summary
Introduced
02/02/2026
02/02/2026
In Committee
02/02/2026
02/02/2026
Crossed Over
Passed
Dead
Introduced Session
Potential new amendment
2026 Legislative Measures
Bill Summary
The statement includes a measure digest written in compliance with applicable readability standards. Digest: The Act changes how OHA decides which health services are covered in the state Medicaid program. (Flesch Readability Score: 63.6). Removes provisions relating to the use of the prioritized list of health services in the state medical assistance program. Requires the Oregon Health Authority to establish a definition of medical necessity and medical necessity criteria. Requires the Health Evidence Review Commission to develop and maintain clinical coverage policies that are consistent with the authority’s definition of medical necessity and with federal laws governing mandatory and optional medical assistance services. Declares an emergency, effective on passage.
AI Summary
This bill, declared an emergency measure effective upon passage, fundamentally alters how the Oregon Health Authority (OHA) determines which health services are covered under the state's Medicaid program, moving away from a "prioritized list of health services" compiled by the Health Evidence Review Commission (HERC) to a system based on a defined definition of "medical necessity" and "medical necessity criteria." The OHA is now required to establish these definitions, while the HERC will develop and maintain "clinical coverage policies" that align with the OHA's medical necessity standards and federal laws governing Medicaid services. This change aims to streamline decision-making regarding covered services and ensure consistency with federal requirements, impacting how health services are evaluated and funded within the state's medical assistance program.
Committee Categories
Health and Social Services
Sponsors (1)
Last Action
House Health Care Work Session (15:00:00 2/12/2026 HR 60) (on 02/12/2026)
Official Document
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