MedicaidCoverageHigh impact
Provider Announcement
Oregon Health Plan·OR · General Practice, Family Medicine·Provider
Effective date
Mar 23, 2020
We identified it
Jun 20, 2026
Summary
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.
Action Required
By April 3, 2020: Billing team and clinical staff at APCM-participating FQHCs and RHCs must: (1) Update patient intake processes to allow telephone-based patient establishment; (2) Begin including patients established via telephone visit on the Per Member Per Month Patient Reporting Template (OHP 3131) submissions; (3) Await further billing guidance from OHA regarding specific codes to use for telephone visits; (4) Ensure PMPM payments are claimed for all telephone-established patients. Contact Jennifer R. Smith (Jennifer.R.Smith@dhsoha.state.or.us, 503-509-5214) for policy questions or Michelle Meuwissen (Michelle.M.Meuwissen@dhsoha.state.or.us, 503-945-5703) for patient list reporting questions. Failure to implement these changes will result in missed PMPM revenue for new patients established via telephone.