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).
Reminder: Safeguarding data
Medicaid partners and providers are encouraged to take proactive steps to safeguard Protected Health Information (PHI) and Personally Identifiable Information (PII) to ensure operational continuity.
Cyber resilience is a shared responsibility that extends to all state employees, volunteers, providers, contractors and vendors. Member data, including Race Ethnicity Language and Disability Sexual Orientation and Gender Identity (REALD SOGI) and immigration data, should not be shared with anyone, including with federal authorities without a subpoena.
 CMS cybersecurity requirements for providers
On Jan. 17, the Centers for Medicare & Medicaid Services (CMS) sent reminders about CMS cybersecurity requirements for all providers and partners that work with Protected Health Information (PHI) and Personal Identifiable Information (PII) data.
To ensure data security, everyone who works with Medicaid IT systems and data is encouraged to take proactive steps to safeguard PHI and PII data to support operational continuity. Cybersecurity is a shared responsibility and includes business partners, providers, contractors and vendors.
By adopting CMS cybersecurity best practices, we can better protect the interests of members and maintain compliance with federal requirements. Failure to meet CMS cybersecurity requirements may result in non-compliance and lead to enforcement actions by CMS.
Request:
Additional resources:
- The HIPAA Security Rule can be viewed at the Federal Register.
- CMS Cybersecurity Guidance materials are available via HHS.gov.
Questions?
For Medicaid questions, please contact OHA.DirectorsOffice@oha.oregon.gov.
For cybersecurity related questions, please contact OIS-ISPO-InfoSecurity@odhsoha.oregon.gov.
If you have other questions about this information or need technical assistance, please contact Brent Weaver at CMS.
DRG hospitals: Versions 42 MS-DRG implemented
On Jan. 27, 2025, OHA updated its fee-for-service claim system with Versions 42 of the Medicare Severity Diagnosis Related Group (MS-DRG) grouper software.
By Feb. 23, 2025, OHA plans to reprocess all inpatient claims with service dates between Oct. 1, 2024, and Jan. 27, 2025. This standard mass adjustment will ensure compliance with MS-DRG versions and claim reimbursement.
Adult mental health residential rates, effective Jan. 1, 2025
The Jan. 1, 2025 adult mental health residential rates are now available in the fee-for-service Behavioral Health Fee Schedule. OHA ensured rates either increased or stayed the same.
For each new assessment completed on or after Jan. 1, 2025, Comagine Health will
enter the new rate, consistent with the fee schedule, in MMIS. MMIS will generate an
approval letter that includes the new rate to bill OHA with a start date of Jan. 1, 2025.
Comagine Health will also send the individual and their provider:
- The resident’s person-centered services plan, and
- Results of the resident’s functional needs assessment.
Providers can bill the new rate starting Feb. 14, 2025.
Provider resources
Medicaid Adult Mental Health Residential Rate Webinar recording and slides (2/4/2025)
Dental Services Provider Guide (2/4/2025)
OHP Dental Periodicity Schedule (2/4/2025)
Approved Culturally and Linguistically Specific Services providers (2/7/2025)
Recent rule revisions
OAR 410-120-2005, 410-120-2030. Emergency filing to support increased access to HRSN housing services.
In case you missed it
Benefit Update Project workplan update (2/10/2025)
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