MedicaidCoverageMedium impact
Notice of intent – OHA will amend the Medicaid State Plan to allow clinic services outside the “four walls” of the clinic.
Oregon Health Plan·OR · Psychiatry, Family Medicine, Internal Medicine·Public notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Oregon Health Authority is amending its Medicaid State Plan to allow clinic services to be provided outside the physical clinic location, with the same reimbursement rates as in-clinic services. This affects behavioral health clinics and IHS/Tribal clinics providing services in non-traditional settings.
Action Required
By April 4, 2025: Oregon providers should review the proposed State Plan Amendment and submit comments to jesse.anderson@oha.oregon.gov if desired. Once approved, billing teams must verify that claims for clinic services provided outside traditional clinic settings (such as behavioral health services in community locations or Tribal clinic outreach services) are properly documented with location and personnel requirements. Update billing procedures to ensure off-site clinic services meet 'under direction of physician' requirements.