Oregon sets up payments for reproductive health providers

The Oregon Health Authority must set up a system to pay eligible providers for services on a fee-for-service basis. Eligible providers are nonprofit reproductive health care providers enrolled in Oregon’s medical assistance program but not eligible for federal Medicaid funds. The authority cannot use federal Medicaid money for these payments. For services provided on or after July 4, 2025, a claim qualifies only if it cannot receive federal funding and the provider has not yet been paid. The authority must align provider enrollment and credentialing with existing program standards and review payment rates at least once every two years. The payment rule applies to qualifying claims for services provided on or after July 4, 2025.

A coordinated care organization may recover an overpayment for routine business reasons, but not solely because the provider cannot receive federal Medicaid funds. This rule covers claims that a coordinated care organization paid to a provider defined in the law. The limit does not prevent recovery for routine business reasons. The rule covers claims paid from July 4, 2025, through March 31, 2026, and ends January 2, 2028.

The Oregon Health Authority must run a grant program to help eligible providers cover service costs. The grant program covers providers that meet the law’s nonprofit, 2023 payment, and federal-funding limits. The program operates only if a state or federal government action bars the defined providers from staying enrolled in Oregon’s medical assistance program. Eligible providers must be nonprofit reproductive health care providers that received more than $800,000 in Medicaid reimbursements in 2023 and cannot receive federal Medicaid funds. The authority cannot use federal Medicaid money for grants. When practicable, a grant must match the amount the provider would receive through fee-for-service payments. The grant program becomes active on the effective date of the state or federal action that bars the defined providers from program enrollment.