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 Oregon Health Plan (OHP) and Citizenship Waived Medical (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.
From Centers for Medicare & Medicaid Services: Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine
The Centers for Disease Control and Prevention (CDC) recommends annual flu shots for everyone 6 months and older. You can give flu shots and COVID-19 vaccines at the same visit. There are updated COVID-19 vaccines designed to protect your patients against the Omicron strain, which makes up almost all COVID-19 cases in the U.S.
Encourage your patients to get a flu shot and updated COVID-19 vaccine by the end of October — your recommendation makes a difference.
New for this flu season: Patients 65 and older should get a preferred vaccine if available. Preferred vaccines are potentially more effective than standard dose flu vaccines. There are three recommended vaccines:
- Fluzone High-Dose Quadrivalent vaccine
- Flublok Quadrivalent recombinant flu vaccine
- Fluad Quadrivalent adjuvanted flu vaccine
If one of these recommended vaccines isn’t available, give your patients a standard-dose flu vaccine instead.
Medicare Part B covers the seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment. There’s no applicable copayment, coinsurance, or deductible for COVID-19 vaccines.
You can now check Medicare eligibility (PDF) for the flu shot and COVID-19 vaccine. If you need help, contact your eligibility service provider.
More Information:
Novavax COVID-19 vaccine receives booster approval for some recipients
October 19, the U.S Food and Drug Administration (FDA) issued emergency use authorization for Novavax COVID-19 vaccine to be administered as a booster dose in limited circumstances. The CDC’s Dr. Rochelle Walensky signed a decision memo allowing Novavax monovalent COVID-19 boosters for people ages 18 years and older targeting the original COVID-19 strain. The Novavax vaccine booster dose:
- May be administered at least 6 months after a primary series.
- Is not authorized to follow any prior booster dose.
- Is the same monovalent Novavax vaccine authorized for the primary series.
- Is the same dose as for the primary series dose of Novavax: 0.5mL.
- Is authorized as a booster only for individuals age 18 and older:
- For whom an FDA-authorized mRNA bivalent COVID-19 booster vaccine is not accessible or clinically appropriate, or
- Who elect to receive the Novavax COVID-19 vaccine because they would otherwise not receive a booster dose of a COVID-19 vaccine.
For those 5 years and older, you are up to date with COVID-19 vaccination if you have completed a primary series and received the most recent booster dose recommended for you by CDC.
COVID-19 vaccine recommendations for children ages 5 through 17
Western States Scientific Safety Review Workgroup has endorsed the CDC Advisory Committee on Immunization Practices recommendation to expand the use of bivalent COVID-19 vaccines to children ages 5 through 11 years. This follows the FDA authorization of:
- Pfizer-BioNTech bivalent vaccine for ages 5 through 11 years, and
- Moderna bivalent vaccine for ages 6 through 17 years.
OHA encourages all providers to talk to their patients and families about the COVID-19 vaccine and the importance of keeping up to date with all recommended vaccinations.
Patient and provider resources
OHA has updated the model protocols, effective Oct. 20, 2022:
FDA Emergency Use Authorization (EUA) fact sheets for recipients and caregivers:
CDC resources related to the bivalent booster recommendation:
How to support people receiving benefits:
If you receive questions about the reminders mailing this fall to OHP members and Medicare Savings Program members. Please help us by encouraging people to:
- Verify or update their contact information or
- Report any changes using the options provided in the letters.
People receiving benefits can also visit Oregon.gov/OR-benefit-changes to:
- Verify the letter they received and
- Access options they can use to update their information.
Be sure to keep informed!
New OHP dental-only programs open Jan. 1, 2023
The 2022 Oregon Legislature passed Senate Bill 1538 and House Bill 4095. Signed into law March 2022, these bills established two new dental-only programs within OHA:
- Compact of Free Association (COFA) Dental Program
- Veteran Dental Program
What do the new dental programs cover? They offer the same dental benefits as the full OHP Plus benefit package.
Who will provide dental services? Coordinated care organizations will manage their dental care. When you verify CCO enrollment, people with this benefit will have the new CCO-F (dental-only) managed care plan type, starting Jan. 1, 2023.
How will providers know who has dental-only OHP? When you verify OHP eligibility, people eligible for the Veteran Dental and COFA Dental programs will have the benefit plan code DEN or DNT ("OHP Dental").
How can people apply for these programs? While the programs open on Jan. 1, 2023, people can apply starting Nov. 1, 2022.
- To apply for these programs, individuals must apply for OHP.
- If they do not qualify for OHP Plus (Medicaid), they will be reviewed for the new dental programs.
When will these programs be in rule? Once final, the revised Oregon Administrative Rules to reflect the new dental-only programs and CCO-F service delivery will be effective Jan. 1, 2023. View the proposed changes.
Provider resource updates
Carveout Drug List, 3rd Quarter 2022
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