MedicaidPrior AuthMedium impact
Changes to hospital transfer policy and prior authorization requirements for long-term acute care (LTAC) hospitals and inpatient rehabilitation services, effective immediately
Oregon Health Plan·OR · PM&R (Physical Medicine & Rehab), Critical Care·Plan
Effective date
Aug 27, 2021
We identified it
Jun 20, 2026
Summary
Oregon Health Authority temporarily waived prior authorization requirements for LTAC hospitals and inpatient rehabilitation services for fee-for-service Medicaid patients during COVID-19 surge. Regional hospitals can now use patient status code 10 for back transfers to rural hospitals to receive full DRG payment, bypassing normal transfer policy restrictions.
Action Required
Immediately: Billing team should use patient status code 10 for back transfers from regional to rural hospitals to ensure full DRG payment. For fee-for-service Medicaid patients, prior authorization requests for LTAC and inpatient rehabilitation will be automatically approved if providers are Medicaid-enrolled, patient has current OHP eligibility, and services are on the Prioritized List. Verify these criteria are met before submitting requests.