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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 Health Systems Division.

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
  
Nprm-141-3110-061516Notice of Rulemaking Hearing
410-141-3110
CCO Substance Use Disorder Provider, Treatment and Facility Certification and Licensure
Rulemaking Hearing: June 15, 2016, 10:30 a.m. Room 137B
Last opportunity for public comment: June 17 by 5 p.m.
Send comments to: dmap.rules@state.or.us
6/15/2016
Nprm-141-3262-061516Notice of Rulemaking Hearing
410-141-3262
Requirements for CCO Appeal
Rulemaking Hearing: June 15, 2016, 10:30 a.m., Room 137B
Last opportunity for public comment: June 17, 2016, by 5 p.m.
Send comments to: dmap.rules@state.or.us
6/15/2016
Nprm-141-3070-06152016Notice of Rulemaking Hearing
410-141-3070
Preferred Drug List Requirements
Rulemaking Hearing: June 15, 2016, 10:30 a.m., Room 137B
Last opportunity for comments: June 17, 2016, by 5 p.m.
Send comments to dmap.rules@state.or.us
6/15/2016
Nprm-141-061516Notice of Rulemaking Hearing
410-141-3060 and 410-141-3080
Amend CCO Enrollment and Disenrollment Rules Aligning Current Practices and Pregnancy Enrollment Exemption Processes
Rulemaking Hearing: June 15, 2016, 10:30 a.m. Room 137B
Last Opportunity for Public Comments: June 17, 2016, by 5 p.m.
Send Comments to: dmap.rules@state.or.us.
6/15/2016
Nprm-141-0000-06152016Notice of Rulemaking Hearing
410-141-0000
Definition Addition of Managed Care Entity (MCE)
Rulemaking Hearing: June 15, 2016, 10:30 a.m. Room 137B
Last Opportunity for Public Comment: June 17, 2016, by 5 p.m.
Send Comments to: dmap.rules@state.or.us.
6/15/2016
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Administrative rulebooks

​​Each rulebook is an interactive PDF that contains all program rules effective on the "Effective Date" listed for the rulebook.
  
  
141rb0301163/1/2016
141rb0107161/7/2016
141rb0101161/1/2016
141rb12271512/27/2015
141rb12101512/10/2015
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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

​​​
  
  
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

​​​
  
  
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

​​​
  
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
OHP 2120

OHA Provider Discrimination Review Request​

English
OHP 3165

​OHP Client Agreement to Pay for Health Services​

English
OHP 3302

Service Denial and Hearing Request Form​

English
OHP 3302

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

English
OHP 3302

Service Denial Appeal and Hearing Request (Spanish)​

Spanish
OHP 3302

Service Denial Appeal and Hearing Request (Vietnamese)​

Vietnamese
OHP 3302

Service Denial Appeal and Hearing Request (Russian)​

Russian
OHP 2405

Notice of Action - English template for OHP health plans​

English
OHP 2405

Notice of Action - Spanish template for OHP health plans​

Spanish
OHP 2405

Notice of Action - Vietnamese template ​for OHP health plans

Vietnamese
OHP 2405

Notice of Action - Russian template for OHP health plans​

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

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

Russian
OHP 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​​​​​​​