1. (1) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers shall obtain prior authorization (PA) for Healthcare Common Procedure Coding System (HCPCS) Level II codes as specified in rule, unless otherwise noted.

   1. (a) Providers shall request PA as follows:

      1. (A) For Medically Fragile Children’s Unit (MFCU) clients, from the Department of Human Services (Department) MFCU;
      2. (B) For clients enrolled in a Coordinated Care Organization (CCO), from the CCO;
      3. (C) For clients enrolled in a prepaid health plan (PHP), from the PHP;
      4. (D) For all other clients, from the Health Systems Division.
   2. (b) For DMEPOS provided after normal working hours, providers must submit PA requests within five working days from the initiation of service.
   3. (c) See OAR 410-120-1320 for more information about PA.
2. (2) Effective January 1, 2026, the Division shall provide notice of determination no later than 72 hours following receipt of PA requests for costs to repair complex rehabilitation technology as defined in Section 2 of Enrolled SB 549 (2025). The 72-hour period of time shall be determined by the time and date stamp on the receipt of request.

Statutory/Other Authority

ORS 414.065 & SB 549 (2025)

Statutes/Other Implemented

ORS 414.065

History

DMAP 87-2025, amend filed 12/09/2025, effective 12/09/2025
DMAP 58-2023, minor correction filed 08/11/2023, effective 08/11/2023
DMAP 61-2015, f. 10-29-15, cert. ef. 11-1-15
DMAP 13-2010, f. 6-10-10, cert. ef. 7-1-10
DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08
OMAP 25-2006, f. 6-14-06, cert. ef. 7-1-06
OMAP 11-2005, f. 3-9-05, cert. ef. 4-1-05
OMAP 44-2004, f. & cert. ef. 7-1-04
OMAP 26-2004, f. 4-15-04 cert. ef. 5-1-04
OMAP 25-2004, f. & cert. ef. 4-1-04
OMAP 20-2004(Temp), f. & cert. ef. 3-15-04 thru 4-30-04
OMAP 6-2004, f. 2-10-04 cert. ef. 3-15-04
OMAP 47-2002, f. & cert. ef. 10-1-02
OMAP 32-2001, f. 9-24-01, cert. ef. 10-1-01
OMAP 37-2000, f. 9-29-00, cert. ef. 10-1-00
OMAP 1-2000, f. 3-31-00, cert. ef. 4-1-00
OMAP 13-1999, f. & cert. ef. 4-1-99
OMAP 11-1998, f. & cert. ef. 4-1-98
HR 17-1996, f. & cert. ef. 8-1-96
HR 41-1994, f. 12-30-94, cert. ef. 1-1-95
HR 10-1994, f. & cert. ef. 2-15-94
HR 9-1993, f. & cert. ef. 4-1-93
HR 10-1992, f. & cert. ef. 4-1-92
HR 13-1991, f. & cert. ef. 3-1-91, Renumbered from 461-024-0010
AFS 48-1989, f. & cert. ef. 8-24-89
AFS 6-1989(Temp), f. 2-9-89, cert. ef. 3-1-89
AFS 40-1984, f. 9-18-84, ef. 10-1-84
AFS 22-1984(Temp), f. & ef. 5-1-84
AFS 14-1984(Temp), f. & ef. 4-2-84
AFS 3-1982, f. 1-20-82, ef. 2-1-82