The Oregon Health Authority (OHA) updated the Oregon Administrative Rule (OAR) on Home Enteral/Parenteral Nutrition and IV Services (410-148-0100(6)). This updated rule states that Oregon Health Plan (OHP) shall be primary payer, before the Women, Infants and Children (WIC) program, for medical grade formula covered by OHP to treat infants and children who are enrolled in both OHP and participating in the WIC program. This includes medical grade formula and nutritional supplements administered orally and/or via tube feeding.
What do providers need to know?
PCPs, OBGYNs and pediatricians should submit prior authorizations for members to CareOregon, not WIC. Providers should follow the prior authorization process for coverage of medical grade formula. Contact Provider Customer Service at 541-500-0567 or 855-722-8208 or TTY 711. Press option 3 for provider. See this FAQ document from WIC for more information.
