All Insurance Policy Changes (Page 523)

Continuing from page 522. 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
SB 1557 Access to Healthcare (Section 5) for children up to 21 with Intellectual or Developmental Disability to Mental Health Assessment, Treatment, Services
Oregon Health Plan·Effective Jul 19, 2024
Oregon Senate Bill 1557 prohibits healthcare organizations from denying mental health assessment, treatment, or services to children under 21 solely because they have an intellectual or developmental disability. Healthcare practices must review policies to ensure compliance and may need to assess staff competence for serving this population.
Medium impact
Replacement of durable medical equipment (DME), supplies, prescription drugs and full or partial dentures in event of natural disasters
Oregon Health Plan·Effective Jul 25, 2024
Oregon Health Plan (OHA) has implemented an emergency policy allowing replacement of DME, supplies, prescription drugs, and dentures lost in natural disasters (specifically fires). For CCO members, coordinate through their CCO; for fee-for-service members, submit prior authorization requests marked 'IMMEDIATE' with reason 'EMERGENT REPLACEMENT – FIRE EVAC' for expedited one-day review.
Medium impact
Notice of intent — OHA will amend the Medicaid State Plan to increase rates for anesthesia, clinical laboratory and some professional services.
Oregon Health Plan·Effective Oct 1, 2024
Oregon Health Authority is increasing Medicaid reimbursement rates effective October 1, 2024: default RVU-based professional services increase from $25.48 to $27.11, anesthesia services from $20.78 to $21.12, and clinical laboratory rates from 70% to 80% of Medicare rates. These increases apply to podiatry, chiropractic, physical therapy, occupational therapy, and other practitioner services not already at 80% of Medicare rates.
Medium impact
Clarification about APAC reporting for 2025
Oregon Health Plan·Effective May 1, 2025
Oregon CCOs (Coordinated Care Organizations) must now submit APAC (All Payer All Claims) data files directly starting in 2025, with phased implementation deadlines from May 1, 2025 to October 31, 2025. A previous incorrect notice requiring 2024 data submission by January 31, 2025 has been clarified - CCOs are not required to submit 2024 data.
Medium impact
Increase in rates for electrocardiographic recording services, effective January 1, 2023
Oregon Health Plan·Effective Jan 1, 2023
Oregon Health Authority increased reimbursement rates for two ECG monitoring CPT codes (93243 and 93247) effective January 1, 2023. Providers are encouraged to resubmit claims for these services to obtain the higher payment rates.
Low impact
Due date extension for Family Connects Oregon community alignment report for January-June 2024
Oregon Health Plan·Effective Aug 6, 2024
Oregon Health Authority extended the due date for Coordinated Care Organizations (CCOs) to submit their Family Connects Oregon bi-annual community alignment report from August 14, 2024 to November 4, 2024. This is an administrative deadline extension that does not affect billing operations.
Low impact
Extension of CCO enrollment limits waiver through Dec. 31, 2024
Oregon Health Plan·Effective Aug 29, 2024
Oregon Health Authority has extended the waiver allowing Coordinated Care Organizations (CCOs) to exceed enrollment limits through December 31, 2024. This extension provides continued flexibility for CCOs managing Medicaid member enrollment beyond their contracted limits.
Low impact
Due date extension for Affiliated Medicare Advantage Plan Report
Oregon Health Plan·Effective Nov 28, 2024
The Oregon Health Authority has extended the due date for the Affiliated Medicare Advantage Plan Report from November 15, 2024 to November 28, 2024. This gives Coordinated Care Organizations (CCOs) an additional 13 days to submit this required contract deliverable.
Low impact
Notice of intent — OHA will amend the Medicaid State Plan to expand the Nurse Home Visiting program to two more counties.
Oregon Health Plan·Effective Nov 1, 2024
Oregon Health Authority is expanding the Family Connects Nurse Home Visiting program to Lane County (effective November 1, 2024) and Polk County (effective January 1, 2025). This program provides Targeted Case Management services to Medicaid-eligible infants from birth through 6 months of age.
Medium impact
End dates for COVID-19 flexibilities (updated 9/24/2024)
Oregon Health Plan·Effective Oct 1, 2024
Oregon is ending several COVID-19 billing flexibilities on September 30, 2024, including 'no wrong door' policies for COVID vaccines and therapeutics, and enhanced reimbursement rates. Providers will need to work directly with individual CCOs for non-contracted COVID services starting October 1, 2024.
High impact
Fee-for-service hospice rates and nursing facility rates effective Oct. 1, 2024
Oregon Health Plan·Effective Oct 1, 2024
Oregon Health Authority updated fee-for-service hospice payment rates effective Oct. 1, 2024, introducing a new revenue code (650) for routine home care after day 61 and requiring quality reporting compliance for full reimbursement rates. Providers must use different revenue codes based on the hospice election timeline and geographic area (CBSA).
Medium impact
Notice of intent — OHA will amend the Medicaid State Plan to increase fee-for-service rates for durable medical equipment and home enteral/parenteral nutrition and IV infusion services
Oregon Health Plan·Effective Oct 1, 2024
Oregon Medicaid is increasing fee-for-service reimbursement rates for durable medical equipment (DME) and home enteral/parenteral nutrition and IV infusion services to 80% of current Medicare rates, effective October 1, 2024. Rates that already exceed 80% of Medicare rates will remain unchanged.
Medium impact
Clarification of Oregon’s Non-Par and Out of State Hospital Billing Rules
Oregon Health Plan·Effective Sep 20, 2024
Oregon Health Authority clarifies that standard non-participating provider reimbursement rules do not apply to out-of-state hospitals. CCOs must negotiate separate rates with out-of-state hospitals located within 75 miles (contiguous) or beyond 75 miles (non-contiguous) of Oregon's border.
Low impact
Notice of intent — OHA will amend the Medicaid State Plan to revise the rate methodology for doula services
Oregon Health Plan·Effective Jan 1, 2025
Oregon Medicaid will increase the global doula benefit from $1,500 to $1,505 per pregnancy and allow payment for more than two prenatal and two postpartum visits at $215 each, effective January 1, 2025. This affects Oregon Medicaid billing for doula services with expanded visit coverage.
Low impact
Notice of intent — OHA will amend the Medicaid State Plan to expand the Family Connects program to Yamhill County
Oregon Health Plan·Effective Jan 1, 2025
Oregon is expanding its Family Connects nurse home visiting program to Yamhill County, providing targeted case management services for Medicaid-eligible infants from birth through 6 months of age. This expansion becomes effective January 1, 2025, and adds Yamhill County to the list of geographic areas where these services are available.
Low impact
Care Coordination report for activities through June 30, 2025
Oregon Health Plan·Identified Jun 20, 2026
Oregon Health Authority is modifying the reporting requirements for Coordinated Care Organizations (CCOs) by adjusting the start date for the Care Coordination activities report covering the period ending June 30, 2025. CCOs will get at least 90 days from when they receive the reporting template, with the due date remaining August 14, 2025.
Low impact
Care Coordination report for activities through June 30, 2025
Oregon Health Plan·Identified Jun 20, 2026
Oregon Health Authority is modifying the reporting requirements for Coordinated Care Organizations (CCOs) by adjusting the start date for the Care Coordination activities report covering the period ending June 30, 2025. The reporting period will begin at least 90 days after OHA provides the CY 2025 reporting template, with the due date remaining August 14, 2025.
Low impact
CY 2024 deliverables due in Q4 CY 2024 (corrected 10/17/2024)
Oregon Health Plan·Effective Oct 17, 2024
Oregon Health Authority issued a corrected reminder about Q4 2024 deliverable requirements for Coordinated Care Organizations (CCOs) under Medicaid contracts. This administrative communication lists reporting deadlines and submission methods for various CCO compliance deliverables through December 31, 2024.
Medium impact
Diagnostic assistance available effective Oct. 22, 2024
Oregon Health Plan·Effective Oct 22, 2024
Starting October 22, 2024, Oregon Medicaid will provide diagnostic assistance through Licensed Practitioners of Healing Arts (LPHA) for youth requesting Behavior Rehabilitation Services (BRS) who lack appropriate ICD-10 diagnosis codes. Providers must first attempt to obtain diagnosis codes from existing sources before requesting assistance through a new form process.
Low impact
Notice of Adverse Benefit Determination (NOABD) for Non-Emergent Medical Transportation (NEMT) Services Requirement Update
Oregon Health Plan·Effective Oct 21, 2024
Oregon Health Authority has waived the requirement to include primary care provider, dentist, or behavioral health professional names in Notice of Adverse Benefit Determination (NOABD) letters specifically for Non-Emergent Medical Transportation (NEMT) services denials. This simplifies the administrative burden for CCOs when issuing denial notices for transportation services.
Medium impact
Fee-for-service dental rate increase effective Oct. 1, 2023
Oregon Health Plan·Effective Oct 1, 2023
Oregon Health Authority has retroactively increased reimbursement rates for 195 dental CDT codes effective October 1, 2023. OHA will automatically reprocess all related claims to apply the correct higher rates.
Low impact
Notice of intent – OHA will amend the Medicaid State Plan to add supplemental payments for behavioral health providers
Oregon Health Plan·Effective Jan 1, 2025
Oregon Health Authority is creating a new supplemental payment program for Medicaid behavioral health providers who participate in enhanced training programs through a labor-management trust. Eligible providers must sign an MOU with OHA and participate in the qualified training trust to receive payments based on their Medicaid revenue share.
Medium impact
How to submit requests for retroactive BRS authorization
Oregon Health Plan·Effective Nov 1, 2024
Oregon Medicaid has established a new process for requesting retroactive authorization for Behavior Rehabilitation Services (BRS). Providers must now request preliminary approval via email before admission, then submit a complete authorization request within one business day of admission to ensure Medicaid payment.
Medium impact
Oregon Health Authority policy regarding safety beds (enclosed beds)
Oregon Health Plan·Effective Nov 1, 2024
Oregon Medicaid now requires case-by-case prior authorization for safety beds (enclosed beds) with strict documentation requirements including proof that less restrictive interventions failed, specialized caregiver training, monitoring plans, and mental health management plans. Oregon Department of Human Services will not approve safety beds under K Plan and waiver authorities due to their restrictive nature.
High impact
Urgent BRS prior authorization requests to end Nov. 11, 2024
Oregon Health Plan·Effective Nov 11, 2024
Starting November 11, 2024, Oregon Health Authority will no longer accept urgent or expedited prior authorization requests for Behavior Rehabilitation Services (BRS). Providers must use retroactive authorization process for youth needing immediate placement and stop submitting urgent requests entirely.

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Archive by year

2023 2024 2025 2026

SB 1557 Access to Healthcare (Section 5) for children up to 21 with Intellectual or Developmental Disability to Mental Health Assessment, Treatment, Services

Replacement of durable medical equipment (DME), supplies, prescription drugs and full or partial dentures in event of natural disasters

Notice of intent — OHA will amend the Medicaid State Plan to increase rates for anesthesia, clinical laboratory and some professional services.

Clarification about APAC reporting for 2025

Increase in rates for electrocardiographic recording services, effective January 1, 2023

Due date extension for Family Connects Oregon community alignment report for January-June 2024

Extension of CCO enrollment limits waiver through Dec. 31, 2024

Due date extension for Affiliated Medicare Advantage Plan Report

Notice of intent — OHA will amend the Medicaid State Plan to expand the Nurse Home Visiting program to two more counties.

End dates for COVID-19 flexibilities (updated 9/24/2024)

Fee-for-service hospice rates and nursing facility rates effective Oct. 1, 2024

Notice of intent — OHA will amend the Medicaid State Plan to increase fee-for-service rates for durable medical equipment and home enteral/parenteral nutrition and IV infusion services

Clarification of Oregon’s Non-Par and Out of State Hospital Billing Rules

Notice of intent — OHA will amend the Medicaid State Plan to revise the rate methodology for doula services

Notice of intent — OHA will amend the Medicaid State Plan to expand the Family Connects program to Yamhill County

Care Coordination report for activities through June 30, 2025

Care Coordination report for activities through June 30, 2025

CY 2024 deliverables due in Q4 CY 2024 (corrected 10/17/2024)

Diagnostic assistance available effective Oct. 22, 2024

Notice of Adverse Benefit Determination (NOABD) for Non-Emergent Medical Transportation (NEMT) Services Requirement Update

Fee-for-service dental rate increase effective Oct. 1, 2023

Notice of intent – OHA will amend the Medicaid State Plan to add supplemental payments for behavioral health providers

How to submit requests for retroactive BRS authorization

Oregon Health Authority policy regarding safety beds (enclosed beds)

Urgent BRS prior authorization requests to end Nov. 11, 2024