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.
Join the Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS) for the April 11, 2023 webinar from 10 to 11 a.m. Pacific Time
Agenda:
- COVID-19 Public Health Emergency unwinding timeline and updates
- Marketplace transition project
- Medical benefit updates
- Food benefit updates
- Returned mail updates
- Reaching priority populations
- Questions and answers
- Resources for partners
Language and disability access: American Sign Language and live closed captioning will be available for this meeting. A separate Spanish webinar will be held April 20, 2023, at 10 a.m. Pacific Time.
OHA welcomes all participants. If you have any questions about accommodations or need any assistance to participate please email Jon McDaid.
Save the date for future webinars in this series!
- May 9, 10 to 11 a.m. Pacific Time
End of COVID-19 behavioral health residential vacancy payments
Coinciding with the May 11, 2023 end of the COVID-19 Public Health Emergency, OHA will no longer provide vacancy payments to behavioral health residential providers.
For dates of vacancy on or before May 11, 2023, providers should submit any remaining vacancy payment requests to OHA by end of business May 25, 2023. Requests submitted after May 25 will not be considered.
Use of HO and HH modifiers limited to Integrated Co-occurring Disorders programs starting May 1, 2023
Starting May 1, 2023, only approved Integrated Co-occurring Disorders (ICD) programs may use modifiers HO and HH when billing OHA for Medicaid-reimbursed behavioral health services provided to OHP members.
- HO is for ICD services rendered by approved QMHP or equivalent practitioners.
- HH is for ICD services rendered by all other approved practitioners.
This means if you are not an approved ICD practitioner providing eligible services through an approved ICD program, OHA may deny claims using the HO or HH modifier on or after May 1.
Payment recovery planned for some fee-for-service substance use disorder residential treatment per diem claims
OHA is reprocessing all fee-for-service per diem claims paid at the Institutes for Mental Disease (IMD) rate to substance use disorder residential programs from July 1, 2022, through March 20, 2023, to recover overpayments that exceed federally approved per diem rates.
If your program experienced overpayments due to this error, OHA will reach out to discuss options for resolving the overpayments.
Recent rule revisions
OAR 410-172-0670: Amend 410-172-0670 to include language related to Community Transition Services, clean up language
OAR 410-121-0030, 410-121-0040: Amending Prior Authorization Approval Criteria Guide & Preferred Drug List DUR/P&T Actions
OAR 410-200-0015, 410-200-0110, 410-200-0120, 410-200-0140, 410-200-0235: HSD Medical Program Eligibility for Residents of Public Institutions; References To Newly-Created Programs
OAR 410-200-0315, 410-200-0436, 410-200-0520, 410-200-0521: Unwinding the Continuous Enrollment Requirement of the FFCRA; Unwinding Renewal Process
Provider resources
April 2023 Behavioral Health Fee Schedule (4/7/2023)
Oregon Medicaid Pharmacy Quick Reference (4/4/2023) - Now includes point of sale information for OHP Dental prescriptions
Oregon Medicaid Pharmaceutical Services Prior Authorization Criteria (4/1/2023)
March 2023 Medical-Dental Fee-for-Service Fee Schedule (3/29/2023)
Procedure and diagnosis code groups (3/1/2023):
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