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At the Oregon Health Authority's August 22 CCO 2.0 webinar, stakeholders and providers across the state learned more about OHA’s communications plan for members with changes to their CCO choices, the next steps in the awards process, and how to support members during this transition.
The following materials from the webinar are available for you to download on OHA’s CCO 2.0 website:
Please share with others who would benefit from this information.
Thank you for your partnership in supporting OHP members through this transition!
OHA has created a fact sheet that explains the requirements for submitting Medical Management Review (MMR) requests.
- Please refer to this fact sheet when requesting OHA review of services that pair below Line 469 of the Prioritized List of Health Services.
- Also refer to Oregon Administrative Rule (OAR) 410-141-0480(8) and any other rules and guidelines that pertain to the requested services.
You can find this and other resources related to fee-for-service prior authorization of physical health services on OHA's Prior Authorization page.
The Transformation Center invites clinicians who serve Oregonians to a recorded free CME-accredited webinar about controlling high blood pressure. The webinar features Dr. Mark Backus, a Bend physician who was named a hypertension control champion by the Centers for Disease Control and Prevention Million Hearts® campaign.
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When: Available on demand through September 20, 2019
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Webinar registration (includes pre-test questions for CME): https://attendee.gotowebinar.com/register/9066652441072643329
CME credit is available to qualified participants who complete the one-hour training and pre- and post-test. Qualified participants include physicians, nurse practitioners, registered nurses, physician assistants, certified nurse midwives, and licensed social workers. To learn more, read OHA's fact sheet.
Independent ESRD should bill OHA the current Medicare Allowed amount for Continuous Ambulatory Peritoneal Dialysis (CAPD), Continuous Cycling Peritoneal Dialysis (CCPD), and Hemodialysis. OHA will reimburse as follows:
- Composite at 80% of the Medicare allowed amount, except for Epoetin.
- Epoetin at 100% of the Medicare maximum allowed amount.
To learn more, see OAR 410-125-0201 - Independent ESRD Facilities.
Earlier this year, OHA updated its claim system and the OHP Behavioral Health Fee Schedule with changes to the units and daily limits for HCPCS codes H0005 and H0015, effective January 1, 2019. Until OHA determines an appropriate per-service rate for H0006, OHA will continue to reimburse H0006 per 15-minute unit.
To learn more about this change, read OHA's May 2019 letter to SUD providers.
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