What types of policy changes does Oregon Health Plan issue?

Oregon Health Plan regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Oregon Health Plan update its policies?

Oregon Health Plan typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Oregon Health Plan policy changes are tracked here?

This page currently tracks 50 documented Oregon Health Plan policy changes. New items are added as they are identified.

What should I do when Oregon Health Plan changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Oregon Health Plan Policy Changes 2026 | Prior Auth & Coverage Updates

Oregon Health Plan Policy Changes & Prior Auth Updates

We track 50 documented policy changes from Oregon Health Plan across OR. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Oregon Health Plan notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Oregon Health Plan updates automatically.

Medium impact

Comagine Health Provider Portal required for most 1915(i) HCBS residential referrals effective July 1, 2026

Oregon Health Plan·Effective Jul 1, 2026

Starting July 1, 2026, Oregon Health Authority requires most 1915(i) Home and Community Based Services (HCBS) residential providers to submit referrals through the new Comagine Health Provider Portal instead of current methods. This affects residential service providers, Community Mental Health Programs, Secure Residential Treatment Facilities, Young Adults in Transition providers, and non-Medicaid residential providers.

Board-Registered Behavioral Health Associates and Mental Health Interns

Rulemaking for Board-Registered Behavioral Health Associates

Anticipated Impacts of H.R.1 and other federal changes on Oregon’s CCOs

Notice of Intent – OHA will submit Oregon’s Medicaid Phase-out Plan for the Waiver Authority Related to the Prioritized List

Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service rates for certain youth intensive treatment services.

Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service rates for family planning services.

Youth intensive treatment services rate changes

Rate increases for family planning visits and vasectomies effective July 1, 2026.

Comagine Health Provider Portal required for most 1915(i) HCBS residential referrals effective July 1, 2026

Notice of intent: OHA will add clinical coverage criteria to the Medicaid State Plan.

Reconciling of The ASAM Criteria, Third Edition and The ASAM Criteria, Fourth Edition – Updated Timeline

Rulemaking for Board-Registered Behavioral Health Associates

Health-Related Social Needs (HRSN) Nutrition-Related Supports updates

Notice of intent: OHA will amend the Medicaid State Plan 1915(k) state plan option - Comments due June 5, 2026

APCM Updates (NeCR Pilot and APCM Quality Metrics Report)

Notice of intent: OHA will amend the Medicaid State Plan to renew the 1915(i) state plan option - Comments due May 29, 2026

New process for non-response to licensing information requests, effective June 1, 2026

High-Cost Drug Carve-Out policy effective Jan. 1, 2026

Addressing discrepancies in the supplemental OHP dental codes list

Next steps for processing suspended Nurse-Family Partnership program claims

Fee-for-service hospice rates and nursing facility rates effective Oct. 1, 2025

Update # 4 regarding Planned Parenthood claims memo 09162025

OHA does not cover the fee-for-service per diem rate for days youth are not in residential care

Planned Parenthood claims

Changes to state match for Nurse-Family Partnership program

Updates and reminders about BRS authorization requirements

2025 fee-for-service rates for handicapping malocclusion services

Changes to Hospital Presumptive Eligibility processes, effective immediately

Notice of intent – OHA will amend the Medicaid State Plan to increase the rate for Freestanding Birth Centers.

Changes to SRTF concurrent stay authorization timeframes effective June 1, 2026

Legal authority for signing BRS Consent to Care and release of information (ROI) forms

Updates to CH-006 Referral Form

Update to timeframe for making HRSN service authorization decisions

Billing guidance for obstetric services provided by FQHCs and RHCs

Children’s Psychiatric Residential Treatment Facility emergency admission procedure

Service Authorizations for Health-Related Social Needs Services

Claim formats for CCO-contracted Out-of-Hospital Birth services providers

Resolving conflicts between OARs 410-130-0700 and 410-130-0220

Notice of intent – OHA will amend the Medicaid State Plan to reimburse two drug therapies for sickle cell disease at Actual Acquisition Cost.

Waiver of select CY 2026 Value Based Payment requirements

Fee-for-service billing criteria for immunization counseling, effective Jan. 1, 2026

Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service rates for dental services

2026 handicapping malocclusion risk corridor and fee-for-service rates

Notice of intent – OHA will amend the Medicaid State Plan to add art therapist as an allowable provider type - Comments due Jan. 23, 2026

Updates to Medicaid Post-Hospital Extended Care Benefit, effective Jan. 1, 2026

Behavioral Health Fee Schedule rate adjustments effective Jan. 1, 2026

Young Adults with Special Health Care Needs eligibility changes effective Jan. 1, 2026

Price increase for eyeglass lenses and frames effective Jan. 1, 2026

Clarification on mental health billing for peer-delivered services

Notice of intent: OHA will amend the Medicaid State Plan to increase the rate for two newborn procedure codes.