MedicaidCoverageMedium impact
Notice of intent - OHA will amend the State Plan to include coverage of patient costs for items and services furnished in connection with qualifying clinical trials, effective January 1, 2022
Oregon Health Plan·OR·Public notice
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Oregon Health Authority is implementing a Medicaid State Plan Amendment to formalize coverage of routine patient costs for qualifying clinical trials, effective January 1, 2022. This clarifies that Medicaid must cover these services even when provided out-of-state or out-of-network for managed care enrollees.
Action Required
Billing team should verify that clinical trial-related services for Oregon Medicaid patients are being properly billed and processed, including services provided out-of-state or out-of-network. Ensure authorization processes are in place for clinical trial costs even when providers are outside the usual network.