Enrolling with Oregon Medicaid

For information on Medicaid in Oregon refer to the Oregon Health Authority Division of Medical Assistance Programs’ Oregon Administrative Rules.

Provider Enrollment

  1. Complete the following RHC enrollment forms: DMAP 3104, OHA 3972, OHA 3974 & OHA 3975. (Available at: OHP Provider Enrollment)

  2. Include:
  3. Submit all of the above to the OHA Medical Assistance Program (MAP): Jamal Furqan | 503-945-6683 | .

RHC Rate Calculation and Increases

Initial RHC Rate Determination
The Medicare Cost Report informs the RHC rate calculation, which will set the clinic’s Medicaid RHC encounter rate. This rate is adjusted annually based on the Medicare Economic Index (MEI). The RHC will be enrolled with Oregon Medicaid on the date the PPS encounter rate is determined.

Oregon Medicaid Change in Scope
A change in the scope of RHC services may occur if the RHC has added, dropped or expanded any service that meets the definition of an RHC service. Full details (OAR 410-147-0362). If you have a change in scope which has significantly changed the cost of services, you may request a change of scope in order to qualify for a readjusted rate.

  1. Submit a narrative outlining the proposed qualifying events for a change in scope to the OHA-MAP: Jamal Furqan | 503-945-6683 | .

  2. OHA-MAP will review for qualifying events and request information on the events and associated costs.

  3. OHA-MAP will work with the clinic to agree upon qualifying events, cost changes and a new rate.

Oregon Medicaid and Coordinated Care Organizations (CCOs)

All clinics, including RHCs, will need to contract with their local CCOs in order to receive Medicaid reimbursement and wrap-around payments for patients enrolled in CCO insurance plans. Contact your local CCO about providing services for CCO patients.

CCO reimbursement rates cannot be less than your calculated RHC encounter rate however full reimbursement may require participating in the “Wrap-around” payments through OHA. Please see RHC Coding and Billing Resources for further details. Please contact OHA-MAP to assure you are receiving your full reimbursement for OHP encounters: Jamal Furqan | 503-945-6683 | .