As we work together to stop the spread of COVID-19 at home, work and in the community, we want to make sure you have the resources you need to keep informed, healthy and safe. If you have any questions about OHP and COVID-19, please let us know.
Updates for Oregon Health Plan providers
Clarification about CAWEM Plus (CWX) eligibility during the COVID-19 emergency: If a member was receiving CAWEM Plus (CWX) coverage through a full eligibility determination on or before March 18, 2020, or obtained CAWEM Plus eligibility since that date:
- They will continue to be covered for CAWEM Plus benefits.
- CAWEM Plus (CWX) benefits will not be reduced to CAWEM-only (CWM) benefits.
Some members with CAWEM Plus benefits had their benefits reduced to CAWEM-only benefits in error. The system issue causing this error was corrected on May 6, and the Oregon Health Authority (OHA) is working to correct records to reflect continued CAWEM Plus benefits for affected members. As records are corrected, OHA will reprocess associated claims for covered CAWEM Plus services.
There are a few reasons why coverage would be closed during the COVID-19 public health emergency. Please see the Eligibility section of the Oregon Medicaid COVID-19 Provider Guide for more information.
Fee-for-service reimbursement for non-emergent medical transportation (NEMT) trips to COVID-19 drive-through vaccination clinics: OHA will reimburse fee-for-service (FFS) NEMT providers for trips associated with a drive-through COVID-19 vaccination at $13.23 per 30-minute unit.
- For the trip to be reimbursable at this rate, the Oregon Health Plan (OHP) member must arrive at the site in the provider vehicle and receive the COVID-19 vaccination without exiting the vehicle.
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The Centers for Medicare & Medicaid Services approved this change on May 7, 2021. The rate is effective for dates of service on and after Jan. 1, 2021, for the duration of the COVID-19 public health emergency.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to OHP and CAWEM coverage of vaccine, testing, screening, treatment and telemedicine services; OHP and CAWEM eligibility; and other information and resources related to providing and billing for covered services during COVID-19.
The guide now contains the above clarification about continued CWX eligibility and information about FFS NEMT reimbursement for rides to COVID-19 drive-through vaccination clinics.
Updates for all health care providers
Patient letter template to encourage COVID-19 vaccination
Primary care providers greatly influence a person’s decision to be vaccinated. OHA has created a letter that providers can customize and send to their patients in multiple languages:
English | Spanish | Arabic | Chinese - Simplified and Traditional | Chuukese | Hmong | Korean Russian | Ukrainian | Vietnamese
You can find these and other COVID-19 vaccine communication resources on the OHA website. To use the templates:
- Please copy to your office's letterhead and customize with your patient's name and your provider signature.
- Please send letters via regular mail in addition to sending via EMR systems. Older adults, communities with barriers to technology, and communities of color are less likely to access their EMR and more likely to have lower vaccine confidence.
Johnson & Johnson COVID-19 vaccine information
Value-based payment webinar series: Next session is May 19
Primary care, behavioral health, and maternity care providers are invited learn how to get ready for value-based payment (VBP) and take advantage of the additional flexibility VBPs offer for innovatively redesigning care models. These upcoming webinars are from noon to 1 p.m.
Speakers: Art Jones, Jeanene Smith, Janet Meyer (Health Management Associates)
Oregon value-based payment focus groups: May and June 2021
To better understand provider perceptions of VBP and the best ways to inform providers about VBP contracting models, OHA encourages Oregon behavioral health, physical health/medical and dental providers to share their thoughts about payment reform at a 1-hour VBP focus group led by the Oregon Rural-based Research Network (ORPRN).
If you choose to participate, ORPRN will share your feedback with OHA to inform VBP activities, but your individual identity and responses will be confidential. Participants will receive a $25 gift card for their time.
Medicaid EHR Incentive Program Year 2021 is open as of May 1, 2021
OHA is now accepting Program Year 2021 attestations for the Medicaid Electronic Health Record Incentive Program (or Promoting Interoperability Program) through August 31, 2021.
Questions? Please call 503-945-5898 or email Medicaid.EHRIncentives@dhsoha.state.or.us.
CAWEM benefit to include emergency dialysis services effective July 1, 2021
OHA is adding emergency dialysis to the CAWEM (CWM) benefit package, effective July 1, 2021. This coverage is limited to hospital and emergency room care needed to sustain life during a medical emergency, for CAWEM members with acute renal failure or end stage renal disease.
To learn more about this change, please read the April 29 announcement from OHA.
Recent rule revisions
OAR 410-129-0070, 410-129-0085 and 410-129-0240 - Auditory Osseointegrated Device Component Replacement Codes and Supporting Rules to Allow for Needed Member Services
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