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Oregon - Assistive Technology Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Oregon Department of Human Services (ODHS) Office of Developmental Disabilities Services (ODDS) authorizes Assistive Technology and Assistive Devices through the 1915(k) K-Plan and 1915(c) waivers using procedure codes OR321 and OR380. Oregon does not issue a distinct facility or agency license for assistive technology providers; instead, businesses must hold a standard Oregon business license and enroll directly as a Medicaid vendor through the Oregon Health Authority (OHA).

The structural precondition to delivering and billing for this service is case-by-case authorization: providers cannot bill for any device or service without a prior authorization generated in the eXPRS system by a local Case Management Entity (CME) Service Coordinator (SC) or Personal Agent (PA). Furthermore, any single purchase or combination of items meeting a single assessed need that costs $1,200 or more, or any specialized medical supply expenditures exceeding $5,000 per plan year, requires secondary funding approval directly from ODDS before the provider can fulfill the order.

1. Service Definition and Scope

In Oregon, Assistive Technology and Assistive Devices encompass evaluations, hardware, maintenance, and specialized medical supplies that address a person's physical condition, communication needs, or life-supporting equipment. These services are designed to increase functional capability and reduce reliance on paid staff, and they must not duplicate supports already provided in a 24-Hour Residential or Supported Living setting.

The scope is divided into specific categories based on the funding source, primarily the K-Plan (Community First Choice) and the 1915(c) waivers. Providers must supply the exact item authorized by the CME, ensuring it is the most cost-effective method to meet the individual's documented need.

2. Regulatory and Oversight Agencies

The Oregon Department of Human Services (ODHS) Office of Developmental Disabilities Services (ODDS) is the primary operating agency that defines the service rules, manages the eXPRS authorization system, and reviews high-cost exception requests. The Oregon Health Authority (OHA) serves as the state Medicaid agency, managing provider enrollment and the Medicaid Management Information System (MMIS).

Local oversight and initial service authorization are handled by Case Management Entities (CMEs), which include Community Developmental Disabilities Programs (CDDPs) and Brokerages.

3. Gatekeeping Prerequisites: Who Can Even Apply

Oregon does not utilize a Certificate of Need, Request for Proposals (RFP), or closed network moratorium for Assistive Technology providers under ODDS. Enrollment is open year-round to any qualified business that meets the basic vendor requirements.

There are no required affiliations with designated network entities to apply for Medicaid enrollment. However, a provider cannot receive payment without an active authorization from a CME, meaning the provider must be selected by the waiver participant and their Service Coordinator.

4. Licensure and Certification Requirements

Because Assistive Technology is primarily a vendor-supplied goods and services category, Oregon does not have a specific "Assistive Technology Agency" license. Providers are regulated through their Medicaid Provider Enrollment Agreement and adherence to OAR 411-323.

If the provider is supplying items that require specific medical or pharmacy licensure (e.g., a noncontiguous out-of-state pharmacy provider), they must hold the appropriate license from the Oregon Board of Pharmacy or relevant medical board.

5. Medicaid Provider Enrollment

Providers must enroll through the OHA MMIS Provider Portal. The process requires submitting a Provider Enrollment Agreement and program-specific addenda.

Digital fax services used for submitting enrollment forms must support the T.38 protocol; otherwise, OHA recommends submitting all forms directly online via the MMIS Provider Portal to prevent transmission failures.

6. Staffing, Training and Background Checks

While AT vendors do not typically provide direct hands-on care in the same manner as DSPs, any responsible person or staff member interacting directly with vulnerable individuals must clear background checks.

The ODHS Background Check Unit (BCU) processes these checks, and the Office of Training, Investigations, and Safety (OTIS) maintains records of abuse investigations.

7. Documentation, Policies and Records

Enrolled providers must maintain comprehensive records of all supplied devices, warranties, and maintenance logs. These records must be made available upon request to ODHS, OHA, or the Department of Justice Medicaid Fraud Control Unit (DOJ MFCU).

If an item is denied by the CME because it does not meet the requirements for purchase, the Service Coordinator must issue a Notice of Planned Action (NOPA), and the provider must retain correspondence related to the denial.

8. Billing, Rates and Claims

Billing for Assistive Technology is processed through the eXPRS system using specific HCPCS codes. Providers must ensure the item is fully authorized in eXPRS before delivery.

Rates are typically based on the invoiced cost of the item or established fee schedules, subject to strict expenditure caps that require state-level override.

9. Approval Sequence and Timeline

The approval sequence begins with obtaining a business license and an NPI, followed by submitting the Medicaid enrollment application to OHA. Once OHA issues a Medicaid Provider ID, the provider is linked in the eXPRS system.

After enrollment, the provider must wait for a CME to generate a prior authorization in eXPRS for a specific participant before any goods can be delivered or billed.

10. Common Denials and Survey Findings

Providers frequently face enrollment delays or claim denials due to administrative errors, such as failing to update NPI information after a change of ownership or failing to secure ODDS approval for high-cost items.

Under OAR 411-323, the Department may terminate a Provider Enrollment Agreement if the agency is not in substantial compliance with program rules or fails to report critical changes.

11. Key Contacts and Resources

Providers should utilize the OHA Provider Services line for enrollment and MMIS portal issues, and contact local CMEs for participant-specific authorization questions.

The ODDS Worker Guide for Assistive Devices is the primary policy manual for understanding coverage limits and exception processes.

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