Oregon WCD Formal Rulemaking – Medical Treatment
The WCD met in November to discuss some issues regarding medical billing, treatment, and MCO procedures. The WCD is moving forward with formal rulemaking on some of these topics. A meeting is set for February 18, 2026, and it will be the last opportunity to provide input on these proposed changes. These changes would take effect on April 1, 2026.
While many of the changes are the usual increase in medical billings, there are a few proposals that could affect your claim processing obligations. I have summarized them below.
- Allows a WRME to bill for addendum report when it was authored in response to IME addendum.
- Allows medical providers to request pre-authorization for physical therapy, occupational therapy, speech/language therapy, referrals to specialists, or diagnostics other than x-rays with a 14-day response from our clients.
- A pre-authorization is still not a guarantee of payment.
- Adds required appeal language for denying pre-authorization, including a 60-day appeal to MRT.
- Failure to respond means the request is considered denied and worker has 60 days from when request was first sent to TPA/insurer to appeal.
- Adds civil penalties.
- Requires the medically stationary notice to go to all actively treating providers and interpreters who have seen claimant in past 90 days (not just AP).
- Requires insurer/TPA to respond to medical provider within two days (current rule) but requires response to be during regular Oregon business hours (8am-5pm, Pacific Time).
- Allows NPs, PAs, and naturopaths in the MCO to perform closing exams.
- Allows workers to continue treatment with current provider for up to 30 days from MCO enrollment mailing date (currently is 14 days).
You can find the materials and meeting information here. If you want to attend the meeting or provide written testimony on these changes, please let me know.
As always, please feel free to contact me at or (503) 595-2130 with any questions or concerns.
Posted by Kevin Anderson.
