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).
Join us Tuesday, May 14 from 10 to 11 a.m. Pacific Time
Community partners, coordinated care organizations, providers, insurers, and more are invited to learn more about how OHA and ODHS are working together to support people in Oregon as the federal COVID-19 PHE phases out.
Agenda:
- Medical renewals updates: Current status; timeline for remaining renewals
- Marketplace Unwinding Special Enrollment Period update
- OHP Bridge: What to expect
- Future partner webinars
- Questions and answers
- Resources for partners
Language and disability access: American Sign Language and live captioning will be available for this meeting. A separate Spanish webinar will be held Tuesday, May 30 at 10 a.m. Pacific Time.
Everyone has a right to know about and use ODHS and OHA programs and services. ODHS and OHA provide free help. For individuals with disabilities or individuals who speak a language other than English, OHA can provide information in alternate formats such as translations, large print, or braille. Contact the Feedback team at (503) 945-5488 or feedback@odhsoha.oregon.gov at least two business days in advance of the webinar if you would like assistance to participate. All relay calls accepted.
OHA is hosting a series of technical assistance trainings associated with becoming an HRSN service provider.
Our next HRSN Service Provider Training will be Tuesday, May 28, 2024, from 1 to 2:30 p.m. on Zoom. These monthly trainings provide technical assistance for organizations that want to become HRSN service providers. In this session, we will cover:
- Information sharing authorization form
- Closed-loop referrals
- Community information exchange
- HRSN request form
The session is open to all organizations who provide, or are interested in providing, HRSN support to OHP (Medicaid) members.
Spanish simultaneous interpretation and closed captioning will be available. If you need support or accommodations to participate, please email 1115Waiver.Renewal@odhsoha.oregon.gov.
View the April 4, 2024 provider training session:
Topics covered: HRSN Service Provider Qualifications, Steps to Become an HRSN Service Provider, Community Capacity Building Funds and HRSN Outreach and Engagement Services
Ready to get started as an HRSN provider?
To begin the process of enrolling as an HRSN service provider:
- Complete the online provider enrollment application:
- Once you've completed the application, please email the Provider Enrollment Team at provider.enrollment@odhsoha.oregon.gov. In the email, let them know that you submitted an application to become an HRSN Service Provider. This will ensure that your application can be processed sooner.
- If you have additional questions about enrolling as an HRSN Service Provider, please see the Provider Enrollment Guide, call the OHA Provider Enrollment team at 800-336-6016 (option 6), or email the team at provider.enrollment@odhsoha.oregon.gov.
OHP coverage of American Society of Addiction Medicine (ASAM) Level 3.7 R services
OHA has updated its fee-for-service claim system to reflect the rate for substance use disorder (SUD) residential treatment services provided at ASAM Level 3.7 R. The April 2024 Behavioral Health Fee Schedule now reflects the new services.
OHA will reimburse this level of services at $647.00 per day using codes H0018 (up to 30 days of service) and H0019 (beginning day 31) for certified SUD residential treatment providers enrolled with Oregon Medicaid.
To bill for this level of care, SUD residential providers with ASAM Level 3.7 certification must enroll with OHA to receive a new billing ID. This separate billing ID is required to bill for Level 3.7 R services.
 Medicare is the primary payer for some outpatient behavioral health services for Medicare-Medicaid members, effective Jan. 1, 2024
As of Jan. 1, 2024, Medicare is the primary payer for the following behavioral health services provided to Medicare members:
- Behavioral health services rendered by Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) as defined by the Centers for Medicare & Medicaid Services (CMS). In Oregon, this will include services rendered by Licensed Marriage and Family Therapists. It may also include services rendered by Licensed Professional Counselors.
- Intensive Outpatient Program (IOP) services furnished by hospital outpatient departments, community mental health centers, rural health clinics, federally qualified health centers, or opioid treatment programs as described in the November 2023 news release from CMS.
The Medicare Learning Network’s guide to Medicare and Mental Health Coverage includes details on these changes to coverage, reimbursement and eligible provider types.
MFT and MHC providers who meet federal education and experience requirements should enroll in Medicare. This document lists the education and experience requirements, and how to enroll. It may take up to 60 days to complete Medicare enrollment.
Clinics and programs with newly Medicare-eligible providers rendering behavioral health services should ensure all applicable staff enroll in Medicare and bill Medicare as primary coverage as Medicaid is the payer of last resort.
Fee-for-service rate increase for Nexplanon, effective Jan. 2, 2024
On Jan. 28, 2024, OHA updated the fee-for-service rate for Nexplanon (HCPCS code J7307: Etonogestrel contraceptive implant system, including implant and supplies). The new rate:
- Reflects the most current Wholesale Acquisition Price of $1156.28, effective Jan. 2, 2024.
- Is published in the March 2024 Medical-Dental Fee Schedule, available on the OHP Fee-for-Service Fee Schedule page.
For claims with dates of service on or after Jan, 2, 2024, providers can adjust claims within their timely filing period for reimbursement at the new rate.
Provider resource updates
Mental Health Peer-Delivered Services Billing Guide (4/25/2024)
Oregon Medicaid Pharmaceutical Services Prior Authorization Criteria (5/1/2024)
Recent rule revisions
OAR 410-138-0005: Amend Targeted Case Management rules to remove leveraging requirement for Nurse Family Partnership Program (4/25/2024)
Reminders
Only send confidential claims as follows:
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