HEALTH SYSTEMS DIVISION Kate Brown, Governor 500 Summer St NE E44 Salem, OR, 97301 Date: December 8, 2016 Voice: 1-800-336-6016 FAX: 503-945-6873 To: Oregon Health Plan providers TTY: 711 www.oregon.gov/OHA/healthplan
From: Don Ross, Physical and Oral Health Programs manager Integrated Health Programs, Health Systems Division
Subject: Oregon Health Plan changes effective January 1, 2017
To meet federal health plan requirements, the Oregon Health Authority (OHA) is making the following changes to Oregon Health Plan (OHP) benefits and copayment requirements, subject to approval by the federal Centers for Medicare & Medicaid Services.
The changes apply to services covered by OHA and all coordinated care organizations on and after January 1, 2017.
OHP Plus benefit changes OHA will update the Prioritized List of Health Services and related administrative rules to add these benefits effective January 1, 2017: A wig benefit of at least $150 per year for patients with hair loss related to chemotherapy or radiation therapy. Separate limits for habilitative and rehabilitative services under Guideline Note 6, which covers physical, occupational and speech therapy for adults with physical health conditions.
Guideline Note 106 on Preventive Services has been modified to reflect that OHP coverage will continue to follow federal requirements for coverage of preventive services including: Services with A and B recommendations from the United States Preventive Services Task Force, Immunizations recommended by the Advisory Committee on Immunization Practices, The Health Resources & Services Administration’s Women’s Preventive Services guidelines, and The American Academy of Pediatrics Bright Futures Guidelines.
Removal of OHP copayments Copays will be removed from all OHP services, including pharmacy, professional, and outpatient hospital services. This means OHA will stop deducting OHP copayment amounts from fee-for-service claim payments beginning January 1, 2017, for services provided on or after January 1.
OHA is updating Oregon Administrative Rule 410-120-1230 (Client Co-Payment) to reflect this change.
What should you do? If you currently collect OHP copayments, please stop collecting copayments for services provided on or after January 1. Copayment amounts owed before January 1, 2017, may still be collected.
16-658 To keep informed about the January 1 Prioritized List and Guideline Notes (currently posted on the Pending Prioritized List page), please sign up to get text or email updates from the Health Evidence Review Commission.
To keep informed about changes to OHA rules related to the January 1 benefit changes, sign up to get OHP Temporary Rule updates.
Questions? If you have any questions about this announcement, contact the Provider Services Unit at [email protected] or call 1-800-336-6016. We are available Monday through Friday between 8 a.m. and 5 p.m. (including lunch hours).
Thank you for your continued support of the Oregon Health Plan and the services you provide to our members.