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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
  
NPRM-141-10172015Notice of Rulemaking Hearing
410-141-0000, 410-141-0080, 410-141-0160, 410-141-0220, 410-141-0320, 410-141-0340, 410-141-0420, 410-141-0860, 410-141-3080 and the repeal of 410-141-0085, 410-141-0410, 410-141-0660, 410-141-0680, 410-141-0700, 410-141-0720, 410-141-0740, 410-141-0760, 410-141-0780, 410-141-0800, 410-141-0820, 410-141-0840
PCCM Program Dissolution of Rules and Program References
This is not a rulemaking hearing.
The end of the public comment period is October 17, 2015 by 5 p.m.
10/17/2015
Nprm-141-0000-09172015Notice of Rulemaking Hearing
410-141-0000
Consolidation of Managed Care Organization Definitions into Chapter 410-120-0000 General Programs Definition Rule
This is rulemaking, not a rulemaking hearing.
Last opporotunity for public comment: Sept. 17, 2015 by 5 p.m.
Send comments to: dmap.rules@state.or.us.
9/17/2015
NPRM-120-148-09172015Notice of Rulemaking Hearing
Update International Classification of Diseases Coding from ICD-9 to ICD-10
This is not a rulemaking hearing; however, the public comment period will end September 17, 2015, at 5 p.m.
You may submit comments to dmap.rules@state.or.us.
9/17/2015
141-3066-09012015Permanent Rule Filing
410-141-3066
CCO Enrollment for Adults and Young Adults Receiving Temporary Out-of-Area Behavioral Health Treatment
9/1/2015
141-3066-08182015Notice of Rulemaking Hearing
410-141-3066
CCO Enrollment for Adults and Young Adults Receiving Temporary Out-of-Area Behavioral Health Treatment
Rulemaking hearing: August 18, 2015 at 10:30 a.m.
Last opportunity for public comment: August 20, 2015 by 5 p.m.
Send comments to: dmap.rules@state.or.us
8/18/2015
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Administrative rulebooks

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141rb0301153/1/2015
141rb0101151/1/2015
141rb12281412/28/2014
141rb10011410/1/2014
141rb0801148/1/2014
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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 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
Cost-to-Charge Ratios for Payment by Managed Care Plans, CY 20091/1/2009
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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​​​​​​​