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).
As of Nov. 17, 2023, 919,879 people have completed the renewal process. This represents 63.8 percent of all OHP and Medicaid members.
- 783,661 people (85.2 percent) were renewed and kept their benefits. This is a 2.7 percent point increase since October.
- 111,941 people (13.0 percent) were found ineligible. This is a 0.8 percent point decrease since October.
- 16,227 people (1.8 percent) had a reduction in their benefits. This is a sharp decrease from the 25,714 (3.2 percent) reductions reported in October, largely due to benefit restorations.
To learn more, including a summary of November renewal letters and how ODHS and OHA are responding to renewal issues, read the latest news release:
This week, OHA announced that the state will revise its plan for how climate-related devices are distributed to eligible OHP members prior to a forecasted weather-related emergency. The benefits are now projected to begin in March 2024, pending federal government approval.
OHA initially proposed introducing climate benefits for OHP members in January 2024 as part of Oregon’s 1115 Medicaid waiver, which uses federal dollars to provide climate devices like air conditioners, air filtration devices, and portable power supplies to eligible Medicaid members; however, the Centers for Medicare & Medicaid Services (CMS) informed the state that distributing climate devices before an emergency declaration would not be possible. This limits distribution of devices to a smaller eligible population and will require OHA to shift how it will deliver resources in a more strategic approach.
While OHA and state partners work on readying climate benefits, OHP members enrolled in a coordinated care organization (CCO) can contact their CCO to see if climate supports are available through “flexible services” (also called health related services). If a member has OHP but is not sure which CCO they are in, they can call the Client Services Unit at 1-800-273-0557 or email Ask.OHP@odhsoha.oregon.gov.
Additional details will be provided in the coming weeks. Information about Oregon’s 1115 Medicaid waiver is currently available on OHA’s website, via this newsletter, and through webinars in English and Spanish.
Administrative examinations providers: Allowable units for code 99244, effective Oct. 1, 2023
OHA found that code 99244’s maximum allowable units changed from two units to one unit effective Oct. 1, 2023. OHA will override this edit so that administrative examinations providers can continue to bill two units per episode of care for the rest of the year.
Effective Jan. 1, 2024, providers will be limited to one unit per episode of care for code 99244.
 Fee-for-service rates for private duty nursing services, effective July 1, 2023
Nov. 28, 2023, OHA updated the Medicaid fee-for-service rates for private duty nursing services effective July 1, 2023. These rates are for private duty nursing services administered by OHA and ODHS.
Please bill using these new rates for dates of service on and after July 1, 2023. If you have already billed for service dates on or after July 1, 2023, please work with the organization that processes your prior authorization requests to coordinate adjustments to your submitted claims.
Reminder: OHP now covers non-routine and travel vaccines
As of Oct. 1, 2023, OHP covers the following codes. These are for nonroutine vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends for adults.
- 90473: Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
- 90474: Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid)
- 90581: Anthrax vaccine, for subcutaneous or intramuscular use
- 90584: Dengue vaccine, quadrivalent, live, 2 dose schedule, for subcutaneous use
- 90586: Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use
- 90587: Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use
- 90625: Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use
- 90690: Typhoid vaccine, live, oral
- 90691: Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use
- 90717: Yellow fever vaccine, live, for subcutaneous use
- 90738: Japanese encephalitis virus vaccine, inactivated, for intramuscular use
- 90758: Zaire ebolavirus vaccine, live, for intramuscular use
Provider resource updates
Rate Review Committee Intensive Services Request Form for behavioral health residential treatment providers (11/16/2023)
The pending January 1, 2024 Prioritized List of Health Services (12/1/2023)
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