PHEC Benefit Oregon: Post-Hospital Extended Care Under Senate Bill 296

Your parent is on OHP and needs skilled nursing rehabilitation after a hospital stay. But Medicare won't cover the SNF because they were under observation status for three days instead of being formally admitted. In most states, that would mean paying out of pocket at $300+ per day.

Oregon has a benefit most families never hear about. The Post-Hospital Extended Care (PHEC) benefit, significantly expanded under Senate Bill 296 (effective January 1, 2026), can cover up to 100 days of skilled nursing care for OHP members — even when Medicare won't pay.

How PHEC Works

PHEC is designed for Oregon Health Plan members enrolled in a Coordinated Care Organization who need skilled nursing facility care after a hospital stay but don't qualify for Medicare SNF coverage. The most common reason: the patient's hospital stay was classified as observation status rather than inpatient, which blocks the Medicare three-midnight qualifying requirement.

Under PHEC, the CCO covers the SNF stay directly from its global budget. Coverage mirrors what Medicare Part A would provide:

• Up to 100 days of skilled nursing facility care
• The patient must meet Medicare's clinical criteria for skilled care (daily therapy, skilled nursing services, or both)
• Coverage requires a preceding hospital event (though not necessarily the three-midnight inpatient stay that Medicare demands)

Who Qualifies

To be eligible for PHEC coverage:

• Your parent must be enrolled in an OHP CCO (Health Share of Oregon, CareOregon, PacificSource, Trillium, AllCare, Advanced Health, Columbia Pacific, Eastern Oregon, InterCommunity Health, Jackson Care Connect, Umpqua Health, or Yamhill Community Care)
• They must have been hospitalized (including under observation status)
• They must need skilled nursing or rehabilitation services that meet Medicare's clinical criteria
• Their condition must require the SNF level of care (not just custodial assistance)

Senate Bill 296: What Changed

Before SB 296, PHEC coverage was inconsistent across CCOs — some covered it, others didn't, and the terms varied. Senate Bill 296 standardized the benefit statewide and expanded access.

Key changes:

• All CCOs must now offer PHEC coverage as part of their standard benefit package
• The benefit covers up to 100 days (matching Medicare's coverage structure)
• CCOs must coordinate with the local APD office upon SNF admission to begin long-term discharge planning
• The CCO care coordination team is required to notify the APD office so that CAPS assessment and K Plan eligibility evaluation can proceed in parallel with the SNF stay

This parallel processing is critical — it means that by the time your parent's PHEC-covered SNF stay is ending, K Plan home care services can be ready to start, avoiding a dangerous gap in care.

How to Access PHEC

PHEC is not something you apply for separately. It's activated through the CCO's care coordination process:

1. At the hospital: When the discharge plan calls for SNF placement and Medicare coverage is blocked (observation status, no qualifying inpatient stay, or Medicare exhausted), tell the discharge planner your parent is on OHP and ask them to contact the CCO for PHEC authorization.

2. If the discharge planner doesn't initiate it: Call your parent's CCO member services line directly. Request PHEC coverage and ask for the care coordinator assigned to the case.

3. At the SNF: The facility should verify PHEC authorization with the CCO before or at admission. If the facility says they don't accept OHP or aren't familiar with PHEC, call the CCO — they can direct you to SNFs in their network that accept PHEC-covered patients.

The Discharge Planning Requirement

Under SB 296, the CCO must notify the local APD office when a member is admitted to a SNF under PHEC. This triggers collaborative discharge planning — the APD caseworker begins the process of evaluating your parent for K Plan Community First Choice services while they're still in the SNF.

This is the part families need to actively monitor. The CCO is required to do it, but administrative friction between CCO care coordinators, hospital discharge planners, and APD caseworkers sometimes delays the notification. Check with your CCO within the first week of the SNF stay to confirm that APD has been notified and that the CAPS assessment is being scheduled.

What Happens After PHEC Runs Out

If your parent reaches the 100-day PHEC limit and still needs care:

• K Plan home care may be authorized through the CAPS assessment (ideally completed during the SNF stay)
• Oregon Medicaid long-term care covers ongoing SNF residence if your parent meets financial eligibility requirements
• Oregon Project Independence may provide home care services on a sliding scale if your parent doesn't qualify for K Plan

The transition from PHEC-covered SNF care to long-term services is where the system most frequently fails families. The Hospital-to-Home Oregon toolkit includes a PHEC coverage tracker and a timeline template for coordinating the parallel CCO + APD processes so your parent doesn't fall through the gap.

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