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).
Updated EPSDT CCO Guidance and FAQ
The EPSDT CCO Guidance Document has been updated to reflect the revised EPSDT administrative rules which took effect Jan. 1, 2024. Additional edits are also included in the guidance document (please note these are for clarification only; there are no changes to EPSDT requirements). The EPSDT FAQ has also been updated.
For a full list of changes to the guidance document and FAQ, please see the EPSDT Change Log of Guidance Updates.
These documents and additional information can be found at www.oregon.gov/EPSDT, including:
For any questions regarding EPSDT, please contact EPSDT.Info@odhsoha.oregon.gov
 OHA invites health care partners and community members to learn about OHP rulemaking and engagement
OHA is holding webinars for the public to learn about the Rules Advisory Committee (RAC) process and get feedback about how to get more community feedback about Oregon Administrative Rules.
Sign up to join OHA at one of these times:
Please share these flyers about the webinar with anyone you think would be interested in attending.
Home health agencies: Send staff email contacts for Electronic Visit Verification by Jan. 31, 2024
OHA asks home health agencies to send the following information to HH.EVVData@oha.oregon.gov this month:
- List of all staff who will submit Electronic Visit Verification (EVV) reports to OHA
- Email address for each staff person
This will help OHA ensure that reporting staff can send their EVV reports via secure email starting February 1.
Join OHA's January 23 webinar to learn about upcoming behavioral health rate increases
Join the webinar to learn about upcoming fee-for-service behavioral health rate increases that, if approved, will:
- Apply to behavioral health services rendered on or after October 1, 2023.
- Be a 3.4 percent increase for rates listed in the current Behavioral Health Fee Schedule.
Temporary rate increase for physician-administered drugs, effective Nov. 5, 2022
Effective Nov. 5, 2022, OHA updated Oregon's Medicaid State Plan to establish a temporary five-year rate increase for certain biosimilar products to align with the Centers for Medicare & Medicaid Services published rate and section 11403 of the Inflation Reduction Act..
The increased rate will:
- Be the biosimilar’s Average Sales Price (ASP) plus eight percent of the reference biological’s ASP.
- Apply only to biosimilars with an ASP that is not more than the reference biological’s ASP.
To reflect this change, OHA updated Oregon Administrative Rule 410-120-1340(6)(b)(D) to remove reference to physician-administered drug reimbursement at ASP plus six percent.
Some eligible CWM members have not yet moved to full OHP benefits
There are close to 150 people who still have Citizenship Waived Medical (CWM) or CWM Plus benefits instead of full OHP benefits through Healthier Oregon. We continue to work on manually moving these members to full benefits.
If you serve a CWM member who does not have full OHP benefits yet:
- Please hold billing until you can verify the member has OHP Plus (BMH) benefits.
- We expect to resolve these cases by February 2024.
Thank you very much for your help and patience.
Provider resource updates
MCIS and Stabilization Services Billing Guide (1/3/2024)
340B Supplemental Chart for Covered Entities and Claims File Instructions (1/4/2024)
Diagnosis and procedure code groups (1/10/2024):
CLSS approvals list (1/12/2024)
Other provider updates
Concurrent billing for Applied Behavior Analysis codes (1/12/2024)
Updates affecting fee-for-service orthodontia claims (1/12/2024)
Reporting inpatient hospital admissions and discharges (1/9/2024)
Reporting SUD residential treatment facility admissions and discharges (1/9/2024)
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