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OHP now covers hMPXV-related vaccine administration, testing, treatment and related office visits for all members, effective July 26, 2022. For services provided to fee-for-service members on or after this date, providers may bill the Oregon Health Authority (OHA) without prior authorization using these codes:
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87593 (lab test): Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (e.g., monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each
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90471: Vaccine administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections): without counseling by physician or other qualified health care professional; 1 vaccine (single or combination vaccine/toxoid)
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90460: Vaccine administration through 18 years of age via any route of administration, with counseling; first or only component of each vaccine or toxoid administered
Providers may also bill separate evaluation and management (E/M) codes as part of the office visit.
As with all Medicaid claiming, correct coding and documentation of services provided must be on file to justify the claim. Please refer to Oregon Administrative Rules and the OHP billing page for guidance.
Read the full memo for more information.
OHP covers the following diabetes self-management prevention education programs for all OHP members with Type I or Type II diabetes:
These programs can help people with diabetes to lower A1C levels, manage medications, prevent or reduce diabetes complications, improve quality of life, build healthier eating and exercise habits, and lower medical expenses.
Nationwide fewer than 60 percent of newly diagnosed people are referred to these programs, despite their proven effectiveness on both short and longer-term outcomes.
OHP also covers two years of National Diabetes Prevention Program (National DPP) services for OHP members who have prediabetes, a history of gestational diabetes, or are overweight (without Type I or Type II Diabetes or End-Stage Renal Disease).
OHA encourages providers to refer or offer these programs to OHP members. To find local programs:
To learn the requirements for offering and billing for these services, refer to OHA’s fact sheets about reimbursement for diabetes self-management programs and National DPP services.
Read the full memo for more information.
The Oregon Health Authority (OHA) encourages providers to offer or refer members to covered, culturally tailored/appropriate programs. OHP covers services provided
through evidence-based fall prevention programs for any OHP member 65 and older, and anyone younger than 65 with identified falls risk, including:
- Tai Ji Quan: Moving for Better Balance (also known as Tai Chi: Moving for Better Balance)
- Stepping On: Falls Prevention Program
- The Otago Exercise Program (Otago)
- Walk with Ease Program
- OHSU’s “Matter of Balance” Program
More information about these programs is available on the OHA Fall Prevention site.
To find local programs:
Billing
To bill for covered services, bill the member’s CCO. If the member is not in a CCO, bill OHA.
- Use diagnosis code Z91.81 (History of Falling/Risk of Falling) for all fall prevention billing.
- Use the following procedure codes as applicable. Add modifier GT or 95 for telehealth programs:
- CPT 98961: Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) for 2-4 patients, each 30 minutes
- CPT 98962 (see description 98961): For 5-8 patients, each 30 minutes
- HCPCS S9451: Exercise classes, non-physician provider, per session
Read the full memo for more information.
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CCO Submitted Address Changes – Update 8/26
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Tasks
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Status
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Estimated Completion Date
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Submit and receive approval for verification waiver
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Completed
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8/1/22
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Create data requirements for secure method for delivery
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Completed
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7/15/22
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Create and select secure delivery method for updates coming from CCO to State
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Completed
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8/15/22
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Evaluate and establish data ingestion options once received
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Completed
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8/15/22
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Create training tools, procedure & training plan for CCO staff on how to use methodology
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In Progress
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9/16/22
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Create procedure for updating addresses by PH Tech staff
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In Progress
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9/16/22
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Conduct system testing with CCOs
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Not Started
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Week of 9/12/22
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State hosts first training sessions with CCOs
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Not Started
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Week of 9/19/22
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If you have any questions or concerns please contact David Ballantyne at DAVID.R.BALLANTYNE@dhsoha.state.or.us. We would love your feedback and to track any challenges you foresee. Thank you!
This week, the Oregon Health Authority (OHA) reprocessed all professional services claims paid from January 1, 2022, through July 31, 2022. You will see this activity on outgoing remittance advices starting August 30, 2022.
Why is this happening?
On August 1, 2022, OHA updated pricing to apply an Oregon-specific conversion factor to increase the fee-for- service rates for procedure codes 99468 through-99480. The reprocessing will apply the updated pricing to claims paid during the timeframe listed above.
What should you do?
No action is required on your part.
What you will see on the paper remittance advice
The Claims Paid section will list the affected claims with a Detail EOB code of 9920: Pricing Adjustment – RBRVS Pricing Applied.
What you will see on the electronic remittance advice (ERA) or Provider Web Portal
Both the ERA and Provider Web Portal will list Adjustment Reason Code 45: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Again, no action is required on your part.
Questions?
If you have any questions about this announcement, contact the Provider Services Unit at dmap.providerservices@dhsoha.state.or.us or call 800-336-6016.
Join OHA and ODHS’s first session Sept. 13, 2022, 10 to 11 a.m.
Community partners, coordinated care organizations, providers, insurers, and more are invited to register for the first in a series of monthly opportunities to learn more about:
- How Oregon Health Authority (OHA) and the Oregon Department of Human Services (ODHS) are working together to prepare for the end of the national COVID-19 PHE with the goal of preserving benefits for individuals and families, and
- How partners can help people receiving OHP or ODHS benefits to prepare for potential changes.
Save the date for future webinars in this series!
- Oct. 18, 10 to 11 a.m.
- Nov. 15, 10 to 11 a.m.
- Dec. 13, 10 to 11 a.m.
If you need help or have questions, please contact Jon McDaid at Michael.J.McDaid@dhsoha.state.or.us at least 48 hours before the meeting.
Weekly updates on major Medicaid projects
1115 Medicaid Waiver
CAC information session: OHA Medicaid waiver and community investment collaboratives August 31, 1–2:30 p.m.
Contact: Tom Cogswell (Thomas.Cogswell@dhsoha.state.or.us, 971-304-9642)
OHA will be hosting an information session on the OHA Medicaid waiver (waiver) for CAC members. The session will provide information on the waiver and an update on the current phase of the waiver renewal. The session will also include an overview of a key equity-focused initiative in the waiver proposal, the community investment collaboratives (CICs). Materials will be shared prior to the meeting. The CIC concept is still being developed and continues to be a topic of discussion with the Centers for Medicare and Medicaid Services (CMS). Therefore, CIC approaches may change as this work and negotiations continue but this session will provide details on the current state.
Meeting goals:
- Provide an overview of the OHA Medicaid waiver
- Give an update on the waiver with a focus on the CICs
- Provide a forum for CAC members to ask questions about the waiver
Register here: https://www.zoomgov.com/meeting/register/vJIscO-qpj8oE37cLkXxLJn-Rpx-JD6ylIg
If you have questions about the content of this meeting please contact 1115waiver.renewal@odhsoha.oregon.gov.
If you have questions about meeting logistics please contact Thomas.Cogswell@odhsoha.oregon.gov or 971-304-9642.
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Oregon Health Plan Redeterminations
No updates
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Healthier Oregon
You can find resources like an outreach toolkit and FAQ on the Healthier Oregon page.
As of August 24, 2022
      
September 1, 2022
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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