MedicaidDocumentationHigh impact
Medical necessity reviews for SRTF level of care
Oregon Health Plan·OR · Psychiatry·Provider
Effective date
Feb 1, 2024
We identified it
Jun 20, 2026
Summary
Starting February 1, 2024, Oregon Health Authority and Comagine Health began conducting medical necessity reviews for Secure Residential Treatment Facility (SRTF) care for Oregon Health Plan (Medicaid) members. SRTFs must provide complete documentation per Oregon Administrative Rules, and if medical necessity isn't met, payment denials may occur with up to 60 days of transitional funding provided.
Action Required
Immediately: SRTF billing teams must ensure complete documentation is provided to Comagine Health according to Oregon Administrative Rules 410-120-1360 and 410-172-0620 for all Oregon Health Plan members. Contact Michael Oyster at michael.w.oyster@oha.oregon.gov for Choice Model/Aid and Assist cases or Megan Harper at megan.l.harper@oha.oregon.gov for Psychiatric Security Review Board cases when payment denials occur. Coordinate with Comagine Health and Exceptional Needs Care Coordinator during payment transitions to avoid service disruptions.