MedicaidPrior AuthHigh impact
PHE Authorities and Flexibilities Memo
Oregon Health Plan·OR·Community partner
Effective date
May 11, 2023
We identified it
Jun 20, 2026
Summary
Multiple Oregon Medicaid (OHP) flexibilities from the COVID-19 public health emergency have ended, including suspension of prior authorization requirements, extended pharmacy flexibilities, and various rate increases. Prior authorizations are now required again and several temporary rate increases have expired.
Action Required
Immediately: Billing team must reinstate prior authorization requirements for all Oregon Medicaid fee-for-service claims that previously required prior auth before the PHE. Update billing system to flag these services for prior auth verification. Remove any COVID-19 specific billing shortcuts or extended day supply pharmacy billing. Verify current fee schedules as COVID-19 diagnostic testing rates have reverted from 100% Medicare rates to regular agency rates. Failure to obtain required prior authorizations will result in claim denials.