All Insurance Policy Changes (Page 512)

Continuing from page 511. 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
Electronic Visit Verification requirements for home health agencies postponed to Jan. 1, 2024
Oregon Health Plan·Effective Jan 1, 2024
Oregon has postponed Electronic Visit Verification (EVV) requirements for Medicaid home health agencies from January 1, 2023 to January 1, 2024. Agencies will need to contract with their own EVV vendor using the Provider Choice Model rather than using a state-provided solution.
Medium impact
Training requirement for CCO SUD Utilization Management Staff
Oregon Health Plan·Effective Jan 1, 2023
Oregon Health Authority now requires Coordinated Care Organizations (CCOs) to annually report the qualifications and training of utilization management staff who make substance use disorder (SUD) treatment authorization decisions. Staff must have working knowledge of ASAM Criteria, DSM criteria, and SUD treatment to make appropriate level-of-care determinations.
High impact
Provider guide regarding services to OHP Children and Youth: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Oregon Health Plan·Effective Jan 1, 2023
Effective January 1, 2023, Oregon Health Plan (OHP/Medicaid) must now cover ALL medically necessary services for children under 21 regardless of the state's Prioritized List, eliminating previous coverage restrictions. Providers must document medical necessity for all EPSDT services and update contact information for prior authorization requests.
Medium impact
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
Oregon Health Plan·Effective Dec 1, 2022
Oregon Health Plan has expanded palivizumab (RSV prophylaxis) coverage to high-risk children aged 12-24 months, extending the previous age limit of 12 months and younger. This expansion is effective immediately and will last for the duration of the Governor's emergency declaration or the 2022-2023 RSV season, whichever is longer.
Medium impact
Oregon Health Plan coverage of oseltamivir (Tamiflu), effective immediately
Oregon Health Plan·Effective Dec 9, 2022
Oregon Health Plan (Medicaid) now covers both brand and generic oseltamivir (Tamiflu) for reimbursement due to generic drug shortages and respiratory infection surge. This emergency measure ensures pharmacies can dispense either version and receive payment.
Low impact
Extension of CCO enrollment limits waiver through March 31, 2023
Oregon Health Plan·Effective Dec 12, 2022
Oregon Health Authority extends the waiver allowing Coordinated Care Organizations (CCOs) to exceed enrollment limits through March 31, 2023. This administrative extension continues the temporary suspension of county and grand total enrollment caps that was originally implemented in May 2020.
Low impact
Clarification about COD Provider certification references in 2023 contract
Oregon Health Plan·Effective Dec 14, 2022
Oregon Health Authority clarified that Co-Occurring Disorder (COD) providers will be 'approved' rather than 'certified' for 2023 CCO contracts. This is a terminology change - wherever the contract says 'certified' COD providers, it now means 'approved' COD providers through OHA's Behavioral Health unit instead of the Licensing and Certification unit.
Medium impact
Rate increase for Medicaid fee-for-service (FFS) Administrative Examinations codes
Oregon Health Plan·Effective Jul 1, 2022
Oregon Health Authority is implementing a 30% rate increase for Medicaid fee-for-service Administrative Examinations codes, effective July 1, 2022, with system updates expected in January 2023. Providers can bill at higher rates, rebill previous claims, or wait for automatic reprocessing by February 2023.
Low impact
Notice of intent – OHA will amend the Medicaid State Plan to continue increased reimbursement for services delivered through the Office of Developmental Disabilities Services (ODDS) - Comments due Jan. 13, 2023
Oregon Health Plan·Effective Jan 1, 2023
Oregon Health Authority (OHA) is extending a temporary 5% rate increase for Office of Developmental Disabilities Services (ODDS) through June 30, 2023, or until the COVID-19 Public Health Emergency ends. This affects reimbursement for adult group homes, behavioral support services, group care homes for children, children's developmental disability foster care, and day support activities.
Medium impact
Notice of intent – OHA will amend the Medicaid State Plan to include community violence prevention services as a State Plan service - Comments due Jan. 13, 2023
Oregon Health Plan·Effective Jan 1, 2023
Oregon Health Authority is adding coverage for community violence prevention services to Medicaid, reimbursed at $99.12 per hour using procedure code H2015. Services must be provided by qualified certified violence prevention professionals and referred by licensed healthcare practitioners for beneficiaries who received medical treatment for community violence injuries.
High impact
Fee-for-service rate increase for Medicaid behavioral health services, effective July 1, 2022
Oregon Health Plan·Effective Jul 1, 2022
Oregon Medicaid is implementing a 30% average fee-for-service rate increase for behavioral health services, retroactive to July 1, 2022. Providers can either adjust previously submitted claims or wait for OHA to automatically reprocess them within 3-4 weeks after system updates are complete.
Medium impact
BRS denials cannot be based on youth's disability
Oregon Health Plan·Effective Dec 16, 2022
Oregon Health Authority prohibits Behavior Rehabilitation Service (BRS) providers from denying admission to youth based on any aspect of their disability, effective immediately. Providers must update admission criteria and cannot exclude youth with intellectual, developmental, or other disabilities from BRS programs.
Medium impact
CCOF coverage of dental services in facility settings
Oregon Health Plan·Effective Jan 1, 2023
Oregon Health Authority is implementing a new CCOF plan type effective January 1, 2023, for dental-only benefits including COFA Dental and Veteran Dental Program members. CCOs must reimburse for covered dental services delivered in ambulatory surgical centers, inpatient or outpatient hospital settings, while OHA will handle facility fees.
Medium impact
Update about palliative care program in 2023 contract
Oregon Health Plan·Effective Apr 1, 2023
Oregon Health Authority announces that coordinated care organizations (CCOs) must participate in a new palliative care program starting no earlier than April 1, 2023, as required by Oregon House Bill 2981. OHA will provide 60 days notice of the exact effective date and program details in coming weeks.
Medium impact
Non-emergent medical transportation (NEMT) coverage for CCOF members
Oregon Health Plan·Effective Jan 1, 2023
Oregon Health Authority implemented new CCOF plan type effective January 1, 2023, requiring CCOs to pay for non-emergent medical transportation (NEMT) services when using contracted providers for covered services. For CCOF members with OHP Dental benefits, CCOs only cover NEMT for dental services and related prescriptions.
Medium impact
Submitting fee-for-service claims to receive the July 1, 2022 behavioral health rate increase
Oregon Health Plan·Effective Jul 1, 2022
Oregon Health Authority implemented a 30% rate increase for behavioral health services effective July 1, 2022, and has now updated their fee-for-service claim system to process these higher rates. Providers can either rebill existing claims by January 31, 2023, or wait for automatic reprocessing by March 1, 2023.
Medium impact
Notice of intent – OHA will amend the Medicaid State Plan to increase client reimbursements for mileage, meals and lodging - Comments due 2/3/2023
Oregon Health Plan·Identified Jun 20, 2026
Oregon Health Authority is proposing to increase Medicaid reimbursement rates for client and attendant travel expenses (mileage, meals, lodging) for non-emergency medical transportation (NEMT). The proposed rates would be 50% of IRS rates for meals, 75% for mileage, and 100% for lodging.
Medium impact
Opening procedure code H2011 for crisis services
Oregon Health Plan·Effective Apr 1, 2022
Oregon Health Authority has opened procedure code H2011 for billing crisis intervention services (per 15 minutes) for Medicaid fee-for-service claims. The code is available for services rendered on or after April 1, 2022, with rates of $30.00 per unit (April-June 2022) and $39.00 per unit (July 1, 2022 onward).
Low impact
Notice of intent – OHA proposes to amend the Medicaid State Plan to add another provider type to the Enhanced Wage Add-On Program for Home and Community-Based Services (HCBS) providers.
Oregon Health Plan·Identified Jun 20, 2026
Oregon Health Authority is proposing to amend the Medicaid State Plan to include Adult Day Service providers in the Enhanced Wage Add-On Program for Home and Community-Based Services (HCBS). This was an oversight in the original SPA 21-0021 that excluded this provider type from financial incentives.
Medium impact
Plan of Care rate increases now complete, effective July 1, 2022
Oregon Health Plan·Effective Jan 13, 2023
Oregon Health Authority has completed rate increases for adult mental health residential Plans of Care effective July 1, 2022. Providers can now bill and adjust claims for services rendered from July 1-December 31, 2022 at the increased rates.
Low impact
Fee-for-service reprocessing of Citizenship Waived Medical Plus postpartum professional and dental claims
Oregon Health Plan·Effective Jan 27, 2023
Oregon Health Authority will automatically reprocess professional and dental claims for postpartum Citizenship Waived Medical Plus services paid from January 1, 2021 through September 30, 2022 to ensure they are paid through RHEA funds instead of Medicaid funds. No provider action is required as this is an administrative reprocessing.
Medium impact
Fee-for-Service Fidelity Wraparound expansion, effective November 30, 2022
Oregon Health Plan·Effective Nov 30, 2022
Oregon Health Authority is expanding Fidelity Wraparound services to fee-for-service Oregon Health Plan (Medicaid) members, adding new procedure code H2021 for care coordination at $27.32 per 15-minute unit. Behavioral health providers can now bill for these services retroactive to November 30, 2022.
Medium impact
Learn more about Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for behavioral health and BRS providers at OHA’s Feb. 15 webinar
Oregon Health Plan·Effective Jan 1, 2023
Oregon Health Authority is implementing EPSDT policy changes for behavioral health providers serving children under 21, requiring documentation of medical necessity and appropriateness for previously non-covered services. Claims system updates by March 2023 will process these services with either prior authorization or OHA review.
Low impact
CY 2022 and 2023 deliverables due in Q2 CY 2023 (corrected 2/21/2023)
Oregon Health Plan·Identified Jun 20, 2026
This is a reminder notice listing CCO (Coordinated Care Organization) deliverables and reporting requirements for Oregon's Medicaid program due in Q2 2023. It outlines specific submission deadlines, methods, and contract sections for various reports including encounter data, fraud/waste audits, and health equity assessments.
Low impact
Extension of CCO enrollment limits waiver through August 31, 2023
Oregon Health Plan·Effective Feb 23, 2023
Oregon Health Authority has extended the waiver allowing CCOs to exceed their enrollment limits through August 31, 2023. This is intended to be the final extension, with new enrollment limit increase request processes coming by end of May 2023.

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Archive by year

2023 2024 2025 2026

Electronic Visit Verification requirements for home health agencies postponed to Jan. 1, 2024

Training requirement for CCO SUD Utilization Management Staff

Provider guide regarding services to OHP Children and Youth: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

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

Oregon Health Plan coverage of oseltamivir (Tamiflu), effective immediately

Extension of CCO enrollment limits waiver through March 31, 2023

Clarification about COD Provider certification references in 2023 contract

Rate increase for Medicaid fee-for-service (FFS) Administrative Examinations codes

Notice of intent – OHA will amend the Medicaid State Plan to continue increased reimbursement for services delivered through the Office of Developmental Disabilities Services (ODDS) - Comments due Jan. 13, 2023

Notice of intent – OHA will amend the Medicaid State Plan to include community violence prevention services as a State Plan service - Comments due Jan. 13, 2023

Fee-for-service rate increase for Medicaid behavioral health services, effective July 1, 2022

BRS denials cannot be based on youth's disability

CCOF coverage of dental services in facility settings

Update about palliative care program in 2023 contract

Non-emergent medical transportation (NEMT) coverage for CCOF members

Submitting fee-for-service claims to receive the July 1, 2022 behavioral health rate increase

Notice of intent – OHA will amend the Medicaid State Plan to increase client reimbursements for mileage, meals and lodging - Comments due 2/3/2023

Opening procedure code H2011 for crisis services

Notice of intent – OHA proposes to amend the Medicaid State Plan to add another provider type to the Enhanced Wage Add-On Program for Home and Community-Based Services (HCBS) providers.

Plan of Care rate increases now complete, effective July 1, 2022

Fee-for-service reprocessing of Citizenship Waived Medical Plus postpartum professional and dental claims

Fee-for-Service Fidelity Wraparound expansion, effective November 30, 2022

Learn more about Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for behavioral health and BRS providers at OHA’s Feb. 15 webinar

CY 2022 and 2023 deliverables due in Q2 CY 2023 (corrected 2/21/2023)

Extension of CCO enrollment limits waiver through August 31, 2023