Skip to main content

Oregon State Flag An official website of the State of Oregon » Homepage

Network Adequacy - Time and Distance Rules for Providers

Network Adequacy

The CCO Quality Assurance team works to ensure health plans meet network adequacy rules.

You may have seen the term "network adequacy" but what does that really mean? Each health plan has a group of doctors and other providers they work with. This group is called a network. Network adequacy means making sure people have access to health care providers. The heart of network adequacy is this one question: Is the care you need available where and when you need it?

Health plans that serve OHP members must follow rules the state makes about how long it takes you and how far you have to go to see your provider. It matters where you live and where your provider works.
OHA is making changes to the network adequacy rules for OHP.  Click on the boxes below to learn more about the proposed changes.

Please contact

Oregon has made changes to the network adequacy rules for OHP with a focus on standards for how long it should take most CCO members to get to different types of providers or services.

These changes were made using considerable feedback from members, community partners, and health plans. OHA made changes based on this feedback and a variety of data sources (for example: claims and encounter data). 

You can see the results of the feedback survey that closed April 3, 2023 in the menu to the right. 

To help those interested in tracking the changes over time, OHA has posted its slides from network standards presentations. Also available is a description of changes to the proposed standards. See documents below.


Changes as of 01/01/2024 are:

New area types

OHA expanded the rules from two area types: urban and rural, to four area types. OHA thought that two area types are not enough to describe Oregon's geography. Here is our new list of area types:

  • County with Extreme Access Considerations (orange) - Counties with 10 or fewer people per square mile.
  • Rural (blue) - More than 10 miles from the center of an urban area.
  • Urban(green) - More than 40,000 people in a 10 mile radius.
  • Large Urban Areas(purple) - Connected urban areas with 1 million people or with more than 1,000 people per square mile.

Network Adequacy Map


The rules are different based on the provider you need to see and the area you live in.  OHA is created tighter time and distance standards for providers that members usually see more often. These providers are "Tier 1" providers.  Primary Care Providers are considered “Tier 1".  A specialty provider that not all members need is a "Tier 2" or "Tier 3" provider. A Dermatologist, for example, is in "Tier 3". 

The charts below lists the time and distance tiers in minutes or miles and the provider or service types by tier. 

Large Urban Urban Rural County with Extreme Access Considerations
Tier 1
10 mins or
 5 miles
25 mins or
15 miles
30 mins or
20 miles
40 mins or
30 miles
Tier 2
20 mins or
10 miles
30 mins or
20 miles
75 mins or
60 miles
95 mins or
85 miles
Tier 3
30 mins or
15 miles
45 mins or
30 miles
110 mins or
90 miles
140 mins or
125 miles

Tier 1 Primary Care, Primary Care Dentistry, Mental Health, Pharmacy, SUD Treatment
Tier 2 Cardiology, Durable Medical Equipment, Hospital, Methadone Clinic, Neurology, Obstetrics and Gynecology, Occupational Therapy, Medical Oncology, Radiation Oncology, Ophthalmology, Optometry, Physical Therapy, Podiatry, Psychiatry, Speech Language Pathology
Tier 3 Allergy & Immunology, Dermatology, Endocrinology,  Gastroenterology, Hematology, Nephrology, Otolaryngology, Pulmonology, Rheumatology, Skilled Nursing Facility, Urology

​Heath plans serving OHP members are responsible for helping members get the care they need. That means that even if the provider or service is not listed in the chart above, your health plan should still help you get access to covered benefits and services. 

OHA has received considerable feedback from members, community partners, and health plans. OHA is dialing in its proposed changes based on this feedback and a variety of other data sources (for example: claims and encounter data). 

If you are interested in tracking the changes over time, see the documents below:

The links below will open a .pdf of the presentation.
For the Contracts and Compliance meetings, full recordings of the meetings are available on the CCO Contracts and Compliance Workgroup Archive site.

Topic Meeting Location Date Presented
  Network Adequacy and RAC Overview
  CCO Contracts and Compliance
  Network Adequacy Rule Changes
  CCO Ops Collaborative
  CCO Contracts and Compliance
  Ombuds Advisory Council
  Network Monitoring
  CCO Contracts and Compliance
  Time and Distance Tiers
  CCO Contracts and Compliance
  Network Adequacy Standards Updates
  Medicaid Advisory Council - Advancing   Consumer Experience subcommittee
  Geographic Regions​
  CCO Contracts and Compliance
  Provider Specialty Matrix  CCO Contracts and Compliance
  ​CCO Network Adequacy Proposed Standards  Changes
  CCO Presentation
  ​Network Adequacy Standards Updates
  Oral Health Forum
  ​Proposed Network Adequacy Standards and  Timelines for 2023/2024
  CCO Contracts and Compliance
  Proposed Network Adequacy Standards and  Timelines for 2023/2024  Medicaid Advisory Council - Advancing   Consumer Experience subcommittee
  ​Network Adequacy Changes
  Workforce Committee
  ​Network Adequacy Updates
  Ombuds Council
  ​Network Adequacy Changes
  Medicaid Advisory Council - Advancing   Consumer Experience subcommittee
  Proposed ​Network Adequacy Changes
  Ombuds Council

The following documents are references to OHA's methodology in developing the proposed TIme and Distance standards. 


Survey results

OHA shared a survey about changes to Network Adequacy rules, which closed on April 3, 2023. Please see the dashboards below for survey results.

Please note: OHA also created a Spanish language version of the Time & Distance survey, but did not receive any responses.

Read the current rules

Time and distance requirements are outlined in Oregon Administration Rule 410-141-3515.

Questions? Please contact us at

Quality Assurance homepage