Thank you for helping Oregonians fight back
Thank you for all you are doing to keep our members healthy. CareOregon has been actively monitoring this situation and working in coordination with local and state public health bodies. We are committed to supporting you and making sure our members get the care they need.
Near the beginning of the COVID-19 pandemic, the government labeled it an official Public Health Emergency (PHE). At that time, all states were ordered to pause the redetermination process. Within 60 days of when the PHE period ends, OHA must restart the redetermination process to confirm that all OHP members still qualify for Medicaid coverage through OHP. Learn more about the redetermination process here.
As you know, the FDA has fully approved the Pfizer vaccine and approved the Moderna and Johnson & Johnson vaccines for emergency use. We are here to support you as the vaccine rolls out. Here is what we know now:
- Click here to read our provider FAQs about the vaccine and vaccine billing.
- Click here to read our billing FAQ for COVID-19 monoclonal antibody (mAb) treatment.
- The Oregon Health Authority is offering guidance to providers. You can learn more on their provider page by clicking here. Read OHA’s COVID-19 Vaccine Administration Site and Provider Guidance (updated May 19, 2021) by clicking here.
- OHA’s public-facing COVID-19 information is found at covidvaccine.oregon.gov. This website features the Get Vaccinated Oregon tool. Learn more about this tool here.
- CDC summary guidance for use of the COVID-19 vaccine
- Everyone age 6 months and over is eligible to receive the COVID-19 vaccine:
- People ages 6 months to 17 are only eligible for the Pfizer and Moderna vaccines.
- Children ages 6 months to 11 will receive a pediatric version of the vaccine.
- Everyone ages 6 months to 14 must have permission from a parent or guardian.
- We are encouraging members to speak with their providers and visit thepublic-facing OHA COVID-19 vaccine page for more information. Members can find out where they can get their vaccine by using one of the following options:
- The federal government is distributing the COVID-19 vaccine to retail pharmacies in Oregon. We are advising members to contact their local pharmacy for details. They can learn more at the following links:
- You can also find information specific to your county at the following websites:
- COVID-19 vaccine transportation resources
- Janssen: Required fact sheet for Johnson & Johnson vaccine recipients and caregivers: English | Spanish
- CareOregon wants to help you and your patients have the best experience, which is why we help you coordinate live interpreters for patients who speak a language other than English. Click here to learn about our resources.
- For additional resources, see COVID-19 vaccine webpages from the CDC and the FDA.
- Tools to support conversations with dental patients about the COVID-19 vaccine.
- As we learn more, we will continue to update this page with more information and resources.
There are local and national lines available for physicians looking for emotional support during this time.
- OPAL-C emotional support for providers: The Oregon Psychiatric Access Line (OPAL) is now opening OPAL-C (COVID-19), providing emotional support to prescribing providers in the state.
- 503-346-1000, 9 a.m. to 5 p.m. Monday through Friday
- Physician Support Line: Free, confidential, national support line run by volunteer psychiatrists.
- 888-409-0141, 5 a.m. to 9 p.m. every day
Testing and specimen collection
For guidance on test ordering, specimen collection and processing please consult your contracted lab, hospital or OHA for the state lab. Medicare and the AMA have released codes to use when testing for COVID-19, which can be found in the "Lab test" section of the Oregon Medicaid COVID-19 Provider Guide.
COVID-19 antibody testing
During the COVID-19 emergency, CareOregon will follow Oregon Health Plan (OHP) coverage guidance for COVID-19 antibody testing. COVID-19 antibody testing (also known as serology testing) to diagnose SARS-CoV-2 coverage criteria:
- Uses tests that have FDA Emergency Use Authorization (EUA) or FDA approval and
- Is to evaluate a hospitalized person under age 21 for possible multisystem inflammatory syndrome in children (MIS-C).
COVID-19 home tests available for members
Home tests for COVID-19 are now available for Medicaid members who have COVID-19 symptoms or may have been exposed to someone with COVID-19. Members may get up to eight tests every 30 days. Many brands of home tests are fully covered, but not all. See our formulary for details.
Members do not need a prescription for tests that do not require prior authorization. All tests must be dispensed by a pharmacy. The Oregon Board of Pharmacy allows pharmacists to prescribe COVID-19 home tests.
Members may be able to get reimbursement if they pay for tests out of pocket. Members should submit for reimbursement using this form. Receipts must be included.
For pharmacies: Processing home tests
- Pharmacies should submit claims for home tests to the Pharmacy Benefit Manager (PBM) through the pharmacy point of sale system.
- Home tests should not be billed through the medical benefit. Please do not submit these to QNXT.
- The prescribing provider on these claims should include a pharmacist that has a current Oregon Medicaid ID.
Telephone and video appointments
Behavioral health resources
- Mental health considerations for older adults and individuals receiving care in facility-based settings during the COVID-19 pandemic
- COVID-19 prioritization guidelines for behavioral health populations
- Substance Abuse and Mental Health Services (SAMHSA): Coronavirus resources
- SAMHSA: Medication-assisted treatment guidance
- Practitioners Clinical Support System: Telemedicine guidance on Buprenorphine
- American Society of Addiction Medicine: Alcohol withdrawal management
- HHS: Emergency situation preparedness, planning and response
- Oregon Recovery Network: Recovery support resources
- American Academy of Family Physicians: Virtual visit algorithm
- Synergy: Flare-ups during COVID-19
- Resource digest - June 19, 2020
- Resource digest - June 26, 2020
- Resource digest - July 10, 2020
- Resource digest - August 17, 2020
- Resource digest - August 24, 2020
- Resource digest - September 22, 2020
- Resource digest - October 5, 2020
- Resource digest - October 14, 2020
- Master Resource List
Information about health-related services to cover immediate member needs like cell phones and hotel rooms — including the forms you need to request health-related services — is found on our Provider Support page.