All Insurance Policy Changes (Page 499)

Continuing from page 498. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Provider Announcement
Oregon Health Plan·Effective Jan 1, 2020
Oregon Health Plan (Medicaid) is expanding teledentistry coverage effective January 1, 2020, allowing oral health providers to bill for telehealth services using audio-visual platforms (including Skype, FaceTime, Google Hangouts) with reimbursement equal to in-person rates. This temporary expansion is tied to the COVID-19 pandemic and CMS 1135 waiver, with lenient HIPAA compliance requirements that will revert to stricter standards when the waiver expires.
Low impact
Provider Announcement
Oregon Health Plan·Effective Mar 26, 2020
The Oregon Health Authority extended or waived multiple CCO contract deliverable due dates for 2020 in response to COVID-19. This impacts reporting timelines for pharmacy expenses, fraud/waste/abuse plans, financial statements, and quarterly compliance reports. Most changes are administrative deadline extensions rather than billing or clinical changes, but billing teams should monitor when financial reports (Exhibit L, quarterly financial statements) are due, as these may affect claims processing and rate adjustments.
Low impact
Changes to DCO deliverable due dates due to COVID-19 response
Oregon Health Plan·Effective Mar 27, 2020
The Oregon Health Authority extended due dates for multiple Dental Care Organization (DCO) contract deliverables in response to COVID-19, including fraud prevention plans, financial reports, and audit documentation. This affects administrative reporting requirements for dental practices contracting with DCOs in Oregon.
High impact
Provider Announcement
Oregon Health Plan·Effective Feb 1, 2020
Oregon Health Plan providers must add modifier CR (Catastrophe/Disaster) to professional claims and condition code DR (Disaster-Related) to institutional claims for all COVID-19-related services. This applies retroactively to services provided on or after February 1, 2020, and ensures proper Medicaid coverage under CMS temporary waivers during the COVID-19 emergency.
Low impact
Provider Announcement
Oregon Health Plan·Identified Jun 20, 2026
This is a webinar rescheduling announcement from Oregon Health Authority regarding the Intensive In-Home Behavioral Health Treatment (IIBHT) program. Due to COVID-19 response efforts, OHA has postponed educational webinars about IIBHT program rules, requirements, and clinical standards. This is an informational notice with no direct impact on billing workflows, coding, or claim submission for the medical billing team.
Low impact
Extension of CAC due dates, new meeting guidance and updated FAQ
Oregon Health Plan·Effective Apr 2, 2020
This policy extends deadlines for Community Advisory Council (CAC) member selection and first meeting requirements for Oregon CCOs under the Medicaid program. The CAC member selection deadline is extended to June 30, 2020, and the first regular CAC meeting deadline is extended to September 30, 2020. The policy also provides guidance allowing virtual meetings via web conference or phone during the COVID-19 emergency.
Medium impact
Provider Announcement
Oregon Health Plan·Effective Apr 2, 2020
Effective immediately, Oregon Health Authority is allowing OHP-certified community partners to perform Presumptive Eligibility (PE) determinations for temporary Oregon Health Plan coverage during the COVID-19 pandemic. Community partner assisters with active assister IDs must complete DHS/OHA training to enroll applicants using hospital PE forms. This expands PE determination authority beyond hospitals to community organizations.
High impact
Fee-for-service hospice rates effective April 1, 2020 through June 30, 2020
Oregon Health Plan·Effective Apr 1, 2020
Oregon Health Authority increased fee-for-service hospice reimbursement rates for revenue codes 658, 191, and 192 (nursing facility room and board on hospice) effective April 1, 2020 through June 30, 2020 as part of COVID-19 response. Billing teams must apply new per diem rates ($359.15 basic, $502.81 complex medical, $805.65 pediatric) and ensure correct revenue code selection based on hospice election day count (651 for days 1-60, 650 for day 61+, 652 for continuous home care).
High impact
Provider Announcement
Oregon Health Plan·Effective Mar 23, 2020
Oregon Health Authority (OHA) is waiving the face-to-face requirement for establishing new patients in the Advanced Payment Care Model (APCM) via telephone visits during the COVID-19 pandemic. APCM-participating FQHCs and RHCs can now add new patients established by telephone to their patient list and receive per-member per-month (PMPM) payments for these patients. Billing guidance and specific codes will follow from OHA.
High impact
Telemedicine-telehealth billing guidance for Oregon Health Plan fee-for-service providers
Oregon Health Plan·Effective Jan 1, 2020
Oregon Health Plan expanded telemedicine/telehealth billing coverage for all provider types during COVID-19, allowing reimbursement at in-person rates for video and telephone services with specific place of service codes and modifiers.
Medium impact
Provider Announcement
Oregon Health Plan·Effective Jan 1, 2020
Oregon Medicaid now covers audio-only teledentistry services using procedure code D9995 during the COVID-19 emergency when synchronous audio/visual delivery is not available or feasible. Providers may use standard telephone, FaceTime, Skype, or Google Hangouts for service delivery, with relaxed HIPAA encryption requirements. All teledentistry claims must use Place of Service 02 regardless of delivery method.
Medium impact
Provider Announcement
Oregon Health Plan·Effective Apr 7, 2020
Oregon Health Authority is clarifying coverage and authorization procedures for non-emergency ambulance (NEA) transports during the COVID-19 pandemic. Billing teams must use procedure code A0999 for NEA transports involving COVID-19 cases or suspected cases, and use the OHP 405T form for authorization of medically necessary transports including dialysis, chemotherapy, oncology, MAT clinics, and life-saving treatments.
Low impact
Provider Announcement
Oregon Health Plan·Effective Apr 10, 2020
This is a COVID-19 administrative relief document from Oregon Health Authority extending or waiving multiple Coordinated Care Organization (CCO) contract deliverable due dates. This affects reporting, settlement, and compliance submissions—not direct patient billing or clinical coding. The policy does not impact medical billing codes, prior authorization, or reimbursement for patient care services.
High impact
Provider Announcement
Oregon Health Plan·Effective Mar 18, 2020
Oregon Health Authority is increasing reimbursement rates for ambulance "Treat in Place" services from $54.45 (A0998) to $420.62 (A0427 ALS1 Base Rate) for Oregon Health Plan fee-for-service members during the COVID-19 emergency, retroactive to March 18, 2020. Additionally, ambulances may now provide non-emergent transportation for COVID-19 positive or presumptive positive patients to primary/urgent care facilities.
High impact
Provider Announcement
Oregon Health Plan·Effective Jan 1, 2020
Oregon Health Authority expanded Medicaid coverage for teledentistry services effective January 1, 2020, allowing reimbursement for services delivered via audio-visual platforms (Skype, FaceTime, Google Hangouts) or audio-only telephone. Billing teams must use procedure code D9995 with Place of Service 02 for all teledentistry claims, with reimbursement rates equivalent to in-person services.
Medium impact
Provider Announcement
Oregon Health Plan·Effective Apr 17, 2020
Oregon Health Authority is allowing OHP pharmacies to temporarily override specific prescription denials during the COVID-19 emergency using Other Coverage Code (OCC) 1 for incorrect third-party liability (TPL) issues and calling for overrides when prescribers are not yet enrolled. This is a temporary emergency measure to ensure patient access to fee-for-service prescriptions.
High impact
Provider Announcement
Oregon Health Plan·Effective Apr 21, 2020
Oregon Health Plan (OHP) now covers telehealth delivery of physical therapy, occupational therapy, and speech therapy services at parity with in-person rates. Providers must use Place of Service 02 when billing telehealth claims, and must obtain prior authorization only for initial assessments/re-evaluations conducted by phone; all other phone services are covered without prior auth during the COVID-19 emergency.
Medium impact
Fee-for-service rates for DHS-OHA private duty nursing services effective January 1, 2020
Oregon Health Plan·Effective Jan 1, 2020
Oregon Health Authority increased Medicaid fee-for-service rates for private duty nursing services effective January 1, 2020. RN rates increased to $62.00/hour and LPN/LVN rates to $38.62/hour for OHA services, with corresponding rate increases for DHS services billed in 15-minute units.
High impact
Provider Announcement
Oregon Health Plan·Effective Mar 1, 2020
Oregon Health Authority (OHA) expanded Medicaid reimbursement for behavioral health skill reintegration services delivered via telemedicine, effective March 1, 2020. Four specific HCPCS codes (H0036, H0046, H2014, H2018) and one technology-based service code (G2012) are now billable for telemedicine delivery during the COVID-19 emergency. Providers must comply with the behavioral health fee schedule, Health Evidence Review Commission guidelines, and Oregon Administrative Rule 410-172-0850.
Low impact
Provider Announcement
Oregon Health Plan·Effective Apr 29, 2020
This is a COVID-19 administrative policy that extends, waives, or consolidates reporting deadlines for Oregon Coordinated Care Organizations (CCOs). It does not directly affect clinical billing codes, claim processing, or reimbursement rates. Billing teams should note that this policy applies only to CCO contract administrators and does not change how medical claims are coded or submitted.
Medium impact
Provider Announcement
Oregon Health Plan·Effective May 1, 2020
The Oregon Health Authority has issued discretionary guidance allowing Coordinated Care Organizations (CCOs) to temporarily suspend or modify prior authorization requirements during COVID-19. CCOs may now accept retroactive authorization requests, extend authorization approval dates by 180 days for elective procedures, waive PA requirements for specific medications and DME, and suspend PA for patient transfers to post-acute care settings. These changes are optional but recommended to reduce provider burden and ensure member access to care.
Low impact
Provider Announcement
Oregon Health Plan·Identified Jun 20, 2026
The Oregon Health Authority (OHA) announced a delay in providing the annual Behavioral Health Report template and Guidance Document to Coordinated Care Organizations (CCOs). Originally due October 3, 2019 and November 25, 2019, these documents will now be provided by June 30, 2020. CCOs must still submit their first annual Behavioral Health Report by October 30, 2020. This is an administrative notification regarding CCO contract compliance, not a direct billing code or coverage change.
Low impact
Provider Announcement
Oregon Health Plan·Effective Oct 1, 2019
The Oregon Health Authority has waived enrollment limit requirements for Coordinated Care Organizations (CCOs) under the Oregon Health Plan for Contract Year 2020, effective October 1, 2019. This temporary waiver allows CCOs to exceed their contracted county and total enrollment caps in response to COVID-19 emergency conditions. The waiver does not eliminate other enrollment-related contract requirements and will be monitored by OHA.
High impact
Provider Announcement
Oregon Health Plan·Effective Feb 1, 2020
Oregon Health Authority temporarily expanded CAWEM (Citizen-Alien Waived Emergency Medical) coverage to include all COVID-19 diagnosis and treatment services across all care settings (not just emergency rooms/hospitals), effective immediately. Providers must use specific billing modifiers (CR for professional claims, DR for institutional claims) and can backbill services from February 1, 2020 onward.
Low impact
Provider Announcement
Oregon Health Plan·Identified Jun 20, 2026
This is a CMS Drug Utilization Review (DUR) survey requirement for Oregon Coordinated Care Organizations (CCOs) covering FFY 2019 (Oct 1, 2018 - Sept 30, 2019). CCOs must complete and submit a fillable PDF survey to the Oregon Health Authority by September 1, 2020. This is an administrative compliance requirement, not a clinical or billing code change.

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Provider Announcement

Provider Announcement

Changes to DCO deliverable due dates due to COVID-19 response

Provider Announcement

Provider Announcement

Extension of CAC due dates, new meeting guidance and updated FAQ

Provider Announcement

Fee-for-service hospice rates effective April 1, 2020 through June 30, 2020

Provider Announcement

Telemedicine-telehealth billing guidance for Oregon Health Plan fee-for-service providers

Provider Announcement

Provider Announcement

Provider Announcement

Provider Announcement

Provider Announcement

Provider Announcement

Provider Announcement

Fee-for-service rates for DHS-OHA private duty nursing services effective January 1, 2020

Provider Announcement

Provider Announcement

Provider Announcement

Provider Announcement

Provider Announcement

Provider Announcement

Provider Announcement