Health Plan updates by email (daily or weekly, your choice, on every plan).

Oregon Health Plan · Effective Jan 1, 2027High impact
Breast and Cervical Cancer Treatment Program Updates Related to Federal Changes
Oregon Health Plan (OHP) is implementing three changes to the Breast and Cervical Cancer Treatment Program (BCCTP) due to federal requirements: (1) noncitizen immigration status eligibility changes effective October 1, 2026 (already in effect); (2) transition of Healthier Oregon members to OHP Open Card starting January 1, 2027, requiring providers to bill OHA directly instead of CCOs; and (3) retroactive coverage reduction from three months to two months for newly eligible BCCTP members effective January 1, 2027.
Oregon Health Plan · Effective Jan 1, 2027High impact
Oregon Health Authority (OHA) expectations for Health-Related Social Needs (HRSN) service transitions for Healthier Oregon members
Effective January 1, 2027, approximately 102,000 Healthier Oregon members will transition from Coordinated Care Organizations (CCOs) to OHP Open Card (managed by Acentra). CCOs must process HRSN (Health-Related Social Needs) service requests on specific timelines through December 31, 2026, then transfer authorization responsibilities to Acentra. This is NOT a service termination—HRSN services will continue uninterrupted under the new plan.
Oregon Health Plan · Effective Jan 1, 2027High impact
Changes to teledentistry codes D9995 and D9996 effective Jan. 1, 2027
Effective Jan. 1, 2027, Oregon Health Authority will discontinue additional compensation for teledentistry add-on codes D9995 and D9996. These codes will pay $0 for fee-for-service claims (except as encounters for safety net clinics), though reimbursement for the actual clinical services delivered during telehealth encounters will continue. Providers must continue billing these codes with appropriate Place of Service codes for documentation purposes, but should not expect separate telehealth fees.
Oregon Health Plan · Effective Jan 1, 2027High impact
Anticipated Impacts of H.R.1 and other federal changes on Oregon’s CCOs
Under H.R.1 and a September 2025 CMS policy update, Healthier Oregon members who are enrolled with coordinated care organizations (CCOs) must move to OHP Open Card, a fee-for-service model, by January 1, 2027, affecting over 100,000 members. H.R.1 also restricts which lawfully residing non-citizens can receive federally funded Medicaid, CHIP and Marketplace subsidies, and it expands state authority to impose Medicaid copayments beginning October 2028. These changes will affect CCO operations, member outreach, billing and encounter reporting, and contractual obligations.
Oregon Health Plan · Effective Jan 1, 2027High impact
Notice of Intent – OHA will submit Oregon’s Medicaid Phase-out Plan for the Waiver Authority Related to the Prioritized List
Oregon will phase out its 1115 waiver authority for the Prioritized List by January 1, 2027. Covered services will then be defined by categories of services in the state plan, with the Prioritized List guiding medical necessity policy, so coverage decisions will be based on medical necessity rather than on whether a treatment-condition pair sits above or below the funding line. OHA estimates a 0.7% increase in 2027 CCO capitation rates to reflect coverage of some services previously not covered.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Healthier Oregon Transition Data Guidance for Prior Authorizations
Oregon's Office of Health Policy (OHA) directed coordinated care organizations (CCOs) to submit prior authorization data for Healthier Oregon members transitioning to the Oregon Health Plan Open Card program, covering approved prior authorizations for prescription, medical, behavioral and oral health services to be rendered on or after Jan. 1, 2027, plus program exception approvals. Practices in Oregon that serve these members should expect prior authorizations to be entered into fee-for-service claims processing on the dates listed, so billing staff should confirm which active authorizations carry 2027 effective dates and that claims reference them correctly.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Health Related Social Needs (HRSN) Data Submission Guidance for Healthier Oregon Transition of Care
Oregon's Medicaid Division requires Coordinated Care Organizations (CCOs) to submit Health Related Social Needs (HRSN) data for members transitioning from CCO enrollment to the Open Card fee-for-service program effective January 1, 2027. CCOs must submit member roster files and supporting documentation on four staggered dates between November 2, 2026, and January 6, 2027, using specific file naming conventions via the Actuarial Managed File Transfer (MFT) server.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Notice of intent: OHA will amend the Medicaid State Plan to comply with several provisions of the Working Families Tax Cut Legislation
Oregon Health Authority will submit State Plan Amendments to comply with Working Families Tax Cut (WFTC) changes to Medicaid and CHIP effective January 1, 2027. The changes add community engagement (work) requirements as a condition of eligibility for the ACA adult expansion population, require eligibility redeterminations every 6 months for ACA adults, shorten the retroactive eligibility period for applications made on or after January 1, 2027, and require a process to regularly obtain address information from a reliable data source. The amendments will not change any coverage or benefits or how Oregon Health Plan provides EPSDT services, and written comments are due by 5 p.m. November 13, 2026.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Non-Emergency Medical Transportation Data Guidance for the Healthier Oregon Transition
Oregon Health Authority (OHA) requires Coordinated Care Organizations (CCOs) to submit Non-Emergency Medical Transportation (NEMT) data for Healthier Oregon members transitioning to the Open Card program effective January 1, 2027. CCOs must provide member access accommodation notes (language needs, directions, mobility accommodations, etc.) to OHA by October 9, 2026, with ongoing submissions for new NEMT users through January 29, 2027. This data transfer ensures Open Card NEMT brokerages can process service requests starting October 1, 2026.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Notice of intent: OHA will amend the Medicaid State Plan to renew the 1915(i) state plan option - Comments due May 29, 2026
Oregon Health Authority will submit a State Plan Amendment to renew the 1915(i) Home and Community-Based Services state plan option, effective January 1, 2027. The 1915(i) HCBS state plan option must be renewed and approved every 5 years. The renewal has no significant changes to program eligibility, Community-Based Integrated Supports, Psychosocial Rehabilitation, In-Home Personal Care, Residential Habilitation, or reimbursement methodologies. Public comments were due by 5 p.m. Friday, May 29, 2026, and the estimated Total Fund 2027 cost is $146,609,320.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Notice of intent: OHA will add clinical coverage criteria to the Medicaid State Plan.
Oregon Health Authority will submit a State Plan Amendment to add clinical coverage criteria to the Medicaid State Plan, effective January 1, 2027. The change supports Oregon's transition away from the 1115 waiver authority for the Prioritized List of Health Services. The Health Evidence Review Commission will continue to define medically necessary services and clinical coverage criteria, and OHA will have a process to assess medical necessity when requested services do not meet clinical coverage criteria. Public comments were due by 5 p.m. Friday, June 26, 2026.
Oregon Health Plan · Effective Jul 1, 2027Medium impact
Reconciling of The ASAM Criteria, Third Edition and The ASAM Criteria, Fourth Edition – Updated Timeline
Oregon Health Authority has extended the deadline for substance use disorder treatment providers to comply with The ASAM Criteria, Fourth Edition from the original date to July 1, 2027. Providers can continue using Third Edition criteria until then, and licensing renewals before July 2027 will maintain previously approved ASAM levels of care.
Oregon Health Plan · Effective Jul 1, 2027Medium impact
Rulemaking for Board-Registered Behavioral Health Associates
Oregon is implementing a rule requiring board-registered behavioral health associates to work for a Certificate of Approval (COA) holding agency to bill Medicaid services. The requirement was delayed from July 1, 2026 to July 1, 2027 due to high volume of COA applications.
Oregon Health Plan · Effective Jan 1, 2027Low impact
Guidance for Developing Local HR1 Resource Lists
Oregon's Medicaid Division (OHA) is directing Coordinated Care Organizations (CCOs) to develop and share local resource lists to help members comply with new federal HR1 work or activity requirements effective January 1, 2027. This is an administrative guidance memo for CCO operations, not a direct billing policy change. Medical billing teams should be aware that members may need documentation support for work, education, or volunteering activities to maintain OHP coverage.
Oregon Health Plan · Effective Jan 31, 2027Low impact
New due date for pre-release Reentry services readiness plan
Oregon Health Authority (OHA) has extended the due date for Coordinated Care Organizations (CCOs) to submit their pre-release Reentry health care services readiness plan from January 1, 2027 to January 31, 2027. This is a plan contract deliverable extension based on anticipated low demand for pre-release services. OHA will provide the readiness plan template by November 2, 2026.
Oregon Health Plan · Effective Nov 1, 2026High impact
Single standard prior authorization request process to begin Nov. 1, 2026
Effective November 1, 2026, Oregon Health Authority (OHA) will consolidate Behavior Rehabilitation Services (BRS) prior authorization into a single standard process, eliminating preliminary, retroactive, and reauthorization PA types. The review timeline is shortened from 10 business days to 7 calendar days, with an optional 14-day pend period for additional information requests. Providers must submit only standard PA requests after October 31, 2026, or risk claim denials.
Oregon Health Plan · Effective Oct 27, 2026High impact
1915(i) Community Based Integrated Supports (CBIS) Authorization Process
Effective October 27, 2026, Oregon Health Authority is transitioning 1915(i) Community Based Integrated Supports (CBIS) billed under H0046 from Prior Authorization (PA) to Plan of Care (POC) authorization in MMIS. All existing PAs will end October 26, 2026, with remaining approved services automatically transferred to POC format starting October 27, 2026. New referrals will be entered directly as POC after IQA approval through the PCSP.
Oregon Health Plan · Effective Oct 1, 2026High impact
Fee-for-Service Hospice Rates Effective Oct. 1, 2026
Oregon Medicaid updated hospice fee-for-service rates effective October 1, 2026, introducing a critical billing distinction: revenue code 651 applies to routine home care (RHC) days 1-60, while new revenue code 650 applies to RHC days 61 and beyond. Providers must track hospice election days carefully for readmissions and ensure compliance with federal quality reporting requirements to receive full Medicaid rates; non-compliant providers will receive lower reimbursement.
Oregon Health Plan · Effective Oct 1, 2026High impact
Rulemaking for Board-Registered Behavioral Health Associates
Starting October 1, 2026, board-registered behavioral health associates in Oregon must work for organizations with a Certificate of Approval (COA) from OHA to bill Medicaid. Associates working independently will no longer be able to bill Medicaid directly unless they work in HRSA clinics or school settings.
Oregon Health Plan · Effective Aug 1, 2026High impact
Reimbursement for nitrous oxide during in-office medical procedures effective Aug. 1, 2026
Effective August 1, 2026, Oregon Health Plan (OHP) now covers nitrous oxide for use during in-office medical procedures. Providers must bill using CPT code 01999 with modifier QS at a reimbursement rate of $44.08. CCOs must update claims processing systems to recognize and reimburse for this service.
Oregon Health Plan · Effective Jul 31, 2026High impact
Change to interRAI Community Mental Health (CMH) assessment tool effective July 31, 2026
Oregon Health Authority is replacing the Level of Service Inventory (LSI) assessment tool with the interRAI Community Mental Health (CMH) instrument for determining 1915(i) HCBS program eligibility effective July 31, 2026. This change affects service eligibility determination and residential rate calculations. The LSI will continue for Young Adults in Transition (YAT) Homes serving individuals under 21.
Oregon Health Plan · Effective Jul 1, 2026High impact
Fee-for-service nursing facility rates effective July 1, 2026
Oregon Health Authority updated fee-for-service hospice payment rates effective July 1, 2026, including new nursing facility room and board bundled rates and revised revenue codes for routine home care billing. Revenue code 650 (Days 61+) replaces previous coding for extended hospice stays, and providers must include the nursing facility's Oregon Medicaid provider number on all claims. Rates vary by geographic Cost-Based Statistical Area (CBSA).
Oregon Health Plan · Effective Jun 30, 2026High impact
Board-Registered Behavioral Health Associates and Mental Health Interns
Oregon Health Plan (Medicaid) will require Board Registered Behavioral Health Associates and Mental Health Interns to work for organizations with Certificate of Approval (COA) to continue billing OHP after June 2026. Current providers can continue direct billing until June 2026, after which they must become fully licensed or work for COA-certified organizations.
Oregon Health Plan · Effective Jun 1, 2026High impact
New process for non-response to licensing information requests, effective June 1, 2026
Oregon Medicaid will auto-terminate mental health and substance use disorder providers who fail to respond to licensing information requests. SUD providers face termination starting June 1, 2026, and MH providers starting July 1, 2026.
Oregon Health Plan · Effective Apr 21, 2026High impact
Billing guidance for obstetric services provided by FQHCs and RHCs
Oregon Health Authority requires FQHCs and RHCs to bill specific obstetric visit codes (0500F, 0502F, 0503F) individually within global obstetric bundles starting April 21, 2026, to enable accurate encounter data matching and supplemental wraparound payment processing. CCOs must pay these codes at $0.00 and report them to OHA. Additionally, retroactive billing for dates of service October 1, 2024 through April 20, 2026 is permitted to resolve past payment discrepancies.
Oregon Health Plan · Effective Jan 1, 2026High impact
2026 handicapping malocclusion risk corridor and fee-for-service rates
Oregon Health Plan (OHP) establishes 2026 fee-for-service (FFS) rates and risk corridor limits for handicapping malocclusion (HM) comprehensive orthodontic treatment effective January 1, 2026. CCO providers must use four specific billing codes, obtain prior authorization per HM Benefit Guidance, and limit priced encounters to 120% of stated FFS rates. Claims must follow OHA's FFS reimbursement model and HLD Index California Modification Scoring Form criteria.
Oregon Health Plan · Effective Jan 1, 2026High impact
High-Cost Drug Carve-Out policy effective Jan. 1, 2026
Oregon Health Authority will now reimburse certain high-cost drugs on a fee-for-service basis for all Oregon Health Plan members, including CCO enrollees. All drugs in this carve-out require prior authorization from OHA, and inpatient-administered drugs must be billed as outpatient hospital claims with acquisition cost invoices.
Oregon Health Plan · Effective Jan 1, 2026High impact
Addressing discrepancies in the supplemental OHP dental codes list
Oregon Health Authority removed the December 31, 2025 supplemental OHP dental codes list due to technical inconsistencies with Oregon Administrative Rules (OARs) effective January 1, 2026. Providers must rely solely on Division 123 OARs for dental benefit coverage and billing guidance until a corrected reference document is posted in the coming weeks.
Oregon Health Plan · Effective Nov 14, 2025High impact
Next steps for processing suspended Nurse-Family Partnership program claims
Oregon Health Authority has resumed processing Nurse-Family Partnership (NFP) Targeted Case Management claims for services from July 1, 2025 onward, but requires providers to submit local match funds to leverage accounts before payments will be issued. Claims for services before July 1, 2025 remain suspended pending further system updates.
Oregon Health Plan · Effective Oct 1, 2025High impact
Fee-for-service hospice rates and nursing facility rates effective Oct. 1, 2025
Oregon Health Authority has updated fee-for-service hospice payment rates effective October 1, 2025 through September 30, 2026. Key changes include new revenue code 650 for routine home care after day 60 and updated rates based on geographic areas (CBSA codes).
Oregon Health Plan · Effective Sep 16, 2025High impact
Update # 4 regarding Planned Parenthood claims memo 09162025
Oregon Medicaid CCOs must immediately hold all unadjudicated Planned Parenthood claims for Medicaid members with service dates on or after July 4, 2025. This does not affect HOP members, Non-Medicaid contracts, or Oregon Health Plan Bridge members.
Oregon Health Plan · Effective Aug 26, 2025High impact
OHA does not cover the fee-for-service per diem rate for days youth are not in residential care
Oregon Health Authority will no longer reimburse providers the per diem rate for days when youth are temporarily absent from residential psychiatric care, including home visits, missing status, or hospitalization. Providers can only bill the per diem rate if youth spend at least 8 hours in residential care and return by 11:59 PM the same day.
Oregon Health Plan · Effective Jul 4, 2025High impact
Planned Parenthood claims
The July 9, 2025 memo instructed CCOs to hold affected Planned Parenthood claims under the 2025 Medicaid Contract, excluding separate Non-Medicaid and OHP Bridge contracts. This historical instruction was subsequently updated. Update #5, issued September 23, 2025, restored processing for July 4–September 10 service dates and narrowed later holds; current October 2026 applicability is not established by this memo.
Oregon Health Plan · Effective Jul 4, 2025High impact
Planned Parenthood claims
Oregon Medicaid has directed CCOs to hold all Planned Parenthood claims with dates of service on or after July 4, 2025, due to federal prohibition under the One Big Beautiful Bill Act. Claims should not be processed or submitted until further guidance is provided.
Oregon Health Plan · Effective Jul 1, 2025High impact
Clarification about billing for S0109 (Methadone, 5 mg) effective July 1, 2025
Oregon Medicaid clarifies that SUD providers can bill for methadone medication (S0109) AND administration (H0020) for all doses, including take-home doses, effective July 1, 2025. This expands billing to cover take-home methadone doses previously unclear in guidance, requiring providers to bill both the medication and administration codes to properly track distribution.
Oregon Health Plan · Effective Jun 28, 2025High impact
Changes to state match for Nurse-Family Partnership program
Oregon's Nurse-Family Partnership (NFP) program funding for state match ended June 28, 2025. All NFP claims submitted on or after this date will be suspended until providers submit their own state match payments once system updates are complete.
Oregon Health Plan · Identified Oct 6, 2026High impact
Update # 4 regarding Planned Parenthood claims memo 09162025
Update #4, dated September 16, 2025, instructed CCOs to hold not-yet-adjudicated Planned Parenthood Medicaid-contract claims, excluded HOP and separate Non-Medicaid/OHP Bridge contracts, and said not to reprocess adjudicated claims. Update #5 on September 23 subsequently changed the affected service-date window. These historical documents do not establish a current October 2026 claims-hold instruction.
Oregon Health Plan · Identified Jun 20, 2026High impact
Notice of intent – OHA will amend the Medicaid State Plan to increase the rate for Freestanding Birth Centers.
Oregon Health Authority is proposing to increase Medicaid reimbursement rates for Freestanding Birth Centers from $1,200 to $3,700 per birth through a State Plan Amendment. This significant rate increase affects the global reimbursement rate that covers all services related to births at these facilities.
Oregon Health Plan · Effective Aug 28, 2026Medium impact
Waiver of CY 2026 REALD and SOGI data collection requirements
Oregon Health Authority has waived CY 2026 REALD (Race, Ethnicity, Ancestry, Language, Disability) and SOGI (Sexual Orientation and Gender Identity) data collection requirements for Coordinated Care Organizations (CCOs) due to community concerns about federal misuse and an ongoing operational review. CCOs should, after verifying current applicability, pause collection and submission of this demographic data until further notice and communicate the pause to downstream contract parties.
Oregon Health Plan · Effective Aug 28, 2026Medium impact
final CY 2026 REALD data waiver 08282026
Oregon Health Authority (OHA) has waived CY 2026 REALD (Race, Ethnicity, Ancestry, Language, Disability) and SOGI (Sexual Orientation and Gender Identity) data collection requirements for all Coordinated Care Organizations (CCOs) effective immediately. CCOs must pause all collection and submission of this demographic data and notify downstream contractors. Data sharing resumes once OHA completes its operational review.
Oregon Health Plan · Effective Aug 20, 2026Medium impact
Waiver of select CY 2026 THW deliverables
Oregon Health Authority (OHA) is waiving submission of two Traditional Health Worker (THW) deliverables for Contract Year 2026: the THW Integration and Utilization Plan report and the THW Payment Grid. This waiver allows CCOs time to integrate OHA feedback from the previous year. CCOs must still submit the remaining THW Integration and Utilization Plan data report by November 15, 2026.
Oregon Health Plan · Effective Jul 31, 2026Medium impact
1915(i) Home and Community Based Services (HCBS) Referral Documentation Standards Update
Oregon's 1915(i) HCBS program is eliminating the requirement for Mental Health Assessments, Residential Care/Treatment Plans, and Progress Notes in referral packets effective July 31, 2026. Referrals now only need documentation dated within 18 months confirming a qualifying psychiatric diagnosis signed by a QMHP or LPHA. This reduces administrative burden and streamlines the referral process.
Oregon Health Plan · Effective Jul 9, 2026Medium impact
Amended dispensing limitations for certain hormone medications
Oregon Health Authority (OHA) updated OAR 410-121-0146 to allow reimbursement for up to 365-day supplies of select hormone medications (estrogens, progesterones, aldosterone antagonists, androgens, and GNRH agonists) for OHP Open Card (fee-for-service) members. This change takes effect immediately for prescriptions filled on or after July 9, 2026, and applies only to preferred drugs in specified therapeutic classes.
Oregon Health Plan · Effective Jul 1, 2026Medium impact
Health-Related Social Needs (HRSN) Nutrition-Related Supports updates
Oregon Health Authority is implementing two new Health-Related Social Needs (HRSN) Nutrition-Related Supports benefits—HRSN Pantry Stocking and Fruit and Vegetable benefits—effective July 1, 2026, for Medicaid and Non-Medicaid CCO contracts. CCOs must submit a completed HRSN Nutrition Readiness Plan Previously due May 1, 2026 (date passed; verify current applicability) (extended from April 3, 2026) to prepare for implementation.
Oregon Health Plan · Effective Jul 1, 2026Medium impact
Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service rates for certain youth intensive treatment services.
Oregon Health Authority is increasing Medicaid fee-for-service rates for youth intensive behavioral health services effective July 1, 2026. Rates will increase for substance use disorder residential treatment (from $444.24 to $582.60), psychiatric day treatment (from $342.13 to $387.52), and secure inpatient psychiatric facilities (from $1630.36 to $1713.78).
Oregon Health Plan · Effective Jul 1, 2026Medium impact
Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service rates for family planning services.
Oregon Medicaid will increase the bundled family planning encounter rate (T1015) to $230 and establish a flat rate of $500 for vasectomy procedures (CPT 55250), replacing the current RVU-based reimbursement for vasectomies. These changes take effect July 1, 2026.
Oregon Health Plan · Effective Jul 1, 2026Medium impact
Youth intensive treatment services rate changes
Oregon Medicaid is increasing reimbursement rates for youth intensive psychiatric treatment services by 3-31%, with most changes effective July 1, 2026, except for Secure Inpatient Programs (SIP) which is already effective July 1, 2025. Rate increases include Day Treatment (13%), Psychiatric Residential Treatment Services (3%), SIP (5%), and Substance Use Disorder Residential Treatment (31%).
Oregon Health Plan · Effective Jul 1, 2026Medium impact
Rate increases for family planning visits and vasectomies effective July 1, 2026.
Oregon Health Authority is increasing reimbursement rates for family planning services effective July 1, 2026. HCPCS code T1015 (family planning clinic visits) will increase from $185 to $230, and CPT code 55250 (vasectomy) will increase to $500 for both facility and non-facility rates.
Oregon Health Plan · Effective Jul 1, 2026Medium impact
Comagine Health Provider Portal required for most 1915(i) HCBS residential referrals effective July 1, 2026
Starting July 1, 2026, Oregon Health Authority requires most 1915(i) Home and Community Based Services (HCBS) residential providers to submit referrals through the new Comagine Health Provider Portal instead of current methods. This affects residential service providers, Community Mental Health Programs, Secure Residential Treatment Facilities, Young Adults in Transition providers, and non-Medicaid residential providers.
Oregon Health Plan · Effective Jun 1, 2026Medium impact
Changes to SRTF concurrent stay authorization timeframes effective June 1, 2026
Starting June 1, 2026, SRTF (Secure Residential Treatment Facility) concurrent stay authorization requests must be submitted 30 days before the end of each 90-day Plan of Care period, reduced from the previous 45-day requirement. The POC will be extended in MMIS rather than creating new entries for concurrent stays.

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Breast and Cervical Cancer Treatment Program Updates Related to Federal Changes

Oregon Health Authority (OHA) expectations for Health-Related Social Needs (HRSN) service transitions for Healthier Oregon members

Changes to teledentistry codes D9995 and D9996 effective Jan. 1, 2027

Anticipated Impacts of H.R.1 and other federal changes on Oregon’s CCOs

Notice of Intent – OHA will submit Oregon’s Medicaid Phase-out Plan for the Waiver Authority Related to the Prioritized List

Healthier Oregon Transition Data Guidance for Prior Authorizations

Health Related Social Needs (HRSN) Data Submission Guidance for Healthier Oregon Transition of Care

Notice of intent: OHA will amend the Medicaid State Plan to comply with several provisions of the Working Families Tax Cut Legislation

Non-Emergency Medical Transportation Data Guidance for the Healthier Oregon Transition

Notice of intent: OHA will amend the Medicaid State Plan to renew the 1915(i) state plan option - Comments due May 29, 2026

Notice of intent: OHA will add clinical coverage criteria to the Medicaid State Plan.

Reconciling of The ASAM Criteria, Third Edition and The ASAM Criteria, Fourth Edition – Updated Timeline

Rulemaking for Board-Registered Behavioral Health Associates

Guidance for Developing Local HR1 Resource Lists

New due date for pre-release Reentry services readiness plan

Single standard prior authorization request process to begin Nov. 1, 2026

1915(i) Community Based Integrated Supports (CBIS) Authorization Process

Fee-for-Service Hospice Rates Effective Oct. 1, 2026

Rulemaking for Board-Registered Behavioral Health Associates

Reimbursement for nitrous oxide during in-office medical procedures effective Aug. 1, 2026

Change to interRAI Community Mental Health (CMH) assessment tool effective July 31, 2026

Fee-for-service nursing facility rates effective July 1, 2026

Board-Registered Behavioral Health Associates and Mental Health Interns

New process for non-response to licensing information requests, effective June 1, 2026

Billing guidance for obstetric services provided by FQHCs and RHCs

2026 handicapping malocclusion risk corridor and fee-for-service rates

High-Cost Drug Carve-Out policy effective Jan. 1, 2026

Addressing discrepancies in the supplemental OHP dental codes list

Next steps for processing suspended Nurse-Family Partnership program claims

Fee-for-service hospice rates and nursing facility rates effective Oct. 1, 2025

Update # 4 regarding Planned Parenthood claims memo 09162025

OHA does not cover the fee-for-service per diem rate for days youth are not in residential care

Planned Parenthood claims

Planned Parenthood claims

Clarification about billing for S0109 (Methadone, 5 mg) effective July 1, 2025

Changes to state match for Nurse-Family Partnership program

Update # 4 regarding Planned Parenthood claims memo 09162025

Notice of intent – OHA will amend the Medicaid State Plan to increase the rate for Freestanding Birth Centers.

Waiver of CY 2026 REALD and SOGI data collection requirements

final CY 2026 REALD data waiver 08282026

Waiver of select CY 2026 THW deliverables

1915(i) Home and Community Based Services (HCBS) Referral Documentation Standards Update

Amended dispensing limitations for certain hormone medications

Health-Related Social Needs (HRSN) Nutrition-Related Supports updates

Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service rates for certain youth intensive treatment services.

Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service rates for family planning services.

Youth intensive treatment services rate changes

Rate increases for family planning visits and vasectomies effective July 1, 2026.

Comagine Health Provider Portal required for most 1915(i) HCBS residential referrals effective July 1, 2026

Changes to SRTF concurrent stay authorization timeframes effective June 1, 2026