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 (PHE): View the May 2023 memo from Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS).
With nearly 84 percent of the state’s 1.5 million renewals complete, more than 5 out of 6 Oregonians are keeping their Oregon Health Plan (OHP) or other Medicaid benefits.
Oregon has not started renewals for over 100,000 people. Many of these renewals were affected by previously reported renewal issues. Oregon is currently seeking federal approval of an amended timeline for these renewals. Under the proposed timeline:
- Oregon would send renewal letters to members in four waves between June and September.
- Members would still have 90 days to respond, and 60 days’ advance notice before any termination or reduction in benefits.
- The final responses from members would be due in December 2024, and the final closures would happen in February 2025.
To learn more:
In this webinar from the Northwest ADA Center and Oregon Health Authority, review best practices for creating accessible healthcare environments!
- Learn about the ADA Standards for Accessible Design, including guidelines for accessible routes, examination rooms, and medical equipment.
- The focus will be on understanding the importance of physical and digital access for people with disabilities.
Learning objectives:
- Understand physical and digital access as a civil right
- Become familiar with the ADA’s general requirement for providing health care services in accessible environments
- Consider the ADA Standards as concrete and practical guidelines for creating accessible facilities
- Be aware of the need for digital access, common barriers, and assistive technology
Wildfires, floods, and other emergencies impact our disability communities every year.
- People with disabilities have their own strengths. They have built community networks and resources they rely on.
- These communities also have specific needs during emergencies. Governments and communities must prepare for crisis together.
Collaboration builds a mutual understanding of community resources, networks and needs. Working together allows government and communities to build a shared response. It ensures people with disabilities can contribute their strengths, while receiving support as they leverage and restore critical resources, and in meeting specific needs.
What is DEMAC?
DEMAC advises Oregon government agencies. They focus on the needs of people with disabilities before, during, and after emergencies and disasters. Three state agencies support DEMAC:
- Oregon Department of Human Services
- OHA's Public Health Division
- Oregon Department of Emergency Management (ODEM)
Who can join?
DEMAC members are people with all types of abilities.
- People with disabilities
- Family members of people with disabilities
- Disability services professionals
- State and local public health and emergency management professionals
- Native American/Tribal government representatives
- Volunteers who work on short-term projects
The goal is to have 25 members who represent communities across Oregon. Two-thirds should be people with disabilities or their family members. People from diverse communities across Oregon are encouraged to apply.
How can I join DEMAC?
To learn more:
Expansion of crisis respite services effective January 1, 2023
Effective Jan. 1, 2023, OHA will reimburse for up to 30 days of crisis respite services provided to Medicaid-eligible individuals:
- In licensed Residential Treatment Homes (RTH) and RTF settings, including Secure Residential Treatment Facilities (SRTF); and
- Not already residing in a mental health residential setting.
An individual may be eligible for crisis respite services when they are experiencing a mental health crisis and need additional intervention or support to ensure their or others’ health, safety, and prevent escalation to a higher level of care.
 Listening session about Secure Residential Treatment Facility (SRTF) denial processes
Effective Feb. 1, 2024, OHA began enforcement of denial processes for Medicaid reimbursement within SRTF settings. Medical necessity reviews will occur every 90 days, upon review by the Independent and Qualified Agent (Comagine Health) and reassessment in SRTF settings.
Please join our listening session to hear from OHA staff how this will impact SRTF programs. During this session, OHA will gather questions and respond in a FAQ that will be provided.
Date and time: Feb. 23, 2024 at 11:05 a.m. Pacific Time
Other join options (Meeting ID 160 499 8438, Passcode 237370):
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Provider resource updates
Healthier Oregon Desk Manual (posted 1/29/2024) - This document explains the claim details for the Emergency Health Benefits Funding portion of the Healthier Oregon benefit.
Fee-for-service medical-dental maximum allowable rates (2/2/2024)
Approved culturally and linguistically specific services (CLSS) providers (2/8/2024)
CLSS Application Guide (2/8/2024)
Recent rule revisions
OAR 410-148-0100 - Amend language to comply with federal regulation regarding primary payer of oral formula. Effective 1/12/2024
OAR 410-120-1280 - Healthier Oregon pathway to OHP benefits expansion to include members of all ages. Effective 2/6/2024
OAR 410-141-3500, 410-141-3860, 410-141-3865, 410-141-3870 - Care coordination rules updated to clarify requirements of CCOs to improve care coordination activities. Effective 2/1/2024
Updates to multiple Durable Medical Equipment Program rules effective 1/1/2024:
- 410-122-0010 Definitions
- 410-122-0020 Orders
- 410-122-0080 Conditions of Coverage, Limitations, and Restrictions
- 410-122-0090 Face-to-Face Encounter Requirements (for Fee-For-Service Clients)
- 410-122-0180 Healthcare Common Procedure Coding System Level II Coding
- 410-122-0184 Repairs, Servicing, Replacement, Delivery, and Dispensing
- 410-122-0186 Payment Methodology
- 410-122-0200 Pulse Oximeter for Home Use
- 410-122-0202 Positive Airway Pressure (PAP) Devices for Adult Obstructive Sleep Apnea
- 410-122-0203 Oxygen and Oxygen Equipment
- 410-122-0204 Nebulizer
- 410-122-0210 Ventilators
- 410-122-0240 Apnea Monitors for Infants
- 410-122-0250 Breast Pumps
- 410-122-0300 Light Therapy
- 410-122-0320 Manual Wheelchair Base
- 410-122-0325 Power Wheelchair Base
- 410-122-0330 Power-Operated Vehicle
- 410-122-0340 Wheelchair Options/Accessories
- 410-122-0360 Canes and Crutches
- 410-122-0365 Standing and Positioning Aids
- 410-122-0375 Walkers
- 410-122-0380 Hospital Beds
- 410-122-0400 Pressure Reducing Support Surfaces
- 410-122-0475 Therapeutic Shoes for Diabetics
- 410-122-0510 Osteogenesis Stimulator
- 410-122-0515 Neuromuscular Electrical Stimulator (NMES)
- 410-122-0520 Glucose Monitors and Diabetic Supplies
- 410-122-0525 External Insulin Infusion Pump
- 410-122-0540 Ostomy Supplies
- 410-122-0560 Urological Supplies
- 410-122-0580 Bath Supplies
- 410-122-0590 Patient Lifts
- 410-122-0600 Toilet Supplies
- 410-122-0630 Incontinent Supplies
- 410-122-0640 Eye Prostheses
- 410-122-0658 Gradient Compression Stockings/Sleeves
- 410-122-0660 Orthotics and Prosthetics
- 410-122-0662 Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses
- 410-122-0700 Negative Pressure Wound Therapy Pumps
- 410-122-0710 Special Needs Car Seats
- 410-122-0720 Pediatric Wheelchairs
- 410-122-0730 Continuous Glucose Monitoring Equipment and Supplies
Other updates
March 21, 2024 listening session for ideas and concerns related to Prioritized List coverage (2/5/2024) - Register to suggest topics by March 5, 2024
Reminders
Only send confidential claims as follows:
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