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
Oregon Health Plan coverage for third dose of COVID-19 vaccine: Effective 8/12/2021, the Oregon Health Plan (OHP) covers a third dose of mRNA vaccines when prescribed by a qualified health care provider.
- A patient’s clinical team is best positioned to determine the degree of immune compromise and appropriate timing of vaccination.
- Moderately to severely immunocompromised persons should be offered a third dose of either Pfizer or Moderna COVID-19 vaccine, depending on the brand received previously.
- There is currently no indication for additional doses of Johnson & Johnson vaccine.
To learn more, please read the Oregon Health Authority's (OHA) Sept. 2 memo.
Flexibility for non-emergent medical transportation brokerages to use private commercial transportation options during the COVID-19 public health emergency: Brokerages can allow Oregon Medicaid members to use private commercial transportation options, including taxicab companies and transportation network companies like Uber and Lyft.
- If their brokerage chooses to pursue this option, members can hail rides from these services and request reimbursement directly from the brokerage.
- To learn more, please read the Sept. 2 memo from OHA.
Mental health residential temporary rate increase for State Fiscal Year 2021 - Reimbursement for T1020 and T2033: Earlier this year, OHA 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 completing reimbursement for this increase in a lump sum payment that will be reported on the Aug. 31 remittance advice from OHA. To learn more, please read the Aug. 30 memo from OHA.
Changes to hospital transfer policy and prior authorization requirements for long-term acute care and inpatient rehabilitation services, effective immediately: OHA is making the following changes to help reduce the burden on Oregon’s hospitals and health systems as they respond to the current surge in COVID-19 hospitalizations:
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Multiple transfers and reimbursement: For in-state and out-of-state contiguous transfers (patient status 02 and 05), regional hospitals can use patient status 10 for back transfers to rural hospitals. Patient status 10 will bypass the current transfer policy (Oregon Administrative Rule 410-125-0165) and allow the transferring regional hospital to receive the full DRG payment and outlier if applicable.
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Prior authorization reviews paused for LTAC hospitals and inpatient rehabilitations: For OHP clients with fee-for-service (FFS or open card) medical benefits, OHA will automatically approve discharge to inpatient rehabilitation units and LTAC hospitals if the prior authorization request shows that:
- The billing and rendering providers are Medicaid-enrolled,
- The client has current OHP eligibility, and
- The requested services are paired above the funded line on the Prioritized List of Health Services.
Coordinated care organizations (CCOs) are encouraged to support these efforts with their providers. To learn more, please read the Aug. 27 memo from OHA.
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 hospital policy changes mentioned above.
- Information about coverage and billing for monoclonal antibody threatment prescribed and administered by Oregon pharmacists (effective 9/1/2021).
- Information about billing for third-dose COVID-19 vaccine administration.
Updates for all health care providers
- Vaccine requirements for health care providers and health care staff:
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Vaccine Religious Exception Request Form (9/1/2021); also available in Spanish
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Vaccine Medical Exception Request Form (9/1/2021); also available in Spanish and Marshallese
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Frequently Asked Questions (8/27/2021, updated 9/2/2021); also available in Traditional Chinese, Marshallese, Arabic, Hmong, Somali, Korean, Simplified Chinese, Russian, Spanish, Vietnamese
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Oregon Administrative Rule 333-019-1010 (8/25/2021, updated 9/1/2021); also available in Arabic, Chuukese, Hmong, Korean, Marshallese, Russian, Simplified Chinese, Spanish, Traditional Chinese, Vietnamese
- Masking requirements:
- Testing information:
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COVID-19 testing information (8/19/2021); also available in Arabic, Chuukese, Hmong, Simplified Chinese, Spanish, Traditional Chinese, Vietnamese
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COVID-19 Additional Doses FAQs (8/16/2021); also available in Arabic, Chuukese, Hmong, Korean, Marshallese, Russian, Simplified Chinese, Somali, Spanish, Traditional Chinese, Vietnamese
- Other updates:
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COVID-19 Health Talking Points (9/3/2021)
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Monoclonal antibody therapy flyer (8/31/2021)
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Behavioral Health Support for Health Care Workers (8/26/2021); also available in Traditional Chinese, Chuukese, Arabic, Hmong, Somali, Korean, Russian, Spanish, Vietnamese, Simplified Chinese, Marshallese
Million Hearts Learning Lab provides cardiovascular disease prevention education with CME: Sessions begin Sept. 15, 2021
The Million Hearts Learning Lab is a bi-monthly learning series focused on cardiovascular disease prevention and management topics. The series is open to clinicians, quality improvement, and other interested staff across the country, but with a focus on community health centers. Clinicians may earn 1.0 CME credit per session and up to 5.0 credits for attending the full series through the American Medical Association’s EdHub.
Visit the Learning Lab's website to:
- Register for live events
- Listen to pre-work audio recordings
- Submit your questions in advance
- Apply for CME credits.
- Access recordings and materials
Join OHA's webinar about continuity of care CCO disenrollment and prior authorizations on Tuesday, Sept. 28, 2021, 8:30 to 10 a.m.
OHA's Community Partner Outreach Program and the OHA Health System Division's Provider Clinical Support Unit are co-presenting an educational webinar to help OHP providers, certified community partners, and other interested stakeholders understand:
- Understand how to submit a prior authorization (PA) for an OHP member with FFS (open card) eligibility and what to expect from that process.
- Understand how and when an OHP continuity of care CCO disenrollment can be requested.
Fact sheet about contract requirements and supplemental payments for the CCO Ground Emergency Medical Transportation Program
A new fact sheet about contract and reimbursement requirements for the CCO Ground Emergency Medical Transportation Program is now available on the program's web page. It explains:
- The requirements for contracts between GEMT providers and CCOs for reimbursement during calendar year 2021; and
- How OHA will determine the supplemental payments to CCOs, which the CCOs will pass through to contracted GEMT providers.
Available authorization forms for administrative exam providers
Due to compatibility issues with the recently revised OHP 729 form, OHA has reverted to the older version of this form. We apologize for the confusion. When a new version is available, we will let you know.
Providers can find all currently accepted administrative examination forms on the Administrative Exams and Reports rules and guidelines page.
October 1, 2021 Prioritized List of Health Services
The Notice of Interim Modifications and all files for the pending October 1, 2021 Prioritized List of Health Services are now available on the Health Evidence Review Commission website.
Recent rule revisions
OAR 410-200-0315 - Income Eligibility Guidelines for HSD Medical Programs
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