MedicaidCoverageMedium impact
CCOs may not use the presence of a caregiver as a reason to deny power wheelchair coverage
Oregon Health Plan·OR · PM&R (Physical Medicine & Rehab), Neurology, Family Medicine +1 more·Plan
Effective date
Jun 15, 2023
We identified it
Jun 20, 2026
Summary
Oregon Coordinated Care Organizations (CCOs) are prohibited from denying power wheelchair coverage solely based on the presence of a caregiver. CCOs must follow Oregon Administrative Rule 410-122-0325 which allows power wheelchair coverage even when caregivers are present, as long as specific medical criteria are met.
Action Required
Immediately: Billing and prior authorization staff must review all pending and future power wheelchair requests for Oregon Medicaid CCO members to ensure caregiver presence is not used as grounds for denial. Update prior authorization review procedures to follow OAR 410-122-0325 criteria. Contact CCO medical directors to confirm understanding of new policy requirements.