The Prioritized List

The Prioritized List of Health Services helps determine what health care services the Oregon Health Plan (OHP) covers. For detailed information about the creation of the Prioritized List, see the Health Services Commission's Brief History of Health Services Prioritization in Oregon or the biennial reports to the Oregon legislature on the HSC reports page. The OHP Overview also outlines how the List has changed over time, according to legislative mandates.

• Brief overview of the Prioritized List
• Where to find Prioritized List information
• Prioritized List information for OHP providers

Brief overview of the Prioritized List

From 1989-1993, the Oregon Legislature passed a series of laws known collectively as the Oregon Health Plan. One of those laws, Senate Bill 27 (1989), extended Medicaid coverage to Oregonians with income below the federal poverty level. This bill also created the Oregon Health Services Commission (HSC) and charged the HSC to rank medical services in a way that represents the comparative benefits (i.e,. clinical effectiveness and cost-effectiveness) of each service to the entire population to be served. This ranking is known as the Prioritized List of Health Services.

• Following public hearings around the state, the HSC established the first Prioritized List with more than 700 lines that prioritized condition and treatment pairs for physical health, dental, chemical dependency and mental health services. Each line represents the rank order of those pairs. The List now contains 680 lines.
• The Legislature sets the funding level for the List, which determines the coverage policies for the OHP Plus and Standard benefit packages. For example, the current funding level is for lines 1 through 503 (out of the 680 lines).

Where to find Prioritized List information

The HSC prioritizes health services and establishes benchmark rates for the Oregon Health Plan. Use the following links on the HSC Web site to get information about current and past Prioritized Lists:

• Current Prioritized List
• Pending changes to the Prioritized List
• Recent changes to the Prioritized List
• You can also eSubscribe to receive e-mail updates from the Health Services Commission whenever Prioritized List information changes.

Prioritized List information for OHP providers

DMAP General Rules and Oregon Health Plan rules contain references to how the Prioritized List is used to determine benefit coverage for OHP clients. Other rules may also refer to Prioritized List coverage or exclusions; refer to the provider guidelines specific to your program for more information.

Enrolled OHP providers can use the HSC List inquiry on the Provider Web Portal at https://www.or-medicaid.gov to determine whether a specific procedure is potentially covered according to the Prioritized List of Health Services. For more information about this service, go to the Web Portal information page.