Bill > HB2225

This bill requires the Oregon Health Authority (OHA) and Coordinated Care Organizations (CCOs) to establish and maintain minimum reimbursement rates for specific healthcare providers serving medical assistance recipients, starting January 1, 2026. The bill defines four primary types of providers - primary care, optometry, dental care, and behavioral health providers - and sets their minimum reimbursement rates using a standardized method based on a conversion factor of $85 multiplied by a resource-based relative value unit (RBVU), which is a standard measurement used by Medicare to determine service costs. For dental and behavioral health services, providers will be reimbursed at either the calculated RBVU rate or a percentage of the average health insurer rate (100% for dental and 150% for behavioral health). The reimbursement rates will increase by 3.4% annually, and CCOs must spend their allocated budgets specifically on these service types. The bill also requires the OHA to monitor the impact of these changes over four years and submit a report by December 31, 2031, assessing improvements in wait times, provider choice, health worker employment, health outcomes, and overall program costs. Additionally, the OHA must seek federal approval for these reimbursement changes, and the provisions will only become operative upon receiving federal approval.

Health and Social Services

https://olis.oregonlegislature.gov/liz/2025R1/Measures/Overview/HB2225