Provider Matters

Provider Matters is an email communication that gives Oregon Health Plan providers timely updates, tips and resources related to fee-for-service benefit coverage, criteria, policies and procedures.

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You can also visit the OHP Announcements page to find specific memos shared in past issues.

Current issue

Issue Date	Link

5/19/2023	OHA now seeking two OHP members and two health organization representatives to join Oregon's Medicaid Advisory Committee
Non-emergent transportation brokerages permitted to use private commercial transportation options beyond the COVID-19 Public Health Emergency ; State lifts COVID-19 response measures as federal emergency ends; OHA now seeking two OHP members and two health organization representatives to join Oregon's Medicaid Advisory Committee; Providers should bill Oregon Health Authority (OHA) for abortion services and CCOs for miscarriage management; updated CLSS approval list

Archive

Issue Date	Link

5/5/2023	Join the Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS) for its next webinar on May 9, 2023, from 10 to 11 a.m. Pacific Time
New English and Spanish videos about OHP renewal letters; Oregon Eligiblity (ONE) Notice Guides about OHP renewals; Fee-for-service reprocessing of inpatient claims planned for the week of May 15, 2023; Payment Error Measurement Rate Program (PERM) and requests for medical records; Oregon Health Plan coverage of services provided by licensed electrology temporary trainees; Prior authorization requirements deferred for Intensive In-Home Behavioral Health Treatment; Recent rule revisions; Provider resource updates


4/21/2023	Sexual Orientation and Gender Identity Learning Collaborative: Learn more about sexual orientation and gender identity (SOGI) data collection, analysis and reporting
Preparing for the COVID-19 Public Health Emergency to end - May 9 partner webinar; Open to the public: OHA to host webinar on continuous enrollment for OHP members; OHP now covers dental therapist services; Recent rule revisions; In case you missed it - Feb. 1, 2023 Prioritized List of Health Services


4/7/2023	Join our webinar about preparing for the end of the COVID-19 Public Health Emergency: April 11, 10 to 11 a.m. Pacific Time
End of COVID-19 behavioral health residential vacancy payments; Use of HO and HH modifiers limited to Integrated Co-occurring Disorders programs starting May 1, 2023; Payment recovery planned for some fee-for-service substance use disorder residential treatment per diem claims; Recent rule revisions; Provider resource updates (fee schedule, Oregon Medicaid Pharmacy Quick Reference, and more)


3/24/2023	Learn more about the OHP 1115 Medicaid Waiver for 2022-2027
Preparing for the COVID-19 Public Health Emergency to end - Join the monthly partner webinar series; Learn more about the OHP 1115 Medicaid Waiver for 2022-2027; Extension of temporary rate increase for Enhanced Care Services, effective April 1, 2023; Administrative Exam Fee Schedule effective Jan. 1, 2023; updated resources about Culturally and Linguistically Specific Services, Integrated Co-occurring Disorders, SUD 1115 waiver, and EPSDT


3/10/2023	Renewals Experience Timeline Now Available
Renewals Experience Timeline now available; Join the Oregon Department of Human Services (ODHS) and Oregon Health Authority (OHA)'s monthly partner webinar series; New Marketplace transition webinar; Sign up for OHA's new partner newsletter: Keep Covered; Member and community survey to help shape 2024 Network Adequacy rules; Fee-for-service reprocessing for certain Home and Community-Based Services (HCBS) claims starting March 3, 2023; Provider resource updates; 2023 OHP Handbook now available in multiple languages


2/24/2023	OHP eligibility renewals resume April 1, 2023
OHP eligibility renewals will resume April 1, 2023; Coming soon: Renewals Operational Timeline available March 3, 2023; Sign up for OHA's new partner newsletter about preparing for the end of the COVID-19 Public Health Emergency; Oregon WIC update: Formula waivers to end March 1, 2023; Healthier Oregon report highlights the program’s positive effect across the state; Substance Use Disorder (SUD) 1115 Waiver Billing and Coding Webinar, March 8, 2023, 9 to 10 a.m.; Provider resource and other updates


2/10/2023	Monthly partner webinar series: Preparing for the COVID-19 Public Health Emergency (PHE) to end
Monthly partner webinar series: Preparing for the COVID-19 Public Health Emergency (PHE) to end; Provider resource updates - Fee-for-service fee schedule, CWM billing guide, 2023 APC codes, EPSDT provider education webinars, behavioral health rate increase page; Transplant rule revisions; HERC coverage guidance posted for public comment


1/27/2023	Join OHA as we review the Substance Use Disorder (SUD) 1115 Demonstration Waiver, Feb. 8 and Feb. 9, 2023
Monthly partner webinar series: Preparing for the COVID-19 Public Health Emergency (PHE) to end; From the Centers for Medicare & Medicaid Services: Resources for Medicare members about savings under the new prescription drug law; Fee-for-service reprocessing of CWM Plus postpartum professional and dental claims; Join OHA as we review the Substance Use Disorder (SUD) 1115 Demonstration Waiver, Feb. 8 and Feb. 9, 2023; New Early and Periodic Screening, Diagnostic and Treatment (EPSDT) education session for behavioral health and Behavior Rehabilitation Service providers; provider resource updates; recent rule revisions


1/13/2023	From the Centers for Disease Control and Prevention: Strategies, resources and data to encourage catch up on routine vaccinations
From the Centers for Disease Control and Prevention: Strategies, resources and data to encourage catch up on routine vaccinations; Join OHA's Rules Advisory Committee to discuss proposed changes to OHP telehealth rules; Join OHA's no-cost provider education sessions about EPSDT; Behavioral health rate increase updates; Other provider resource updates


12/30/2022	Join OHA's no-cost provider education sessions about EPSDT in Oregon
Implementing Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit in Oregon; Join OHA's no-cost provider education sessions about EPSDT; Change log for 1/1/2023 Prioritized List; Provider resource updates; Recent rule revisions


12/16/2022	Updated COVID-19 Immunization Protocols (bivalent booster and third vaccine doses for ages 6 months through 5 years)
Updated COVID-19 Immunization Protocols; Flu communications resources; Masking signage for businesses and health care settings; Flu, COVID-19, RSV and holiday safety flyers and social cards for partners to share; Medicaid behavioral health rate increases effective July 1, 2022; RSV member fact sheet translations; Prioritized List change logs; Spanish translations of partner fact sheets (COFA Dental and Veteran Dental programs); Recent rule revisions


12/2/2022	Oregon Health Plan coverage of palivizumab for Respiratory Syncytial Virus (RSV) prophylaxis expanded to high-risk children from 12 to 24 months of age, effective immediately
Respiratory Syncytial Virus (RSV) updates and resources; Preparing for the COVID-19 Public Health Emergency (PHE) to end: Join OHA and ODHS’s Dec. 13 webinar; Motivational interviewing trainings – Level 2 and Group Trainings Now Available (no-cost CME available); EPSDT update: Coverage for OHP members under age 21 is changing Jan. 1, 2023; Oregon DRG hospitals: Fee-for-service reprocessing of outpatient claims planned for Dec. 10, 2022; Provider resource updates; Recent rule revisions


11/18/2022	RSV, COVID-19, flu resources and updates
Respiratory infection resources and updates; If the holidays are hard: Resources for emotional and mental health; Join OHA's Provider Collaborative Webinar about CWM program updates Tuesday, Dec. 6, from 9 to 10 a.m.; Discontinuation of therapeutic foster care code S5146, effective March 1, 2023; updated Novel Coronavirus Coding recommendations


11/4/2022	New partner toolkit to support people receiving benefits prepare for the end of the COVID-19 Public Health Emergency
Updated COVID-19 investigative guidelines; New partner toolkit to prepare for the end of the COVID-19 Public Health Emergency; Scam alert: Fake caller posing as OHA asking for personal health information; Medicaid coverage of outpatient gambling disorder treatment services; Language access requirements for health care providers; CWM coverage of immunosuppressant medications post-kidney transplant; Reminder about new dental-only OHP programs; Correction to Oct. 3 hospice rate memo


10/21/2022	Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine
From Centers for Medicare & Medicaid Services: Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine; Novavax COVID-19 vaccine receives booster approval for some recipients; COVID-19 vaccine recommendations for children ages 5 through 17; Patient and provider COVID-19 vaccine resources; Preparing for the end of the federal COVID-19 PHE - Partner webinar recordings and material now available; New OHP dental-only programs open Jan. 1, 2023


10/7/2022	COVID-19 bivalent booster and seasonal flu vaccine administration - Billing codes and immunization protocols
Administration of COVID-19 bivalent booster and seasonal flu vaccines: Face-to-face assessments for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant (BH PCA) services begin October 15, 2022; Preparing for the end of the federal COVID-19 PHE: Letters to OHP and Medicare Savings Program members; Reminders and best practices related to member billing prohibitions; Fee-for-service hospice rates effective October 1, 2022; Temporary rate increase for Enhanced Care Services, effective October 1, 2022; Provider resource updates; Recent rule revisions


9/23/2022	COVID-19 bivalent vaccine boosters: Billing codes and updated fact sheets
Pfizer and Moderna COVID-19 bivalent booster vaccine administration for ages 12 and older, effective 9/1/2022; Fact sheet updates: Bivalent boosters; Masking requirements in health care settings FAQ update; Webinar series: Preparing for the end of the federal COVID-19 Public Health Emergency continues Oct. 18 and Nov. 15, 2022; Complete Agreement to Pay forms before providing non-covered services to CWM members on or after July 1, 2022; Provider resource updates; Recent rule revisions


9/9/2022	Novavax COVID-19 vaccine administration for ages 12 and older, effective 8/22/2022
Novavax age limit update; Partner webinar series about preparing for the end of the federal COVID-19 Public Health Emergency now starts Sept. 20, 2022; Reminder: Bill Oregon Health Plan (OHA or the CCO) last; Oct. 1, 2022 Prioritized List of Health Services now available; CCO-F: DCO members moving to CCOs, effective Jan. 1, 2023; Fee-for-service reprocessing of neonatal and pediatric intensive care service professional claims planned for week of Sept. 12, 2022; Recent rule revisions


8/26/2022	OHA seeks members for Rules Advisory Committee to discuss changes to Pharmaceutical Services rules effective Jan. 1, 2023
Recordings: COVID-19 vaccine rollout for the 6-month to 5-year old populations; Spread the word: Monthly partner webinar series about preparing for the end of the federal COVID-19 Public Health Emergency; Community resources to improve health care services to people who are Deaf, DeafBlind or Hard of Hearing; OHA seeks members for Rules Advisory Committee to discuss changes to Pharmaceutical Services rules effective Jan. 1, 2023; Reminder: Member reimbursement for retroactive OHP Supplemental benefits; Billing for covered fall prevention programs; OHP coverage of hMPXV (human monkeypox virus) vaccines and testing, effective July 26, 2022; Billing for diabetes self-management and prevention programs; Recent rule revisions; Provider resource updates


8/12/2022	Monthly partner webinar series: Preparing for the COVID-19 Public Health Emergency (PHE) to end
Monthly partner webinar series: Preparing for the COVID-19 Public Health Emergency (PHE) to end; OHA seeks members for Rules Advisory Committee to discuss changes to Medicaid rule about clinical trial coverage changes; Jan. 1, 2022 CWM coverage of emergency cancer and behavioral health crisis treatment to be implemented this September; Recent rule revisions; Provider resource updates

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