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’s Medicaid Advisory Committee (MAC) is recruiting candidates to fill the following open position:
- One physician living or practicing outside of the Willamette Valley
Ideal candidates are committed to eliminating inequities and improving health care access and quality for Oregonians who are enrolled in Oregon’s Medicaid program, the Oregon Health Plan (OHP). MAC members are appointed by the Governor to serve up to two, two-year terms. Individuals from all areas of the state are encouraged to apply.
The MAC is a federally mandated body that advises the Oregon Health Policy Board (OHPB), OHA and ODHS about the operation of Oregon’s Medicaid program through a consumer and community lens. Key responsibilities of MAC members include:
- Attend and participate in at least 80% of committee meetings, which are held eight times
each year (attendance can be virtual)
- Engage in policy-level discussions about health care in Oregon
- Work to elevate the voices and perspectives of OHP members
- Participate fully, respectfully, and constructively
- Spend approximately one to two additional hours each month to prepare for meetings
MAC members influence health policy in many important ways. Recent work includes:
- Recommendations to Improve OHP Consumer Experience
- Using Health Related Services to Address Housing Needs: A Guide for CCOs
- Addressing the Social Determinants of Health – Recommendations for Oregon’s CCO
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See OHA's recruitment announcements for more details and how to apply.
OHA seeking members for two Rules Advisory Committees: Prior authorization rule for gender-affirming care and rule for air ambulance reimbursement
OHA is seeking participants for two Rules Advisory Committees (RACs) for the following Medicaid program rules. If these changes are likely to affect you, you can ask to join as a RAC member. At each RAC:
- Members will provide input that will help OHA develop the Notice of Proposed Rulemaking and help OHA better understand the fiscal impact of the proposed rule changes.
- Members will also analyze the Racial Equity Impact Statement on proposed rules.
Please share this information with others who may be affected by, and interested in providing input about, the proposed rule changes.
Oregon Administrative Rule (OAR) 410-130-0200 (Prior Authorization)
- Date and time: March 28, 2024, 3 to 5 p.m.
- Purpose: Review to include newly covered medical procedures for gender-affirming care
OAR 410-136-3180 (Reimbursement for Ground and Air Ambulance Transports)
- Date and time: April 15, 2024, 3:30 to 5 p.m.
- Purpose: Review to update air ambulance reimbursement for emergency medical transports
Health-Related Social Needs (HRSN) Provider Training Series: Becoming an HRSN provider and billing for outreach and engagement services: April 4, 2024
Are you interested in providing 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 series of technical assistance trainings to walk through the process of becoming an HRSN provider. The next session will be on Thursday, April 4, 2024, from 1 to 2:30 p.m. We will cover:
- Overview of HRSN service provider qualifications
- Steps to become an HRSN service provider
- Community capacity-building funds – the application window closes for these funds on May 31, 2024
- HRSN outreach and engagement services, including how to support a member in filling out the HRSN request form
The session is open to all organizations who provide, or are interested in providing, support to OHP (Medicaid) members.
Spanish simultaneous interpretation and captions will be available. If you need any help or accommodations to participate, please email us at 1115Waiver.Renewal@odhsoha.oregon.gov.
View past provider training sessions:
February 27, 2024: How to enroll as an HRSN service provider and submit invoices for HRSN services
Ready to get started as an HRSN provider?
You can begin the process to enroll as an HRSN service provider by completing the application. If you have additional questions about enrolling as an HRSN service provider:
Timely filing limits waived for Citizenship Waived Medical cancer claims until July 1, 2024
OHA will bypass the timely filing requirement for billing of eligible Citizenship Waived Medical (CWM) cancer claims. Providers have until July 1, 2024, to submit claims that contain an approved cancer diagnosis code that have exceeded the timely filing guidance in OAR 410-120-1300.
To bypass the timely filing requirement providers must submit paper claims to OHA. You can do this two ways:
OHP is primary payer for formulas and nutritional supplements covered by OHP and WIC, effective Jan. 12, 2024
Effective Jan. 12, 2024, OHA updated OAR 410-148-0100(5)(d) to clarify that OHP is the primary payer for formulas covered by OHP to treat women, infants and children who are both enrolled in OHP and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). This includes formula and nutritional supplements administered orally and/or via tube feeding.
Other provider updates
Request to mental health adult residential homes for Calendar Year 2022 and 2023 financial data (3/14/2024)
Submitting fee-for-service claims to receive the 3.4% rate increase for Medicaid behavioral health services effective Oct. 1, 2023 (3/11/2024)
Provider resource updates
Flowchart for Culturally and Linguistically Specific Services (CLSS) application (3/12/2024)
Approved CLSS providers (3/14/2024)
Frequently asked questions from adult foster home documentation training (3/13/2024)
Provider journey: HRSN services (3/14/2024)
2024 Non-Contract Rates for Type A and B Hospitals (3/18/2024)
Medical-Dental Fee Schedule (3/19/2024)
Code Group 6014: Citizenship Waived Medical Emergency Diagnosis Codes (3/22/2024)
Code Group 6186: Emergency Cancer Diagnosis Codes (3/22/2024)
Recent rule revisions
In case you missed it:
Reminders
Only send confidential claims as follows:
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