OHA is confirming the use of In Lieu of Services as an option for CCOs to reimburse members for over-the-counter COVID tests. Read the full memo.
OHA is issuing this guidance in alignment with guidance released on January 15, 2022, by the Centers for Medicare and Medicaid Services (CMS) requiring private insurance to cover the costs of over-the-counter COVID-19 diagnostic tests.
In Lieu of Services (ILOS) are services determined by the state to be medically appropriate and cost-effective substitutes for covered services or settings under the State Medicaid Plan.
Reimbursing members
You must provide members with access to free COVID-19 test kits. Access must be made available in a manner that is equitable with those who have private insurance. Health plans are required to cover:
- Up to 8 per month without PCP order or prior authorization, or unlimited tests with an order from a licensed healthcare provider;
The most efficient way to achieve this access may be accepting receipts and reimbursing members directly. However, if you can operationalize more efficient, equitable, access you may do so to the extent that access is made in compliance with applicable state and federal law.
If you accept receipts and reimburse members directly, you are required to cover:
- Up to $12 per individual test. Please note this is per test, not per kit. For example, if there are two tests in a kit, reimbursement would be up to $24.
ILOS must meet requirements, including being listed in member handbooks
ILOS must meet requirements outlined in 42 CFR 438.3(e)(2) and Exhibit B, Part 2, Section 11 of the 2022 CCO Contract. ILOS must be a medically appropriate and cost effective substitute for a covered service consistent with provisions in OAR 410- 141-3820.
- OHA considers over-the-counter COVID tests as part of prevention programs for ILOS.
- For CCOs to offer ILOS, services must be listed in member handbooks. If a CCO’s member handbook does not currently list ILOS prevention programs, it would need to be amended.
- Please submit amended member handbooks to the Quality Assurance team for approval.
If you have any questions, please contact ILOS.info@dhsoha.state.or.us.
A helpful new guide comparing CCO spending programs provides an overview of health-related services (HRS), in lieu of services (ILOS) and the SHARE Initiative (Supporting Health for All through Reinvestment) is now available.
The guide includes and examples of activities that could fall into each category.
If you have questions, please contact Anona Gund, Anona.E.Gund@dhsoha.state.or.us, or Laura Kreger, Laura.E.Kreger@dhsoha.state.or.us
Please share this important resource with your networks.
The Oregon Psychiatric Access Line (OPAL) provides free, same-day child and adult psychiatric phone consultation to primary care providers in Oregon.
OPAL provides the support that medical practitioners need to care for more patients in their medical home. With OPAL, medical practitioners may be able to treat youth with mental health issues right away rather than placing patients on waiting lists to receive care. Earlier intervention may decrease complications of untreated mental disorders including hospitalization and suicides.
The program also offers evidence-based support to medical practitioners in need of psychiatric treatment information. Overall, OPAL helps build a system that allows primary care providers to deliver the best possible care.
Toll-Free: 855-966-7255
Portland Metro: 503-346-1000
9 a.m. – 5 p.m. Monday through Friday, excluding major holidays
OPAL is a collaboration between OHSU's Division of Child and Adolescent Psychiatry, Adult Psychiatry, the Oregon Pediatric Society (OPS) and the Oregon Council of Child and Adolescent Psychiatry (OCCAP).
For questions about the Oregon Psychiatric Access Line, please contact opal@ohsu.edu.
The list of CCO deliverables for Contract Years 2021 and 2022 due in the second quarter of 2022 has been posted on the CCO Contract Announcements page.
If you have questions, please contact Cheryl Henning, CCO Contracts Administrator, at Cheryl.L.Henning@dhsoha.state.or.us.
OHA is publishing an updated quarterly report on age-adjusted rate ratios of COVID-19 cases, hospitalizations and deaths by race and ethnicity over time. Age adjustment is a method used to quantify inequities among different racial and ethnic groups. When adjusted for age, people from Pacific Islander/Native Hawaiian, Latinx, Black and American Indian/Alaska Native communities have experienced disproportionate rates of COVID-19 cases, hospitalizations and death. These inequities were acutely pronounced earlier in the pandemic and have decreased over the course of the pandemic. However, there continues to be inequities of COVID-19 cases, deaths and hospitalizations for communities of color and tribal communities
Rates as of 02/16/2022
February 22
February 23
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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