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) coverage of COVID-19 vaccine, testing, screening, treatment and telemedicine services and other information and resources related to providing and billing for covered services related to COVID-19.
Review what is ending and continuing with the May 2023 end of the COVID-19 Public Health Emergency: View the May 2023 memo from Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS).
Oregon is over halfway through medical redeterminations for more than 1.5 million members with OHP and other medical benefits. As of Oct. 19, 2023:
- 668,265 people (82.5%) were renewed and kept their benefits.
- 111,998 people (13.8%) were found ineligible and received 60-day notices of termination. Losses of coverage began at the end of June.
- 25,714 people (3.2%) had a reduction in their benefits. Most of these members lost full OHP, but were able to continue our Medicare Savings Programs that help pay their Medicare costs.
This month, OHA and ODHS also responded to three issues with the renewal process:
Extending coverage for members who received incorrect approval notices:
Around 11,700 members who did not respond to renewal requests received incorrect approval notices instead of closure notices. ODHS/OHA extended their coverage extended through the end of the year. These members received a new notice and call explaining that they can provide the missing information by the end of the year to prevent closure.
Correcting or preventing incorrect terminations
Medical benefits for 2,268 people incorrectly ended at the end of September. 1,226 people incorrectly received notices explaining that their benefits would end at the end of October. ODHS/OHA will restore these people’s benefits or prevent them from closing. All affected members will receive new notices in November. In 2024, they will get another notice letting them know whose benefits are renewed without needing a response, and who in their household still needs to respond to a renewal to keep benefits.
Restoring Oregon Supplemental Income Program — Medical (OSIPM) benefits:
OSIPM is a program that provides OHP coverage to Oregonians who are legally blind, have a disability, and/or are 65 or older--and have limited income and financial resources. ODHS:
- Paused closures and restored coverage to 20,000 people found over the income or financial resource limits for OSIP-M.
- Is updating OSIP-M notices with more information about members’ options, such as spending down excess financial resources. This way, they can make an informed decision and have additional time to report changes and keep their benefits if still eligible.
In 2024, these members will get another renewal notice, after which benefits may end if still over the income or resource limits.
OHA and ODHS will share partner Information soon. Providers can also join this month's PHE unwinding webinars to learn more.
 Winding down the COVID-19 Public Health Emergency webinars: Join the last webinars of the year November 14 and 16, 2023, from 10 to 11 a.m. Pacific Time
Join ODHS and OHA for webinars about how the two agencies are working together to wind down the COVID-19 Public Health Emergency. Webinars are held in English and Spanish from 10 to 11 a.m. Pacific Time. Agenda:
- Food benefit updates: Pandemic EBT food benefits for children and SNAP Able-Bodied Adults without Dependents (ABAWD) requirements
- Medical renewals updates: Current status and recent issues
- Open enrollment through the Marketplace
- Questions and answers
- Resources for partners
Language and disability access:
American Sign Language and live closed captioning will be available for these webinars.
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. If you would like help to participate in the webinar, contact the Feedback Team at 503-945-5488 or feedback@odhsoha.oregon.gov at least two business days before the webinar. All relay calls accepted.
OHA was notified earlier this year about plans for CareOregon to combine with SCAN Group.
- CareOregon provides Oregon Health Plan coverage to over 500,000 people in Oregon through three coordinated care organizations (CCOs): Columbia Pacific CCO, Jackson Care Connect, and Health Share of Oregon.
- SCAN Group is a California-based non-profit company focused on providing health benefits to older adults. It offers Medicare Advantage plans and health care services. CareOregon and SCAN plan to create an organization that will provide Medicaid and Medicare coverage in multiple states.
OHA has authority to review health care business transactions, like this transaction, and is responsible for making sure that transactions do not create harm for people and communities in Oregon.
Public input is crucial to OHA’s review. Your feedback can help us understand how this transaction could help or harm people in your community. Public input will be used to inform OHA’s review and may be included in publications. Visit the OHA web page to learn more about this transaction.
There are two ways to share your thoughts about this transaction.
1. Listening sessions:
OHA is holding listening sessions in each CareOregon service area on the proposed plans for CareOregon and SCAN Group to combine. Spanish and ASL interpretation will be available at each session. Please register for the appropriate session using the links below.
OHA welcomes all participants. If you have any questions about accommodations or need any assistance to participate, please contact us as soon as possible at formacareoregon.cco@odhsoha.oregon.gov or 971-888-3358 (voice/text). We accept all relay calls. Every effort will be made to provide services to requests received at least 48 hours in advance, however submitting your request as early as possible is greatly appreciated.
2. Written comments:
All members of the public are invited to provide written comments during the public comment period. OHA is accepting comments through Dec. 6, 2023 at 11:59 p.m., and will post all public comments received on OHA’s website. Please submit comments via email to FormACareOregon.CCO@odhsoha.oregon.gov and mention CareOregon in your message.
For more information, please visit the OHA web page or read the transaction summary. The transaction summary is also available in multiple languages on the OHA web page.
OHA invites applicants with lived or professional experience related to health, racial equity and community engagement for the following open positions on the Public Health Advisory Board:
- An expert in health equity;
- A person who represents a community-based organization serving a rural community;
- A person who represents a community-based organization serving an urban community;
- A person who represents the education system from early learning though high school; and
- A person who represents coordinated care organizations.
Each position serves a term that begins Jan. 1, 2024. The end dates for the positions vary, but terms may last a total of four years with the option to renew for a second term. Board members are appointed by the Governor.
Updated EPSDT Provider Guide and Webinar
OHA has updated the Medicaid Management Information System (MMIS) to support review of all fee-for-service (FFS, or "open card") claims related to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services. MMIS now suspends FFS claims for manual review if they are for services:
- Provided to OHP members under age 21,
- Not requiring a prior authorization, and
- Are below the line, non-pairing, or otherwise not historically covered.
OHA has issued an updated EPSDT Provider Guide and Frequently Asked Questions to reflect this change, and is planning the following education session so providers can learn more.
Join OHA's free webinar about EPSDT: Overview and Open Card Process Updates
This webinar is an EPSDT refresher that also shares updates to OHA's FFS review processes for EPSDT services.
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Date and time: December 4, noon to 1 p.m.
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Audience: Clinicians and practice managers serving children and youth who are OHP members, with a focus on open card providers.
Presenters will include Dawn Mautner, MD, MS, Medicaid Medical Director.
Simultaneous American Sign Language and Spanish interpretation will be available. The session will be recorded, and webinar materials will be made available in Spanish.
Please contact Tom Cogswell (thomas.cogswell@oha.oregon.gov, 971-304-9642) if you need an accommodation to fully participate in this webinar.
Additional information may be found at Oregon.gov/EPSDT, including:
 Billing for Mobile Crisis Intervention Services
OHA has found that some behavioral health providers have been submitting claims for H2011 (Crisis Intervention Services per 15 minutes) with the HE and/or HT modifiers when they are:
- Not certified to do so, or
- Providing a service that cannot be billed with this code/modifier combination.
Providers may only bill code H2011 with the HE or HT modifiers:
This ensures only certified MCIS providers are reimbursed for these services as described in the MCIS billing guide.
 Provider resource updates
Recent rule revisions
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