MedicaidReimbursementMedium impact
Clarification of Oregon’s Non-Par and Out of State Hospital Billing Rules
Oregon Health Plan·OR·Plan contract
Effective date
Sep 20, 2024
We identified it
Jun 20, 2026
Summary
Oregon Health Authority clarifies that standard non-participating provider reimbursement rules do not apply to out-of-state hospitals. CCOs must negotiate separate rates with out-of-state hospitals located within 75 miles (contiguous) or beyond 75 miles (non-contiguous) of Oregon's border.
Action Required
Immediately: Billing teams serving Oregon Medicaid CCO patients must identify out-of-state hospital services and verify negotiated rates with each specific CCO before billing. Do not apply standard non-participating provider rates from OAR 410-120-1295 to out-of-state hospitals. Contact CCOs directly to confirm reimbursement rates for each out-of-state facility.