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
Fee-for-service coverage of COVID-19 home testing effective Nov. 8, 2021: The Oregon Health Authority (OHA) will cover self-administered home COVID-19 antigen testing kits through pharmacy point-of-sale (POS) for fee-for-service Oregon Health Plan (OHP) and CAWEM members who have symptoms consistent with COVID-19 or who have had confirmed or suspected exposure to COVID-19.
- This coverage is for home tests as a diagnostic tool, not a general screening tool; and does not replace coverage for COVID-19 testing done in clinics and labs.
- Qualifying products are tests FDA-authorized for over-the-counter (OTC) sale that do not require an internet connection or a smartphone for test interpretation.
OHA will cover up to four units per month without a primary care provider’s (PCP) order or prior authorization. OHA may cover more than four units per month when ordered by the PCP as a necessary component of an individualized care plan.
All other COVID-19 home test products, including those that require internet or a smartphone, require PCP order and prior authorization.
To learn more, please read the announcement from OHA.
CAWEM coverage of COVID-19 home tests and flu vaccinations during the COVID-19 Public Health Emergency: OHA will cover the following services for CAWEM members during the COVID-19 Public Health Emergency:
- Flu vaccinations effective Nov. 4, 2021; and
- COVID-19 home tests FDA authorized for over-the-counter sale effective Nov. 8, 2021, as described in the Oct. 29 memo from OHA.
As a reminder, OHA covers COVID-19 testing, vaccines and treatment for CAWEM members during the COVID-19 Public Health Emergency. Please refer to the Oregon Medicaid COVID-19 Provider Guide for information about CAWEM coverage during COVID-19.
To learn more, please read the announcement from OHA.
OHP coverage of children’s COVID-19 and flu immunizations at OHP-enrolled pharmacies: Effective 10/20/2021, OHA will accept fee-for-service pharmacy point of sale claims for covered flu immunizations for children ages 3 to 18 years. OHA will also accept pharmacy point-of-sale claims for children’s COVID-19 immunizations authorized under FDA Emergency Use Authorization. OHA has asked coordinated care organizations (CCOs) to also make the necessary arrangements to reimburse pharmacies for these immunizations.
To increase the number of places OHP-eligible children and families can go to access flu and COVID-19 immunizations, 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. Pharmacies will need to enroll in the VFC program to provide any other children’s immunizations.
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.
To learn more, please read OHA's fax to Oregon pharmacies and memo to CCOs, and share OHA's new fact sheet for OHP and CAWEM members about this change.
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 includes the following information:
- Updated billing codes and rates for pediatric vaccine and booster doses
- Coverage of children's flu and COVID-19 vaccinations administered by OHP-enrolled pharmacies
- Coverage of COVID-19 home tests
- Coverage of flu vaccinations for CAWEM members effective 11/4/2021
- Inpatient hospital billing for monoclonal antibody therapy
Virtual learning sessions: Pediatric COVID vaccines for clinics
The OHA Transformation Center, in partnership with the OHA Vaccine Planning Unit, is hosting a learning series focused on pediatric COVID-19 immunizations.
As a participant, you will hear from subject matter experts and peers on key topics such as pediatric vaccine updates, how to build vaccine confidence in parents, and using equity in all planning and delivery of vaccine. Time will be reserved to answer questions from clinical staff.
Space will be limited to the first 500 participants. Please register for each date below and join us via Zoom. All sessions are Thursdays from noon to 1 p.m. Pacific Time.
Updates for all health care providers
Applications open through Nov. 17, 2021
The Health Information Technology Oversight Council (HITOC) is seeking members for a new chartered Community Information Exchange (CIE) Workgroup to recommend strategies to accelerate, support, and improve CIE across the state.
- The CIE Workgroup is a great opportunity for individuals who want to help advance health equity in Oregon through health information technology (IT), and those who have experience with CIE or social determinants of health. It will bring together individuals representing Oregon’s diverse landscape of community, health care, and social services partners.
- Workgroup recommendations will inform HITOC’s Health IT Strategic Plan for Oregon and OHA efforts. CIEs help connect people to services by providing a common technology for health care, coordinated care organizations (CCOs), social services, and other partners to identify and refer individuals to social supports.
Applications are open now through Nov. 17, 2021. To apply, those interested should complete this application and submit via email to HITOC.info@dhsoha.state.or.us.
Questions? Please contact hope.peskin-shepherd@dhsoha.state.or.us.
October 2021 Behavioral Health Fee Schedule update
OHA has updated the OHP fee-for-service Behavioral Health Fee Schedule. To learn about the changes, please view these documents (also available on the OHP Fee Schedule page):
Change Log for the 10/1/21 Prioritized List
The Health Evidence Review Commission released a Change Log for the 10/1/2021 Prioritized List of Health Services. View details and files and the Commission's Prioritized List page.
Questions? Please email HERC.Info@dhsoha.state.or.us.
Recent rule revisions
OAR 410-141-3510 - Suspension of CCO credentialing requirements for flu vaccination administration providers
OARs 410-129-0070, 410-129-0085, 410-129-0240 - Auditory osseointegrated device component replacement codes and supporting rules to allow for needed member services
OAR 410-140-0160 - Corneoscleral lenses are covered. Rules needed to support practice, to allow for needed member services
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