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Oregon - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Oregon, Home Health Services are licensed by the Oregon Health Authority (OHA) Health Care Regulation and Quality Improvement (HCRQI) section and enrolled under the Oregon Health Plan (OHP) Fee-for-Service (FFS) program or through Coordinated Care Organizations (CCOs). The service is defined under Oregon Administrative Rules (OAR) Chapter 410 Division 127 and requires a physician-ordered plan of care for intermittent skilled nursing, therapy, and home health aide services.

To become a Medicaid Home Health Provider in Oregon, an agency must first obtain a Home Health Agency license from OHA HCRQI and meet Medicare certification requirements, including capitalization requirements under 42 CFR 489.28. Once licensed and Medicare-certified, the agency must enroll as a Medicaid provider through the OHA Provider Enrollment portal using their National Provider Identifier (NPI).

1. Service Definition and Scope

Oregon defines Home Health Services as part-time or intermittent skilled nursing care, physical, occupational, or speech-language pathology services, and home health aide services provided to a client under the care of a physician. Services must be delivered in the client's home or a setting where normal life activities take place, excluding hospitals, nursing facilities, or ICF/IIDs.

The service requires a face-to-face encounter with a physician or allowed practitioner within 90 days before or 30 days after the start of services. The physician must establish and periodically review the plan of care at least every 60 days.

2. Regulatory and Oversight Agencies

The Oregon Health Authority (OHA) is the primary state agency responsible for both the licensure and Medicaid enrollment of Home Health Agencies. Within OHA, the Health Care Regulation and Quality Improvement (HCRQI) section handles facility licensing and Medicare certification surveys.

The OHA Health Systems Division manages the Oregon Health Plan (OHP) and Medicaid provider enrollment. Most Medicaid members in Oregon are served by Coordinated Care Organizations (CCOs), which manage their own provider networks and contracting.

3. Gatekeeping Prerequisites: Who Can Even Apply

Oregon requires Home Health Agencies to meet Medicare certification requirements as a precondition for Medicaid enrollment. This includes meeting the capitalization requirements under 42 CFR 489.28.

There is no Certificate of Need (CON) requirement specifically for Home Health Agencies in Oregon. However, providers must secure a state license from HCRQI and achieve Medicare certification before they can enroll as a Medicaid Home Health Provider.

4. Licensure and Certification Requirements

To operate in Oregon, a Home Health Agency must be licensed by the OHA Health Facility Licensing & Certification Program (HFLC). The agency must be primarily engaged in providing skilled nursing services and at least one other therapeutic service.

The licensure process involves submitting an application, paying the required fees, and undergoing a state licensure survey. HFLC also conducts routine federal Medicare certification surveys.

5. Medicaid Provider Enrollment

After obtaining licensure and Medicare certification, agencies must enroll as an Oregon Health Plan (OHP) Fee-for-Service (FFS) provider. Enrollment is completed online through the MMIS Provider Portal or by submitting fillable PDF forms via fax.

Providers must obtain a National Provider Identifier (NPI) and select the appropriate provider type and specialty code. If an NPI changes due to a change of ownership, a new enrollment application must be submitted.

6. Staffing, Training and Background Checks

Home Health Agencies must employ qualified personnel to deliver services. Skilled nursing must be provided by or under the supervision of a registered nurse.

Home health aides must successfully complete required training and certification. They provide services under the direction and supervision of a registered nurse or licensed therapist familiar with the client's plan of care.

7. Documentation, Policies and Records

Agencies must maintain comprehensive medical records for each client, including the physician-ordered plan of care, face-to-face encounter documentation, and clinical notes. The plan of care must specify the type, frequency, and duration of services.

The certifying physician must document the face-to-face encounter in a separate and distinct section of the certification, clearly titled, dated, and signed. An Outcome and Assessment Information Set (OASIS) assessment is also required.

8. Billing, Rates and Claims

The OHA Health Systems Division recalculates home health services rates every other year. Reimbursement is set at a level of 74 percent of Medicare costs reported on the audited, most recently accepted or submitted Medicare Cost Reports, pending CMS approval and legislative funding.

Agencies must submit requested Medicare Cost Reports to the Division by the specified due date. Payment authorization is required for certain services, such as skilled nursing visits exceeding limits and all therapy visits.

9. Approval Sequence and Timeline

The approval process begins with obtaining a Home Health Agency license from OHA HCRQI, which includes a state survey. Concurrently or subsequently, the agency must achieve Medicare certification.

Once licensed and certified, the agency applies for OHP FFS enrollment. OHA offers Provider Enrollment Support webinars to assist with the process. Application status can be checked online using the Application Tracking Number (ATN).

10. Common Denials and Survey Findings

Applications for Medicaid enrollment may be delayed or denied if the agency fails to provide proof of Medicare certification or state licensure. Using outdated OHA forms (older than three months past revision date) will also result in rejection.

During surveys, common deficiencies include inadequate documentation of the face-to-face encounter, failure to review the plan of care every 60 days, and non-compliance with EVV reporting requirements.

11. Key Contacts and Resources

Providers should utilize OHA's online resources for the most current rules, forms, and fee schedules. The OHA Provider Enrollment team can be contacted for assistance with FFS enrollment.

For licensing inquiries, contact the Health Facility Licensing & Certification Program. Providers are encouraged to join the HFLC listserv for critical program updates.

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