OR HB4003

Eliminates Oregon's prioritized list of health services for determining Medicaid coverage and replaces it with clinical coverage policies that include diagnosis-treatment code pairings and coverage guidelines for medically necessary services

Requires the Oregon Health Authority to establish a definition of medical necessity, medical necessity criteria, and outcome and quality measures by rule, consistent with federal mandatory and optional Medicaid service requirements

Directs the Health Evidence Review Commission to develop and maintain clinical coverage policies that must be consistent with the authority's medical necessity definition and reported to the authority by July 1 of each even-numbered year for budget determinations

Mandates studies on implementing coverage decisions based on clinical coverage policies, aligning fee-for-service and coordinated care systems, and the feasibility of identifying services that are not medically necessary, with a report due January 1, 2027

Takes effect upon passage as an emergency measure, with substantive amendments becoming operative January 1, 2027, and includes transition requirements for publishing guidance on a single webpage and developing technical assistance materials