MedicaidPrior AuthMedium impact
Children’s Psychiatric Residential Treatment Facility emergency admission procedure
Oregon Health Plan·OR · Psychiatry, Pediatrics·Plan
Effective date
Mar 13, 2026
We identified it
Jun 20, 2026
Summary
Oregon Medicaid has clarified emergency admission procedures for Psychiatric Residential Treatment Facilities (PRTFs) for children, establishing specific criteria that must be met and requiring completion of certification of need for services (CONS) within 14 days of emergency admission. The policy affects billing documentation and prior authorization requirements for PRTF services.
Action Required
Within 14 days of any PRTF emergency admission: Complete certification of need for services (CONS) documentation with team signatures and credentials. For fee-for-service members, submit retroactive authorization requests to Comagine Health within 14 days including emergency justification documentation, CONS, cover sheet with provider IDs, recipient Medicaid ID, service dates, procedure codes, and units requested. Update intake procedures to verify all three emergency criteria are met before admitting patients.