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).
Study shows Oregon Medicaid renewal rate highest in nation
Oregon has the highest rate in the nation for Medicaid renewals since the lifting of the COVID-related continuous enrollment requirement in March 2023, according to a Georgetown study.
With 92 percent of the state’s nearly 1.5 million renewals complete, more than four out of five Oregonians are keeping their OHP or other Medicaid benefits.
As of July 19, 1,347,208 people have completed the renewal process. This represents around 92.7 percent of all OHP and Medicaid members.
- 1,114,627 people (82.7 percent) were renewed and kept their benefits.
- 221,260 people (16.4 percent) were found ineligible.
- 11,321 people (0.8 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.
Providers can help members get the care they need by working with coordinated care organizations (CCOs) outside their area. In rural areas, members may need to see providers outside their CCO's network for the care they need. By working with CCOs throughout Oregon, providers can:
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Offer members more services and options for choosing health care providers.
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Improve care coordination, especially for members with complex health needs.
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Help medically underserved communities get the care they need.
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Offer diverse views and resources that may not be available locally.
To work with CCOs outside your service area, you can:
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Provide care through single-payer agreements and prior authorizations.
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Reach out to CCOs to discuss other ways to work together.
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Consider challenges related to care coordination, scheduling and added paperwork.
Portland State University and Oregon Health & Science University have issued their first edition of the Older Adult Behavioral Health Newsletter with a focus on older adults and depression.
Presented by Oregon’s Center of Excellence for Behavioral Health & Aging, this quarterly newsletter:
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- Will highlight important topics related to behavioral health and aging, with special emphasis on emerging research and innovative programs to support the behavioral health needs of older adults.
- Features many programs, tools, as well as virtual and in-person learning events for providers to learn how to support the behavioral health of older adults.
Join OHA's August 9 webinar about Senate Bill 1557 (2024) and Access to Mental Health Assessment, Treatment, Services for Children with Intellectual or Developmental Disabilities
Under Section 5 of Senate Bill 1557 (2024), organizations and licensed practitioners may not deny children or youth under age 21 access to mental health assessment, treatment or services based on their intellectual or developmental disability.
OHA will host a listening session to hear from community on feedback, participation and support needed to implement this law.
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Date: Friday, August 9
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Time: 12:30 to 1:30 p.m. Pacific Time
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Meeting ID: 160 648 7077
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Passcode: 316754
 Replacement of durable medical equipment, supplies, prescription drugs and full or partial dentures in event of natural disasters
OHA asks providers to help OHP members obtain replacement durable medical equipment, supplies, prescription medications and full or partial dentures lost in the fires burning
throughout Oregon. This includes replacing covered items that OHP did not originally purchase.
Providers may see requests from members or their Oregon Department of Human Services case manager.
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For CCO members, please coordinate replacement through the member’s CCO.
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For fee-for-service (open card) members needing DME, supplies or dentures, submit a prior authorization request to OHA . If marked correctly, these requests will be reviewed within one business day.
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For fee-for-service prescription medications, pharmacies may request emergent or urgent dispensing as outlined in Oregon Administrative Rule 410-121-0060.
Billing for professional services provided offsite to individuals experiencing houselessness
Professional (non-institutional) providers may bill outpatient preventive, screening, diagnostic, and/or treatment services to unsheltered individuals experiencing houselessness using Place of Service (POS) code 27 ("Outreach Site/Street") when no other POS code applies.
- POS code 27 is for "a non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals."
- Other codes that may apply to services provided to individuals experiencing houselessness include POS 04 (Homeless Shelter), POS 15 (Mobile Unit) and POS 16 (Temporary Lodging).
The following professional provider types cannot use POS 27:
- School Medical providers must use POS 03 (School).
- Indian Health Care Providers not enrolled as FQHCs may only bill for services provided within the “four walls” of the clinic.
Provider resources
Early Periodic Screening, Diagnosis and Treatment frequently asked questions in English and Spanish (7/18/2024)
Provider Requirements for Behavioral Health Services Delivered Outside Oregon (7/19/2024)
Recent rule revisions
OAR 410-124-0081, 410-124-0091. Adopting Rules with Criteria and Specifications for Bone Marrow, Autologous, Allogeneic Transplant, and Harvesting.
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