Updates for Oregon Health Plan (OHP) providers
OHA recently notified pharmacies that the Centers for Medicare & Medicaid Services is allowing state Medicaid programs to pay for COVID vaccines administered by non-VFC providers to members under age 19. OHA now has confirmation of the end date for this authorization. Authorization continues through September 30, 2024.
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).
Join Us: Public Health Emergency Unwinding Community Partner Office Hour
Based on partners’ feedback, ODHS/OHA have turned the recurring PHE Unwinding Community Partner Forum into office hours.
- The office hours will provide a brief presentation, then focus on answering questions and hosting discussions.
- We hope you will gain useful answers while we learn from your experiences and better prepare for the needs of people in Oregon.
The next office hour is Tuesday, December 12 from 2:05 to 2:55 p.m. Pacific Time.
Register for OHA's 90-minute listening event planned for Dec. 12, 2023, from 9 to 10:30 a.m.
The Health Evidence Review Commission manages the Prioritized List of Health Services and related guidance. The Oregon Legislature uses the list to guide funding decisions related to the benefits OHP covers. OHA is hosting a virtual listening event to:
- Hear your ideas and concerns related to coverage of health services,
- Discuss four topics to consider for future coverage guidance, and
- Answer your questions.
The commission wants to hear from OHP members, their caregivers and providers.
HERO Kids has recently released three new marketing videos to help families understand the value of using the HERO Kids Registry.
- Each video has a different focus and are only 1 minute long.
- Videos are available in both English and Spanish.
HERO Kids Registry is a voluntary, no-cost, secure system that:
- Lets families and young adults record critical health details.
- Gives first responders and hospital emergency department providers quick and easy access to these health details in an emergency.
HERO Kids is open to any Oregon child or young adult through age 26.
Electronic Visit Verification (EVV) for Home Health Agencies
OHA has published the following resources for home health agencies to use to meet EVV requirements in Section 12006(a) of the 21st Century Cures Act. Home health agencies should prepare to use these resources to report EVV on and after Jan. 1, 2024.
Telehealth billing for covered fall prevention and diabetes self-management programs
As of Sept, 20, 2023, providers may now bill OHA for covered fall prevention program and diabetes management program services delivered via telehealth. To do this:
- Add modifier 95 for telehealth programs.
- Use Place of Service code 02 when the member is in a place other than their home.
- Use Place of Service code 10 when the member is in their home.
Fee-for-service reprocessing of 2019 DRG outpatient claims begins Nov. 17, 2023
OHA will reprocess 2019 DRG outpatient claims on the following weekends:
- Nov. 17, 2023
- Nov. 24, 2023
- Dec. 1, 2023
This activity will apply the correct Ambulatory Payment Classification Medicare conversion factor for claims with dates of service from Jan. 1, 2019, through Dec. 31, 2019.
Use Z codes to identify members' health-related social needs
The Centers for Medicare & Medicaid Services is encouraging providers to document identified psychosocial risk factors in the form of Z codes. Using these codes can help OHP and other payers to::
- Understand the complexity of patients served, and
- Determine eligibility for services to support the social determinants of health (SDOH), such as housing and nutrition supports.
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