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Under the CCO contracts, CCOs are not responsible for covering abortion services, but are responsible for covering services related to managing a miscarriage and complications following abortion. Services which could fall into either category but reasonably be considered an abortion are also carved out of CCO contracts.
| Service |
Common
procedure codes |
Modifier |
Bill to |
| Abortion |
S0199, 59841, 59840 |
U4 |
OHA |
| Managing miscarriage |
59820, 59821, 59812, E/M codes for non-surgical
intervention |
|
CCO |
Treating complications
following an abortion |
|
|
CCO |
| Unclear services |
|
U4 |
OHA |
Why is this happening?
Questions have come to our attention regarding whether OHA or CCOs are responsible to pay for covered abortion and miscarriage management services. We determined that both providers and CCOs could benefit from clarification of responsibilities.
What should you do?
Ensure that provider billing requirements are in place for covered services to manage a
miscarriage and for complications following an abortion. Also ensure that care coordinators and other staff can help members understand how to access covered abortion services.
Questions? Please contact Jason Daniels at
JASON.H.DANIELS@oha.oregon.gov or 503-945-6357.
Medical Assistance Programs-Chapter 410; Division 123- Dental / Denturist Services
The RAC will discuss proposed rule changes, effective 07/01/2023
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Meeting date and time: 06/06/2023, 10:00 a.m. to 12:00 p.m.
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Join (for mobile or PC): Click here to join the meeting
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Call-in number and participant code: +1 971-277-2343,,692487448# United States, Portland ; Phone Conference ID: 692 487 448#
Seeking RAC members? Yes
Proposed changes
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Rule(s)
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Description of proposed changes
|
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410-123-1260
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Specifying difference in codes D0190 & D0191 and when should one be used vs the other.
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410-123-1060
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Pregnant vs non-pregnant urgent appointment timeframe.
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Rules Advisory Committee contact information
If these changes are likely to affect you, and the Division is seeking RAC members, you can ask to join us as a RAC member. To do this, contact the person listed below. Include the date, time and program name of the RAC meeting you want to attend.
Organizations will only be allowed one (1) individual to be seated as a RAC member. It will be incumbent upon organizations to identify who their representative will be prior to the beginning of the RAC. To sign up to participate, contact the person listed below by May 31, 2023.
If you are not chosen to join the RAC, you are welcome to observe the RAC and email your written input following the RAC meeting.
Everyone has a right to know about and use Oregon Health Authority (OHA) programs and services. OHA provides free help. Some examples of the free help OHA can provide:
- Sign language and spoken language interpreters
- Written materials in other languages
- Braille
- Large print
- Audio and other formats
If you need help or have questions, please contact Vesna Hopkins at 503-400-5544, 711 TTY, or vesna.g.hopkins@oha.oregon.gov at least two business days before the meeting.
The Transformation Center published a 2022 report on its work and impact: https://www.oregon.gov/oha/HPA/dsi-tc/Documents/Transformation-Center-2022-Report.pdf
This report briefly describes select initiatives and their outcomes. Key successes include the following:
- Hosting 64 multiple-partner learning sessions, including events, trainings and webinars;
- Managing the review and feedback process for ten CCO contract deliverables primarily focused on community health, quality improvement, social determinants of health spending, and value-based payment (VBP);
- Providing technical assistance to support CCOs’ health-related services programs, in lieu of services, SHARE initiative and incentive metrics; and
- Supporting Oregon payers and practices to transition to value-based payment models by implementing CCO contract requirements and facilitating the VBP Compact work group and Primary Care Payment Reform Collaborative.
OHA will submit a Medicaid State Plan Amendment to the Centers for Medicare & Medicaid Services to change from the flat telehealth rates used during the COVID-19 Public Health Emergency to rates based on Relative Value Units (RVUs) multiplied by the Oregon conversion factor.
This change would align with the rate methodology OHA uses for most other professional health services and increase the rates for covered telehealth codes.
To learn more, read the public notice from OHA.
OHA welcomes public review and input. Please send written comments by 5 p.m. Friday, June 2, 2023, to jesse.anderson@oha.oregon.gov.
OHA Public Health Division is seeking applicants for the Maternal Mortality and Morbidity Review Committee (MMRC).
OHA invites applications from individuals who meet the criteria outlined in ORS 432.600. Applicants can find information about the Oregon MMRC, including a link to the full 2018 house bill text, at https://www.oregon.gov/oha/PH/HEALTHYPEOPLEFAMILIES/DATAREPORTS/Pages/Maternal-Mortality-Morbidity-Review-Committee.aspx.
Board members are appointed by the Governor and members serve terms of four years each. To apply, complete the electronic application process by June 30, 2023, at https://www.oregon.gov/gov/Pages/board-list.aspx.
Note that only completed applications will be processed and considered for appointment. The application site lists items needed to apply, including:
- Uploaded cover letter and resume (PDF only).
- Uploaded short, personal bio referencing applicant’s community, professional and/or lived experience related to maternal health promotion (PDF only).
- Responses to the general application and background questions.
Those unable to complete the form electronically should contact the Executive Appointments Office at executive.appointments@oregon.gov for assistance.
For more information, email the OHA Public Health Division at MCHSection.Mailbox@odhsoha.oregon.gov or call 971-990-9893.
Upcoming deadlines
- Second chamber work session deadline* is today, May 19
*Deadlines do not apply to Ways & Means, Revenue, Rules, and other joint committees.
Helpful links:
For more information about 2023 bills and legislative schedules, please visit the Oregon State Legislature site.
Do you have news or a story to share? Submit your content for an upcoming CCO Weekly Update!
May 22, 2023
May 23, 2023
May 24, 2023
Please visit the committee and workgroup links below for more information about meetings. You can also view the OHA Public Meeting calendar.
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