Division of Medical Assistance Programs (DMAP) - formerly OMAP
The Division of Medical Assistance Programs (DMAP) administers state programs that provide medical coverage to low-income Oregonians, such as the Oregon Health Plan, Medicaid and the Children's Health Insurance Program. DMAP is a division of the Department of Human Resources (DHS). The following links will help you reach key contacts within the agency to answer state medical program questions:
DMAP Resources
 http://arcweb.sos.state.or.us/banners/rules.htm: Link to state agency rules, filings, notices and information on who to participate in public comment activities.
http://arcweb.sos.state.or.us/rules/coordinators.html: State Agency Rules Coordinator contacts list – whom to call regarding a particular proposed or modified rule.
http://www.dhs.state.or.us/policy/healthplan/main.html: Oregon Health Plan policies, administrative rules, proposed rules, schedule.
http://www.dhs.state.or.us/policy/healthplan/rules/notices.html#hospital: Oregon Health Plan rule making notices and rule making hearing schedules.
http://www.oregon.gov/DHS/healthplan/index.shtml: Oregon Health Plan.
http://www.oregon.gov/DHS/healthplan/data_pubs/faqs/faqprovohpstan.shtml: Provider FAQ, Oregon Health Plan benefits.
http://www.dhs.state.or.us/policy/healthplan/guides/main.html: DMAP policy, rules and guidelines.
http://www.oregon.gov/DHS/healthplan/data_pubs/feeschedule/main.shtml: OHP providers’ fee-for-service fee schedules.
Department of Human Services/Office of Medical Assistance Programs: Follow-up to Hospital Reimbursement Filing
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DMAP News
Hospital Emergency Department Triage Assessment Fee Program Cancelled
Oregon Department of Human Services, Division of Medical Assistance Programs (DMAP) will cancel plans to implement the Emergency Department Triage Assessment Fee policy announced following the end of the 2005 legislative session. The policy was scheduled to be implemented in early 2007. The proposed policy would have limited payment to hospitals for treatment provided to Medicaid enrollee treated in an ED setting, unless the treatment was listed on a specifically designed list of conditions developed by DMAP. The triage assessment fee was set at $42 and would have been considered payment in full for any services provided by the ED for a non-listed condition.
OAHHS and member hospitals have argued that existing lack of access to primary care for Oregon Health Plan enrollees, combined with the ED’s challenge of diagnosing to rule out any emergent conditions, put hospital EDs in a position of providing necessary patient care that would not be reimbursed by the state. To read the department's notice, go to
http://www.oregon.gov/DHS/healthplan/stakeholders/canceltriagefee.pdf
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Revised OMAP Medical Care Identifications
The Office of Medical Assistance Programs (OMAP) has revised the clients' OMAP Medical Care ID (OMAP 1417) effective November 1, 2005. The main change is in the Benefit Package Field (9a) to accommodate the new designation, "D-OHP with limited drug," for recipients of Medicare Part D prescription drug benefit. For more information, go to http://www.oregon.gov/DHS/healthplan/notices_providers/main.shtml.
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OMAP Revises OHP Contractor Rules
Last week the Office of Medical Assistance Programs (OMAP) released the January 2006 rates for Oregon Health Plan (OHP) contractors prepared by PriceWaterhouseCoopers (PwC), the state's consulting actuaries. Some of the contractors have been voicing concerns to the Centers for Medicare and Medicaid Services (CMS) about whether the reduced rates are adequate to cover services.
According to PwC, the statewide rates for Fully Capitated Health Plans (FCHP) should decrease by 21.2 percent (based on a weighted average of the August 2005 enrollment categories). A substantial portion of this reduction is attributable to the implementation of Medicare Part D. Rates for Blind and Disabled enrollees, for example, will decrease 72 percent. Rates for TANF adults will be reduced by 20.3 percent and PLM adults will receive 17.6 percent less.
Similar (or even larger) reductions are scheduled for dental and mental health contractors. In OHP Standard, for example, dental contractors will receive 49.2 percent less than they do now for Families and 57.2% less for Adults/Couples. Mental Health contractors will see their rates decline by 55.4% and 33.8%, respectively, for these populations.
If you would like a copy of the PwC rates for 2006, please contact Kevin Earls at OAHHS, 503/636-2204 or kcearls@oahhs.org.
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OMAP Publishes Proposed Rules on Non-Participating Providers
The Department of Human Services, Office of Medical Assistance Programs (OMAP) has released temporary administrative rules on payment for services provided to clients and reimbursement methodology for hospitals and managed care organizations. See the following link to access the proposed rules and contact Gwen Dayton or Kevin Earls at OAHHS to express comment or ask questions.
http://www.dhs.state.or.us/policy/healthplan/rules/notices.html
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Co-Payments Dropped for OHP Standard, Effective June 19th, 2004
The Department of Human Services (DHS) is eliminating co-payments for OHP Standard clients, effective 6/19/2004 in response to legal action taken by some of the OHP Standard clients.
OHP Standard Clients currently show the letter "B" in field 9b (Benefit Package) of the OMAP Medical care ID. Effective with the July 2004 mailing, these id cards will show "no co pay" in the 9b field.
Hospitals are advised that OMAP will stop deducting the co-payment amount for services and supplies provided to these clients after June 18th.
OMAP's administrative rules are being revised to reflect this change.
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Health Plan's Standard Benefit Package Closes to New Enrollments Effective July 1, 2004
The Oregon Health Plan's Standard benefit package will be closed to new enrollment beginning July 1, as officials begin to scale back the plan in response to budget limitations.
The Standard plan currently covers about 50,000 Oregonians. This figure must be reduced by more than half by June 30, 2005, to be sustainable with available dollars, according to the Oregon Department of Human Services (DHS).
In addition to the suspension of new enrollments, reaching this goal will likely require stricter income eligibility requirements as plan participants reach the end of their six-month enrollment periods and reapply.
State general-fund dollars are being withdrawn from the Standard plan under a budget-balancing plan that the legislative Emergency Board approved in April, in response to the Feb. 3 defeat of Measure 30.
The 2003 Legislature approved two taxes -- one on Medicaid managed care plans and one on hospitals -- to help fund the Standard plan.
The managed care tax has received the required approval from the federal Centers for Medicare and Medicaid Services; a request for approval of the hospital tax is pending. Each dollar from the taxes will be matched with $1.50 in federal Medicaid money to fund the Standard plan. However, these revenues will not fund the plan at its current level.
Notices of the closure to new enrollments are being mailed today to people currently on the Standard plan -- low-income adults who don't qualify for traditional Medicaid.
"We are advising people already on the Standard plan that for now, they can keep their eligibility by paying their premiums on time, and by reapplying timely when they are notified that their six-month eligibility is about to end," said Lynn Read, state Medicaid director for DHS. "We will provide additional notice to participants if we need to make changes in Standard eligibility."
Department officials are still reviewing projections to determine what changes to eligibility may be necessary to reduce the plan's expenses to a sustainable level. Currently, participants must have an income below 100 percent of the federal poverty level, or $1,041 a month for a family of two.
Pending the necessary federal approvals, it is anticipated that the remaining covered population would receive a benefit package covering doctor visits, prescription drugs, outpatient mental-health and chemical-dependency treatment, emergency dental, lab, x-ray, medical supplies and a limited hospital benefit.
The nearly 300,000 people covered by the Health Plan's Plus package are entitled to coverage under federal Medicaid law and aren't affected by the changes. The Plus package is available to foster children and to people who are aged, blind, disabled or on public assistance.
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