How to start a skilled nursing facility in Oregon

Oregon requires a Nursing facility license (or specialty nursing facility license) from Oregon Department of Human Services, Aging and People with Disabilities — Nursing Facility Licensing to operate a skilled nursing facility.

License required

Yes

License

Nursing facility license (or specialty nursing facility license)

Issuing agency

Oregon Department of Human Services, Aging and People with Disabilities — Nursing Facility Licensing

Renewal

Every year · Annual renewal tied to the recertification survey; renewal documents and fees due at least 45 days before license expiration (OAR 411-085-0010).

Certificate of need

Required

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

OAR 411 Divisions 73 and 85–89; OAR 333-610 (specialty long-term care beds CON)

1. Obtain a certificate of need from the Oregon Health Authority for a new or expanded facility or new services, or an OHA determination that none is required
2. Apply to ODHS for initial licensure under OAR 411-085
3. Pass the licensure survey
4. For Medicare/Medicaid, complete federal certification and enroll with the Oregon Health Plan

Program

Oregon Health Plan (OHP), Oregon Health Authority (OHA)

Enrollment portal

Oregon MMIS Provider Portal (or-medicaid.gov)

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. OHA's enrollment page does not list a separate state fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. The OHA enrollment and revalidation pages do not describe a separate state fingerprint process.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. The OHA enrollment and revalidation pages do not describe a separate state site visit process.

Revalidation

OHA rescreens every actively enrolled provider at least once every 5 years. It mails a notice to the provider's mail-to address. The provider returns the listed forms (for organizations OHA 3972, 3974 and 3975; for payable individuals OHA 3972 and 3975; for other individuals OHP 3113 and OHA 3975) by the due date, ideally online through the MMIS Provider Portal. If the forms are not returned, participation can end under OAR 410-120-1260. A revalidation received within 30 days after inactivation is treated as a revalidation; after that it is treated as a re-enrollment.

Full Oregon Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Oregon Health Authority, Public Health Division (Certificate of Need Program)

Services covered

• new hospitals
• new skilled nursing or intermediate care services or facilities (long-term care), including rebuilds and bed relocations through expedited review

Oregon certificate of need details →

State minimum wage

$15.55 an hour

Effective

2026-07-01

Scheduled increases

Adjusted each July 1 by CPI (US DOL); the July 2027 rates were not yet published in the sources reviewed.

Direct-care wage floor

Homecare and personal support workers paid through ODHS earn a base rate set by collective bargaining: $21.25/hour at step 1 for 2026, plus add-ons (CPR/first aid, enhanced and exceptional pay).

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Skilled nursing facilities — active organization NPIs (NPPES)

284 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

128 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,264,858 (as of Jun 1, 2026)

All Oregon Skilled nursing Medicaid rates, ranked →