Learn how the Prioritized List of Health Services helps determine what services the Oregon Health Plan (OHP) covers.
For detailed information about the creation of the Prioritized List, see the Health Evidence Review Commission's (HERC) Brief History of Health Services Prioritization in Oregon or the biennial reports to the Oregon legislature on the HERC reports page.
How the Prioritized List works
The Oregon Health Evidence Review Commission (HERC) ranks health care condition and treatment pairs in order of clinical effectiveness and cost-effectiveness.
The Prioritized List emphasizes prevention and patient education. In general:
Treatments that help prevent illness are ranked higher than services that treat illness after it occurs.
OHP covers treatments that are ranked on a covered Prioritized List line for the client's reported medical condition.
Effective Jan. 1, 2012, the OHP covers Prioritized List lines 1 through 498.
Where to find past, current and proposed Prioritized Lists
Use the following links on the HERC Web site. You can also eSubscribe to receive e-mail updates from HERC whenever Prioritized List information changes or view all recent HERC updates.
Information for OHP providers
For DMAP policies related to Prioritized List coverage or exclusions, see the General Rules, Oregon Health Plan rules, and the provider guidelines specific to your program.
To find out whether a specific procedure is potentially covered according to the Prioritized List, use the HSC List inquiry on the Provider Web Portal at https://www.or-medicaid.gov or call the Benefit RN Hotline at 800-393-9855 or 503-945-5939 (Salem).