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To increase the number of places OHP-eligible children and families can go to access flu and COVID-19 immunizations, the Oregon Health Authority (OHA) will not require Vaccines for Children (VFC) program enrollment for:
- Any OHP provider administering children’s COVID-19 immunizations; or
- Any OHP-enrolled pharmacies providing children’s flu immunizations, for the duration of the COVID-19 Public Health Emergency (PHE). Pharmacies will need to enroll in the VFC program to provide any other children’s immunizations.
The Oregon State Board of Pharmacy will also issue orders allowing pharmacists to vaccinate ages 3 and above for flu (and COVID-19 once authorized). OHA’s Immunization Program will also issue updates to the vaccine protocols that pharmacies use. These orders will be effective for the duration of the COVID-19 PHE.
OHA has a “no wrong door” policy for COVID-19 immunizations. OHA is extending this policy to include pharmacies offering flu vaccines to OHP-eligible children. This means pharmacies who are not contracted with CCOs may bill OHA directly.
What should you do?
CCOs should make the necessary arrangement to reimburse pharmacies for flu and COVID-19 immunizations provided to OHP-eligible children. CCOs may reimburse pharmacies for flu immunizations for dates of service on and after 10/20/2021, and for COVID-19 immunizations as soon as FDA-authorized products are available. CCO reimbursement should be as follows.
For COVID-19 vaccines, reimburse for administration only since the is serum is distributed to providers at no cost.
- For flu vaccine outside of the VFC program, reimburse for both the administration and the serum.
- Reimburse VFC-enrolled providers for administration only since VFC vaccines are distributed at no cost to providers.
If you have questions, please contact your CCO Account Representative.
Effective November 8, 2021, the Oregon Health Authority (OHA) has determined that the Oregon Health Plan will cover COVID-19 home testing kits for members who have symptoms consistent with COVID-19 or who have had confirmed or suspected exposure to COVID-19.
- Up to four units per month may be covered without restrictions and without requiring documentation of symptoms or exposure.
- More than four tests per month and products other than the basic home tests are also covered when ordered by a health care provider as a necessary component of an individualized care plan.
This applies to home test products for COVID-19 that are:
- Dispensed by pharmacies
- Authorized by the FDA, including products authorized for over the counter (OTC) sale
- Billed through pharmacy point of sale (POS)
This coverage is in addition to reimbursement to clinics and labs for COVID-19 testing.
Why is this happening?
Federal guidance issued August 30, 2021 makes clear that state Medicaid programs must cover all COVID- 19 testing products authorized by Emergency Use Authorization (EUA), including home test products.
States may apply utilization management controls so long as they are not arbitrary barriers to accessing COVID-19 testing.
What should you do?
CCOs should reimburse pharmacy providers for covered COVID-19 home tests. Please work with pharmacies to determine whom to list in the prescribing provider field on POS claims. This may be the pharmacy itself or an enrolled pharmacist processing the OTC sale.
CCOs may direct members to existing in-network pharmacies if adequate access is ensured. CCOs may also apply reasonable utilization management limits as described below.
Utilization management limits for COVID-19 home tests
For the purposes of determining the number of tests per month:
- One test is the collection and processing of one sample, regardless of package size or packaging
- For example, a product that comes in a package with two tests and directs the user to use the second test 36 to 72 hours after the first should be counted as two
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Tests
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Number per month
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Limits allowed
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Self-administered antigen tests authorized for OTC sale. Limited to test kits that do not require an internet connection or a smartphone for test interpretation.
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4
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None. CCOs may not require primary care provider (PCP) order/prescription or prior authorization (PA).
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Self-administered antigen tests authorized for OTC sale. Limited to test kits that do not require an internet connection or a smartphone for test interpretation.
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More than 4
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CCOs may require PCP order/prescription and/or PA.
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All self-administered tests that require an internet connection or a smartphone for test interpretation.
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Any quantity
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CCOs may require PCP order/prescription and/or PA.
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Home-sampled molecular diagnostic tests sent to a lab for analysis.
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Any quantity
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CCOs may require PCP order/prescription and/or PA.
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If you have questions, please contact your CCO Account Representative.
Metrics and Scoring Committee / Health Plan Quality Metrics Committee
OHA is seeking members for two committees which oversee health care quality measurement and quality bonus payments, the Metrics & Scoring and Health Plan Quality Metrics committees. We are seeking motivated members with a passion for eradicating inequities and improving health care for people in Oregon, particularly those subjected to historical and contemporary injustices.
People with lived experience of health inequities and members of the Oregon Health Plan are especially encouraged to apply. While there are several current vacancies on each committee, we are seeking applications for all positions to create a robust applicant pool for additional vacancies occurring over the next year.
Applications due November 15, 2021
Please review the application instructions for more information about how to apply.
Dental Pilot Project Program accepting applications to serve on advisory committee
The OHA Dental Pilot Projects Program is seeking applicants to serve on the Advisory Committee for Dental Pilot Project #300, “Dental Therapist Project: Dental Hygiene Model.”
Applications due by 5 p.m. Monday, November 22, 2021
Application information and submission instructions can be located at the Dental Pilot Project Program Website at healthoregon.org/dpp.
All committee meetings will be held virtually. The first advisory committee meeting will be on Jan. 31, 2022, from 9-11 a.m.
Dental Pilot Projects are intended to evaluate the quality of care, access, cost, workforce, and efficacy by teaching new skills to existing categories of dental personnel; developing new categories of dental personnel; accelerating the training of existing categories of dental personnel; or teaching new oral health care roles to previously untrained persons.
If you have questions, please reach out to Sarah Kowalski at sarah.e.kowalski@dhsoha.state.or.us.
The Oregon Rural Practice-based Research Network (ORPRN) received funding from OHA Injury and Violence Prevention Section to explore suicide prevention in primary care. This funding will support a one-year ORPRN project to understand:
- How primary care clinics are approaching the topic of suicidality
- If/how patients are screened for suicidal ideation and/or depression
- What local resources exist for supporting patients
- Clinician comfort and knowledge around this topic
Project activities include participation in a brief online survey, key informant interview, and/or panel. A brief survey will be shared with primary care clinicians (including MDs, DOs, NDs, NPs, and PAs) throughout the state. Survey responses will inform the development of a semi-structured interview guide and resources to support primary care clinics with addressing suicide.
Learn more about the project and survey. Providers who are interested in participating in this panel or have questions about the project, please contact Tiff Weekley at weekley@ohsu.edu.
Oregon allotment
For the week of 10/18/21, Oregon has been allotted the following:
- Casirivimab/Imdevimab – 960
- Bamlanivimab/Etesevimab – 490
- Sotrovimab – 294
Be advised, Sotrovimab is now in circulation via federal supply. It will not be available for commercial purchase. Sotrovimab will be included in this week’s site allocation and will make up part of your IV requests. Please review the EUA fact sheet.
Placing requests
- If your site has already received mAb from Amerisource Bergen or has signed up to receive mAb via Oregon Health Authority or HHS: You may place a request.
- Sites that are unable to use at least 70% of their allocation can expect to receive a reduced allocation the following week. We recommend ordering no more than you anticipate being able to administer week to week.
- If your site has not received mAb from Amerisource Bergen and has not signed up to receive mAb via Oregon Health Authority or HHS: Please email OR ESF8 AOC Logistics Chief LogisticsChiefs@dhsoha.state.or.us for more information on how to sign up.
To learn more about the allocation process and see the weekly allocation data visit the OHA mAb provider web page.
Mental health parity means that mental health and substance use disorder services are treated generally the same as, or better than, medical and surgical services. The Oregon Health Authority tasked the Health Services Advisory Group (HSAG) with analyzing mental health parity across Oregon's Medicaid delivery system.
For 2021, HSAG conducted an analysis based on recommendations documented in the 2020 Mental Health Parity Analysis Summary Report and developed in partnership with OHA, focusing on adherence to utilization management for medical/surgical and mental health/substance use disorder benefits and services. The 2021 report provides a summary of the findings from the analysis across all organizations.
Read the full 2021 Mental Health Parity Analysis Summary Report.
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. Learn more about the opportunities.
US Department of Health and Human Services Secretary Xavier Becerra signed a renewal of the determination that a "public health emergency" exists due to the COVID-19 pandemic. The previous 90-day declaration was last renewed in July and set to expire. This latest renewal is effective October 15 and will continue for another 90 days. Read the renewal declaration.
     
Please visit the committee and workgroup links below for more information about meetings. You can also view the OHA Public Meeting calendar.
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