Updates for Oregon Health Plan (OHP) 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).
Hosted by Northwest ADA Center in collaboration with OHA, this webinar series focuses on ensuring accessibility and inclusivity within health care environments through Americans with Disabilities Act (ADA) compliance.
- Session 1: Disability Foundations
- Date: Thursday, January 25
- Time: Noon to 1 p.m.
Description:
People with disabilities are a diverse and unique identity group! In our first webinar, we will explore disability as a legal, political, and cultural identity. We will present a brief history of disability activism in the United States, overview disability identity and pride, and examine the impacts of ableism and persistent disability bias in healthcare today.
Learning objectives:
- Understand disability from a diversity perspective
- Reflect on how U.S. history impacts views on disability
- Learn about best practices for talking about disability
- Recognize the impacts of disability bias in healthcare
Non-emergent medical transportation (NEMT) for approved EPSDT services, effective Jan. 1, 2023
When approving NEMT for children and youth under age 21, brokerages must consider whether services are medically necessary and medically appropriate for their individual needs and approve exceptions as appropriate. For example:
- Brokerages cannot use age as the sole reason to deny requests for caregiver travel with members over age 12.
- EPSDT requires granting exceptions to age and other hard limits when medically necessary and appropriate for the member’s individual needs and circumstances.
To learn more about EPSDT and how to determine service eligibility, please refer to the EPSDT provider guide.
Fee-for-service coverage of continuous glucose monitoring (CGM) devices effective Jan. 1, 2024
Effective Jan. 1, 2024, providers can order CGM devices for people with Type 2 diabetes or gestational diabetes who meet the coverage criteria in Guideline Note 108 of the Jan. 1, 2024 Prioritized List of Health Services.
- OHA asks ordering providers to ensure all fee-for-service (open card) patients who qualify for a CGM device get their device through a local pharmacy instead of a durable medical equipment (DME) supplier, if possible.
- For fee-for-service (open card) members, OHA will require prior authorization of CGM devices through the Oregon Pharmacy Call Center. OHA expects to publish prior authorization criteria in January 2024.
- OHA will continue to accept Medicare crossover claims for CGM devices ordered through DME suppliers to align with Medicare requirements.
OHP coverage of gender-affirming treatment, effective Jan. 1, 2024
Effective Jan. 1, 2024, OHA will cover all treatments according to the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, published by the World Professional Association for Transgender Health (also known as WPATH 8.0 or SOC 8).
- The Jan. 1, 2024 Prioritized List of Health Services pairs these treatments on Line 309.
- Guideline Note 127 notes that OHP must also cover CPT or HCPCS codes not on Line 309 if they meet requirements of House Bill 2002 (2023) and WPATH 8.0. These treatments will require prior authorization.
Local research group to conduct Oregon’s 1115 Medicaid waiver evaluation
As part of Oregon’s 1115 Medicaid waiver, the state is required to secure an independent evaluation partner to measure the outcomes of waiver benefits. It was recently announced that Portland, Oregon-based Center for Outcomes Research & Education (CORE) was selected through a competitive process to develop the waiver evaluation design.
CORE is an independently funded team of scientists, researchers, and data experts. Their team will work with OHA to seek input and feedback from a variety of Oregon partners and focus on three major components:
- Develop a robust evaluation design, leveraging input from interested parties
- Formulate a plan to gain input and insight from a diverse range of groups and individuals
- Gather input and ongoing recommendations of governance processes for evaluation implementation.
CORE’s stated goal is to produce an evaluation design informed by the experiences of OHP beneficiaries, community-based organizations, CCOs and other interested parties.
Provider resource updates
Approved Culturally and Linguistically Specific Services providers (12/28/2023)
Administrative Exam Fee Schedule effective Jan. 1, 2024 (12/28/2023)
December 2023 Medical-Dental Fee Schedule (12/19/2023)
Jan. 1, 2024 Prioritized List Change Log (12/19/2023)
Recent rule revisions
OAR 410-141-3515 - Update Network Adequacy Standards and Expectations and Language Access Standards Applicable to Coordinated Care Organizations
OAR 410-141-3830 - Adopt the January 2024 Prioritized List of Health Services for the Oregon Health Plan
OAR 410-141-3805, 410-141-3810, 410-141-3815 - Remove weekly enrollment references and replace with “next available enrollment date”
OAR 410-120-0000, 410-120-1210, 410-121-0147, 410-123-1540, 410-125-0230, 410-134-0000, 410-134-0001, 410-134-0002, 410-134-0003, 410-134-0004, 410-134-0005, 410-136-3020, 410-200-0015, 410-200-0100, 410-200-0240 - Update Citizenship Waived Medical, Healthier Oregon references
OAR 410-120-1200, 410-130-0245, 410-151-0000, 410-151-0001, 410-151-0002, 410-151-0003, 410-151-0004, 410-151-0005, 410-151-0006, 410-151-0007, 410-151-0008 - Update EPSDT Rules & Definitions for Medical Necessity & Medical & Dentally Appropriate to Align with Federal Requirements
OAR 410-121-0030, 410-121-0032, 410-121-0040, 410-121-0146, 410-121-0147 - Amending Pharmacy Rules; PDL, Exclusions & Limitations, Dispensing Limitations, Criteria to Reference EPSDT & P&T Recommendations.
OAR 410-125-0101 - Enrollment Process Improvement for Hospital Based Long Term Care Nursing Facility Services & Medicaid Swing Beds.
OAR 410-127-0020, 410-127-0046 - Adding new section implementing Electronic Visit Verification definition and requirements.
OAR 410-129-0020, 410-129-0070, 410-129-0085, 410-129-0240, 410-129-0260, 410-129-0280 - Incorporation and Clarification for EPSDT Coverage and HB 2994.
410-136-3000, 410-136-3010, 410-136-3020, 410-136-3040, 410-136-3060, 410-136-3080, 410-136-3100, 410-136-3120, 410-136-3140, 410-136-3160, 410-136-3180, 410-136-3200, 410-136-3220, 410-136-3240, 410-136-3260, 410-136-3280, 410-136-3300, 410-136-3320, 410-136-3340, 410-136-3360, 410-141-3920, 410-141-3960 - Updates to references, requirements, and processing procedures for Non-Emergency Medical Transportation (NEMT)
OAR 410-172-0745 Effective 112024 OHP will cover facial gender confirmation surgery. This change repeals conflicting rule language.
Other updates
Changes in CCO enrollment timeframes (12/28/2023)
Keep Covered - Updates on changes to Oregon benefits (12/28/2023) - Partner updates and learning opportunities about OHP redeterminations
|