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).
OHA is hosting office hours for Health-Related Social Needs (HRSN) service providers this month. If you have recently enrolled as a housing provider, or are planning on becoming one, join us for an opportunity to ask questions and get answers from OHA subject matter experts.
Audience:
HRSN housing service providers.
Organizations and individuals interested in becoming HRSN housing providers.
Date and time:
Nov. 19, 2024, from 1 to 2:30 p.m.
Spanish simultaneous interpretation and closed captioning will be available. If you need support or accommodations to participate, please email 1115Waiver.Renewal@odhsoha.oregon.gov.
Becoming an HRSN service provider:
To begin the process of enrolling as an HRSN service provider, complete the Provider Enrollment application:
Where to find "Providers">"Enrollment" at https://www.or-medicaid.gov
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:
Questions?
If you have questions related to HRSN services:
Starting in 2025, OHP, Oregon’s Medicaid program, plans to roll out a set of incentive payments for dental providers, pending Centers for Medicare & Medicaid Services approval.
The incentives will reward dental providers contracted with coordinated care organizations (CCOs) or CCO dental partners for preventive care and increasing access for OHP members. The following two options will be available in 2025:
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Preventive and Minimally Invasive Bundle: If a provider completes a set of preventive services for a member in six months, OHP will pay an additional $30 for a pediatric member and $50 for adult member on top of normal reimbursement for those services.
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Provider Incentive: There will be incentives for new providers who have recently served fewer than 25 members and existing providers who have served more than 25 members. The bonuses range from $3,500 to $15,000 for dental providers depending on their service volume and members served.
OHA will host webinars this fall and winter on these incentives. Please watch for more details in the coming months!
Fee-for-service dental rate increase effective Oct. 1, 2023
OHA has increased fee-for-service reimbursement rates for one hundred ninety-five (195) Current Dental Terminology (CDT) codes with an effective date of Oct. 1, 2023. The December 2024 publication of the Medical-Dental Fee Schedule will reflect the increase.
These codes should have been included in the original system updates to apply an Oct. 1, 2023 rate increase to all covered CDT codes. This activity corrects the error. No action is required on your part. OHA will reprocess all related claims accordingly.
We regret any inconvenience this may cause and appreciate your patience as we resolve this matter.
DRG hospitals: Versions 41 and 41.1 of MS-DRG implemented
On July 14, 2024, OHA updated its fee-for-service claim system with Versions 41 and 41.1 of the Medicare Severity Diagnosis Related Group (MS-DRG) grouper software. On or before Nov. 9, 2024, OHA plans to reprocess all inpatient claims with service dates between Oct. 1, 2023, and July 14, 2024. This standard mass adjustment will ensure compliance with MS-DRG versions and claim reimbursement.
Safety bed coverage through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program
OHA will only approve prior authorization requests for safety beds (enclosed beds) through EPSDT when:
- Medical necessity documentation clearly demonstrates that the bed is to mitigate acute episodes when restraint is necessary for the youth’s safety;
- Supporting documentation confirms that less restrictive and less costly interventions failed to address safety risks;
- The bed is approved by the U.S. Food and Drug Administration for the youth’s current setting; and
- The prior authorization request includes a written monitoring plan and a plan for transitioning away from using the bed.
If approved, safety beds cannot be used longer than needed. Home caregivers must be trained on how to use the bed. OHP will not cover any costs related to this training. The caregiver must also provide care as approved in the monitoring plan.
Provider resources
Approved Culturally and Linguistically Specific Behavioral Health Providers
Visit the HRSN Information for Providers page to find these resources in multiple languages:
- HRSN housing resources: Eligibility guidelines, fact sheet, and qualifying income limits for at-risk of homeless
- HRSN outreach and engagement resources: Tenancy supports, fact sheet
- HRSN Service Provider Quick Reference
Recent rule revisions
OAR 410-200-0215. Amend Rule to Align Definition of Lawfully Present for Basic Health Program with Federal Regulation.
OAR 410-120-0000, 410-120-1210, 410-120-2000, 410-120-2005, 410-120-2010, 410-120-2015, 410-120-2020, 410-120-2025, 410-120-2030, 410-141-3510, 410-141-3515, 410-141-3820, 410-141-3920. Establishing Health Related Social Needs Housing and Nutrition Benefits as Oregon Health Plan Covered Services
OAR 410-138-0005. Amend Targeted Case Management Rules to Remove Leveraging Requirement for Nurse Family Partnership Program
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