Temporary fee-for-service rate increase for behavioral health residential providers: The Oregon Health Authority (OHA) has applied a temporary 10% rate increase to fee-for-service claims submitted by Oregon Medicaid mental health and substance use disorder residential providers serving adults or children, for dates of service from 7/1/2020 through 6/30/2021. OHA is issuing reimbursement for the increase two ways:

• On June 30, providers received a lump sum payment for claims submitted from 7/1/2020 through 5/16/2021.
• The increase automatically applies to claims submitted on or after 5/17/2021.

To view the specific procedure codes affected by the increase, and how the lump sum payment is reported on the remittance advice from OHA, please read the July 8 announcement from OHA.

Additional payment for in-home COVID-19 vaccine administrations: Providers who administer COVID-19 vaccines at the patient's home can bill the Oregon Health Plan an in-home visit fee of $35.50 per visit, for dates of service on or after June 8, 2021. This fee:

• Is in addition to the base vaccine administration rates in the Oregon Medicaid COVID-19 Provider Guide,
• Applies only once per visit for members who are unable to leave to their home or otherwise difficult to reach as described in the Centers for Medicare & Medicaid Services (CMS) fact sheet about the fee, and
• Does not apply to providers paid at an all-inclusive encounter rate for COVID-19 vaccine administration, including Federally Qualified Health Centers, Rural Health Clinics, Indian Health Services and Tribal 638 programs.

To learn more, please review the July 6 announcement from OHA.

Coverage of COVID-19 vaccine counseling: Counseling patients about COVID-19 vaccine, including advising them about the risks from getting and not getting vaccinated, is covered by the Oregon Health Plan.

• Counseling with vaccine administration (same visit): Reimbursement under the vaccine administration codes (0001A-0031A) is for up to 20 minutes of counseling and the vaccine administration. Providers may bill for counseling that exceeds 20 minutes.
• Counseling without vaccine administration (separate visit): Counseling that does not occur during the vaccine administration visit is reimbursed under the Evaluation and
  Management (E/M) code appropriate for the time spent counseling.

Reimbursement for counseling-only visits or more than 20 minutes of counseling time is available only through the professional billing pathway. View the Oregon Medicaid COVID-19 Provider Guide for billing details.