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 over 91 percent of the state’s 1.5 million renewals complete, more than four out of five Oregonians are keeping their Oregon Health Plan (OHP) or other Medicaid benefits.
At this point in the PHE unwinding process:
- Just 443 members, about 0.03 percent, still need to respond to renewal requests.
- 7,473 members, about 0.5 percent, have responded to their renewal but are awaiting state action on the response.
- The remaining renewals, about 8.3 percent of the total, will occur over the summer.
As of May 17, 2024, 1,323,772 people have completed the renewal process.
- 1,085,635 people (82 percent) were renewed and kept their benefits.
- 224,014 people (16.9 percent) were found ineligible.
- 14,123 people (1.1 percent) had a reduction in their benefits. Most of these members lost full OHP but were able to continue Medicare Savings Programs that help pay their Medicare costs.
OHA reviews health care business deals, like mergers and acquisitions, to make sure they won’t harm people and communities in Oregon.
UnitedHealth Group. Inc. (UHG) is planning to buy Amedisys, a home health and hospice company with locations in Salem, Portland, and Roseburg. OHA is reviewing this deal to understand how it could affect home health and hospice services in Oregon.
OHA is seeking public comment from current or former employees or contractors of Amedisys or UHG operated home health or hospice agencies in Oregon. OHA is also looking to hear from other professionals involved in caring for home health or hospice patients. Agency names are listed below.
- Amedisys Home Health Care
- Amedisys Hospice Care
- Assured Home Health
- Assured Hospice
- Brookdale Home Health
- Health at Home Hospice
- Heart ‘n Home Hospice and Palliative Care
- Innovative Senior Care Home Health
- Salem Home Care
- Southern Oregon Home Health
- Three Rivers Home Care
To share a public comment, email hcmo.info@oha.oregon.gov or call 503-945-6161 to leave a voicemail. Make sure to include the word “Amedisys” in your comment.
OHA seeks Rule Advisory Committee members to discuss proposed care coordination rules
The General Rules in Chapter 410, Division 120 affect many providers and people. Please share this information with others who may be affected by, and interested in
providing input about, the proposed rule changes.
OHA is holding two RAC meetings to discuss new rules about care coordination for OHP fee-for-service (open card) members:
- Tuesday, June 25, 2024, 1 to 3 p.m. Pacific Time
- Wednesday, June 26, 2024, 10:30 a.m. to 12:30 p.m. Pacific Time
At each RAC meeting, members will provide input about the following proposed rule changes. This input will help OHA develop the Notice of Proposed Rulemaking and better understand the fiscal impact of the proposed rule changes.
- 410-120-1215 Care Coordination: Administration, Systems and Infrastructure
- 410-120-1220 Care Coordination: Identification of Member Needs
- 410-120-1225 Care Coordination: Service Coordination
Meetings will be held virtually via Zoom and in-person in Salem. To attend or express interest in joining the RAC as a member, register using the links below.
 New option for verifying substance use disorder treatment appointments
Effective immediately, OHA offers fee-for-service non-emergent transportation brokerages two options for verifying substance use disorder (SUD) treatment appointments for OHP members:
Option 1: As described in the December 2023 memo (confirmation with member only; no separate confirmation of SUD appointments with the provider).
Option 2: Confirm the initial set of SUD appointments with the member only. Verify follow-up appointments and conduct post-visit verifications with the provider. To use this option, allow sufficient time for the provider to obtain a Release of Information (ROI) from the member. The provider keeps the ROI on file. The brokerage is not required to keep a copy.
Secure residential treatment facility approval and reauthorization timeframes
All approved SRTF placements are good for 90 days after the approval date. SRTF providers should ensure continuity of care by doing the following no later than 30 days before the approval’s expiration date:
- Submit a completed CH-009 form with supporting documents for the Plan of Care.
- Coordinate with the Independent and Qualified Agent (IQA), Comagine Health to schedule an assessment and develop the Person-Centered Service Plan.
Failure to complete and submit a new CH-009 form to the IQA within these timeframes may affect payment from Medicaid.
Provider resources
How to complete the 835 Signup Form (5/24/2024)
Approved Culturally and Linguistically Specific Providers (5/23/2024)
Post-Hospital Extended Care Benefit Summary and web page (5/23/2024)
Culturally and Linguistically Specific Services Billing Guide (5/23/2024)
July 1, 2024 Health-Related Services Climate Device Fee Schedule (5/22/2024)
Recent rule revisions
OAR 410-200-0436: Amending rule to reflect closure of MAGI Expanded Adult Program (temporary Medicaid eligibility) to new enrollment effective 7/1/2024. This program is being replaced by OHP Bridge.
OAR 410-130-0015: Changes required to support the new procedure code for doula services; updated Traditional Health Worker rule references
Adopting OHP Bridge Rules (Chapter 410 Division 115)
Reminders
Only send confidential claims as follows:
|
