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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_111814Notice of Rulemaking Hearing
AMEND: 410-141-0420 and OAR 410-141-3420
REPEAL: 410-141-0420(T) and OAR 410-141-3420(T)
PHP and CCO Payment Methodologies for A & B Hospitals
Rulemaking Hearing: November 18, 2014 at 10:30 AM, Room 137C
Last Opportunity for Public Comment: November 20, 2014, by 5 p.m. Send comments to: dmap.rules@state.or.us.
11/18/2014
Nprm-141-3060-111814Notice of Rulemaking Hearing
AMEND:  OAR 410-141-3060
REPEAL: OAR 410-141-3060(T)
Revise CCO Enrollment Requirement and Remove Sunset Date for Third Trimester Pregnancy Exemption
Last Opportunity for Public Comment: November 20, 2014, by 5 p.m. Send comments to dmap.rules@state.or.us
11/18/2014
141-0520-100114Temporary Rule Filing
OAR 410-141-0520
Amendment of HERC Prioritized List of Health Services Reflecting Approved Modifications Effective October 1, 2014
10/1/2014
141-changes-080114Permanent Rule Filing
410-141-0000, 410-141-0050, 410-141-0120, 410-141-0180, 410-141-0270, 410-141-0410, 410-141-0420, 410-141-0480, 410-141-0740, 410-141-3010, 410-141-3015, 410-141-3050, 410-141-3120, 410-141-3145, 410-141-3200, 410-141-3270
Amendment to Program Updates: Marketing, Benefits, Assessment Plan, Measures and Enrollment
The OHP program administrative rules govern the Division of Medical Assistance Programs’ payments for services provided to clients. The Division needs to permanently amend these rules to incorporate program updates, federal and state regulations, and housekeeping changes.
8/1/2014
141-0520-070114Permanent Rule Filing
OAR 410-141-0520
Amendment of HERC Prioritized List of Health Services Reflecting Approved Modifications Effective April 1, 2014
The OHP Program administrative rules govern the Division of Medical Assistance Programs’ payments for services provided to clients. The Division needs to amend 410-141-0520 to reference the Health Evidenced Review Committee (HERC) Prioritized List of Health Services January 1, 2011 through December 31, 2013. The HERC has made interim modifications and technical changes to the October 13, 2013 Prioritized List of Health Services. The changes will be effective April 1, 2014.
7/1/2014
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Administrative rulebooks

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141rb0801148/1/2014
141rb0701147/1/2014
141rb0601146/1/2014
141rb0404144/4/2014
141rb0401144/1/2014
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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 name.

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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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
Cost-to-Charge Ratios for Payment by Managed Care Plans, CY 20081/1/2008
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Forms

​​​
  
Description
  
DMAP 720

AI/AN Health Plan Disenrollment Request - For American Indian/Alaska Native clients who do not want to be enrolled in a DMAP medical, dental, or mental health plan.​

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​​​​​​​