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Medical Assistance (General Rules) Program

Medical Assistance (General Rules) Program

Oregon Administrative Rules and supplemental information administered by the Health Systems Division.

Recent rule filings

You can sort or filter by document type or effective date. You can also view Medical Assistance (General Rules) Program rules as filed with the Secretary of State (please note that rules filed by the first of the month will not be posted on the Secretary of State website until the middle of the filing month).

  
  
File Description
  
Nprm-120-1230-12202016Notice of Rulemaking Hearing
410-120-1230, 1230-1 Table
Client Copayment
Rulemaking Hearing: December 20, 2016, 10:30 a.m., Room 160
Last Opportunity for Public Comment: December 22, 2016, by 5 p.m.
Send comments to: hsd.rules@state.or.us.
12/20/2016
Nprm-125-120-12202016Notice of Rulemaking Hearing
410-125-0085, 410-125-0360, 410-120-0000
Adding Definition of Psychiatric Emergency Services and Its Reimbursement Method to General and Hospital Rules
Rulemaking Hearing: December 20, 2016, 10:30 a.m., Room 160
Last Opportunity for Public Comment: December 22, 2016, by 5 p.m.
Send Comments to: hsd.rules@state.or.us.
12/20/2016
125-120-changes-11102016Temporary Rule Filing
410-125-0085, 410-125-0360, 410-120-0000
Adding Definition of Psychiatric Emergency Services and Its Reimbursement Method to General and Hospital Rules
11/10/2016
120-0006-10012016Permanent Rule Filing
410-120-0006
Align with Department of Human Services OAR Chapter 461 Rules
10/1/2016
Nprm-120-0006-09192016Notice of Proposed Rulemaking
410-120-0006
Align with Department of Human Services OAR Chapter 461 Rules
This is not a rulemaking hearing.
Last opportunity for written public comments: September 19, 2016, by 5 p.m.
Send comments to: hsd.rules@state.or.us.
9/19/2016
1 - 5Next

Administrative rulebooks

Each rulebook is an interactive PDF that contains all program rules effective on the "Effective Date" listed for the rulebook.

  
  
120rb11101611/10/2016
120rb10011610/1/2016
120rb0901169/1/2016
120rb0801168/1/2016
120rb0701167/1/2016
1 - 5Next
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Supplemental information and guidelines

Provider guides

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Prior Authorization Handbook
General Rules Provider Guide, 9-26-2014
Paving the Road to Good Health
EPSDT Coverage Guide
Employee Education about False Claims Recoveries

Fraud and abuse authorities

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Answer
You can also report fraud online. For more information, see the DHS frequently asked questions about reporting fraud.
 
Medicaid Fraud Control Unit (MFCU)
1515 SW 5th Avenue, Suite 410, Portland, OR 97201
Phone (971) 673-1880, or fax (971) 673-1890
Provider Audit Unit (PAU)
3406 Cherry Ave NE, Salem, OR 97303
Phone (888) 372-8301, or fax (503) 378-2577
Fraud Investigations Unit (FIU)
P.O. Box 14150, Salem, OR 97309-5027
Phone (888) 372-8301, or fax (503) 373-1525


Other resources

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Upcoming Oregon Health Plan changes
Provider Tips - Billing Clients
Oregon Medicaid Third Party Liability Requirements
Provider Tips - OHP and QMBs
Oregon primary care providers and procedure codes
Eligibility Group categories
Questions and answers about client co-payments
2014 federal primary care codes and rates
Sample Oregon Health ID (formerly Medical Care ID)
2013 federal primary care codes and rates
Provider Discrimination Review Process

Forms

  
  
OHP 1074OHP 1074 - Prior Authorization for Out-of-State Services
OHP 3035OHP 3035 - Provider Information Update
OHP 3113OHP 3113 - Provider Enrollment Short Form
OHP 3162OHP 3162 – AVR Quick Reference Guide
OHP 3161OHP 3161 - PWP eligibility verification screen
MSC 3970MSC 3970 - EDMS Cover Sheet
OHP 3085OHP 3085 - Request for Claim or Payment Authorization Review
OHP Provider Enrollment FormsOHP Provider Enrollment Forms
OHP 3165OHP 3165 - OHP Client Agreement to Pay for Health Services
OHP 3165OHP 3165 - OHP Client Agreement to Pay for Health Services
OHP 3165OHP 3165 - OHP Client Agreement to Pay for Health Services
OHP 3165OHP 3165 - OHP Client Agreement to Pay for Health Services

Who to call for help

Provider Services 800-336-6016 or email us
Address and telephone contacts

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