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 a Health-Related Social Needs (HRSN) Service Provider Training on Tuesday, Jan. 28, 2025, from 1 to 2:30 p.m. on nutrition services. 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) members.
This month’s session will cover:
- The HRSN nutrition benefit (what is and is not covered).
- How to connect OHP members to nutrition services.
- Eligibility requirements to get nutrition services.
Spanish simultaneous interpretation and closed captioning will be available. If you need support or accommodations to participate, please email: 1115Waiver.Renewal@odhsoha.oregon.gov.
Next Steps:
To begin the process of enrolling as an HRSN service provider:
- Complete the Provider Enrollment application:
- Visit: https://www.or-medicaid.gov
- Then click: “Provider” > “Enrollment”
- Once you've completed the application, please email the Provider Enrollment Team at Enrollment@odhsoha.oregon.gov letting 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 Enrollment@odhsoha.oregon.gov.
Questions?
If you have questions related to HRSN services, please visit our HRSN webpage or contact 1115Waiver.Renewal@odhsoha.oregon.gov.
New Home and Community-Based Services page
We are thrilled to announce that OHA has launched a Home and Community-Based Services webpage for adults with mental health needs. The page offers new resources for individuals, families, guardians, caregivers, and providers, including:
- Steps to access services
- Answers to frequently asked questions
- independent and Qualified Agent (IQA) office hours and engagement sessions
We encourage everyone to visit the new site and share any feedback to help us improve the user experience!
La nueva página web de servicios basados en la communidad y el hogar
Nos complace anunciar que Oregon Health Authority (OHA, por sus siglas en inglés) ha lanzado una página web de Servicios Basados en la Comunidad y el Hogar (HCBS, por sus siglas en inglés) para adultos con necesidades de salud mental. La página ofrece nuevos recursos para individuos, familias, tutores, cuidadores y proveedores, incluidos los pasos para acceder a los servicios y respuestas a preguntas frecuentes. ¡Te invitamos a visitar el nuevo sitio y a compartir tus comentarios para ayudarnos a mejorar la experiencia del usuario!
 New Dental Provider Type Specialty 119
Licensed dentists (Provider Type 17) who are not orthodontic specialists (Specialty Type 113), but wish to provide comprehensive orthodontic treatment for handicapping malocclusion may qualify for the new Specialty Type 119 (Orthodontia CE or Prior Cases). To qualify, dentists must have completed in the past three years:
- 30 hours of orthodontic continuing education (CE), or
- Five comprehensive orthodontic treatment cases.
If you meet the criteria for Specialty Type 119, contact OHP Provider Enrollment to state that you meet the criteria. Call 800-336-6016 (option 6) or email Provider.ENROLLMENT@odhsoha.oregon.gov.
Updated Trading Partner Agreement
OHA has updated the Oregon Medicaid Trading Partner Agreement (TPA) for electronic data interchange (EDI) transactions, effective January 2025.
- Please use this form when submitting new or revised TPAs going forward.
- Do not resubmit any TPAs that you have already submitted to OHA. OHA is processing them.
OHA will stop accepting older versions of the TPA March 1, 2025. Please work with your clearinghouse/submitter to make sure they use the January 2025 version when submitting new or revised TPAs.
Hospital reimbursement updates coming soon
OHA is submitting State Plan Amendments for federal approval to update hospital reimbursement as follows:
- Pay for inpatient hospital psychiatric services delivered by Diagnosis-Related Group (DRG) hospitals in Oregon using a tiered Medicare Severity Diagnosis-Related Group
(MS-DRG) payment structure. Once approved, the rates will be effective Jan. 1, 2025.
- Pay out-of-state hospitals for outpatient services using the same Ambulatory Payment Classification methodology used for in-state hospitals. Once approved, the rates will be effective Jan. 4, 2025.
Fee-for-service rate increase for adult foster home providers effective Jan. 1, 2025
OHA, working with Comagine Health, has updated fee-for-service reimbursement rates for adult foster home providers, effective Jan. 1, 2025.
- Comagine Health has entered the updated amounts into each individual’s plan of care in
the Medicaid Management Information System (MMIS).
- MMIS will send an updated rate letter to the individual and their provider.
Please bill for services provided at the rate identified in the approved rate letter.
Provider resources
PERC Codes Eligible for PPS or PMPM Reimbursement for Healthier Oregon, Youth with Special Health Care Needs and Bridge benefit packages (1/8/2025)
Carve-Out Drug List, 4th Quarter 2024 (1/8/2025)
Primary care providers and procedure codes (1/10/2025)
Maximum allowable fee-for-service rates for medical and dental services (1/13/2025)
Doula Billing Guide (1/13/2025)
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) member fact sheets (1/16/2025), provider guide and change log (1/17/2025) on the EPSDT page
Recent rule revisions
OAR 410-130-0015. Additional doula support visits
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