HOME HEALTH CARE SERVICES PROVIDER IN OREGON

Fatumata Kaba
Oct 6
4 min read

DELIVERING SKILLED NURSING AND THERAPEUTIC CARE TO OREGONIANS IN THE COMFORT OF THEIR HOMES

Home Health Care Services in Oregon are Medicaid-funded medical services provided to individuals who require skilled nursing or therapy care at home due to illness, injury, or disability. These services are aimed at avoiding or reducing institutional care, supporting recovery, and promoting independence. Home Health Care is reimbursed through the Oregon Health Plan (OHP) and may also be delivered under the K Plan (1915(k)) and certain HCBS Waivers for eligible individuals.

1. GOVERNING AGENCIES

Agency: Oregon Health Authority (OHA)

Role: Oversees Oregon Health Plan, Medicaid reimbursement for home health services, and provider enrollment.

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

Role: Coordinates referrals and service authorization for Medicaid-eligible adults with medical needs at home.

Agency: Oregon State Board of Nursing (OSBN)

Role: Licenses and regulates nursing staff involved in home health service delivery.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures Oregon's Medicaid program complies with federal standards for skilled home care.

Agency: Oregon Secretary of State (SOS)

Role: Registers businesses and legal entities offering home health care.

2. HOME HEALTH CARE SERVICES OVERVIEW

These services involve clinical care prescribed by a physician and delivered in the client’s residence. Providers must meet strict clinical and regulatory standards.

Approved providers may deliver:

Skilled Nursing Services: Wound care, catheter care, IV therapy, health assessments, and disease management.
Home Health Aide Services: Basic personal care under RN supervision, including bathing, dressing, and hygiene.
Physical Therapy (PT): Mobility improvement and rehabilitation after surgery or injury.
Occupational Therapy (OT): Skill development for activities of daily living (ADLs).
Speech Therapy (ST): Communication improvement and swallowing support.
Medical Social Services: Counseling, crisis support, and resource navigation (if authorized).
Care Coordination: Documentation, case review, and communication with the primary care provider.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Oregon Secretary of State.
Obtain an EIN and a Type 2 NPI.
Apply for Medicaid provider enrollment through the OHA Provider Portal.
Secure a Home Health Agency License from OHA’s Health Care Regulation and Quality Improvement (HCRQI) section.
Meet staff licensure and accreditation requirements (ACHC, CHAP, or Joint Commission recommended).
Maintain liability, malpractice, and workers’ compensation insurance.
Develop a Home Health Care Policy & Procedure Manual that complies with federal and state standards.

4. OREGON PROVIDER ENROLLMENT PROCESS

Step 1: Form your business and obtain EIN, NPI, and appropriate insurance.

Step 2: Apply for your Home Health Agency License through OHA-HCRQI.

Step 3: Submit a Medicaid provider application via the Oregon Health Plan Provider Portal.

Step 4: Complete agency inspection, policy review, and credentialing process.

Step 5: Begin accepting referrals once approved and authorized.

5. REQUIRED DOCUMENTATION

Business registration and Articles of Incorporation
EIN and NPI confirmations
OHA-issued Home Health Agency License
Accreditation certificate (if obtained)
Proof of insurance coverage (liability, workers’ comp, malpractice)
Home Health Care Services Policy & Procedure Manual including:
- Nursing and therapy care delivery protocols
- Infection control and universal precautions
- Medication management and administration policies
- Staff supervision and evaluation systems
- Emergency preparedness and disaster plans
- HIPAA compliance and client rights materials
- Physician order tracking and visit documentation
- Medicaid billing formats and progress notes

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN) / Case Manager

Requirements: Active Oregon nursing license; oversees care plans, performs assessments, and supervises aides.

Role: Home Health Aide (HHA)

Requirements: Certification or competency evaluation; works under RN supervision; trained in ADL support.

Role: Physical, Occupational, or Speech Therapist

Requirements: Licensed in Oregon; provides therapy per physician order and plan of care.

Role: Medical Social Worker (if applicable)

Requirements: Licensed MSW; provides supportive counseling and social service coordination.

All staff must complete:

HIPAA and patient rights training
CPR/First Aid and infection control education
Documentation, visit logging, and billing compliance training
Annual skills verification and continuing education

7. MEDICAID WAIVER PROGRAMS

Home Health Services are authorized through:

State Plan Home Health Benefit: Requires physician order and prior authorization for eligible OHP members.
K Plan (1915(k)): May cover additional personal care and nursing support needs.
APD HCBS Waivers: For individuals needing skilled home care to avoid nursing facility placement.
Children’s and Medically Fragile Waivers: Covers pediatric home nursing and therapy services.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Development

Timeline: 1–2 months

Phase: OHA Licensing & Medicaid Enrollment

Timeline: 3–4 months (may vary depending on licensing inspections)

Phase: Staff Hiring, Credentialing & Accreditation (optional)

Timeline: 30–60 days

Phase: Service Launch & Referral Network Building

Timeline: Begins once licensure and Medicaid approval are complete

9. CONTACT INFORMATION

Oregon Health Authority – Health Care Regulation and Quality Improvement (HCRQI)

Website: https://www.oregon.gov/oha

Oregon Health Authority – Medicaid Enrollment

Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx

Oregon State Board of Nursing (OSBN)

Website: https://www.oregon.gov/osbn

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON HOME HEALTH CARE PROVIDER

WCG assists Home Health providers in Oregon with launching high-quality, clinically compliant programs that meet the demands of Medicaid and home-based patient care.

Scope of Work: