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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
None at this time.
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.
 COVID-19 vaccines for 6-month through 5-year old age groups
Model immunization protocols (updated 6/29/2022):
Resource updates:
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Under 5 vaccine flyer (6/13/2022): Also available in Spanish, Russian, Vietnamese, Somali, Arabic, Hmong, Korean, Traditional Chinese, Simplified Chinese, Chuukese, Marshallese, Portuguese
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Comparing the vaccines (6/21/2022): Also available in Spanish, Russian, Vietnamese, Somali, Arabic, Hmong, Korean, Traditional Chinese, Simplified Chinese, Chuukese, Marshallese, Portuguese
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Frequently asked questions for ages 6 months to 17 years (6/22/2022): Also available in Spanish, Russian, Vietnamese, Somali, Arabic, Hmong, Korean, Traditional Chinese, Simplified Chinese, Chuukese, Marshallese, Portuguese
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Booster dose FAQs (6/22/2022): Also available in Spanish, Russian, Vietnamese, Somali, Arabic, Hmong, Korean, Traditional Chinese, Simplified Chinese, Chuukese, Marshallese, Portuguese, Ilocano, Tagalog, Palauan
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Vaccine doses flyer (6/23/2022): Also available in Spanish, Russian, Vietnamese, Somali, Arabic, Hmong, Korean, Traditional Chinese, Simplified Chinese, Chuukese, Marshallese, Portuguese
Vaccine Learning Series
The Oregon Health Authority (OHA) is hosting a new learning series in support of the COVID-19 vaccine rollout for the 6-month through 5-year old populations. Click the links below to view recent recordings or register for upcoming sessions:
- Vaccine Status Update: Information and guidance on the 6-month through 5 year-old vaccine rollout (hosted June 16). View recording.
- Immunizing Young Children: Vaccine administration techniques and considerations for the 6-months through 5 year-old age groups (hosted June 23). View recording.
- Navigating Pediatric COVID-19 Vaccines: Products & Management. July 7, noon to 1 p.m. Register here.
- Data and Strategies for Pediatric Vaccine Catch-up. July 21, 9 to 10 a.m. Register here.
If you require an accommodation to fully participate in any learning session, please contact Tom Cogswell (971-304-9642).
If you have questions about specific session content, please contact Jill Johnson or Irma Murauskas.
Reminder: Starting today, more people may be eligible for OHP Plus benefits
Starting July 1, 2022, people who are ages 19-25 or 55 and older may be eligible for full OHP regardless of their immigration status through Healthier Oregon.
As part of this change, approximately 12,000 CWM and CWM Plus members now have medical, dental, prescription, vision and behavioral health coverage through the OHP Plus (BMH) benefit plan.
- This transition happened automatically. Most members won’t have to do anything to receive coverage.
- Most members will also enroll in a coordinated care organization (CCO) on or around July 11.
- Between July 1 and July 11 they will be on fee-for-service (“open card”) OHP.
 Use the MMIS Provider Portal to submit fee-for-service prior authorization requests online
OHA recommends using the MMIS Provider Portal at https://www.or-medicaid.gov to submit prior authorization requests for fee-for-service OHP members. When submitting requests through the web portal, be sure to include the following information for timely processing of your request:
- The specific procedure codes you are seeking approval for. Complete a line item for each code.
- Direct contact information for person submitting the request for the rendering provider. When this information is missing, OHA cannot follow up to obtain missing information necessary for review, which causes significant delays in the review process. You can do this two ways:
- Include a completed MSC 3971 (ODHS/OHA Prior Authorization Request Form) as an attachment with all other supporting documentation.
- Add the person's name and direct contact information in the Notes section of the web portal request.
Including this information with each request you submit will decrease wait times for many prior authorization reviews.
Thank you for your help and patience as we explore other ways to improve this process for you and the members we serve.
 Fee-for-service nursing facility room and board rates effective July 1, 2022
OHA has updated the fee-for-service payment rates for the nursing facility room and board services billed through the Hospice Services program. The rates are posted on the
Hospice Services rules and guidelines page.
These rates include the enhanced Medicaid rates for approved nursing facilities who pay certified nursing assistant wages at a specific threshold.
- Nursing facilities may be eligible for these increases between October 1, 2021, and June 30, 2023.
- For nursing facilities approved to participate in the program, OHA will add a specialty code to the facility’s Oregon Medicaid provider number that allows billing for the enhanced rate.
 Recent rule revisions
OAR 410-121-0030, 410-121-0040: Amending Prior Authorization Criteria Guide and Preferred Drug List (DUR/P&T Actions Effective July 1, 2022)
OAR 410-120-0001: New Health Care Interpreter Services Rule
OAR 410-141-3565: Allow Providers to Submit Claims for OHP Postpartum Benefits Beyond 120- or 365-Day Timeframe
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