MedicaidPrior AuthHigh impact
Certification of Need for Services for children’s Subacute treatment, effective January 1, 2020
Oregon Health Plan·OR · Psychiatry, Pediatrics·Plan contract
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Authority now requires Certification of Need for Services (CONS) for ALL children admitted to Psychiatric Residential Treatment Facilities (PRTFs), including those receiving Subacute treatment. Emergency admissions must have CONS completed within 14 days, while non-emergency admissions require pre-certification by an independent team.
Action Required
Immediately: Billing teams working with Oregon Medicaid pediatric psychiatric residential treatment must update processes to ensure all PRTF admissions have required CONS documentation before billing. For emergency/subacute admissions, CONS must be completed within 14 days by PRTF team. For non-emergency admissions, independent team certification is required before admission. Update billing workflows to verify CONS completion before submitting claims, as Medicaid will not authorize payment without proper certification.