MedicaidReimbursementHigh impact
OHA does not cover the fee-for-service per diem rate for days youth are not in residential care
Oregon Health Plan·OR · Psychiatry·Provider
Effective date
Aug 26, 2025
We identified it
Jun 20, 2026
Summary
Oregon Health Authority will no longer reimburse providers the per diem rate for days when youth are temporarily absent from residential psychiatric care, including home visits, missing status, or hospitalization. Providers can only bill the per diem rate if youth spend at least 8 hours in residential care and return by 11:59 PM the same day.
Action Required
Immediately: Billing team must update residential psychiatric billing procedures to only bill per diem rates when youth spend 8+ hours in facility and return by 11:59 PM same day. Stop billing per diem for absent days including home visits, missing status, or hospital stays. Begin billing outpatient codes for services provided during temporary absences. Update billing system rules and train staff on new 8-hour minimum requirement.