Jackson Care Connect is a CareOregon-affiliated OHP CCO for Jackson County. CareOregon’s Behavioral Health Utilization Management Procedure Handbook (July 2026) covers JCC members and carries a JCC- and Columbia Pacific-specific ABA rule: "Due to a smaller region and provider network, ABA assessment authorization requests ... are approved without the requirement of clinical documentation."
CareOregon applies its practice guidelines with Guideline Note 75. Treatment requests go through CareOregon Connect or fax with a documented ASD or Stereotypic Movement Disorder diagnosis (by an MD, DO, PhD or PsyD using ADOS, CARS-2, or an educational diagnosis) and a comprehensive plan: measurable goals with baseline data and graphs, medical concerns, family, custody and language information, barriers, the diagnosing clinician’s credentials and date of diagnosis, school and Early Intervention services, at least two measurable caregiver goals, prior ABA providers, assessment data, and units for the full six-month authorization. Members 13 or older and requests above 25 hours a week go to a CareOregon Medical Director. Standard decisions come within 7 calendar days, expedited within 72 hours. BH UM: 503-416-3404.[2][3][4][11]
JCC’s forms page still posts a 2019 "Treatment Authorization Form - Applied Behavioral Analysis Services," which asks for the assessment, goals, frequency, duration, prognosis and a caregiver participation signature. That form says determinations "will be made within 14 days"; the July 2026 handbook and OAR 410-141-3835 set 7 calendar days, so go by the handbook.[2][3][4][11]
OHA’s managed-care billing rule binds every CCO, Jackson Care Connect included (OAR 410-141-3565, effective January 1, 2025). Initial claims are due "within no more than 120 days of the date of service," or within 365 days for pregnancy, retroactive eligibility, Medicare as primary payer, third-party liability and other delays not caused by the provider; a CCO "may negotiate terms within this timeframe," so your contract can set a shorter limit but not a longer one. For a timely claim that needs correction or resubmission, the CCO must allow "a minimum of 180 days after the initial adjudication date." Other insurance "must be exhausted prior to payment." On payment, CCOs "shall pay or deny at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days of receipt," make an initial determination on 99 percent within 60 days, and "may not require providers to delay claims submission." The rule sets no weekly payment cycle or submission cutoff.[1]
The questions that decide whether a family can start with Jackson Care Connect, and what they have to bring. Each maps onto something intake should ask on the first call.
No age cap; requests for members 13 or older require Medical Director review. OHP rules require ABA beyond Guideline Note 75 when medically appropriate, including at 13 and older, and under 21 EPSDT bars age-group-wide denials.[2][7][15]
No recency rule; the plan must give the diagnosing clinician’s credentials and date of diagnosis. JCC’s ABA form asks for the date of diagnosis and whether it is provisional.[2][4]
An MD, DO, PhD or PsyD.[2]
ADOS or CARS-2 (or an educational diagnosis by an MD, DO, PhD or PsyD).[2]
CareOregon adds no referral rule of its own, so the OHP rule applies. Yes. Before services, OAR 410-172-0770(1)(k) requires "A referral for ABA treatment with or without specification of hours or intensity" that includes the diagnosis and a copy of the evaluation, from a physician, psychologist, or nurse practitioner or physician associate specializing in developmental medicine who has experience diagnosing and treating autism (OAR 410-172-0760(1)).[2][7][6]
CareOregon’s ABA guidance publishes no telehealth rule of its own. The state rule applies: "For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person" (OAR 410-172-0850(5)), using synchronous two-way video (telephone and e-mail only where HERC guidelines allow). OHA’s behavioral health fee schedule lists modifier GT ("Via Interactive Simultaneous Audio and Video Telecommunication Systems") as an allowable modifier on every ABA code it prices, 97151 through 97157, including the 97151 assessment and 97155 protocol modification.[2][9][10]
Standard requests within 7 calendar days of receipt, expedited within 72 hours, up to 14 more days on extension (CareOregon handbook, July 2026). The older JCC/CPCCO ABA form still prints "within 14 days."[2][4][11]
CareOregon’s handbook adds nothing on other insurance for JCC, so the state rule applies. Medicaid pays last. OHA must be "the payer of last resort," and "Providers shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). Bill the commercial plan first and follow its authorization rules.[2][14][17]
Coverage decides whether Jackson Care Connect pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
CareOregon publishes no ABA supervision ratio, so the state rule applies. OHA does not pay assistant behavior analysts or registered behavior analysis interventionists directly (OAR 410-172-0760(4)); they work under a directly payable Licensed Behavior Analyst, licensed health care professional or declarant. The licensing rule sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," including direct supervision at least once per calendar month, by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional (OAR 824-040-0010). Direct supervision may be remote if it is synchronous audio and video (OAR 824-010-0005).[2][6][13]
No numeric cap; requests above 25 treatment hours a week require Medical Director review, and units are requested per six-month authorization by CPT code.[2]
CareOregon’s handbook sets no session-note rule. The OHP floor applies: each note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)).[2][8]
CareOregon publishes no ABA rendering-provider rule. The OHP rule applies: only a Licensed Behavior Analyst, licensed health care professional or declarant is eligible for direct payment (OAR 410-172-0760(3)–(4)).[2][6]
Not addressed in CareOregon’s BH UM handbook or JCC’s ABA form.[2][4]
Ask the plan: CareOregon Provider Customer Service, 800-224-4840 (option 3), or your provider agreement.
Not addressed; the treatment plan must list school and Early Intervention services, but no setting rule is stated.[2]
Ask the plan: CareOregon BH UM, 503-416-3404: ask which settings and place-of-service codes JCC pays for ABA.
120 days from the date of service under OAR 410-141-3565 (365 days for exceptions such as retroactive eligibility, Medicare or other insurance primary); your contract may set a shorter limit. Corrections and resubmissions get at least 180 days from the initial adjudication.
Submit an authorization through CareOregon Connect, but CareOregon approves JCC assessment requests without requiring clinical documentation.
CareOregon’s July 2026 handbook sets 7 calendar days for standard requests and 72 hours for expedited ones. The older JCC ABA form’s 14-day figure is out of date.
A CareOregon Medical Director reviews requests for members 13 or older and requests above 25 hours a week.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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