Thank you for all you are doing to keep our members healthy. Columbia Pacific CCO 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.
COVID-19 vaccine
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 5 and over is eligible to receive the COVID-19 vaccine:
- People ages 5-17 are only eligible for the Pfizer vaccine.
- Children ages 5-11 will receive a pediatric version of the vaccine.
- Everyone ages 5-14 must have permission from a parent or guardian.
- We are encouraging members to speak with their providers and visit the public-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:
- Click here to visit the OHA’s vaccine locator.
- Visit vaccines.gov.
- Call 211 or TTY 711 for the latest information, or text “ORVAX” to 898211 for live text help in English or Spanish
- 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:
- Columbia Pacific CCO 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.
- Mobile COVID-19 vaccination frequently asked questions
- COVID-19 vaccine transportation resources
- Janssen: Required fact sheet for Johnson & Johnson vaccine recipients and caregivers: English | Spanish
- For additional resources, see COVID-19 vaccine webpages from the CDC and the FDA.
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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.
Provider support
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.
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.