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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 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.
Implementing Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit in Oregon
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 OHA 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.
- Whether it is covered under the State Plan..
Join OHA's no-cost provider education sessions about EPSDT
OHA invites clinicians and practice managers serving children and youth who are Oregon Health Plan members to join these sessions. 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 (FFS) Medical Director.
Both sessions are from noon to 1 p.m. OHA will also record both sessions and have webinar materials will be made available in Spanish.
Meeting accessibility: Please contact Tom Cogswell (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.
Learn more about EPSDT
Visit Oregon.gov/EPSDT to find resources such as
 Other updates
Change log and updated files to the 1/1/2023 Prioritized List (12/20/2022)
Administrative Exam fee schedule (12/22/2022)
Fee-for-service community pharmacist billing (12/23/2022)
Oregon Medicaid Preferred Drug List (1/1/2023)
Oregon Medicaid Pharmaceutical Services Prior Authorization Criteria (1/1/2023)
Recent rule revisions
OAR 410-141-3850: Protect Members from Access to Care Issues due to the DCO to CCOF Contract Transition
OAR 410-141-3830: Updating Date for Prioritized List Jan. 1, 2023
Dental, OHP and Health Systems Division Medical Program rules: DCOs, CCO-F, New Dental Benefits, Orthodontia, Clarification and Removal of Outdated Language
OAR 410-120-1210: Describes the Benefit Package for the Compact of Free Association (COFA) Dental Program and Veteran Dental Program
OAR 410-120-1295 Increase Par Rate Effective 1/1/2023 through 12/31/2023, Updating Percentage for Non-Participating DRG Hospitals
OAR 410-134-0004 Technical Correction to Clarify Intent for CWM Billing Rules Emergency Cancer and Behavioral Health Crisis
OAR 410-180-0320 Adds Requirement for Continuing Education Hours for Suicide Prevention for QMHAs and QMHPs
OAR 410-121-0030, 410-121-0040 Amending Prior Authorization Approval Criteria Guide & Preferred Drug List DUR/P&T Actions
OAR 410-120-1160, 410-120-1200 Clinical Trial Routine Services Coverage
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