ADULT HEALTH SERVICES PROVIDER IN OREGON

Fatumata Kaba
Oct 6
4 min read

DELIVERING INTEGRATED MEDICAL AND PERSONAL SUPPORT SERVICES TO PROMOTE WELL-BEING AND INDEPENDENCE FOR ADULTS ACROSS OREGON

Adult Health Services in Oregon are Medicaid-funded supports that address the complex medical, functional, and supportive care needs of adults with disabilities, chronic conditions, and age-related limitations. These services aim to help individuals maintain their health and independence in their homes or community settings, and they are provided through the Oregon Health Plan (OHP), K Plan (1915(k)), and several Home and Community-Based Services (HCBS) waivers administered by the Oregon Department of Human Services (ODHS).

1. GOVERNING AGENCIES

Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD)

Role: Manages and authorizes adult health services through local APD offices and Area Agencies on Aging (AAAs).

Agency: Oregon Health Authority (OHA)

Role: Oversees Medicaid provider enrollment and policy compliance through the Oregon Health Plan (OHP).

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures Oregon’s Medicaid and HCBS programs meet federal regulations and guidelines.

Agency: Oregon Secretary of State (SOS)

Role: Registers provider businesses and manages corporate compliance.

2. ADULT HEALTH SERVICES OVERVIEW

Adult Health Services include both skilled and non-skilled care delivered in the client’s home or community, with a focus on chronic condition management, daily assistance, and preventative care.

Approved providers may deliver:

Skilled Nursing Services: Medication administration, wound care, health monitoring, and chronic disease management.
Personal Care Services: Assistance with activities of daily living (ADLs), such as bathing, toileting, and dressing.
Health Monitoring: Routine vitals, symptoms tracking, and health documentation.
Medication Management: Administration, reminders, and medication education.
Nutrition Assistance: Meal planning, feeding support, and special diet preparation.
Therapeutic Services (optional): Physical, occupational, or speech therapy as authorized.
Care Coordination: Development and implementation of individualized care plans.
Adult Day Health (optional): Daytime supervision, wellness checks, and social engagement in licensed settings.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Oregon Secretary of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll with Oregon Medicaid via the OHA Provider Portal.
If providing skilled services, acquire licensure for home health or nursing through the Oregon State Board of Nursing (OSBN) or the Oregon Health Authority (OHA).
Obtain necessary facility licensing if operating an adult day health center.
Maintain general liability, workers’ comp, and malpractice insurance (if applicable).
Develop an Adult Health Services Policy & Procedure Manual in alignment with OARs and Medicaid standards.

4. OREGON PROVIDER ENROLLMENT PROCESS

Step 1: Form your business entity and acquire EIN, NPI, and insurance.

Step 2: Submit your Medicaid provider application via the Oregon Health Plan Provider Portal.

Step 3: For skilled services or facilities, apply for licensure through OHA or OSBN.

Step 4: Complete readiness review, staff onboarding, and documentation submission.

Step 5: Receive approval and begin accepting service authorizations and referrals.

5. REQUIRED DOCUMENTATION

Articles of Incorporation and business registration
EIN and NPI confirmations
Insurance certificates (general, workers’ comp, malpractice if applicable)
State-issued healthcare facility licenses (if required)
Adult Health Services Policy & Procedure Manual including:
- Care plan development and review procedures
- Medication management and safety protocols
- Personal care delivery and documentation guidelines
- HIPAA compliance and client rights statements
- Incident reporting and risk mitigation plans
- Quality assurance processes and review schedules
- Medicaid billing forms, logs, and EVV records

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN) / Clinical Supervisor

Requirements: Active Oregon nursing license; responsible for clinical oversight, care planning, and staff training.

Role: Certified Nursing Assistant (CNA) / Home Health Aide / Personal Care Aide

Requirements: Background check, CPR/First Aid, relevant certification or training per service model.

Role: Program Coordinator

Requirements: Supervises service delivery, compliance tracking, and staff performance.

Role: Therapists (optional)

Requirements: Licensed PT, OT, or SLP if providing therapeutic services.

All staff must complete:

HIPAA and confidentiality training
Abuse prevention and incident reporting
Documentation and Medicaid compliance modules
Annual performance reviews and refresher training

7. MEDICAID WAIVER PROGRAMS

Adult Health Services are delivered through:

K Plan (1915(k)): In-home nursing and personal care support for individuals with ADL/IADL needs.
APD HCBS Waivers: Provide skilled and unskilled services for older adults and individuals with physical disabilities.
State Plan Home Health Benefit: Skilled services prescribed by a physician and authorized through OHP.
Living Choices & Transition Services: For adults leaving institutional settings who need care in the community.
Children’s Medically Fragile Programs (if applicable): Home health services for individuals aging out of pediatric systems.