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Oregon - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Oregon, the Office of Developmental Disabilities Services (ODDS) certifies Medicaid agencies and approves endorsements for specific services under Oregon Administrative Rule (OAR) 411-323. The full waiver service array for people with intellectual and developmental disabilities (I/DD) is funded through the state's Medicaid waivers, including the K-Plan (Community First Choice) and comprehensive waivers, and requires providers to obtain Medicaid Agency Certification before they can be authorized to deliver services.

To become an approved I/DD services provider, an applicant must first meet all qualifications in OAR 411-323, complete the Medicaid agency application to receive certification and specific service endorsements, and subsequently complete a Provider Enrollment Agreement with ODDS. For providers seeking to operate 24-hour residential or host homes, a separate license application and walk-through inspection for each site are required, but these site-specific applications are not reviewed until the entity has been granted its initial Medicaid Agency Certification.

1. Service Definition and Scope

Oregon's I/DD service array encompasses a broad range of supports designed to assist individuals with intellectual and developmental disabilities in living as independently as possible. Services range from ancillary supports such as nursing, occupational therapy, speech therapy, and behavioral consulting, to comprehensive 24-hour residential and foster care programs.

All 24-hour residential programs in Oregon are required to use the Individual Support Plan (ISP) System, which defines the specific support services to be provided to each individual based on their assessed needs.

2. Regulatory and Oversight Agencies

The primary regulatory body for I/DD services in Oregon is the Department of Human Services (ODHS), specifically the Office of Developmental Disabilities Services (ODDS). ODDS is responsible for certifying Medicaid agencies, approving service endorsements, and licensing 24-hour residential sites.

The Oregon Health Authority (OHA) manages the broader Medicaid program (Oregon Health Plan) and oversees the Medicaid provider enrollment process and the MMIS Provider Portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

Before an agency can provide services or even have a site-specific license application reviewed for a 24-hour residential home, it must first obtain Medicaid Agency Certification from ODDS. This structural precondition means that standalone site applications are not accepted without the overarching agency certification.

Additionally, providers must have an executive director who meets the specific qualifications outlined in OAR 411-323. For certain specialized foster care designations, such as Level 2M (Medical), the provider or resident manager must have at least two years of full-time experience providing care to individuals with serious medical conditions.

4. Licensure and Certification Requirements

To become a certified Medicaid agency, applicants must submit a full application with a descriptive scope of service, business plan, financial documents, and applicable policies and procedures. The agency must also apply for specific service endorsements at the time of initial certification.

For 24-hour residential programs, a separate license application is required for each site, including a floor plan, lease or ownership agreement, walk-through checklist, and application fee. A licensing walk-through is conducted only after Medicaid Agency Certification is granted, and any deficiencies must be corrected prior to licensure.

5. Medicaid Provider Enrollment

After receiving Medicaid Agency Certification and any applicable site licenses, providers must complete a Provider Enrollment Agreement with the ODDS Contract Unit. Providers are not authorized to deliver services until this agreement is finalized.

Providers must also enroll with the Oregon Health Authority (OHA) to receive a Medicaid ID. This requires a National Provider Identifier (NPI) and submission of the Oregon Organization Medicaid ID Application (for businesses) or the Oregon Provider Medicaid ID Application (for solo practitioners).

6. Staffing, Training and Background Checks

Agencies are responsible for recruiting, supervising, and paying support workers. All owners and employees must undergo background checks through the Background Check Unit (BCU) to receive final fitness determinations before providing services.

Staff must complete specific training requirements, including Mandatory Abuse Reporting, CPR/First Aid, and training regarding the Individual Support Plan (ISP) requirements.

7. Documentation, Policies and Records

Providers must maintain comprehensive documentation to support their certification and licensure. This includes business plans, financial documents, insurance coverage, and detailed policies and procedures that align with Oregon Administrative Rules.

Agencies must remain in continual compliance with all applicable rules and respond completely and timely to any Plan of Improvement requirements issued during surveys or inspections.

8. Billing, Rates and Claims

Payment for I/DD services in Oregon is managed through the eXPRS payment system. Once a provider is certified and licensed, I/DD Licensing automatically notifies the eXPRS team to facilitate payment setup.

Providers must ensure their taxonomy codes match the services they are billing for, as discrepancies will cause claim errors. Claims submitted prior to obtaining an active Medicaid ID and completing the Provider Enrollment Agreement will be denied.

9. Approval Sequence and Timeline

The approval process begins with the submission of the Medicaid Agency Certification application, including requests for specific service endorsements. Concurrently, the applicant works with the Background Check Unit to clear all owners and employees.

Once agency certification is granted, I/DD Licensing will review site-specific applications for 24-hour residential homes and schedule walk-through inspections. After all licenses are issued, the provider must complete the Provider Enrollment Agreement with ODDS before they are authorized to begin serving individuals.

10. Common Denials and Survey Findings

Applications may be delayed or denied if they are incomplete; I/DD Licensing explicitly states that incomplete application packets will not be accepted for review. This includes missing financial documents, policies, or personnel information.

During the licensure walk-through for 24-hour residential sites, physical plant deficiencies are common. These must be corrected, or a variance accepted, before the home can be licensed. Additionally, failure to match taxonomy codes with the NPI registry during Medicaid enrollment will cause claim and enrollment issues.

11. Key Contacts and Resources

Prospective providers should utilize the resources provided by the Office of Developmental Disabilities Services and the Oregon Health Authority to navigate the certification and enrollment processes. The local Community Developmental Disabilities Program (CDDP) is also a critical partner for referrals and service approval.

For Medicaid enrollment questions, providers can contact OHA, and for payment system issues, the eXPRS team is the primary contact.

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