MedicaidCoverageMedium impact
In Lieu of Services option for member reimbursement of over-the-counter COVID tests
Oregon Health Plan·OR·Plan
Effective date
Feb 18, 2022
We identified it
Jun 20, 2026
Summary
Oregon Health Authority confirms that Coordinated Care Organizations (CCOs) can use In Lieu of Services to reimburse Medicaid members for over-the-counter COVID tests. CCOs must provide access to up to 8 free tests per month without prior authorization, reimbursing up to $12 per individual test, and must update member handbooks to include ILOS prevention programs.
Action Required
Immediately: CCOs must establish process to reimburse Medicaid members up to $12 per individual COVID test (up to 8 tests monthly without prior auth, unlimited with provider order). Billing teams must update member handbooks to include ILOS prevention programs and submit amended handbooks to Quality Assurance team for approval. Set up receipt acceptance and direct member reimbursement workflow.