Oregon Health Authority: Provider Matters (Oregon Health Plan provider bulletin) · July 24, 2026 · Primary source
EPSDT Education: Screening in the Early and Periodic Screening, Diagnostic and Treatment benefit
Summary
The Oregon Health Authority issued a July 24, 2026 provider bulletin explaining EPSDT screening requirements under the Oregon Health Plan, including mandatory compliance with the Bright Futures periodicity schedule, blood lead testing obligations under OAR 410-151-0004 and OAR 410-151-0040, and the requirement that OHA and CCOs conduct case-by-case medical necessity review before denying services to children. The bulletin also announces a July 27, 2026 technical assistance webinar for SUD treatment providers covering fee-for-service claim processing and a minor technical correction to OAR 410-120-1295 relocating inpatient psychiatric rate language.
What this may mean
Oregon Health Plan fee-for-service providers serving Medicaid-eligible children must follow the Bright Futures periodicity schedule and obtain blood lead tests at ages 12 and 24 months, with a completion of the Lead Screening Questionnaire insufficient to satisfy the testing requirement under OAR 410-151-0040. OHA and CCOs bear the obligation to conduct individualized medical necessity review before denying any EPSDT service, reinforcing that coverage denials for children require affirmative clinical justification rather than categorical exclusion.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
Related items
- Oregon Health Authority: Provider Matters (Oregon Health Plan provider bulletin) · October 3, 2026Update on Oregon Health Authority (OHA) policy changes for board-registered behavioral health associatesScore 81
- Oregon Health Authority: Provider Matters (Oregon Health Plan provider bulletin) · October 3, 2026Join OHA's July 23 Rules Advisory Committee (RAC) to provide feedback on updates to billing rulesScore 75
- Oregon Health Authority: Provider Matters (Oregon Health Plan provider bulletin) · October 3, 2026Medicaid program updates: EPSDT, hospice services, substance use disorder Medicaid ratesScore 73
- Oregon Health Authority: Provider Matters (Oregon Health Plan provider bulletin) · October 3, 2026Provide feedback on draft rule to support implementation of Senate Bills 1557 and 729Score 70
- Oregon Health Authority: Provider Matters (Oregon Health Plan provider bulletin) · October 3, 2026Reminders about member billing prohibitionsScore 66
- Oregon Health Authority: Provider Matters (Oregon Health Plan provider bulletin) · October 3, 2026EPSDT Education: Covered services under EPSDTScore 63