|
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.
Oregon Health Plan coverage of palivizumab for Respiratory Syncytial Virus (RSV) prophylaxis expanded to high-risk children from 12 to 24 months of age, effective immediately
The Oregon Health Authority (OHA) is expanding palivizumab eligibility to children from 12 months of age or younger to 24 months of age or younger who have any of the comorbidities in OHA’s prior authorization criteria for palivizumab. This expansion:
For children 12 to 24 months who are likely at high risk for severe RSV:
- Please make parents and caregivers aware of this option to prevent severe RSV, and
- Ask for prior authorization as required by the member’s coordinated care organization (CCO) or OHA.
 RSV resources
The flu, COVID-19, and RSV: What you need to know: Available in English, Spanish, Arabic, Chuukese, Hmong, Korean, Marshallese, Portuguese, Russian, Simplified Chinese, Somali, Traditional Chinese, Vietnamese
Protect yourself from RSV: Available in English, Spanish, Arabic, Chuukese, Hmong, Korean, Marshallese, Portuguese, Russian, Simplified Chinese, Somali, Traditional Chinese, Vietnamese.
How to stay safe from respiratory infections during the holidays: Available in English, Spanish, Arabic, Chuukese, Hmong, Korean, Marshallese, Portuguese, Russian, Simplified Chinese, Somali, Traditional Chinese, Vietnamese.
Preparing for the COVID-19 Public Health Emergency (PHE) to end: Join OHA and ODHS’s next session Dec. 13, 2022, 10 to 11 a.m. Pacific Time
Thank you to those that attended our third webinar on Nov. 15, 2022. Community partners, CCOs, providers, insurers, and more are invited to register for our next webinar to learn more about:
- How Oregon is preparing for when the national COVID-19 PHE ends.
- Communication tools partners can use to engage people who receive Oregon Health Plan (OHP) or ODHS benefits.
The webinar will also have time for you to share your questions and feedback.
Background: The federal COVID-19 PHE brought regulatory flexibilities and funding for temporary benefits and services to OHA and ODHS, including continuous coverage for OHP members and more food benefits for people enrolled in the Supplemental Nutrition Assistance Program (SNAP).
The federal government will eventually declare an end to the PHE. When that happens, many of the flexibilities and temporary programs will expire.
- States will be given 60 days' advance notice prior to the end of the PHE, confirming that the expiration will occur on that date.
- Oregon will be required to redetermine eligiblity for all OHP members in the 14 months after the PHE ends.
- HHS reviews the PHE declaration every 90-days and can opt to renew it. The current PHE declaration ends on January 11, 2023, however we did not receive 60-day notice.
Language and disability access: American Sign Language, live closed captioning, and real-time interpretation from English to Spanish will be available for this meeting.
Everyone has a right to know about and use ODHS and OHA programs and services. ODHS and OHA provide free help. For individuals with disabilities or individuals who speak a language other than English, OHA can provide information in alternate formats such as translations, large print, or braille. Contact the COVID-19 Communications Unit at 1-971-673-2411 or COVID19.LanguageAccess@dhsoha.state.or.us at least 2 business days in advance of the webinar. ODHS and OHA accept all relay calls.
Motivational interviewing trainings – Level 2 and Group Trainings Now Available (no-cost CME available)
Oregon Medicaid providers are invited to no-cost virtual trainings (with no-cost continuing medical education credits) on motivational interviewing. The course will use diabetes management as the core topic during the training.
The trainings will focus on improving providers' confidence and skills in conversations about sensitive behavior change topics. Dana Sturtevant, MS, RD, will lead these trainings. Three types of trainings are available, with multiple opportunities to attend each between June 2022 and February 2023:
- Motivational interviewing for diabetes management: Level 1
- Motivational interviewing for diabetes management: Level 2
- Using motivational interviewing in diabetes management groups
EPSDT update: Coverage for OHP members under age 21 is changing Jan. 1, 2023
Effective Jan. 1, 2023, OHA and CCOs must cover any medically necessary and medically appropriate service for OHP-enrolled children and youth until their 21st birthday, regardless of the Prioritized List, under the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
OHA has developed this guide for providers to share information about services that will now be eligible for coverage for OHP members under age 21 starting Jan. 1. It was designed for health care clinicians and providers to:
- Understand the change to EPSDT policy and coverage as required by federal regulations for both OHA and CCOs, and
- Learn how to seek approval and reimbursement for medically necessary and medically appropriate EPSDT services provided to fee-for-service (open card) members.
OHA is also developing webinars about this new guidance, to be shared via Provider Matters and OHA's EPSDT page at Oregon.gov/EPSDT.
If you serve fee-for-service (open card) members, we strongly encourage you to update your contact information with OHA.
- This will help us process your claims and prior authorization requests promptly -- Especially if we need to contact you for more required documentation.
- To do this, contact Provider Enrollment (1-800-336-6016, Option 6).
 Oregon DRG hospitals: Fee-for-service reprocessing of outpatient claims planned for Dec. 10, 2022
The weekend of Dec .10, 2022, OHA plans to reprocess all outpatient claims for dates of service from Jan. 1, 2022, through Aug. 7, 2022.
- This reprocessing will ensure that 2022 claims comply the most current version of the Ambulatory Payment Classification software.
- Remittance advices produced during the Dec. 16 financial cycle will report this reprocessing activity in the Claims Paid section. This section will list the affected claims with a Detail EOB code of 8008: Provider Requested
Claim Adjustment Due to Misc. or Unspecified Error.
- Both the electronic remittance advice and MMIS Provider Portal will list Adjustment Reason Code 16: Claim/service lacks information
or has submission/billing error(s) which is needed for adjudication.
No action is required on your part. If you have questions, contact Provider Services (800-336-6016).
 Other updates
Reporting inpatient hospital admissions: New fact sheet, posted 11/21/2022
OHP benefits for members under age 21: New member fact sheet, posted 11/22/2022
Electronic Visit Verification requirements for home health agencies postponed to Jan. 1, 2024: Posted 11/29/2022
Oregon Medicaid Pharmaceutical Services PA Criteria: Palivizumab criteria updated 11/30/2022
Jan. 1, 2023 Prioritized List of Health Services: Posted 12/1/2022
Recent rule revisions
OAR 410-200-0215: Parolees from Afghanistan and Ukraine eligible for Medicaid benefits under certain circumstances
OAR 410-200-0135, 410-200-0240: Pregnant individuals on Medicaid/CHIP receive protected coverage for 12 Months after pregnancy ends
OAR 410-200-0015, 410-200-0230: Removing the word “alien” from Chapter 410 Division 200 Oregon Administrative Rules
OAR 309-019-0162, 309-019-0163: Rule changes to ensure fee-for-service OHP members have access to Fidelity Wraparound services
OAR 309-065-0000, 309-065-0010, 309-065-0030, 309-065-0040, 309-072-0020: Eligibility requirements for enhanced Medicaid rate increases for culturally and linguistically specific behavioral health services
|
