MedicaidReimbursementMedium impact
Oregon DRG rate methodology and non-par rules
Oregon Health Plan·OR · General Surgery, Cardiology, Neurology +1 more·Plan
We identified it
Jun 20, 2026
Summary
Oregon Medicaid CCOs must now use Medicare outlier methodology (not Medicaid methodology) when reimbursing non-participating providers for DRG inpatient hospital services, as clarified in Oregon Administrative Rule 410-120-1295(3)(b).
Action Required
Immediately: CCOs must review and update reimbursement policies and procedures for non-participating providers to ensure use of the applicable year Medicare outlier methodology instead of Medicaid methodology for DRG inpatient services. Contact Angel Wynia at angel.wynia@oha.oregon.gov with questions.