State Plan Amendment OR-23-0015.pdf
Oregon Medicaid Reimbursement Implementation: January 1, 2027
The Northwest Portland Area Indian Health Board (NPAIHB), in coordination with the Oregon Health Authority (OHA), is pleased to provide an important update regarding Oregon Medicaid reimbursement for Community Health Aide Program (CHAP) providers.
The Centers for Medicare & Medicaid Services approved Oregon State Plan Amendment OR-23-0015.pdf, which recognizes certified Indian Health Service CHAP providers as Medicaid eligible practitioners when practicing within their certified scope of practice and under the supervision of a licensed health care professional.
Following continued coordination between NPAIHB and OHA to operationalize the State Plan Amendment, Oregon Medicaid reimbursement for eligible CHAP services will begin January 1, 2027.
This represents an important milestone for Oregon Tribes implementing CHAP and supports the long-term sustainability of Tribal health workforce development, expanded access to care, and delivery of culturally responsive health services within Tribal communities.
Provider Enrollment
CHAP providers who have successfully completed an approved CHAP education program and have been certified by the Portland Area CHAP Certification Board (PACCB) will need to enroll with OHA as Oregon Health Plan Medicaid providers before Medicaid reimbursement can occur.
Tribal health programs should begin preparing their certified CHAP providers for enrollment prior to January 1, 2027, implementation.
OHA Medicaid Provider Enrollment Steps
1. Confirm PACCB Certification
The CHAP provider must hold current certification issued by the Portland Area CHAP Certification Board for the provider’s applicable CHAP discipline and level of practice.
2. Obtain or Confirm a National Provider Identifier (NPI)
Each CHAP provider subject to NPI requirements must obtain an individual National Provider Identifier through the National Plan and Provider Enumeration System (NPPES) before enrolling as an Oregon Medicaid provider.
When applying for or updating an NPI, CHAP providers should use the appropriate health care provider taxonomy code applicable to Oregon’s CHAP enrollment requirements.
Taxonomy Code: 172V00000X
Classification: Community Health Worker
CHAP providers who already have an NPI should review their NPPES record to ensure the appropriate taxonomy is associated with their individual NPI before submitting an Oregon Medicaid enrollment application.
Apply for or update an NPI:
https://nppes.cms.hhs.gov/
Verify an existing NPI and taxonomy:
https://npiregistry.cms.hhs.gov/
3. Begin Oregon Health Plan Provider Enrollment
Certified CHAP providers must enroll with OHA as Oregon Medicaid providers before their services can be reimbursed.
OHA’s official Oregon Health Plan Provider Enrollment webpage provides current enrollment instructions, forms, provider type and specialty information, and submission requirements.
OHA Provider Enrollment:
https://www.oregon.gov/oha/OHP/Providers/Pages/Enroll.aspx
4. Determine the Appropriate OHA Provider Enrollment Category
Certified CHAP providers whose services will be billed through a Tribal Health Organization (THO) will generally enroll as individual rendering providers whose services are billed through the Tribal Health Organization.
The applicable CHAP provider type, specialty code, taxonomy, certification documentation, and organizational affiliation requirements should be confirmed with OHA as part of the CHAP enrollment process.
5. Complete and Submit Required OHA Enrollment Documentation
Tribal health programs should use the most current provider enrollment forms and requirements available through the OHA Provider Enrollment webpage.
CHAP providers should be prepared to provide their individual NPI, PACCB certification information, Tribal health program affiliation, and other supporting documentation required by OHA.
Enrollment applications and supporting documentation should be submitted according to OHA’s current provider enrollment instructions.
6. Establish Oregon Medicaid Provider Portal Access
Following successful enrollment, providers and Tribal health programs should establish appropriate access to the Oregon Medicaid Provider Portal.
Oregon Medicaid Provider Portal:
https://www.or-medicaid.gov/
Newly enrolled providers generally receive information necessary to establish Provider Portal access following enrollment.
7. Confirm Enrollment Before Billing
Before submitting claims, Tribal health programs should confirm that each CHAP provider is actively enrolled with Oregon Medicaid and that the provider’s NPI and enrollment information are correctly associated with the Tribal health program’s billing processes.
The NPI reported on an Oregon Medicaid claim must be actively enrolled for the applicable date of service.
What Oregon Tribes Should Do Before January 1, 2027
Tribal health programs with PACCB certified CHAP providers should begin preparing for Medicaid reimbursement by:
• Confirming current PACCB certification for each CHAP provider
• Obtaining or verifying each provider’s individual NPI
• Confirming the appropriate taxonomy associated with the provider’s NPI
• Preparing required OHA Medicaid provider enrollment documentation
• Confirming the provider’s relationship with the Tribal health program for billing purposes
• Establishing appropriate Oregon Health Authority (OHA) Medicaid Provider Portal access
• Coordinating with billing and revenue cycle staff to prepare for CHAP claims beginning January 1, 2027
NPAIHB and OHA Coordination
NPAIHB will continue working with OHA to support implementation of CHAP Medicaid reimbursement and provide technical assistance to Oregon Tribes.
Additional implementation guidance will address CHAP provider types and specialty codes, taxonomy requirements, enrollment documentation, billing procedures, organizational affiliations, and other requirements necessary for successful Medicaid reimbursement.
Tribal health programs with PACCB certified CHAP providers are encouraged to begin enrollment preparation now to support timely Medicaid billing when reimbursement becomes available January 1, 2027.
Northwest Portland Area Indian Health Board
NW Community Health Aide Program (CHAP)
