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
“No Wrong Door” for Oregon Health Plan providers billing for covered monoclonal antibody (mAb) services: Effective immediately, the Oregon Health Authority (OHA) is implementing a “no wrong door” policy for billing covered monoclonal antibody (mAb) services provided to eligible Oregon Health Plan (OHP) members. This means:
- Providers contracted with the member’s coordinated care organization (CCO) should bill the CCO.
- Providers not contracted with the member’s CCO should bill OHA.
To learn more, please review the Sept. 22 announcement from OHA.
Oral ivermectin is not approved to treat or prevent COVID-19: OHA requires prior authorization (PA) for fee-for-service coverage of oral ivermectin tablets of any strength.
- Ivermectin for treatment or prevention of COVID-19 is not currently approved by the FDA or authorized by an EUA. At this time, use of oral ivermectin for COVID-19 should be limited to the clinical trial setting.
- Oral ivermectin is a prescription-only product that is not covered or federally funded for use in COVID-19.
- Ivermectin can be associated with drug interactions and has teratogenic risk in pregnancy. Inappropriate use has also been linked to increases in ivermectin overdoses reported to state Poison Control Centers.
- Benefit for treatment or prevention of COVID-19 has not been established.
To learn more, including current evidence for oral ivermectin use, please review OHA's Sept. 27 fax to prescribing providers.
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 following updates:
- "No Wrong Door" policy for mAb services
- Oral ivermectin is not approved to treat or prevent COVID-19
- Non-emergent transportation brokerage flexibility to use private commercial transportation options
Apply now for new COVID-19-related funding opportunities - Applications close Oct. 26, 2021
The application is now open for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments.
The application will close on Oct. 26, 2021, at 11:59 p.m. ET. Applications must undergo a number of validation checks before financial information is submitted so providers are encouraged to begin their application as soon as possible to ensure they are able to meet the deadline.
In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application, and HRSA will use existing Medicaid, Children's Health Insurance Program (CHIP), and Medicare claims data in calculating portions of these payments.
Updates for all health care providers
- Vaccine requirements for health care providers and health care staff:
- Booster dose information:
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Frequently Asked Questions (9/30/2021): Also in Spanish, Traditional Chinese, Marshallese, Arabic, Somali Korean Simplified Chinese Portuguese Russian Vietnamese Chuukese
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"Is a COVID-19 vaccine booster recommended for me?" (flyer) (9/24/2021): Also in Marshallese, Arabic, Hmong, Somali, Korean, Portuguese, Russian, Chuukese, Simplified Chinese, Traditional Chinese, Vietnamese
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Is a COVID-19 vaccine booster recommended for me? (social card) in Marshallese, Arabic, Hmong, Somali, Korean, Portuguese, Russian, Chuukese, Simplified Chinese, Traditional Chinese, Vietnamese, Spanish
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Booster and Third Dose website (also in Spanish)
- Monoclonal antibody therapy:
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Talking Points (9/16/2021)
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Flyer (8/31/2021) now available in Arabic, Simplified Chinese, Traditional Chinese, Chuukese, Hmong, Korean, Marshallese, Russian, Somali, Spanish,
Vietnamese
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- Other updates:
OHA has established a goal of eliminating health inequities by 2030, and it is important to OHA and coordinated care organizations (CCOs) that health information technology (health IT) support this goal.
OHA is collaborating with CCOs to launch the 2021 Oregon Health IT Survey to collect health IT information from all contracted organizations, whether or not they use an electronic health record (EHR).
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Information collected from the survey will inform:
- CCOs’ efforts to support health IT adoption and use across their provider networks.
- OHA's decisions related to health IT policy, strategy, and funding.
Physical, oral, and behavioral health organizations should expect to receive an email from OHA over the next few weeks. The survey will include questions about the following topics:
- Your organization’s EHR,
- The health IT tools your organization uses,
- The benefits and barriers to exchanging electronic health information, and
- Patient engagement in health IT.
Your organization’s participation in the survey is very important. Whether or not your organization uses health IT is important for your CCOs and OHA to know, including the barriers your organization faces with health IT implementation and use. We thank you in advance for taking the time to complete the survey!
For questions about the 2021 Oregon Health IT Survey, please contact OHAhealthIT.Survey@dhsoha.state.or.us.
The Health Evidence Review Commission has current vacancies and is accepting applications through Oct. 31, 2021 or until these volunteer positions are filled:
- A physician Commission member with expertise in clinical expertise in the areas of family medicine, internal medicine, obstetrics, perinatal health, pediatrics, disabilities, geriatrics or general surgery.
- A Commission member who is a dentist.
- Multiple subcommittee members (especially surgeons, chiropractic physicians or consumer representatives).
For more information about these vacancies please contact herc.info@dhsoha.state.or.us or visit the Commission's membership interest page for application details.
The Commission evaluates clinical evidence and prioritizes health services to determine covered services for the Oregon Health Plan. Subcommittees do in-depth review of coverage policy questions and clinical evidence and prepare recommendations for the Commission.
The Commission member is appointed by the Governor; the subcommittee members are appointed by the Commission. Skill or experience evaluating clinical evidence, understanding the needs of health plan members and working with or representing Oregon Health Plan members will be considered in the application process.
SUD treatment code and rate changes effective Jan. 1, 2022
Effective Jan. 1, 2022, OHA will implement fee-for-service reimbursement for:
- Treatment provided within SUD facilities with more than 16 beds, and
- Community integration services (housing and employment support services) for members with SUD.
OHA is working to identify applicable CPT and HCPCS procedure codes and develop rates commensurate to these services. To learn more and view the preliminary list of services effective on or after Jan. 1, 2021, please view the announcement from OHA.
Fee-for-service prior authorization reminders
OHA's Provider Clinical Support Unit (PCSU) thanks you for your service to OHP members. Please review these important tips to help you submit and reference prior authorization (PA) requests to OHA:
- Please submit all PAs with the EDMS coversheet included as the cover page for supporting documentation. This includes all PAs submitted via fax and the online Provider Web Portal.
- Please use the PA hotline (800-336-6016 option 3) for verification of PA status and PA submission guidance only.
- For all other questions including those related to PA requirement for specific services, please use the Code pairing hotline at (800-336-6016 option 4).
- For education about the PCSU, general PA submission information, and details about submitting Continuity of Care/CCO disenrollment requests, please view this recorded webinar presentation.
Contact change for reporting inpatient admissions and discharges
Please submit all notices of inpatient admissions and discharges for fee-for-service (open card) members via secure email to DMAP.CES@dhsoha.state.or.us. The Provider Clinical Support Unit does not require this information.
In the subject line, list "Patient Admission/Discharge From Our Facility." In the body of your email, please include the following information:
- Patient's name (First Name Last Name)
- Patient's date of birth (MM/DD/YYYY)
- Patient's 8-digit Oregon Medicaid ID (AA####AA, AAA#####A)
- Admission date (MM/DD/YYYY)
- Discharge date (MM/DD/YYYY)
- Discharge disposition ("Home" or "Self Care")
Medicaid EHR Incentive Program Year 2021 is scheduled to close Oct. 15, 2021
OHA will continue to accept Program Year 2021 attestations for the Medicaid Electronic Health Record Incentive Program (or Promoting Interoperability Program) through Oct. 15, 2021.
Questions? Please call 503-945-5898 or email Medicaid.EHRIncentives@dhsoha.state.or.us.
DRG hospitals: Version 39 MS-DRG and LTC-DRG implementation delay
OHA must delay implementation of Version 39 of the inpatient MS-DRG and LTC-DRG grouper, effective Oct. 1, 2021. When OHA confirms an implementation date, we will let you know.
Recent rule revisions
OAR 309-019-0140 - Clarifies Who Can Approve or Sign a Behavioral Health Service Plan
OAR 410-120-1260 - Requiring OHP Enrolled Providers Review The Prescription Drug Monitoring Program (PDMP) Before Prescribing Controlled Substances.
OAR 410-121-0030 - Amending Preferred Drug List
OAR 410-141-3855 - Requiring CCO Contracted Providers Check the Prescription Drug Monitoring Program Before Prescribing Controlled Substances
OAR 415-020-0005, 415-020-0010, 415-020-0025, 415-020-0065, 415-020-0070, 415-020-0075 - Rule Change to Allow Mid-level Practitioners to Write Medication Orders at Opioid Treatment Programs
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