Sharing on behalf of OHA:
Oregon will not renew the longstanding waiver around EPSDT for children. The decision comes as a result of clear feedback from the community, advocates, children's service organizations, and other interested parties. Oregon will continue to base OHP benefits on the Prioritized List of Health Services, however, the state will arrange for, and make available to children, all medically necessary and medically appropriate services that are required for treatment of conditions identified as part of an EPSDT screening.
States must cover all medically necessary and medically appropriate services that are part of the federal EPSDT benefit, even if the service is not available or defined under the state's Medicaid plan.
Beginning January 1, 2023, OHP members under age 21 will have access to all medically necessary and medically appropriate services, determined on a case-by-case basis, taking into account a member's needs.
If a service is provided for a BTL service that is beneficial for a child in their development (0-21 yrs old), please submit a PA request prior to the service, or an appeal upon claim denial.