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Oregon Health PlanMedicaid · Reimbursement · Provider · OR · PsychiatryHigh impact

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

Act
immediately
Effective date
Aug 26, 2025
Identified
Jun 20, 2026

Summary

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.

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What to do

immediately · 4 steps
01Billing team must update residential psychiatric billing procedures to only bill per diem rates when youth spend 8+ hours in facility and return by 11:59 PM same day.
02Stop billing per diem for absent days including home visits, missing status, or hospital stays.
03Begin billing outpatient codes for services provided during temporary absences.
04Update billing system rules and train staff on new 8-hour minimum requirement.

Original notice

OHA does not cover the fee-for-service per diem rate for days youth are not in residential care
oregon.gov · Always check the source before changing claims.
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Related policy hubs

Oregon Health Plan policiesOR policy changesPsychiatry

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