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
New member fact sheets: The Oregon Health Plan (OHP) COVID-19 page for OHP and Citizenship Waived Medical (CWM) members now has fact sheets to help members prepare for the end of the federal COVID-19 Public Health Emergency (PHE):
Some CWM Plus (CWX) members reduced to CWM coverage in error: During the federal COVID-19 PHE, CWM Plus members retain their post-partum coverage from 3/18/2020 until the end of the federal PHE. However, the Oregon Health Authority (OHA) has found that some CWM Plus members had their coverage reduced to emergency-only (CWM) coverage because their pregnancy had ended.
- This error began March 2, 2022. OHA expects to fix the issue causing this error on April 13.
- It will take more time to manually correct records to restore CWX benefits for affected members. We hope to complete this work by the end of this month.
In the meantime:
- If you check eligibility for a patient who you believe should receive CWM Plus (CWX) benefits instead of CWM, call Provider Services at 800-336-6016.
- If you served a CWM Plus (CWX) member on or after March 2, 2022, please check their current eligibility. If it has changed to CWM, please wait to bill OHA until the member's CWX benefits are restored.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to OHP and CWM coverage of vaccine, testing, screening, treatment and telemedicine services; OHP and CWM eligibility; and other information and resources related to providing and billing for covered services during COVID-19.
Hesitance and Mistrust: Vaccine hesitancy for the six-month to four-year old populations
Register today for this one-hour remote learning session will empower providers with tools on how to best tackle hesitancy, inequity and vaccine-avoidant behaviors.
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Date: Thursday, April 14
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Time: Noon to 1 p.m.
Masking requirements in health care settings
Frequently asked questions (updated 4/6/2022)
COVID-19 immunization protocols
Pharmacy protocol and model immunization protocol (updated 3/29/2022)
Booster dose resources (updated 4/1/2022)
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Additional Dose FAQ; also available in Traditional Chinese, Simplified Chinese, Portuguese, Russian, Vietnamese, Chuukese, Marshallese, Arabic, Hmong, Korean, Spanish
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Booster Dose Table; also available in Traditional Chinese, Tagalog, Ilocano, Arabic, Hmong, Korean, Simplified Chinese, Portuguese, Russian, Spanish, Vietnamese
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Booster Dose FAQ; also available in Traditional Chinese, Tagalog, Pohnpeian, Chuukese, Marshallese, Palauan, Ilocano, Arabic, Hmong, Somali, Korean, Simplified Chinese, Portuguese, Russian, Spanish, Vietnamese
- Booster Dose Mix and Match FAQ
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Booster Doses for 12+ Fast Facts; also available in Traditional Chinese, Marshallese, Arabic, Hmong, Somali, Korean, Simplified Chinese, Portuguese, Russian, Spanish, Vietnamese.
- Guidance for people vaccinated against COVID-19 outside of the United States
- Vaccine for 5- to 17-year-olds FAQs
Starting July 1, 2022, people who are 19-25 or 55 and older will be eligible for full OHP benefits regardless of their immigration status. This is possible because of House Bill 3352 which put into law a program called “Cover All People.” The program is now known as “Healthier Oregon.”
Current Citizenship Waived Medical (CWM) members who are 19-25 or 55 and older will automatically move from emergency coverage to full benefits in July. People in these age groups can also enroll after July 1.
This is a historic and important milestone that will:
- Bring us closer to achieving health equity.
- Better lives.
- Save lives.
Kids and teens younger than 19 will remain eligible for full OHP benefits regardless of immigration status.
Questions?
Email maria.vargas@dhsoha.state.or.us.
New substance use disorder (SUD) treatment reimbursement codes and rate changes effective Jan. 1, 2022
OHA published the fee-for-service Behavioral Health Fee Schedule effective Jan. 1, 2022, to include the following changes for SUD treatment services:
- New customary charge structure and rate increase for SUD residential facilities. OHA will contact each Medicaid-enrolled SUD residential program to confirm their specific customary charge.
- New codes and rates for community integration services (housing and employment services) to help members with SUD transition from hospital or residential settings back into the community.
- New codes and rates for crisis services, intervention, care coordination and case management.
- Increased rates for select outpatient SUD services and supports.
OHA has updated the Medicaid Management Information System (MMIS) with these changes. Providers can now bill for these new rates and services for dates on or after Jan. 1, 2022.
Payment Error Rate Measurement (PERM) provider education webinars: Sign up by April 10, 2022
The Centers for Medicare & Medicaid Services (CMS) PERM program is presenting a one-hour Provider Education Webinar to help providers prepare for future PERM cycles.
Featured topics:
- The PERM process and provider responsibilities during a PERM review
- Recent trends, frequent mistakes and, best practices
- The Electronic Submission of Medical Documentation (esMD) program
Dates and times:
- Tuesday, April 12, 10 to 11 a.m. Pacific Time
- Wednesday, April 13, noon to 1 p.m. Pacific Time
- Thursday, April 14, 1 to 2 p.m. Pacific Time
Providers that have questions following the webinar can send them to the PERM Review Contractor’s email address at PERMRC_Providerinquiries@nciinc.com.
Fee-for-service rate change for Nexplanon®, effective Aug. 16, 2021
Fee-for-service reimbursement for Nexplanon® (HCPCS code J7307) is now $1030.64 per unit, to match the current Wholesale Acquisition Cost for Nexplanon®.
- OHA will publish this change in the next OHP medical-dental fee schedule update.
- To receive reimbursement at this new rate, providers can adjust previously submitted claims for dates of service on or after Aug. 16, 2021.
Certified Sexual Offense Therapists can now enroll to bill OHP for outpatient behavioral health services
Mental health professionals who are also certified as Sexual Offense Therapists may bill for OHP-covered outpatient behavioral health services provided to OHP members as part of Sexual Abuse-Specific Treatment as defined in Oregon Revised Statute (ORS) 675.365(8).
- The services must be outpatient.
- Services provided to members housed in a public institution are not covered.
To bill OHP for these services, certified providers must:
Questions?
About Medicaid policy: Email medicaid.programs@dhsoha.state.or.us.
About CCO network participation and billing: Contact the member's CCO.
Recent rule revisions
OAR 410-120-1340: Aligning with Legislatively Approved Rate Adjustment for Neonatal, Pediatric Intensive Care Services
OAR 410-121-0030, 410-121-0040: Amending PDL DUR/P&T Actions and PA Approval Criteria Guide, Effective April 2022
OAR 410-123-1510: Additional 12 Months of Dental Benefits Added During Post-Partum Period
OAR 410-140-0050, 410-140-0140: Adding 12 Months of Protected Post-Partum Vision Coverage, Following End of Pregnancy
OAR 410-141-3855: Requiring CCO Contracted Providers to Check the Prescription Drug Monitoring Program
OAR 410-200-0135, 410-200-0240: OHP-Eligible Pregnant Individuals Shall Be Provided 12-Month Continuous Eligibility after Their Pregnancy Ends
OAR 410-172-0776, 410-172-0796 and OAR 410-172-0600, 410-172-0710, 410-172-0780, 410-172-0790, 410-172-0800, 410-172-0810, 410-172-0820, 410-172-0830, 410-172-0840: Update Medicaid Behavioral Health OARs To Reflect Required Program Changes For Personal Care Services.
Other provider resource updates
Oregon Medicaid Pharmaceutical Services PA Criteria (4/1/2022)
Oregon Medicaid Preferred Drug List (4/1/2022)
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