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

12/1/2023	OHP renewal update: 5 out of 6 people are keeping their medical benefits
OHP renewal update: 5 out of 6 people are keeping their medical benefits; OHA updates plan for climate benefits; Administrative examinations providers: Allowable units for code 99244, effective Oct. 1, 2023; Fee-for-service rates for private duty nursing services, effective July 1, 2023; Reminder: OHP now covers non-routine and travel vaccines; Provider resource updates

Archive

Issue Date	Link

11/17/2023	Join Us: Public Health Emergency Unwinding Community Partner Office Hour
COVID provider resources; OHP renewal updates; Share your concerns and questions about OHP coverage; Available now: New HERO Kids Registry videos; Medicaid program updates


11/3/2023	OHP renewal updates
COVID-19 provider resources; OHP renewal updates - Oregon's progress and recent issues; CareOregon plans to become part of SCAN Group. Share your thoughts! Public Health Advisory Board accepting applications for new members; Medicaid program updates - EPSDT, Mobile Crisis Intervention Services; Updated Pharmaceutical Services Prior Authorization Criteria


10/20/2023	Community listening sessions about Behavior Rehabilitation Services rules
Winding down the COVID-19 Public Health Emergency webinars; Needs assessment options for behavioral health services in the home and community; Community listening sessions about Behavior Rehabilitation Services rules; Provider resource updates; Recent rule revisions


10/6/2023	Oregon Health Plan covers travel and nonroutine adult vaccines starting Oct. 1, 2023
Winding down the COVID-19 Public Health Emergency webinars (November 2023); Hospice program rates effective Oct. 1, 2023; Billing for outpatient dialysis provided to Citizenship Waived Medical members through June 30, 2023; Oregon Health Plan covers travel and nonroutine adult vaccines starting Oct. 1, 2023; Provider resource updates; Recent rule revisions


9/22/2023	Tell OHA what you think! Date announced for listening sessions about CareOregon
Winding down the COVID-19 Public Health Emergency webinars; Tell OHA what you think! Date announced for listening sessions about CareOregon; Join OHA's Café Connect Event series about social needs screening and referral; Starting Nov. 1, 2023, OHP covers flu vaccine administration for members under age 19 only when provided through the Vaccines for Children program; Non-participating provider reimbursement for child/adolescent psychiatric units, effective July 1, 2023; Fee-for-service rate increases for dental services effective Oct. 1, 2023; Provider resource updates; Recent rule revisions (telehealth and ground emergency medical transportation)


9/8/2023	Help inform Oregon's Health Information Technology (IT) Strategic Plan for 2024-2028
Winding down the COVID-19 Public Health Emergency webinars; Help inform Oregon's Health Information Technology (IT) Strategic Plan for 2024-2028; Fee-for-service rate increase for general anesthesia provided in dental clinic settings, effective Oct. 1, 2023; Oregon proposes timelines for offering new Medicaid benefits to support health-related social needs; Provider resource updates; Recent rule revisions


8/25/2023	OHA seeking OHP members and others to join new community advisory committee to inform OHP open card policy and program decisions
Tell us what you need to know about the unwinding of the COVID-19 Public Health Emergency; Winding down the COVID-19 Public Health Emergency webinars; Check out the latest updates for partners and providers in "Keep Covered"; OHA seeking OHP members and others to join new community advisory committee to inform OHP open card policy and program decisions; Some eligible CWM members have not yet moved to full OHP benefits; Rate of uninsured Oregonians at an all-time low; OAR 410-124-0040 updated to remove language excluding transplant services from Healthier Oregon benefit


8/11/2023	Starting Aug. 14, 2023, Provider Services will no longer perform basic claim status and member eligibility checks for providers
Now available: Frequently asked questions about EPSDT; Clarification of coverage for vision exams and corrective lenses; Providing meaningful access to language services; Join OHA’s quarterly collaboratives for therapy and vision services providers; OHA seeks comments on proposed changes to OHP telehealth rules: Comments due Aug. 21, 2023; OHA seeks OHP open card members, their family members, community health workers, application assisters and OHP member advocates to join the Lived Experience Advisory Panel


7/28/2023	Face-to-face and in-person assessments required for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant services effective Aug. 15, 2023
Face-to-face and in-person assessments required for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant services effective Aug. 15, 2023; Winding down the COVID-19 Public Health Emergency webinars; OHP covers organ transplants for members eligible through Healthier Oregon; Some eligible CWM members have not yet moved to full OHP benefits; We want your input on rules for OHP coverage for members under 21


7/14/2023	Join OHA's special provider webinar – Healthier Oregon expansion, July 19, 2023, 11 a.m. to noon
Winding down the COVID-19 Public Health Emergency webinars for September and November 2023; Special provider webinar – Healthier Oregon expansion; Rules Advisory Committee for proposed non-emergent medical transportation rule changes effective Jan. 1, 2024; Mental health assessments required for all individuals seeking services through a community mental health program; Provider resource updates (pharmacy program and Healthier Oregon); Recent rule revisions (multiple programs)


6/30/2023	Health Emergency Ready Oregon (HERO) Kids Registry is open to any Oregon child or young adult through age 26
On-demand technical assistance from OHA's Transformation Center: Diabetic care; July 11 PHE Unwinding webinar; July 5 OHP 1115 waiver webinar; Request for feedback on EPSDT rules; fee-for-service nursing facility rate changes effective July 1, 2023 ; fee-for-service reprocessing of outpatient Oregon DRG hospital claims planned for July 7, 2023; H0039 restricted to certified Assertive Community Treatment providers beginning July 1, 2023; Per member, per day reimbursement changes for Certified Community Behavioral Health Clinics effective Jan. 1, 2023; Provider resource updates


6/26/2023	Full Oregon Health Plan benefits open to people of any age or immigration status starting July 1
In 2022, Healthier Oregon opened a pathway to free, full Oregon Health Plan (OHP) coverage to adults ages 19-25 and 55 and older, no matter their immigration status. We are thrilled that as of July 1, 2023, full OHP benefits will open to people of any age or immigration status who meet income and other criteria.


6/16/2023	Download or order free Keep Covered printed materials
Join the Oregon Health Authority and Oregon Department of Human Services for its July 11 webinar about Winding Down the COVID-19 Public Health Emergency; Download or order free Keep Covered printed materials; Join OHA's quarterly collaborative for physical and occupational therapy providers; • Inappropriate fee-for-service payments for some E&M codes and Medicare crossover claims; Temporary rate increase for Enhanced Care Services ends June 30, 2023; State offices closed Monday, June 19


6/2/2023	Reminder: Citizenship Waived Medical (CWM) members remain eligible for COVID-19 testing, vaccines and treatment.
Citizenship Waived Medical (CWM) members remain eligible for COVID-19 testing, vaccines and treatment; Sign up for Keep Covered campaign overview; PHE Authorities and Flexibilities Memo; Oregon Resource Allocation Advisory Committee now seeking feedback about Oregon's crisis care guidelines; OHA seeks public comment on health care transaction; Learn more about upcoming changes to OHP and other Medicaid benefits; June Provider Webinar featuring the Fair Housing Council of Oregon; Join OHA's new quarterly collaborative for physical and occupational therapy providers; Air conditioner and air filter device distribution for 2023; Provider resource updates


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


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 Eligibility (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

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