Oregon Health Authority's proposed rules, therapy program notice, and Benefit Update Project guidance
Oregon occupational therapy practices have two days to weigh in on a Medicaid proposal that would remove funding-line references from the state's therapy coverage rules. Written comments close October 21 at 5 p.m. Pacific; a virtual hearing is scheduled October 20 from 2 to 2:45 p.m. Pacific.
In brief
- The public-comment deadline is October 21 at 5 p.m. Pacific, with a virtual hearing the day before.
- The proposed OT amendments retain referral, plan-of-care, and authorization provisions.
- OHA says the broader January 2027 transition will preserve existing benefits and cover medically necessary treatment for more conditions.
Why the funding line is changing
For decades, Oregon has ranked conditions and treatments on a Prioritized List, with a legislative funding line separating services generally covered by the Oregon Health Plan from those generally outside coverage. The state says federal officials required it to phase out that waiver authority by January 1, 2027.
The Benefit Update Project shifts coverage into Medicaid benefit categories recorded in the State Plan. OHA says members will retain their existing benefits and gain medically necessary treatment for more conditions, including tension headaches and fibromyalgia. Some services will continue to require approval from OHA or a coordinated care organization, the regional health plans known as CCOs.
What the OT proposal preserves
The September 30 filing amends four rules governing physical and occupational therapy. In the coverage exclusions, it removes the word 'funded' before diagnosis and updates references to the OHA Prioritized List. Companion edits remove funding-line wording from prepayment review.
The proposed text retains practitioner referrals, signed plans of care and medical-appropriateness requirements. It also retains visit and authorization provisions, including separate instructions for CCO members. The filing is a proposal; practices should continue using current requirements while the rulemaking proceeds.
A useful check before Wednesday
For clinics preparing comments, a useful starting point is a recent denial tied to the funding line. Compare the reason given with the proposed language, then ask how the same request would be reviewed in January. A concrete example can expose uncertainty about the evidence a therapist needs to submit or the office responsible for a decision.
Practice owners can also ask their CCO contacts when updated authorization instructions will arrive. Patients need an explanation of the coverage decision that applies to their own care; the statewide transition alone cannot settle an individual request.
OHA's therapy program page directs written comments to medicaid.rules@oha.oregon.gov and says submissions will be posted publicly. The hearing link is in the proposed-rule notice. Clinicians submitting examples should remove patient identifiers.