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373-1985 FAX (503) 378-5511 August 31, 2020

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373-1985 FAX (503) 378-5511 August 31, 2020 HEALTH POLICY & ANALYTICS DIVISION Health Evidence Review Commission Kate Brown, Governor 500 Summer St NE, E-65 Salem, OR 97301 Voice (503) 373-1985 FAX (503) 378-5511 August 31, 2020 The Honorable Peter Courtney The Honorable Tina Kotek Senate President Speaker of the House Oregon State Senate Oregon House of Representatives 900 Court St. NE, S-201 900 Court St NE, Rm 269 Salem, OR 97301 Salem, OR 97301 Dear Senator Courtney and Representative Kotek: The Health Evidence Review Commission of the Oregon Health Authority’s Health Policy & Analytics Division respectfully reports to you, in accordance with ORS 414.690(7), several interim modifications that have been made to the Prioritized List of Health Services appearing in the Health Evidence Review Commission’s May 2019 Report to the Governor and 80th Oregon Legislative Assembly. Therefore, in accordance with ORS 414.690 (8), the Health Evidence Review Commission is reporting these interim modifications. The coding changes are listed in detail in Attachments A and B. They represent technical changes to the List and other changes made due to new evidence on the effectiveness or ineffectiveness of treatments. Technical changes represented here include the prioritization of new ICD-10-CM diagnosis codes, the addition of previously omitted diagnosis/procedure codes, changes to more appropriately pair diagnosis and treatment codes previously appearing on the List, and codes removed from the List that are obsolete or for which coverage should appropriately be determined by broader Oregon Administrative Rules (e.g., diagnostic, ancillary, excluded and informational codes). In addition to these changes, the Commission made changes to practice guidelines and coding specifications associated with the Prioritized List. Attachment C shows new practice guidelines. Attachment D shows revised guidelines. Attachment E shows deleted guidelines and Attachment F shows new and deleted coding specifications. Finally, the changes and errata published since the publication of the August 14, 2020 Prioritized List appear in Attachment G. Attachment H contains errata to the 10/1/2020 Prioritized List. The changes described in this letter are being forwarded to the Health Systems Division (HSD) which, in consultation with the OHA Actuarial Services Unit, will determine if these changes will involve a significant financial impact under the Medicaid Demonstration. If the changes are found to be within the current funding level of the Prioritized List, HSD will determine the effective date for these changes, which will be no earlier than October 1, 2020 pending approval by the Centers for Medicare and Medicaid Services. In the event any of these technical changes are determined to impact the funding level of the List as defined by HSD’s legislatively authorized budget, we will send a separate notice to you prior to requesting direction from the Joint Ways & Means Committee. Interim Modifications to the Prioritized List of Health Services 8/31/2020 Page 2 The Health Evidence Review Commission thanks you for the opportunity to continue to serve the citizens of Oregon. Respectfully submitted, Jason Gingerich Director, Health Evidence Review Commission cc: Health Evidence Review Commission Patrick Allen, Director, Oregon Health Authority Dawn Jagger, Chief of Staff, Oregon Health Authority Lori Coyner, Medicaid Director, Oregon Health Authority Margie Stanton, Director, Health Systems Division, Oregon Health Authority Jeremy Vandehey, Director, Health Policy & Analytics Division, Oregon Health Authority Trilby de Jung, Deputy Director, Health Policy & Analytics Division, Oregon Health Authority Dana Hargunani, Chief Medical Officer, Oregon Health Authority ATTACHMENT A Coding Changes to Condition-Treatment Pairs for the October 1, 2020 Prioritized List of Health Services Line: 1 Condition: PREGNANCY Treatment: MATERNITY CARE Delete: 58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants Add: O34.218 Maternal care for other type scar from previous cesarean delivery Add: O34.22 Maternal care for cesarean scar defect (isthmocele) Add: O99.891 Other specified diseases and conditions complicating pregnancy Add: O99.892 Other specified diseases and conditions complicating childbirth Add: O99.893 Other specified diseases and conditions complicating puerperium Add: S2404 Repair, myelomeningocele in the fetus, procedure performed in utero Line: 6 Condition: REPRODUCTIVE SERVICES Treatment: CONTRACEPTION MANAGEMENT; STERILIZATION Delete: 58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography Delete: 58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants Delete: 74740 Hysterosalpingography, radiological supervision and interpretation Line: 9 Condition: ASTHMA Treatment: MEDICAL THERAPY Add: J82.83 Eosinophilic asthma Line: 23 Condition: INTRACRANIAL HEMORRHAGES; CEREBRAL CONVULSIONS, DEPRESSION, COMA, AND OTHER ABNORMAL CEREBRAL SIGNS OF THE NEWBORN Treatment: MEDICAL THERAPY Add: P91.821 Neonatal cerebral infarction, right side of brain Add: P91.822 Neonatal cerebral infarction, left side of brain Add: P91.823 Neonatal cerebral infarction, bilateral Add: P91.829 Neonatal cerebral infarction, unspecified side Line: 24 Condition: ENDOCRINE AND METABOLIC DISTURBANCES SPECIFIC TO THE FETUS AND NEWBORN Treatment: MEDICAL THERAPY Add: 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed Line: 30 Condition: EPILEPSY AND FEBRILE CONVULSIONS Treatment: MEDICAL THERAPY Add: G40.42 Cyclin-Dependent Kinase-Like 5 Deficiency Disorder Add: G40.833 Dravet syndrome, intractable, with status epilepticus Add: G40.834 Dravet syndrome, intractable, without status epilepticus Line: 41 Condition: INTUSSCEPTION, VOLVULUS, INTESTINAL OBSTRUCTION, HAZARDOUS FOREIGN BODY IN GI TRACT WITH RISK OF PERFORATION OR OBSTRUCTION Treatment: MEDICAL AND SURGICAL TREATMENT Add: K59.81 Ogilvie syndrome Line: 46 Condition: RHEUMATOID ARTHRITIS AND OTHER INFLAMMATORY POLYARTHROPATHIES Treatment: MEDICAL THERAPY, INJECTIONS Add: M05.7A Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvement Add: M05.8A Other rheumatoid arthritis with rheumatoid factor of other specified site Add: M06.0A Rheumatoid arthritis without rheumatoid factor, other specified site Add: M06.8A Other specified rheumatoid arthritis, other specified site Add: M08.0A Unspecified juvenile rheumatoid arthritis, other specified site Page A-1 ATTACHMENT A Coding Changes to Condition-Treatment Pairs for the October 1, 2020 Prioritized List of Health Services Add: M08.2A Juvenile rheumatoid arthritis with systemic onset, other specified site Add: M08.4A Pauciarticular juvenile rheumatoid arthritis, other specified site Add: M08.9A Juvenile arthritis, unspecified, other specified site Line: 55 Condition: COMPLICATED STONES OF THE GALLBLADDER AND BILE DUCTS; CHOLECYSTITIS Treatment: MEDICAL AND SURGICAL TREATMENT Add: 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed Line: 65 Condition: SUBSTANCE-INDUCED DELIRIUM; SUBSTANCE INTOXICATION AND WITHDRAWAL Treatment: MEDICAL/PSYCHOTHERAPY Add: F10.130 Alcohol abuse with withdrawal, uncomplicated Add: F10.131 Alcohol abuse with withdrawal delirium Add: F10.132 Alcohol abuse with withdrawal with perceptual disturbance Add: F10.139 Alcohol abuse with withdrawal, unspecified Add: F10.930 Alcohol use, unspecified with withdrawal, uncomplicated Add: F10.931 Alcohol use, unspecified with withdrawal delirium Add: F10.932 Alcohol use, unspecified with withdrawal with perceptual disturbance Add: F10.939 Alcohol use, unspecified with withdrawal, unspecified Add: F11.13 Opioid abuse with withdrawal Add: F12.13 Cannabis abuse with withdrawal Add: F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated Add: F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium Add: F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance Add: F13.139 Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified Add: F14.13 Cocaine abuse, unspecified with withdrawal Add: F14.93 Cocaine use, unspecified with withdrawal Add: F15.13 Other stimulant abuse with withdrawal Add: F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated Add: F19.131 Other psychoactive substance abuse with withdrawal delirium Add: F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance Add: F19.139 Other psychoactive substance abuse with withdrawal, unspecified Line: 67 Condition: VENTRICULAR SEPTAL DEFECT Treatment: CLOSURE Delete: Z79.01 Long term (current) use of anticoagulants Line: 71 Condition: NEUROLOGICAL DYSFUNCTION IN BREATHING, EATING, SWALLOWING, BOWEL, OR BLADDER CONTROL CAUSED BY CHRONIC CONDITIONS; ATTENTION TO OSTOMIES Treatment: MEDICAL AND SURGICAL TREATMENT (E.G., G-TUBES, J-TUBES, RESPIRATORS, TRACHEOSTOMY, UROLOGICAL PROCEDURES) Add: E70.81 Aromatic L-amino acid decarboxylase deficiency Add: E70.89 Other disorders of aromatic amino-acid metabolism Add: G11.10 Early-onset cerebellar ataxia, unspecified Add: G11.11 Friedreich ataxia Add: G11.19 Other early-onset cerebellar ataxia Add: G40.42 Cyclin-Dependent Kinase-Like 5 Deficiency Disorder Add: G71.20 Congenital myopathy, unspecifed Add: G71.21 Nemaline myopathy Add: G71.220 X-linked myotubular myopathy Add:
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