MedicaidReimbursementMedium impact
Notice of intent – OHA will amend the Medicaid State Plan to change the methods used to pay out-of-state hospitals.
Oregon Health Plan·OR·Public notice
Effective date
Jan 4, 2025
We identified it
Jun 20, 2026
Summary
Oregon Medicaid is changing how out-of-state hospitals are paid for outpatient services, moving from payment based on billed charges to using the same Ambulatory Payment Classification (APC) methodology used for in-state hospitals. This will result in lower reimbursement rates for out-of-state hospital outpatient services.
Action Required
Before January 31, 2025: If your practice refers Oregon Medicaid patients to out-of-state hospitals for outpatient services, notify those facilities of the payment methodology change from billed charges to APC rates effective January 4, 2025. Review any existing agreements with out-of-state hospitals as they may need to request grandfathered rates of 50% of 2024 charge master if beneficial.