MedicaidCoverageHigh impact
DCBS-OHA Telehealth Guidance - Issued March 24 2020
Oregon Health Plan·OR·Plan
Effective date
Mar 24, 2020
We identified it
Aug 19, 2026
Summary
Oregon health plans must immediately expand telehealth coverage to replace in-person visits during COVID-19, including video, telephone, and other delivery modes for all conditions. Billing teams must ensure cost-sharing for telehealth matches in-person rates, update provider communications about telehealth billing, and remove prior authorization barriers for established patient requirements.
Action Required
Effective immediately (March 24, 2020): (1) Billing team must update claim processing rules to ensure telehealth services are reimbursed at rates equal to or mirroring equivalent office visit rates; (2) Billing team must modify system settings to eliminate cost-sharing differentials—telehealth cost-sharing cannot exceed in-person visit cost-sharing; (3) Provider relations team must communicate telehealth billing procedures to contracted providers, including that verbal authorizations are now acceptable; (4) Compliance team must audit prior authorization requirements and remove restrictions limiting telehealth to established patients only; (5) Marketing/communications team must update member-facing materials and website prominently displaying telehealth access options and billing information; (6) For Medicaid plans: submit all member communications to OHA for approval within one business day. Failure to implement these changes will result in member complaints, provider network friction, and potential regulatory action from DCBS/OHA.