Bill would let registered nurses bill Medicaid directly for care coordination

The Senate Committee on Health Care held a public hearing April 22 on House Bill 2,789, which would prohibit the Oregon Health Authority from requiring that certain case-management or care‑coordination services be ordered by a primary care provider before a registered nurse may seek Medicaid reimbursement.

Supporters said the change would let registered nurses provide and be reimbursed for transitional and care‑management services — for example, post‑hospital discharge follow‑up, wound checks and medication teaching — without the delay of securing a primary care order. Representative Travis Nelson, House District 44, introduced the bill and called it “a practical, patient‑centered bill” brought forward by the American Nurses Association to address gaps in access and equity.

The bill’s proponents described several rationales for the change. Jennifer Kennedy, RN, president of the American Nurses Association–Oregon and faculty at the OHSU School of Nursing, told the committee that RNs already deliver many of the services in question and that direct Medicaid billing would expand access where primary care is scarce. “Expanding Medicaid billing privileges to RNs will enhance patient access to timely preventive services, chronic disease management and patient education,” Kennedy said.

Saiko Izumi, a health‑services researcher in Portland, said more than half of Oregonians live with chronic illnesses that require ongoing management. “Allowing nurses to deliver services within their scope and bill for them without the bargaining of primary care providers will allow more patients to receive care they need, preventing worsening of their conditions and reducing overall cost,” Izumi said.

Other witnesses described examples and pilot work. Dana Womack, an RN and clinical informatics researcher who studied nurse‑led care coordination in rural Oregon, said nurses often fill urgent gaps when a patient lacks an established primary‑care relationship and can help avoid emergency visits by providing in‑home assessments and system navigation. Dr. Deva Rajan, a physician in the Department of Family Medicine at Oregon Health & Science University, described a clinic pilot of nurse‑led advanced care planning funded by the Cambria Health Foundation and conducted from July 2021 to December 2024; Rajan said standardized nurse‑led conversations improved documentation and continuity of care.

Committee members asked whether the change would require a Medicaid waiver. Witnesses said they would follow up with more detailed information about waivers and implementation mechanics; testimony did not establish a definitive answer.

The public hearing was opened by Chair Patterson and closed by the committee without a recorded vote; no formal action on the bill was taken during the hearing.

If enacted, the bill would direct the Oregon Health Authority to establish a list of covered care‑management services for which a registered nurse could seek reimbursement without a primary‑care order. The bill text and implementing guidance would determine whether billing would occur directly by individual RNs or through employing organizations or billing entities.

Proponents urged the committee to consider the bill as a way to reduce delays and inequities in access to basic care coordination for Medicaid enrollees, particularly in rural and underserved communities.