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Oregon Health Plan (MCO and CCO) Program

Oregon Health Plan (MCO and CCO) Program

Oregon Administrative Rules and supplemental information administered by the Division of Medical Assistance Programs.

Recent rule filings

You can sort or filter by document type or effective date. You can also view OHP (MCO and CCO) 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
  
141-3345-03012016Permanent Rule Filing
410-141-3345
General Financial Reporting and Financial Solvency Matters; CCO Reporting Method
3/1/2016
Nprm-141-0520-021916Notice of Proposed Rulemaking
410-141-0520
Prioritized List, Effective 1/1/16, including Modifications Effective 10/1/15 and Biennial Changes January 1, 2016-December 31, 2017
This is a rulemaking, not a rulemaking hearing.
Last opportunity for public comment is February 19, 2016 at 5 p.m.
Send comments to dmap.rules@state.or.us.
2/19/2016
Nprm-141-3345-01202016Notice of Rulemaking Hearing
410-141-3345
General Financial Reporting and Financial Solvency Matters; CCO Reporting Method
Rulemaking Hearing: January 20, 2016 at 10:30 a.m. Room 160
Last Opportunity for Public Comment: January 22, 2016 by 5 p.m.
Send Comments to: dmap.rules@state.or.us
1/20/2016
141-3040-01072016Permanent Rule Filing
410-141-3040
Service Area Change for Existing CCOs
1/7/2016
141-changes-01012016Temporary Rule Filing
410-141-3060, 410-141-3080
Amend CCO Enrollment and Disenrollment Rules Aligning Current Practices and Pregnancy Enrollment Exemption Processes
1/1/2016
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Administrative rulebooks

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141rb0107161/7/2016
141rb0101161/1/2016
141rb12271512/27/2015
141rb12101512/10/2015
141rb11061511/6/2015
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Supplemental information and guidelines

Also visit the OHP Tools for Health Plans, DHS Managed Care Tax Rules and Forms, and Prioritized List of Health Services websites.

Guidelines

  
CCO Provider Change Request Guide
Employee Education about False Claims Recoveries
Encounter Data Submission Guidelines

Drug Carve out

  
7-11 Drug Carveout List, February 2014
7-11 Drug Carveout List, November 2013
7-11 Drug Carveout List, October 2013
7-11 Drug Carveout List, September 2013
7-11 Drug Carveout List, June 2013
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Other resources

  
Questions and answers about client co-payments
Oregon Long-Term Care Services Fact Sheet
Facts about managed care organization drug rebates
Clarification and guidance regarding coverage of therapy services for school children


Hospital reimbursement

You can sort or filter by effective date.

DRG hospital reimbursement

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FCHP Non-Contracted Reimbursement Rates, 1-1-20071/1/2007
FCHP Non-Contracted Reimbursement Rates, CY 20061/1/2006
FCHP Non-Contracted Reimbursement Rates, 10-1-200510/1/2005
FCHP Non-Contracted Reimbursement Rates, 6-1-20056/1/2005
FCHP Non-Contracted Reimbursement Rates, 10-1-200410/1/2004
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Type A/B hospital reimbursement

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CCO-PHP Reimbursement Rates, CY 20161/1/2016
CCO-PHP Reimbursement Rates, CY 20151/1/2015
Cost-to-Charge Ratios for Payment by Managed Care Plans, FFY 201210/1/2011
Cost-to-Charge Ratios for Payment by Managed Care Plans, CY 20111/1/2011
Cost-to-Charge Ratios for Payment by Managed Care Plans, CY 20101/1/2010
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Forms

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Description
  
OHP 7208M

​Medicare Advantage Plan Election​

English
OHP 7208M

​​Medicare Advantage Plan Election (Spanish)​

Spanish
OHP 7208M

Medicare Advantage Plan Election (Vietnamese)​

Vietnamese
OHP 7208M

Medicare Advantage Plan Election (Russian)​

Russian
DMAP 2120

OHA Provider Discrimination Review Request​

English
DMAP 3165

​OHP Client Agreement to Pay for Health Services​

English
DMAP 3302

Service Denial and Hearing Request Form​

English
DMAP 3302

Service Denial Appeal and Hearing Request (English large print)​

English
DMAP 3302

Service Denial Appeal and Hearing Request (Spanish)​

Spanish
DMAP 3302

Service Denial Appeal and Hearing Request (Vietnamese)​

Vietnamese
DMAP 3302

Service Denial Appeal and Hearing Request (Russian)​

Russian
DMAP 2405

Notice of Action - English template for OHP health plans​

English
DMAP 2405

Notice of Action - Spanish template for OHP health plans​

Spanish
DMAP 2405

Notice of Action - Vietnamese template ​for OHP health plans

Vietnamese
DMAP 2405

Notice of Action - Russian template for OHP health plans​

Russian
DMAP 3165
OHP Client Agreement to Pay for Health Services (Spanish)​​
Spanish
DMAP 3165

OHP Client Agreement to Pay for Health Services​ (Russian)​

Russian
DMAP 3165

OHP Client Agreement to Pay for Health Services​ (Vietnamese)​

Vietnamese

Who to call for help

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