PAYER POLICY CHANGES

Oregon Medicaid Policy Changes

Policy changes from Oregon Health Plan and from Medicaid managed care plans in Oregon, with the Medicaid prior authorization lists and payer contacts we track for the state. Each item links to its public source.

Oregon Health Plan · Effective Jan 1, 2027Medium impact
Healthier Oregon Transition Data Guidance for Prior Authorizations
Oregon's Office of Health Policy (OHA) directed coordinated care organizations (CCOs) to submit prior authorization data for Healthier Oregon members transitioning to the Oregon Health Plan Open Card program, covering approved prior authorizations for prescription, medical, behavioral and oral health services to be rendered on or after Jan. 1, 2027, plus program exception approvals. Practices in Oregon that serve these members should expect prior authorizations to be entered into fee-for-service claims processing on the dates listed, so billing staff should confirm which active authorizations carry 2027 effective dates and that claims reference them correctly.
PacificSource Health Plans · Effective Nov 1, 2026Medium impact
New Provider Payment Dispute (PPD) Process Effective November 1, 2026
PacificSource is introducing a dedicated Provider Payment Dispute (PPD) process effective November 1, 2026, for disputes about claims that were submitted correctly but paid incorrectly, denied in error, or processed incorrectly. Starting November 1, 2026, a separate standardized Provider Payment Dispute Request Form must be completed in full with required attachments for each disputed claim and faxed to the new dedicated PPD fax line, 541-225-1901. Medical necessity, authorization, coverage disputes, and billing errors (incorrect codes, dates of service, or modifiers) must not use this form.
PacificSource Health Plans · Identified Nov 4, 2026Low impact
Why Stable Housing Matters for Better Health
This is an informational article from PacificSource about the connection between stable housing and health outcomes. It describes PacificSource's Health-Related Social Needs program for eligible Oregon Health Plan members and directs readers to housing assistance resources. No billing, coding, coverage, or operational changes are announced.
Oregon Health Plan · Effective Jan 1, 2027High impact
Breast and Cervical Cancer Treatment Program Updates Related to Federal Changes
Oregon Health Plan (OHP) is implementing three changes to the Breast and Cervical Cancer Treatment Program (BCCTP) due to federal requirements: (1) noncitizen immigration status eligibility changes effective October 1, 2026 (already in effect); (2) transition of Healthier Oregon members to OHP Open Card starting January 1, 2027, requiring providers to bill OHA directly instead of CCOs; and (3) retroactive coverage reduction from three months to two months for newly eligible BCCTP members effective January 1, 2027.
Oregon Health Plan · Effective Aug 28, 2026Medium impact
Waiver of CY 2026 REALD and SOGI data collection requirements
Oregon Health Authority has waived CY 2026 REALD (Race, Ethnicity, Ancestry, Language, Disability) and SOGI (Sexual Orientation and Gender Identity) data collection requirements for Coordinated Care Organizations (CCOs) due to community concerns about federal misuse and an ongoing operational review. CCOs should, after verifying current applicability, pause collection and submission of this demographic data until further notice and communicate the pause to downstream contract parties.
Oregon Health Plan · Identified Oct 17, 2026Low impact
Care Coordination Data Guidance for the Healthier Oregon Transition
The Oregon Health Authority memo dated Oct. 16, 2026 sets care coordination data guidance for coordinated care organizations (CCOs) as Healthier Oregon members transition to the Oregon Health Plan (OHP) Open Card program effective Jan. 1, 2027. CCOs must submit Tier 2 reporting data, Care Plan PDFs and Health Risk Assessment PDFs to OHA on Nov. 6, 2026, Dec. 8, 2026 and Jan. 7, 2027, and they participate in warm handoff meetings that Acentra Health schedules. The memo is addressed to CCOs and lists no billing codes or claim requirements.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Health Related Social Needs (HRSN) Data Submission Guidance for Healthier Oregon Transition of Care
Oregon's Medicaid Division requires Coordinated Care Organizations (CCOs) to submit Health Related Social Needs (HRSN) data for members transitioning from CCO enrollment to the Open Card fee-for-service program effective January 1, 2027. CCOs must submit member roster files and supporting documentation on four staggered dates between November 2, 2026, and January 6, 2027, using specific file naming conventions via the Actuarial Managed File Transfer (MFT) server.
Oregon Health Plan · Effective Oct 1, 2026Low impact
Notice of intent: OHA will amend the Medicaid State Plan to expand the Family Connects Oregon nurse home visiting program into Harney and Wallowa counties.
Oregon Health Authority (OHA) is amending the Medicaid State Plan to expand the Family Connects Oregon nurse home visiting program into Harney and Wallowa counties, effective October 1, 2026. The program provides Targeted Case Management services to Medicaid-eligible infants from birth through 6 months of age. This is a notice of intent with a public comment period; the change has already taken effect as of the analysis date.
Oregon Health Plan · Effective Jan 1, 2027Medium impact
Notice of intent: OHA will amend the Medicaid State Plan to comply with several provisions of the Working Families Tax Cut Legislation
Oregon Health Authority will submit State Plan Amendments to comply with Working Families Tax Cut (WFTC) changes to Medicaid and CHIP effective January 1, 2027. The changes add community engagement (work) requirements as a condition of eligibility for the ACA adult expansion population, require eligibility redeterminations every 6 months for ACA adults, shorten the retroactive eligibility period for applications made on or after January 1, 2027, and require a process to regularly obtain address information from a reliable data source. The amendments will not change any coverage or benefits or how Oregon Health Plan provides EPSDT services, and written comments are due by 5 p.m. November 13, 2026.
PacificSource Health Plans · Effective Nov 15, 2026Medium impact
November 2026 Medicaid Drug List Change Notification
PacificSource Community Solutions Medicaid formulary is removing five medications (Xeljanz, Xeljanz OS, Xeljanz XR, Januvia, Ofev) from coverage and updating quantity limits for Pirfenidone formulations effective November 15, 2026. Billing teams must verify patient coverage and update prior authorization workflows before this date.
Oregon Health Plan · Effective Oct 27, 2026High impact
1915(i) Community Based Integrated Supports (CBIS) Authorization Process
Effective October 27, 2026, Oregon Health Authority is transitioning 1915(i) Community Based Integrated Supports (CBIS) billed under H0046 from Prior Authorization (PA) to Plan of Care (POC) authorization in MMIS. All existing PAs will end October 26, 2026, with remaining approved services automatically transferred to POC format starting October 27, 2026. New referrals will be entered directly as POC after IQA approval through the PCSP.
Oregon Health Plan · Identified Oct 7, 2026Low impact
Request for comment – Draft SUD 1115 Waiver Application - Comments due February 21, 2020
This is a historical public notice from January 14, 2020, requesting comments on Oregon Health Authority's draft Substance Use Disorder (SUD) 1115 Waiver application. The waiver, if approved, would expand Medicaid coverage for residential SUD treatment, recovery support services, and transitional housing support in Oregon. The comment deadline of February 21, 2020, has long elapsed; this document does not represent a current billing or coverage change.
Oregon Health Plan · Identified Oct 7, 2026Low impact
Provider Announcement
HISTORICAL MATERIAL: This is a COVID-19 emergency guidance document from April 7, 2020, newly discovered on 2026-10-07. It clarified Oregon Health Authority (OHA) coverage and billing for non-emergency ambulance (NEA) transports during the pandemic, including authorization procedures and billing code requirements. This guidance was issued under temporary emergency rules and is no longer current; verify current Oregon Medicaid NEMT policies with OHA before implementing any billing changes.
Oregon Health Plan · Effective Jul 1, 2020Low impact
Fee-for-service hospice NF rates effective July 1, 2020 – June 30, 2021
This is historical material (published July 13, 2020; discovered October 7, 2026). Oregon OHA updated fee-for-service hospice nursing facility (NF) per diem room and board rates for revenue codes 658, 191, and 192, effective July 1, 2020 through June 30, 2021. Two new NF hospice revenue codes (190 for Bariatric, 194 for Vent services) were added, requiring DHS approval to bill. A proposed rule comment period for ventilator-assisted program rates closed August 28, 2020. All effective dates and deadlines have elapsed; verify current applicability with Oregon OHA before billing.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Request for comment - State Plan Amendment to add CCBHC Program
This is a historical public notice from April 2019 requesting public comments on Oregon's proposed State Plan Amendment to add Certified Community Behavioral Health Clinics (CCBHCs) as recognized Medicaid providers. The comment period (ended May 17, 2019) and all deadlines referenced are long past. The policy change itself may or may not have been implemented; current applicability requires verification with Oregon Health Authority.
Oregon Health Plan · Effective Sep 3, 2019High impact
OCC 1 override for fee-for-service prescriptions ends September 2, 2019
This is historical material (published 2019-08-02, discovered 2026-10-06). Oregon Health Plan (OHP) ended the OCC 1 override for fee-for-service prescriptions effective September 3, 2019. Pharmacies can no longer use OCC 1 ('No other coverage') to override claim denials; claims will deny if OCC 1 is submitted. Only OCC codes 2, 3, and 4 are now accepted to indicate how the primary payer processed the claim.
Oregon Health Plan · Effective Oct 1, 2019Low impact
Request for Comment - State Plan Amendment to increase fee-for-service SUD rates
This is a historical public notice from September 2019 proposing a State Plan Amendment to increase Oregon Medicaid fee-for-service rates for substance use disorder (SUD) treatment and mental health services, effective October 1, 2019. The SUD rates increased by 10–38% depending on service code, and mental health rates increased by 4%. This change is now over 6 years in the past; verify current rate applicability with Oregon Health Authority rather than acting on this archived notice.
Oregon Health Plan · Effective Nov 1, 2019Low impact
Request for comment - State Plan Amendment to increase TCM home visiting rate - Comments due November 1, 2019
This is a historical public notice from October 2019 regarding a proposed Oregon Medicaid State Plan Amendment to increase fee-for-service reimbursement rates for Targeted Case Management (TCM) Maternal and Child Health home visiting programs by 29 percent, effective November 1, 2019. The comment period closed on November 1, 2019, and this document was newly discovered on October 6, 2026. Verify current applicability with Oregon Health Authority, as this policy is nearly seven years old.
Oregon Health Plan · Effective Oct 1, 2019Low impact
MS-DRG and LTC-DRG updates and inpatient claim reprocessing
HISTORICAL MATERIAL: This is an October 2019 policy newly discovered in October 2026. Oregon Health Authority updated its MS-DRG and LTC-DRG grouper software effective October 1, 2019, with system implementation on November 3, 2019. Nine Oregon-specific DRG codes were reassigned (old codes 317–325 mapped to new codes 521–529). OHA automatically reprocessed affected claims from October 1–November 3, 2019 during the weekend of November 15, 2019; no billing team action was required at that time. This change is now nearly 7 years past effective date and past all stated deadlines.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Request for Comment - Draft Medicaid State Plan Amendment to Align MH and SUD Services - Comments due Feb. 21, 2020
This is a historical public notice from January 2020 announcing Oregon's proposed Medicaid State Plan Amendment (SPA) to align mental health and substance use disorder (SUD) services. The comment period (deadline February 21, 2020) has elapsed. The notice describes Oregon's intent to expand SUD treatment coverage, including residential services, recovery support services, and transitional housing support, contingent on federal waiver approval. Specific billing codes for SUD services were to be determined in a future submission.
Oregon Health Plan · Effective Oct 1, 2019Low impact
Change in reporting of member enrollment in Patient Centered Primary Care Homes 02242020
This is a historical policy document (published February 24, 2020; discovered October 6, 2026) describing changes to Oregon CCO contract requirements effective October 1, 2019. The Oregon Health Authority changed PCPCH member enrollment reporting from quarterly to annual submission, effective immediately in 2019, with the first annual report due January 30, 2021. This change is now over 5 years past effective date and all stated deadlines have elapsed. Billing teams should verify current applicability with Oregon CCOs, as this guidance predates the analysis date by 6+ years.
Oregon Health Plan · Effective Mar 15, 2021Low impact
Clarification about Annual Training and Education Report due dates
This is a historical clarification (issued Feb 26, 2020) correcting a clerical error in Oregon CCO contracts effective Oct 1, 2019. The error omitted language stating that Annual Training and Education Reports are first due March 15, 2021, not 2020. The correction has already been implemented; no current action is required unless your practice is an Oregon CCO that has not yet submitted its first report.
Oregon Health Plan · Effective Mar 13, 2020Medium impact
Oregon Health Plan coverage of telemedicine services
HISTORICAL MATERIAL (Published 2020-03-13; newly discovered 2026-10-06). Oregon Health Plan expanded telemedicine and telephone service coverage during COVID-19, effective March 13, 2020 for CCOs (with retroactive encouragement to January 1, 2020) and January 1, 2020 for fee-for-service Medicaid. Multiple billing codes for audio/video, telephone, online, and provider-to-provider consultations were activated for physical and behavioral health. Billing team must verify current applicability, as this 6+ year old guidance may have been superseded by subsequent Oregon Health Plan policy updates.
Oregon Health Plan · Effective Jan 1, 2020Low impact
Correction to 2019 notice about the State Plan Amendment to increase TCM home visiting rates
This is a historical correction notice (published March 17, 2020, newly discovered October 6, 2026) regarding a State Plan Amendment that increased fee-for-service reimbursement rates by 29% for Targeted Case Management Maternal and Child Health home visiting programs in Oregon, effective January 1, 2020. The notice clarifies that the rate increase is already past and provides federal fiscal impact estimates. Verify current applicability with Oregon Health Authority rather than treating this as a pending deadline.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Request for Comment - Adding lactation consultants to Medicaid State Plan - Comments due April 16, 2020
This is a historical public notice from March 2020 requesting comments on a proposed Oregon Medicaid State Plan Amendment to add lactation consultants as an eligible provider type. The comment period ended April 16, 2020, and this document does not establish whether the amendment was ultimately approved or implemented. The billing team should verify current Oregon Medicaid policy to determine if lactation consultant services are now covered and what billing requirements apply.
Oregon Health Plan · Effective Jan 1, 2020Medium impact
Public notice - State Plan Amendment to expand Medicaid coverage of telehealth services
This is historical material (published March 20, 2020; discovered October 6, 2026). Oregon Health Authority expanded Medicaid coverage of telehealth and telephone services retroactively effective January 1, 2020, increasing reimbursement rates for three telehealth CPT codes (99441, 99442, 99443). The billing team should verify whether this practice has already implemented these rate increases and confirm current applicability with OHA, as the State Plan Amendment submission deadline (March 31, 2020) has long elapsed.
Oregon Health Plan · Effective Mar 24, 2020Low impact
Changes to Hospital Presumptive Eligibility processes, effective immediately
This is a historical policy document (published March 24, 2020, discovered October 6, 2026) that temporarily modified Oregon's Hospital Presumptive Eligibility (HPE) processes during the COVID-19 pandemic. The changes allowed phone-based applications without face-to-face interviews, acceptance of verbal signatures, and suspension of coverage terminations for incomplete applications. These emergency measures were stated as 'effective immediately and until further notice,' making their current status uncertain and requiring verification of ongoing applicability.
Oregon Health Plan · Effective Mar 24, 2020Medium impact
DCBS-OHA Telehealth Guidance - Issued March 24 2020
This is historical guidance issued March 24, 2020, during the COVID-19 emergency requiring all Oregon health plans (Medicaid and commercial) to expand telehealth coverage, eliminate barriers to telehealth delivery, ensure cost-sharing parity with in-person visits, and examine reimbursement rates. The guidance was conditional on the duration of the COVID-19 outbreak or until further direction from state authorities. Billing teams should verify current applicability and whether these emergency provisions remain in effect or have been superseded by permanent policy.
Oregon Health Plan · Effective Jul 1, 2020Low impact
Comagine Health is the Oregon Behavioral Health Independent Qualified Agent effective July 1, 2020
This is historical material published March 25, 2020, announcing that Comagine Health replaced KEPRO Inc. as Oregon's Behavioral Health Independent Qualified Agent effective July 1, 2020. The change affected prior authorization, utilization review, and eligibility determinations for behavioral health services. All stated transition activities (April–June 2020) have elapsed. Billing teams should verify current applicability with Oregon Health Authority, as this policy is now 6+ years old.
Oregon Health Plan · Effective Mar 20, 2020Low impact
Public notice - State Plan Amendment to increase Medicaid ventilator rate for nursing facilities
This is a historical public notice from March 2020 regarding Oregon Medicaid's retroactive increase to the Nursing Facility Ventilator Assisted Program (VAP) rate from 200% to 235% of the basic nursing facility rate, effective March 20, 2020. The policy was submitted as an expedited State Plan Amendment to CMS. This change is already fully effective and elapsed; verify current applicability with Oregon Health Authority as this represents COVID-19 pandemic-era emergency policy.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Changes to DCO deliverable due dates due to COVID-19 response
This is a historical policy document from March 27, 2020 that extended or waived multiple contract deliverable due dates for Oregon Dental Care Organizations (DCOs) in response to COVID-19. All effective dates in this document have elapsed as of the analysis date (October 6, 2026). The practice should verify current applicability with Oregon Health Authority rather than completing any of these now-historical deadlines.
Oregon Health Plan · Effective Apr 1, 2020Low impact
Fee-for-service hospice rates effective April 1, 2020 through June 30, 2020
This is historical material (published April 3, 2020; discovered October 6, 2026). Oregon temporarily increased fee-for-service hospice reimbursement rates for nursing facility room and board (revenue codes 658, 191, 192) from April 1–June 30, 2020, as part of COVID-19 response. The policy also clarified billing rules for Routine Home Care (codes 651/650) and Continuous Home Care (652) based on hospice election day count. These rates and the temporary increase have long since elapsed; verify current Oregon hospice rates and billing rules with OHA.
Oregon Health Plan · Effective Jan 1, 2020Low impact
Telemedicine-telehealth billing guidance for Oregon Health Plan fee-for-service providers
This is historical guidance issued April 6, 2020, expanding Oregon Health Plan telemedicine/telehealth coverage effective January 1, 2020, during the COVID-19 emergency. It permits billing for synchronous video, audio-only telephone, and electronic communication services using specific place-of-service codes and modifiers. The policy allowed temporary flexibility on HIPAA encryption requirements, established patient status verification, and provider location restrictions during the emergency declaration. This guidance is now 6+ years old; verify current applicability with OHA, as COVID-19 emergency authorities have expired.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Providing Culturally and Linguistically Appropriate Services During the COVID-19 Emergency
This is historical material (published May 11, 2020, discovered October 6, 2026) establishing Oregon Health Authority expectations for culturally and linguistically appropriate services (CLAS) during COVID-19, including mandatory use of certified interpreters via telemedicine at face-to-face rates and compliance with federal civil rights requirements. No current effective date is stated; verify current applicability with OHA before implementing changes.
Oregon Health Plan · Effective Jul 1, 2020Low impact
Transition to Comagine Health - New Independent Qualified Agent effective July 1, 2020
This is historical material (published June 1, 2020; discovered October 6, 2026). Oregon's Medicaid program transitioned from KEPRO to Comagine Health as the Independent Qualified Agent (IQA) effective July 1, 2020. Comagine Health assumed responsibility for prior authorizations, utilization review, eligibility determinations, needs assessments, and person-centered service planning for 1915(i) HCBS and fee-for-service behavioral health services. This change is already effective and elapsed; verify current applicability with Comagine Health or Oregon Health Authority.
Oregon Health Plan · Effective Apr 10, 2020Low impact
Oregon Health Plan coverage of COVID-19 antibody testing
This is historical material (published June 8, 2020, newly discovered October 6, 2026) establishing Oregon Health Plan coverage criteria for COVID-19 antibody testing during the emergency period. OHP covers antibody testing only when using FDA-authorized tests AND testing evaluates hospitalized patients under age 21 for multisystem inflammatory syndrome in children (MIS-C). Two billing codes are specified with payment rates effective April 10, 2020. Billing teams should verify current applicability with OHA, as this 6-year-old emergency guidance likely has been superseded.
Oregon Health Plan · Effective Jul 1, 2020Low impact
Other Coverage Code (OCC) 1 override ends July 1, 2020
This is historical material from June 2020 regarding Oregon Health Plan (OHP) pharmacy billing. The OCC 1 override ended July 1, 2020 (over 6 years ago). Pharmacies can no longer use Other Coverage Code (OCC) 1 to override claim denials for patients with third-party liability; claims will now deny. Only OCC codes 2, 3, and 4 are accepted going forward. This policy is no longer current and should not drive billing actions; verify current OHP pharmacy billing requirements with Oregon Health Authority.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Conducting PASRR Level II evaluations during the COVID-19 emergency
This is historical guidance from June 2020 regarding COVID-19 emergency procedures for PASRR Level II evaluations in nursing facilities. During the emergency period, evaluations were restricted to telemedicine only (phone, digital platform, or tablet); in-person visits were not permitted per Department of Human Services visitation policy. Billing codes and e-invoicing processes remained unchanged, but evaluations required documentation noting telemedicine was used.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Changes to ACA Section 1557 do not affect Oregon Health Plan coverage of gender transition services
This is historical material (published June 25, 2020; discovered October 6, 2026) clarifying that federal changes to ACA Section 1557 nondiscrimination rules do not affect Oregon Health Plan (OHP) coverage of gender transition services. OHP continues to cover hormone therapy, counseling, and surgeries for transgender members under HERC Guideline 127 and Oregon state law (ORS 659.875), which independently prohibit discrimination based on gender identity regardless of federal regulatory changes.
Oregon Health Plan · Identified Oct 6, 2026Low impact
CAC member selection deadline extended to September 30, 2020
This is historical material (published June 30, 2020; discovered October 6, 2026). The Oregon Health Authority extended the deadline for Coordinated Care Organizations to complete Community Advisory Council member selection from June 30, 2020 to September 30, 2020. This deadline is now 6 years past and no longer actionable.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Expired Oregon DMV credentials for NEMT drivers
This is historical guidance from July 2020 regarding a temporary COVID-19 pandemic flexibility that allowed Oregon NEMT (non-emergent medical transportation) drivers to operate with expired DMV credentials through October 1, 2020. This policy is no longer applicable as of the analysis date (October 6, 2026); all temporary flexibilities expired over six years ago. Billing and credentialing teams should verify current NEMT driver credential requirements directly with Oregon Health Plan and ensure all active drivers maintain valid, current licenses and registrations.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Please send us your most recent Medicare Cost Reports by August 5, 2020
This is a historical notice from the Oregon Health Authority (OHA) dated July 13, 2020, requesting home health agencies to submit their most recent Medicare Cost Reports Previously due August 5, 2020 (date passed; verify current applicability). The deadline has long passed (analysis date: October 6, 2026). OHA used these reports to calculate updated fee-for-service home health rates for 2021–2022. This document requires no current action and is provided for historical context only.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Short-term Medicaid stability loans for providers with reduced business caused by COVID-19
This is historical material (published August 3, 2020; discovered October 6, 2026) announcing a COVID-19 interim stability loan program for Oregon Medicaid fee-for-service providers. Eligible providers could apply for short-term loans based on 2019 average monthly payments, with repayment via accounts receivable withhold against future claims. No current effective date or deadline for action is stated in the source.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Oregon Health Plan coverage of COVID-19 testing
This is historical material (published August 14, 2020; discovered October 6, 2026) establishing Oregon Health Plan coverage of COVID-19 viral testing as a diagnostic service for all OHP members when ordered by a qualified provider, and antibody testing only for hospitalized persons under age 21 with suspected multisystem inflammatory syndrome in children (MIS-C). Tests must have FDA Emergency Use Authorization or FDA approval. Billing teams should verify current applicability, as this emergency-period policy may have been superseded or modified.
Oregon Health Plan · Effective Aug 10, 2020Low impact
Clarification on DHS-mandated COVID 19 testing in long-term care facilities
This is historical material from August 2020 clarifying COVID-19 testing requirements for long-term care facilities in Oregon. The policy narrowed the definition of 'Associated Staff' subject to DHS-mandated testing to only those with direct contractual relationships with facilities, exempting home health and hospice staff without such contracts. This change is no longer actionable and applies only to a specific pandemic-era emergency rule that has expired.
Oregon Health Plan · Effective Sep 3, 2020Low impact
OHP coverage of home blood pressure monitoring services during the COVID-19 emergency
This is a historical policy (issued September 3, 2020, newly discovered October 6, 2026) that provided temporary Oregon Health Plan coverage of home blood pressure monitoring supplies (HCPCS A4760, A4670) and associated visit codes (CPT 99473, 99474) during the COVID-19 emergency without prior authorization. The policy established workflow requirements for prescription fulfillment, patient education, and monitoring protocols. Billing teams should verify whether this emergency coverage remains in effect or has been superseded by current OHP guidance, as the source does not specify an end date or current applicability.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Emergency fire response memorandum to CCOs
This is a historical emergency response memorandum from September 12, 2020, addressing Oregon Medicaid (Oregon Health Plan) CCO procedures during the September 2020 wildfire emergency. It provides guidance on FEMA reimbursement documentation, use of Health Related Services (HRS) funds for displaced member needs (medications, DME, housing, personal items), and coordination with local emergency management. This document was newly discovered on 2026-10-06 but describes an emergency response that concluded over 6 years ago; it is not current policy.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Extension of CCO enrollment limits waiver through June 30, 2021
This is historical material (published December 22, 2020; discovered October 6, 2026). Oregon Health Authority extended a waiver of CCO enrollment limits through June 30, 2021—a deadline that has already passed. The waiver allowed Coordinated Care Organizations to exceed county and total enrollment caps specified in their CCO 2.0 contracts. No current action is required; verify with your current CCO contract whether this waiver remains in effect or has been superseded.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Due date extensions for deliverables due in Q1 CY 2021
This is historical material (published January 19, 2021, discovered October 6, 2026) documenting due date extensions for Oregon Coordinated Care Organizations' Q1 2021 contract deliverables. Three FWA-related reports were extended from 1/31/2021 to 2/15/2021; Wraparound Policies and Procedures due date was extended to at least 30 days after evaluation criteria release (Previously due 1/31/2021 (date passed; verify current applicability)). All stated deadlines have long elapsed. Verify current applicability with Oregon Health Authority before taking any action.
Oregon Health Plan · Identified Oct 6, 2026Low impact
Extreme heat outreach to vulnerable and at-risk OHP members
This is a historical outreach directive from Oregon's Medicaid program (July 27, 2021) requesting coordinated care organizations to proactively contact vulnerable OHP members during predicted extreme heat events. It provides guidance on identifying at-risk populations, available cooling center resources, and communication tools—but does not establish new billing codes, coverage policies, reimbursement rates, or prior authorization requirements. No billing workflow changes are mandated.

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Healthier Oregon Transition Data Guidance for Prior Authorizations

New Provider Payment Dispute (PPD) Process Effective November 1, 2026

Why Stable Housing Matters for Better Health

Breast and Cervical Cancer Treatment Program Updates Related to Federal Changes

Waiver of CY 2026 REALD and SOGI data collection requirements

Care Coordination Data Guidance for the Healthier Oregon Transition

Health Related Social Needs (HRSN) Data Submission Guidance for Healthier Oregon Transition of Care

Notice of intent: OHA will amend the Medicaid State Plan to expand the Family Connects Oregon nurse home visiting program into Harney and Wallowa counties.

Notice of intent: OHA will amend the Medicaid State Plan to comply with several provisions of the Working Families Tax Cut Legislation

November 2026 Medicaid Drug List Change Notification

1915(i) Community Based Integrated Supports (CBIS) Authorization Process

Request for comment – Draft SUD 1115 Waiver Application - Comments due February 21, 2020

Provider Announcement

Fee-for-service hospice NF rates effective July 1, 2020 – June 30, 2021

Request for comment - State Plan Amendment to add CCBHC Program

OCC 1 override for fee-for-service prescriptions ends September 2, 2019

Request for Comment - State Plan Amendment to increase fee-for-service SUD rates

Request for comment - State Plan Amendment to increase TCM home visiting rate - Comments due November 1, 2019

MS-DRG and LTC-DRG updates and inpatient claim reprocessing

Request for Comment - Draft Medicaid State Plan Amendment to Align MH and SUD Services - Comments due Feb. 21, 2020

Change in reporting of member enrollment in Patient Centered Primary Care Homes 02242020

Clarification about Annual Training and Education Report due dates

Oregon Health Plan coverage of telemedicine services

Correction to 2019 notice about the State Plan Amendment to increase TCM home visiting rates

Request for Comment - Adding lactation consultants to Medicaid State Plan - Comments due April 16, 2020

Public notice - State Plan Amendment to expand Medicaid coverage of telehealth services

Changes to Hospital Presumptive Eligibility processes, effective immediately

DCBS-OHA Telehealth Guidance - Issued March 24 2020

Comagine Health is the Oregon Behavioral Health Independent Qualified Agent effective July 1, 2020

Public notice - State Plan Amendment to increase Medicaid ventilator rate for nursing facilities

Changes to DCO deliverable due dates due to COVID-19 response

Fee-for-service hospice rates effective April 1, 2020 through June 30, 2020

Telemedicine-telehealth billing guidance for Oregon Health Plan fee-for-service providers

Providing Culturally and Linguistically Appropriate Services During the COVID-19 Emergency

Transition to Comagine Health - New Independent Qualified Agent effective July 1, 2020

Oregon Health Plan coverage of COVID-19 antibody testing

Other Coverage Code (OCC) 1 override ends July 1, 2020

Conducting PASRR Level II evaluations during the COVID-19 emergency

Changes to ACA Section 1557 do not affect Oregon Health Plan coverage of gender transition services

CAC member selection deadline extended to September 30, 2020

Expired Oregon DMV credentials for NEMT drivers

Please send us your most recent Medicare Cost Reports by August 5, 2020

Short-term Medicaid stability loans for providers with reduced business caused by COVID-19

Oregon Health Plan coverage of COVID-19 testing

Clarification on DHS-mandated COVID 19 testing in long-term care facilities

OHP coverage of home blood pressure monitoring services during the COVID-19 emergency

Emergency fire response memorandum to CCOs

Extension of CCO enrollment limits waiver through June 30, 2021

Due date extensions for deliverables due in Q1 CY 2021

Extreme heat outreach to vulnerable and at-risk OHP members