Oregon Health Authority: Provider Matters (Oregon Health Plan provider bulletin) · May 15, 2026 · Primary source
Reminders about member billing prohibitions
Summary
The Oregon Health Authority issued a May 15, 2026 provider update reminding OHP-enrolled providers that ORS 414.066 prohibits them from billing OHP members for any health care service, whether covered or non-covered, unless the member independently initiates an agreement to pay. OHA is updating the OHP 3165 Agreement to Pay form and OAR 410-120-1280 to clarify these member billing prohibitions and is soliciting provider feedback through listening sessions. The update also announces upcoming behavioral health billing guide revisions and new provider training opportunities.
What this may mean
The member billing prohibition under ORS 414.066, as clarified by OHA, applies to all providers serving OHP members regardless of enrollment status as an open card or CCO provider. Providers who solicit payment from members outside a member-initiated OHP 3165 process are exposed to enforcement under the updated OAR 410-120-1280.
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.
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