Provider updates

What is changing?

Effective January 1, 2026, the Oregon Health Authority (OHA) implemented changes to the Post Hospital Extended Care Benefit. The changes include the following:

• Members can be admitted to a Skilled Nursing Facility (SNF) if they have a medically necessary, qualifying hospital stay. The admission to the SNF must be an approved inpatient stay to an acute-care hospital bed (not including a hold bed, observation bed, or emergency room bed). The stay must consist of three or more consecutive days, not counting the day of discharge or observation time.
• Members can stay at a SNF for 100 days per benefit period if they meet the criteria for medical necessity. These 100 days do not have to be concurrent and can be used at different facilities. Previously, members could stay for 20 days.
• After a member leaves a SNF for 60 consecutive days, or the member receives a new diagnosis, the benefit period resets.
• After the first 14 days of the stay, members will begin to undergo concurrent reviews. Concurrent reviews will continue every seven days until the member is discharged from the SNF.

Why is CareOregon implementing this change?

CareOregon is implementing this change to align with updates from OHA. For more information please refer to OAR 411-070-0033.

Who is affected by this change?

Skilled nursing facilities and hospitals serving CareOregon members should be aware of this update.

What do providers need to do differently?

Beginning January 1, 2026, providers must send CareOregon documentation for concurrent reviews. Providers should continue following all current claims billing guidance when submitting claims.

Who should providers reach out to with questions?

For further questions please reach out to Provider Customer Service at 503-416-4100 or 800-224-4840. Press option 3 for provider.