Bill > HB4028

This bill, effective January 1, 2027, establishes new regulations for how insurers, coordinated care organizations (CCOs), and the Oregon Health Authority (OHA) conduct audits of behavioral health treatment claims, which include mental health and substance use disorder services but exclude those provided in hospitals or hospital-affiliated clinics. Insurers must provide providers with clear, plain-language descriptions of claim requirements and notify them at least 30 days in advance of any changes to these requirements, with audits generally limited to claims within the last 12 months (or six years for suspected fraud) and requiring behavioral health professional review. CCOs and OHA have similar audit limitations, with a three-year lookback period for paid claims unless fraud is suspected, and audits must be completed within 180 days unless the provider causes delays. The bill also mandates that certain carriers annually report to the Department of Consumer and Business Services (DCBS) on their compliance with behavioral health parity requirements, ensuring that mental health and substance use disorder benefits are treated comparably to medical and surgical benefits.

Health and Social Services

https://olis.oregonlegislature.gov/liz/2026R1/Measures/Overview/HB4028