 In this issue ...
Reproductive Health Equity Act (RHEA) services effective April 1, 2018
RHEA services through fee-for-service OHP
Providers can now bill fee-for-service OHP for the following services.
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For CAWEM Plus (CWX) members: Comprehensive medical services
including dental care (for 60 days postpartum); and immediate postpartum
reproductive health care, including IUDs, implants and female sterilization.
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For CAWEM (CWM) members: Female sterilization, and hospital-based
abortion services.
For sterilizations, please continue to obtain sterilization consent at least 30 days prior
to the procedure (as outlined in Oregon Administrative Rule 410-130-0580 –
Hysterectomies and Sterilization).
RHEA services through Reproductive Health Program clinics
Individuals who can become pregnant, have incomes under 250% FPL, and would
otherwise be eligible for full Medicaid if not for their immigration status can also enroll in OHA’s Reproductive Health Program to get the following services:
- Contraception and contraceptive-related services, including counseling;
- Well-woman visits;
- Screenings for breast and cervical cancer;
- Screenings for pregnancy and sexually transmitted infections (STIs);
- Counseling on STIs, relationship safety, and tobacco use;
- Mammography and screening for genetic cancer risk factors; and
- Outpatient abortion services.
Individuals can enroll in the program at a participating clinic to receive services and
supplies the same day. For a complete list of clinics, please call 211 or visit
www.healthoregon.org/rhclinics.
To learn more
For more information about RHEA-covered services, please contact the Oregon
Reproductive Health Program at 971-673-0355 or rh.program@dhsoha.state.or.us.
New web-based pain education module now available
The Oregon Pain Management Commission has released its free, one-hour pain
education module, which is required training for the following state-licensed health
care professionals under Oregon’s Pain Education Program:
- Physicians, physician assistants and acupuncturists (except for those waived
under OAR chapter 847.677);
- Registered nurses, licensed practical nurses and nurse practitioners;
- Psychologists;
- Chiropractors;
- Naturopathic physicians;
- Pharmacists;
- Dentists;
- Occupational therapists; and
- Physical therapists.
Practitioners earn 1 CEU for completing the module.
The Module and Pain Care Toolbox are now available from the Oregon Pain
Management Commission’s website.
To register for the course go to www.oregonpainmodule.org.
Nursing facility room and board rates effective July 1, 2018
The Department of Human Services has updated nursing facility room and board
rates effective July 1, 2018. OHA has updated the Hospice Services Program Rates
to reflect this change.
Two vaccine codes now open for fee-for-service billing
As of June 27, 2018, the following vaccine codes are now open for billing to OHA, effective for dates of service on and after January 1, 2018:
- 90739, $113.10
- 90750, $138.60
OHA will list these changes in the next issue of the OHP fee-for-service fee schedule.
Changes to fee-for-service coverage of J9035 planned for July 16, 2018
Effective July 16, 2018, OHA plans to cover CPT code J9035 (Injection,
bevacizumab, 10 mg) only when a full 10 mg vial was used for one patient on one
date of service.
For compounded doses (typically 0.05 ML) to treat covered ophthalmological
conditions, bill J3490 or J7999. Bill NDC units of measure (“ML” and NDC units)
equal to the actual amount administered.
Only bill J9035 if a full 10 mg vial was used. Modifier JW may be used to account for
waste as appropriate.
Doulas can enroll to directly bill OHA starting July 1, 2018
Starting July 1, 2018, doulas may enroll to bill OHA directly for services provided to
fee-for-service members. They do not need to work through a clinic or supervising
practitioner to do so.
They can do this two ways:
- Bill OHA themselves under Provider Type 13, Specialty 600. They will get
Provider Web Portal and Automated Voice Response PIN letters once their
provider type and specialty is able to bill OHA; or
- Work as rendering providers through a Traditional Health Worker Billing
Organization (Provider Type 9, Specialty 059). The billing organization would
then bill OHA on their behalf.
This change is effective for dates of service on and after January 1, 2018.
To learn more:
Recent rule revisions
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Semi-Annual CCO Rule Updates
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410-141-0520 – Updates the Covered and Non-Covered Services According to
the Prioritized List
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410-120-0006 – Revising Rule about Limits on Estate Claims to Comply with
OAR 461-135-0835
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410-123-1220 – Correction of Date Error in Coverage According to the
Prioritized List of Health Services
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410-120-1210 – Cover All Kids and RHEA Benefit Statutory Minor Correction
Sign up to get rule updates via text or email
You can also sign up to get text or email updates about:
To learn more, read about how
to sign up for rulemaking notices.
- Claim-specific questions and issues – Contact Provider Services at 800-336-6016 (option 5).
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EDI and the 835 ERA – Contact EDI Support Services or visit the EDI page.
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Provider enrollment updates - Contact Provider Enrollment at 800-336-6016 (option 6).
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Pharmacy and prescriber questions (for technical help and fee-for-service prescription PAs) – Contact the Oregon Pharmacy Call Center at 888-202-2126. You can also fax PA requests to 888-346-0178.
- Prior authorization status – Call the PA Line at 800-336-6016 (option 3).
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Web portal help and resets – Contact Provider Services at 800-336-6016 (option 5).
Find more phone numbers, email addresses and other resources in OHA's Provider Contacts List.
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