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 now offers free health coverage to people in more income categories through OHP Bridge. This new eligibility category has no member costs, which means no premiums, copayments, coinsurance, or deductibles.
What does OHP Bridge cover?
Through OHP Bridge, people in Oregon can get medical, dental and behavioral health care with no member costs. Members will also have access to more benefits, like transportation to medical appointments and other health-related services.
What does OHP Bridge not cover?
There are a few things OHP Bridge will not cover that other Medicaid programs cover. OHP Bridge will not cover:
Who qualifies for OHP Bridge?
People in Oregon will qualify for OHP Bridge if they:
- Are 19 to 64 years old;
- Have an income between 138 percent and 200 percent of the Federal Poverty Level;
- Have an eligible citizenship or immigration status; and
- Do not have access to other affordable health insurance.
People looking for health coverage should start at OregonHealthCare.gov/WindowShop. They can use the Window Shopping tool to preview coverage options available to them.
What do providers need to do to serve OHP Bridge members?
Providers enrolled with their local coordinated care organizations (CCOs) should not need to do anything.
- OHP Bridge requires CCO enrollment for the vast majority of members.
- Only members who are American Indian/Alaska Native members will have the option for fee-for-service (open card) coverage through OHP Bridge.
How will providers know who has OHP Bridge?
When verifying coverage in the MMIS Provider Portal, providers will see the BRG benefit plan for members with OHP Bridge coverage.
OHA and Trauma Informed Oregon are hosting a Health-Related Social Needs (HRSN) Service Provider Training on Tuesday, July 23, 2024, from 1 to 2:30 p.m. This month’s session on trauma-informed care will cover:
- What it means to be trauma-informed and why it is important.
- A framework for implementing trauma-informed care.
- Tools and strategies for beginning, sustaining, and measuring this work.
- Resources available from Trauma Informed Oregon for ongoing support.
Spanish simultaneous interpretation and closed captioning will be available. If you need support or accommodations to participate, please email 1115Waiver.Renewal@odhsoha.oregon.gov.
This session is part of a monthly training series for organizations that are, or want to become, HRSN service providers for fee-for-service (open card) OHP members.
Becoming an HRSN service provider:
To begin the process of enrolling as an HRSN service provider, complete the Provider Enrollment application:
Once you've completed the application, please email the Provider Enrollment Team at provider.enrollment@oha.oregon.gov.
- In your 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:
Questions?
If you have questions related to HRSN services:
Code G0330 opens for fee-for-service billing in ambulatory surgical center settings, effective Oct. 1, 2024
OHA will open procedure code G0330 (Facility services for dental rehabilitation procedures performed on a patient who requires monitored anesthesia and use of an operating room) for fee-for-service billing effective Oct. 1, 2024.
- This code is only for procedures provided in the ambulatory surgical center setting on or after Oct. 1, 2024.
- Reimbursement for this code is $1,055.11.
- Maximum units that can be billed is 1.
 July 1, 2024 fee-for-service rate increase for Medicaid behavioral health services completed
OHA has updated its fee-for-service claim system to reflect the new
reimbursement rates effective July 1, 2024 and completed the following actions:
- Posted communications to the Behavioral Health Rate Increase page.
- Posted the July 1, 2024 Behavioral Health Fee Schedule.
- Adjusted rates for adult mental health residential billing codes T1020 and T2033.
Hospital Presumptive Eligibility (HPE) recertification postponed
The Community Partner Outreach Program (CPOP) has postponed this year’s HPE recertification until later this year. This is to align with other annual recertification training for CPOP's network of OHP partners.
- Until further notice, HPE determination sites should not take any HPE recertification training. Taking training now will not count towards annual recertification requirements.
- CPOP will reach out in late summer with more information about to complete annual training requirements.
- In the meantime, all HPE determination sites will remain on the approved HPE assister list unless they request removal.
Provider resources
Corrected July 1, 2024 nursing facility rates for hospice providers (7/12/2024)
Carveout Drug List, 2nd Quarter 2024 (7/10/2024)
Electronic Data Interchange 271 Supplement - EB05 Benefit Descriptions (7/9/2024)
Approved Culturally and Linguistically Specific Behavioral Health Providers (7/1/2024)
Provider Enrollment Guide (How to Complete the Online Provider Enrollment Application) (7/1/2024)
Oregon Medicaid Preferred Drug List (7/1/2024)
Oregon Medicaid Pharmaceutical Services Prior Authorization Criteria (7/1/2024)
Quick Guide to Income Eligibility for HPE Determinations (6/28/2024)
Ground Emergency Transportation Private Provider Program slides and recording (6/28/2024)
Community pharmacist professional billing (6/28/2024)
Recent rule revisions
OAR 410-130-0200: Updates prior authorization list to include newly covered procedures for gender-affirming care.
OAR 410-151-0040: Public health authorities are made eligible to claim for the reimbursement of lead investigation.
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