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).
Oregon is still among the top states for keeping people covered
With more than 85 percent of the state’s 1.5 million renewals complete, 5 out of 6 Oregonians are keeping their Oregon Health Plan (OHP) or other Medicaid benefits. Oregon’s 85 percent renewal rate continues to be the second highest in a national comparison of state renewal rates by KFF, a nonpartisan health policy organization.
At this point in the unwinding, Oregon has sent the initially planned 10 waves of renewal letters. About 6 percent of members are still responding to those initial waves.
Remaining renewals approved to begin in June 2024
On February 13, the federal government approved Oregon’s plan for the remaining 8 percent of renewals not included in the initial waves. Under this plan:
- Renewal letters will be sent to members in four waves between June and September.
- Members will still receive 90 days to respond, and 60 days’ advance notice before any termination or reduction in benefits.
This means the final responses would be due in December 2024, and the final closures will happen in February 2025. A May 2024 update to Oregon’s automated renewal process will enable Oregon to begin this work.
Many of these remaining renewals were affected by a federal request for more than 30 states to review automated renewal processes, or restorations of some Oregon Supplemental Income Program Medical (OSIPM) benefits.
In this webinar from the Northwest ADA Center and OHA, explore the ADA requirements for providing effective communication and reasonable modifications. This webinar builds on the framework established in the previous webinars:
- Just as inaccessible environments can exclude disabled people, so too can inflexible policies and practices.
- By providing reasonable modifications and effective communication, we can ensure that standard policies and practices will not pose a barrier to healthcare.
Learning objectives:
- Consider diverse experiences of disability
- Understand reasonable modifications as a way to create access
- Be familiar with the requirements related to service animals
- Explore best practices for providing effective communication
Date and time:
- March 27, 2024
- Noon to 1 p.m. Pacific Time
OHA seeks Rules Advisory Committee members for changes to General Rules and Medical-Surgical Rules
OHA is holding a Rules Advisory Committee (RAC) March 14, 2024, at 2 p.m. to discuss proposed changes to General Rules (Division 120) and Medical-Surgical Rules (Division 130):
- 410-120-0000 (Definitions): Updating Definitions, including care coordination and
‘Licensed practitioner of the healing arts” (LPHA)
- 410-120-1280 (Billing): Cleaning up language around 340B entities, and clarifying confusing language
- 410-120-0045 (Applications for Medical Assistance at Provider Locations): Clean up confusing language in Section (9)
- 410-120-1195 (SB 5548 Population): Repeal the rule when no longer needed for anyone who was on OSIP-MN Medically Needy Program as of Jan. 21, 2003
- 410-120-1870 (Client Premium Payments): Repeal rule
- 410-130-0200 (Prior Authorization): Update reference or date
OHA is still seeking members to attend this RAC. The General Rules affect many providers and people,
 Requesting fee-for-service (open card) prior authorizations for gender-affirming care
When submitting prior authorization (PA) requests to OHA, please indicate the nature of the request by completing the PA Assignment field as follows:
- For Provider Portal requests submitted at https://www.or-medicaid.gov, choose the new “Gender Affirm” option in the PA Assignment drop-down menu.
- For fax requests, mark the “Other” box in the PA Assignment section of the ODHS/OHA Prior Authorization Request Form (MSC 3971). Write “Gender Affirm” in the fill-in field.
This ensures that your requests are routed and reviewed correctly, and helps reduce delays in the PA process.
Learn how to become a health-related social needs provider at OHA's February 27 webinar from 1 to 3 p.m.
Would you like to provide health-related social needs (HRSN) services to OHP members? HRSN services are a new set of benefits in the current OHP 1115 Medicaid waiver. HRSN services include:
- Climate-related resources
- Outreach and engagement
- Housing supports
- Nutritional services
OHA is hosting a technical assistance training on Feb. 27, 2024, to walk through the process of becoming a HRSN provider, including:
- Enrolling with OHA
- invoicing and billing OHA for HRSN services to open card (also known as fee-for-service) members.
The session will focus on the climate, outreach and engagement services that will go live March 1, 2024. But all organizations who provide or are interested in providing support to OHP (Medicaid) members are welcome.
Fee-for-service rate increase for Medicaid behavioral health services effective October 1, 2023
OHA is updating its fee-for-service claim system to reflect new reimbursement rates effective Oct. 1, 2023. The increase:
- Applies to behavioral health services rendered on or after Oct. 1, 2023.
- Is a net average of 3.4 percent for rates listed in the current Behavioral Health Fee Schedule.
OHA aims to complete this work by March 1, 2024. When this work is complete, OHA will:
- Post communications on the Behavioral Health Rate Increase page.
- Update the Behavioral Health Fee Schedule with the new rates.
- Adjust rates for adult mental health residential billing codes T1020 and T2033 retroactive to Oct. 1, 2023.
Provider resource updates
Oregon primary care providers and codes (2/23/2024)
340B State Policy (2/16/2024)
Frequently asked questions about Behavior Rehabilitation Services and provider enrollment (posted 2/15/2024)
How to complete the Oregon Medicaid Trading Partner Agreement (2/15/2024)
Approved culturally and linguistically specific services (CLSS) providers (2/13/2024)
Veteran Dental Program Partner Fact Sheet (2/8/2024)
Recent rule revisions
Changes to all 1915(i) Home- and Community-Based Services (HCBS) rules; adoption of five new HCBS rules (173-0080 through 0100) (effective 2/29/2024):
- 410-173-0000 (Purpose)
- 410-173-0005 (Definitions)
- 410-173-0010 (Eligibility)
- 410-173-0015 (Service Authorization)
- 410-173-0020 (Functional Needs Assessment)
- 410-173-0025 (Person-Centered Service Planning Process)
- 410-173-0030 (Qualifications for HCBS Providers)
- 410- 173-0035 (HCBS Services and Setting Qualities)
- 410-173-0040 (Individually Based Limitations)
- 410-173-0045 (Documentation Standards)
- 410-173-0050 (HCBS Community-Based Integrated Supports)
- 410-173-0055 (Eligibility Criteria for Community-Based Integrated Supports)
- 410-173-0060 (HCBS Residential Habilitation)
- 410-173-0065 (Eligibility Criteria for HCBS Residential Habilitation)
- 410-173- 0070 (HCBS Psychosocial Rehabilitation for Persons with Chronic Mental Illness)
- 410-173-0075 (Eligibility Criteria for HCBS Psychosocial Rehabilitation for Persons with Chronic Mental Illness)
- 410-173-0080 (Housing Support Services)
- 410-173-0085 (Eligibility for Housing Support Services)
- 410-173-0090 (Home-Delivered Meals)
- 410-173-0095 (Eligibility for Home-Delivered Meals)
- 410-173-0100 (Provider Qualifications for Home-Delivered Meals)
Reminders
Only send confidential claims as follows:
|
