Rules Advisory Committee (RAC) on January 17
OHA is holding a Rules Advisory Committee to discuss proposed rules related to a new palliative care program resulting from HB 2981.
The RAC will be held on January 17, 5 to 8 p.m.
-
Join the meeting. Meeting ID: 223 458 627 589, Passcode: qS92L5
Call-in number and participant code (audio only): 971-277-2343, ID: 368745848#
- Contact Kian Messkoub at Kian.Z.Messkoub@dhsoha.state.or.us or 971-283-6563 if you are interested in becoming a RAC member.
Learn more about HSD rules advisory committees.
Palliative care program update
At this time, the Oregon Health Authority (OHA) anticipates that the palliative care program will begin no earlier than April 1, 2023.
OHA will provide CCOs with more information about the program, including the associated Rules Advisory Committee, in the coming weeks.
For CCO members in plan types CCOG and CCOF:
- CCOs must reimburse for covered dental services delivered in an ambulatory surgical center, inpatient or outpatient hospital setting.
- CCOs are not required to cover the facility fees associated with these The Oregon Health Authority (OHA) will reimburse for these facility fees.
Oregon Administrative Rule 410-123-1490 explains when the CCO, under the CCOF and CCOG plan types, is the payer and when OHA is the payer.
What should you do?
Please prepare to administer the CCOF benefit including for COFA Dental and Veteran Dental members to include dental services delivered in facility settings. For dental services delivered in a facility setting, CCOs should coordinate care with OHA for the facility payment.
Questions?
If you have questions about this announcement, please contact your CCO Account Representative.
As you may be aware, the OHA is implementing the new CCOF plan type, effective January 1, 2023. This plan type is for:
- Dental care organization members enrolling in coordinated care organizations (CCOs), as noted in OHA’s September 14 memo. These members have full OHP Plus benefits.
- Compact of Free Association Dental Program and Veteran Dental Program members, as noted in OHA’s November 2 memo. These members have OHP Dental benefits, which offers dental benefits only. OHP Dental does not cover behavioral or physical health services.
CCOs are responsible for paying for NEMT services when:
- The member uses the CCO’s contracted NEMT providers and
- The services are related to travel for services covered by the member’s benefit
For members with OHP Dental benefits, this means the CCO is responsible for NEMT related to dental care and related prescriptions only.
What should NEMT providers do?
Verify the member’s benefit plan and CCO enrollment to know whether NEMT is covered for a particular service and, if so, who is responsible for payment.
- For CCOF members with OHP Plus (BMH, BMM or BMD benefit package identifier in MMIS) benefits, the CCO is responsible for NEMT related to all covered OHP Plus
- For CCOF members with OHP Dental (DEN or DNT in MMIS) benefits, the CCO is responsible for NEMT related to dental services and related prescriptions only.
Questions?
-
FFS brokerages: Contact Provider Services (800-336-6016, Option 5). Provider Services is available Monday through Friday between 8 a.m. and 5 p.m.
-
CCO brokerages: Contact the CCO.
Webinars will be held on January 24 and February 7
Effective January 1, 2023, Oregon will implement the full Early and Periodic Screening, Diagnosis and Treatment benefit (EPSDT) for children and youth until their 21st birthday. This means both the Open Card program and coordinated care organizations (CCOs) must cover any medically necessary and medically appropriate services (and dentally appropriate, for dental services) for enrolled children and youth, regardless of:
- The location of the diagnosis on the Prioritized List of Health Services;
- Whether it pairs, or is a non-pairing service;
- Whether it is a previously “non-covered” ancillary service; or
- Whether it is covered under the State Plan.
Provider education (no-cost):
-
Audience: Clinicians and practice managers serving children and youth who are Oregon Health Plan members.
-
Presenters will include the following OHA clinician leaders: Dana Hargunani, MD, MPH, OHA Chief Medical Officer; Dawn Mautner, MD, MS, Medicaid Medical Director; Margaret Cary, MD, MPH, OHP Fee-For-Service Medical Director.
- Both sessions will be recorded, and webinar materials will be made available in Spanish.
- Please contact Tom Cogswell (Thomas.Cogswell@dhsoha.state.or.us, 971-304-9642) if you need an accommodation to fully participate in these webinars. Examples of accommodations include American Sign Language (ASL) or language interpretation, and closed captioning.
Session 1: January 24, Noon–1 p.m.
Session 2: February 7, Noon–1 p.m.
Additional information may be found at: www.oregon.gov/EPSDT, including:
 |
|
Estela Gomez will be retiring from the Oregon Health Authority and the Innovator Agent team at the end of January. Estela and her incredible knowledge across much of Eastern Oregon, her knowledge of the Oregon Health Plan, her in-depth relationships with communities and with Eastern Oregon CCO (ECOCC), and commitment to excellence and working with communities to elevate their voices will be incredibly missed. |
The Oregon Health Authority is grateful for Estela’s service and commitment to people in Oregon. Estela has spent almost 9 years working as an Innovator Agent, 15 years of state service to people in Oregon and seven years in Malheur County. She has been instrumental in supporting health care transformation in Oregon, sharing her in-depth knowledge and relationships with Eastern Oregon communities to ensure Oregon Health Plan services support rural Oregon communities, and elevating community voice through trusted local relationships with community based organizations, local public health authorities, and Community Advisory Councils.
Yami Gonzalez Perez will continue working in Eastern Oregon and with EOCCO as that region’s Innovator Agent.
Awab Al-Rawe, OHA Ombuds and Innovator Agent on rotation working with Trillium Tri-County and South and Pacific Source Lane for the past six months has finished his rotation. He will be OHA’s CCO Services Manager for the next year. With Awab’s deep knowledge of Medicaid, OHA, and our communities, he will support interconnectivity across CCOs, Innovator Agent, Ombuds, Account Reps, and the work we all do in community.
Senna Towner has returned from parental leave and will be working with Trillium Tri-County and South and Pacific Source Lane. Current Innovator Agent assignments can be found here: https://www.oregon.gov/oha/ERD/Pages/Innovator-Agents.aspx
Do you have news or a story to share? Submit your content for an upcoming CCO Weekly Update!
For the week of 12/14/22
    
January 2, 2023
- OHA closed for observation of New Year's Day
January 4, 2023
Please visit the committee and workgroup links below for more information about meetings. You can also view the OHA Public Meeting calendar.
|
