Text Size:   A+ A- A   •   Text Only
Find     
Site Image

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-141-021715-EnrollmentNotice of Rulemaking Hearing
410-141-0060 and 410-141-3060
Rewrite OHP Enrollment Rules to Reflect Current Enrollment Practices Including Full Pregnancy Enrollment Exemption Process
Rulemaking Hearing: February 17, 2015, 10:30 a.m., 500 Summer St. NE, Salem, OR 97301, Room 166
Last Opportunity for Public Comment: February 19, 2015 by 5 p.m.


2/17/2015
141-3060-010115-SunsetPermanent Rule Filing
410-141-3060
Revise CCO Enrollment Requirement and Removing Sunset Date for Third Trimester Pregnancy Exemption
1/1/2015
141-changes-010115 At Risk A and B HospitalsPermanent Rule Filing
410-141-0420 and 410-141-3420
PHP and CCO Payment Methodologies for At Risk A & B Critical Access Hospitals
1/1/2015
141-changes-010115-EnrollmentTemporary Rule Filing
410-141-0060 and 410-414-3060
Rewrite Enrollment Rules to Reflect Current Enrollment Practices Including Full Pregnancy Enrollment Exemption Process
1/1/2015
141-0520-123114NewPermanent Rule Filing
410-141-0520
Amendment of HERC Prioritized List of Health Services Reflecting Approved Modifications Effective Oct. 1, 2014
12/31/2014
1 - 5Next

Administrative rulebooks

​​​
  
  
141rb12281412/28/2014
141rb10011410/1/2014
141rb0801148/1/2014
141rb0701147/1/2014
141rb0601146/1/2014
1 - 5Next

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
1 - 5Next

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
1 - 5Next

Type A/B hospital reimbursement

​​​
  
  
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
1 - 5Next

Forms

​​​
  
Description
  
DMAP 720

AI/AN Enrollment Status Change Request - For American Indian/Alaska Native clients can use this form to change their current fee-for-service ("open card") or OHP health plan enrollment.​

English
OHP 7208M

​Medicare Advantage Plan Election​

English
OHP 7208M

​​Medicare Advantage Plan Election​

Spanish
OHP 7208M

Medicare Advantage Plan Election​

Vietnamese
OHP 7208M

Medicare Advantage Plan Election​

Russian
DMAP 2120

OHA Provider Discrimination Review Request (Word)​

English
DMAP 2120

OHA Provider Discrimination Review Request (PDF)​

English
DMAP 3165 (Word)

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

English
DMAP 3165 (PDF)

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

English
DMAP 3302 (PDF)

Service Denial and Hearing Request ​

English
DMAP 3302 - Large Print (PDF)

Service Denial and Hearing Request​

English
DMAP 3302 (PDF)

Service Denial Appeal and Hearing Request​

Spanish
DMAP 3302 (PDF)

Service Denial Appeal and Hearing Request​

Vietnamese
DMAP 3302 (PDF)

Service Denial Appeal and Hearing Request​

Russian
DMAP 3302 (Word)

Service Denial and Hearing Request Form​

English
DMAP 3302 - Large Print (Word)

Service Denial Appeal and Hearing Request​

English
DMAP 3302 (Word)

Service Denial Appeal and Hearing Request​

Spanish
DMAP 3302 (Word)

Service Denial Appeal and Hearing Request​

Vietnamese
DMAP 3302 (Word)

Service Denial Appeal and Hearing Request​

Russian
DMAP 2405 - English

Notice of Action - English template for OHP health plans (Word)​

English
DMAP 2405 - Spanish

Notice of Action - Spanish template for OHP health plans (Word)​

Spanish
DMAP 2405 - Vietnamese

Notice of Action - Vietnamese template ​for OHP health plans (Word)

Vietnamese
DMAP 2405 - Russian

Notice of Action - Russian template for OHP health plans (Word)​

Russian
DMAP 3165 (Word)

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

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

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

Russian
DMAP 3165 (PDF)

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

Russian
DMAP 3165 (Word)

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

Vietnamese
DMAP 3165 (PDF)

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

Vietnamese

Who to call for help

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