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
Aug 19, 2026
Summary
Oregon Medicaid (CCOs) must now reimburse members for over-the-counter COVID-19 tests as an In Lieu of Services (ILOS) benefit. Practices can accept receipts and reimburse members directly at up to $12 per individual test, or provide free test kits directly. Members are entitled to up to 8 tests per month without prior authorization, or unlimited tests with a healthcare provider order.
Action Required
By March 31, 2022: (1) Billing/administrative team must establish OTC COVID test reimbursement process for Oregon Medicaid members—either direct distribution of free test kits or receipt-based reimbursement at $12/test maximum. (2) Update billing system to track and process member reimbursement claims for OTC tests. (3) Verify member handbooks include ILOS prevention programs listing OTC COVID tests; submit amended handbooks to OHA Quality Assurance team for approval if not already listed. (4) Train front desk and billing staff on reimbursement limits (up to 8/month without PCP order; unlimited with provider order) and proper documentation requirements. (5) Contact ILOS.info@dhsoha.state.or.us with implementation questions. Failure to implement may result in member complaints and compliance issues with CCO contracts.