EOCCO Clinics & Staff,
Welcome to the January 2025 issue of the EOCCO monthly newsletter. Below is a preview of the articles you will find in this month's email:
News From EOCCO:
- Health-related social needs (HRSN): Nutrition benefit
- Provider DMAP revalidation
- Blood pressure monitor benefit
- EOCCO’s 2025 grant cycle
- EOCCO’s new independent pharmacy project
- 2025 incentive program updates
From our partners:
- Learn about the Spanish healthcare interpreter course hosted by OSU
- Behavioral health navigator
- Motivational interviewing training for providers in Morrow, Umatilla and Union Counties
Plese let us know if you have any questions, concerns or recommendations. We would love to hear from you!
Please contact: EOCCO Provider Inquiry
Thank you,
Your EOCCO Team
Health-Related Social Needs (HRSN): Nutrition benefit
Effective January 1, 2025, eligible EOCCO members will have access to Medically Tailored Meals (MTM) under the new 1115 Waiver HRSN benefit.
Providers will play a vital role in connecting members with this benefit. Below are the steps to requesting an MTM:
- Member schedules visit with PCP
- Provider refers member to a registered dietician
- Member completes visit with registered dietician and obtains an assessment
- A request for MTM is submitted by filling out the Health-Related Social Needs request form: Introduction. (members, member representatives, THWs, registered dieticians, PCPs or other support persons may submit this request.)
- EOCCO will automatically refer authorized requests to our MTM service provider, Mom’s Meals, for meal delivery
Important: A copy of the registered dietician assessment must be uploaded with the MTM request in order to submit.
PCP Visit, Registered Dietician Assessment and Nutrition Education should be billed to the members EOCCO (medical) plan as normally would bill.
If your member has a ‘below the line’ diagnosis and is ineligible for a registered dietician assessment or nutrition education under their medical plan, the following modifiers may be used: U1, U6, UC
To be eligible, members must first meet the following criteria:
- Be an EOCCO member with EOCCO medical coverage
- Have an HRSN-eligible social risk factor
- Have an HRSN-eligible clinical risk factor
- Experiencing food insecurity
Access OAR 410-120-2005 Table 2 with more information on nutrition social and clinical risk factors: 410-120-2005. Scroll to the bottom of the page and click: “[ED. NOTE: To view attachments referenced in rule text, click here for PDF copy].”
Learn more about HRSN, visit our Health-Related Social Needs (HRSN) | EOCCO Provider.
Who is a good candidate for MTM?
- Members recently discharged from hospital setting
- Members with new medical diagnosis
- Members unable to prepare meals independently
- Members needing additional support managing health condition(s)
What kind of meals does Mom's Meals offer for authorized MTM members?
- Diabetes-friendly
- Gluten-free/Celiac-friendly
- Heart-friendly
- Lower sodium
- Pureed
- High protein
- Renal/Kidney-friendly
- Vegetarian
Keep an eye out on the EOCCO website for more nutrition benefit updates coming soon! The nutrition section and request form will be live and available on Jan. 1, 2025.
Questions? Email us at HRSNQuestions@eocco.com
Provider DMAP revalidation
The 2025 Medicaid DMAP revalidation period has begun, and a portion of the EOCCO network has been identified for revalidation.
If you enrolled or re-enrolled in 2024, you likely will not appear on this list. For those who do, we will require completed forms and accompanying documentation, such as individual practitioner licensure or clinic/group W-9s.
Action item:
- Please check this page to find/enter your NPI to see if an individual provider or clinic needs to be revalidated: Provider DMAP revalidation lookup
- If you are still unsure whether you need to complete this process, feel free to contact us at providerDMAPApps@modahealth.com. When emailing us, please use the subject line “2025 Medicaid DMAP Revalidation” so we may properly expedite your emails/applications
Please note:
- The deadline for revalidation is March 31, 2025
- We will do our best to do individual outreach and follow-up if we do not receive applications prior to the deadline
- If revalidation is not completed by this date, claims may begin to deny due to a lack of DMAP registration
- If this occurs, contact us immediately so we can assist with re-enrollment, backdate your registration, and reprocess claims
We appreciate your patience as we work to make this process as seamless as possible for everyone involved.
Blood pressure monitor benefit
We're excited to share that automatic blood pressure monitors are now covered for Oregon Health Plan (OHP) members through Durable Medical Equipment (DME). This benefit allows members to monitor their blood pressure regularly from the comfort of their home.
Here's what EOCCO members need to know about obtaining a blood pressure monitor through OHP:
- Prescription required: Members must have a prescription from their healthcare provider. Providers will document the medical necessity for home blood pressure monitoring to justify the prescription.
- DME supplier: Once members have a prescription, they'll need to contact a qualified DME supplier enrolled with OHP. The supplier will assist members in getting the blood pressure monitor.
- Coverage details: With the provider's prescription and documentation, the cost of the blood pressure monitor will be covered by OHP when obtained through an enrolled DME supplier.
This coverage ensures that members have the tools they need to take an active role in managing their health. Any questions can be directed to EOCCO Customer Service at 888-788-9821.
Access preferred DME providers
Ancillary guidelines:
The below ancillary guideline was added to coverage as of 1/1/2025.
What this means is that an automated BP measuring device is covered on every funded line of the prioritized list that would medically necessitate checking blood pressures.
Devices that measure arm (not wrist) cuffs are preferred and using a validated device is also preferred, but lack of access to either of these things will not cause the payment to be denied.
There are 3 validated devices for patients who are pregnant and 1 for pediatrics.
Various cuff sizes are also available.
As of Dec. 18, 2024 OHP fee schedule, reimbursement is as follows:
| A4660 | Sphyg/bp app w cuff and stet | $23.81 |
| A4663 | Dialysis blood pressure cuff | $21.63 |
| A4670 | Automatic bp monitor, dial | $52.38 |
Ancillary guideline A4, home blood pressure monitors
Home blood pressure monitors (HCPCS A4660, A4663, A4670) are covered for diagnosing and monitoring hypertension, including hypertensive diseases of pregnancy, and related cardiac conditions.
- Automated arm (non-wrist) monitors are preferred as first-line devices
- HERC prefers devices included on the US Blood Pressure Validated Device Listing (https://www.validatebp.org/devices retrieved on 11/14/2024) when possible
For patients:
For providers:
EOCCO’s 2025 grant cycle
EOCCO’s 2025 grant cycle is approaching. Visit the EOCCO Grants webpage for more information and Requests for Applications (RFAs).
- The Community Benefit Initiative Reinvestment (CBIR) New Ideas Grant application will run from January 31 to March 28, 2025, offering up to $50,000 for innovative ideas focused on areas like telehealth, workforce strategies and addressing health disparities. The full CBIR grant package will open in summer 2025
- The Supporting Health for All through Reinvestment (SHARE) Grant (application open January 31 to March 28, 2025) supports projects addressing Social Determinants of Health and Equity (SDOH-E), such as housing, food and transportation. Eligible organizations can apply for funding between $15,000 and $250,000 for projects lasting 1 to 3 years
- The Community Capacity Building Funds Grant (application open April 1 to May 31, 2025) helps build infrastructure for the new Health-Related Social Needs benefit, supporting technology, business practices, workforce development and outreach efforts
For questions or help determining eligibility, contact EOCCOGrants@eocco.com
EOCCO’s new independent pharmacy project
EOCCO is launching a new program to improve member health and support local pharmacies! EOCCO has partnered with independent pharmacies in its service area—Murray’s Drug (Condon, Heppner, Boardman), Len’s Drug (John Day), Winding Waters (Wallowa County), Red Cross Drug (La Grande) and Malheur Drug (Vale)—to help strengthen their businesses and improve health outcomes. These pharmacies are all certified as Critical Access Pharmacies, which will result in enhanced reimbursement.
The pilot program offers a PMPM payment to pharmacies that implement blood pressure measurements and counseling for ~1,300 hypertension patients, plus a $3,500 stipend for hosting an annual vaccination clinic. Funded by a $100,000 grant from the Roundhouse Foundation, the program will run for one year. If successful, EOCCO may expand to include Hemoglobin A1C testing, smoking cessation and PCP visit referrals.
EOCCO will keep the Clinical Advisory Panel updated on the program’s progress. Please reach out to EOCCOGrants@eocco.com with any questions.
2025 incentive program updates
Please note the following EOCCO incentive programs that will be implemented in 2025:
- Well-Child Visit 3-6 incentive program: $50 Amazon gift card incentive for completed well-child visits for ages 3-6 will continue in 2025
- Childhood immunizations incentive program: $50 Amazon gift card incentive for completed Combo-3 immunization series will continue in 2025
Note: 2025 EOCCO incentive measure guide and quality bonus payment formula will be available in February.
Behavioral health navigator
Need to schedule a behavioral health appointment for a patient? Too busy to call several providers to see what openings are available? Whether it be when a patient is discharging from the Emergency Department and needs a behavioral health appointment scheduled as part of the discharge plan or a behavioral health need is identified in primary care and the patient wants to leave their doctor's office with a behavioral health appointment in hand, GOBHI has created a Behavioral Health Navigator to assist providers and members in scheduling behavioral health appointments in real time (business hours: Mon-Fri 8 a.m.-5 p.m. PST). This position will help coordination of care, reduce barriers and wait times to scheduling appointments, and ensure that any transportation that is needed for a patient or member to attend their appointment is scheduled.
Please contact Maria Carrera at 541-206-2488 or appointments@gobhi.org
Learn about the Spanish healthcare interpreter course hosted by OSU!
Oregon State University (OSU) is preparing for their spring Spanish-English health care interpreter training program, that will take place April 11 – June 13, 2025. The course will teach students about interpreting in a medical setting and prepare them to become an Oregon-qualified or certified interpreter.
This eight week/64-hour course requires online and in-person coursework. The course requires students to attend three in-person sessions and two live Zoom sessions to help facilitate interpreting skills. In-person sessions will be held at the OSU extension center in Ontario, Oregon. See the OSU Continuing Education website for the full schedule.
Interested in learning more? Register for the free, online webinar, Friday, February 21, from 11:00 a.m. – 12:00 p.m. PST. The webinar will cover questions including prerequisites, the anticipated time commitment, and how to apply to become a qualified or certified interpreter after completing this course. Sign up today!
Motivational interviewing training for providers in Morrow, Umatilla and Union Counties
Motivational Interviewing can be particularly helpful in conversations about vaccines and other topics around which people may express ambivalence. If you have conversations with families who are vaccine-hesitant, this training is for you. Participants will also have access to post-training coaching, webinar and printed resources.
Training opportunity 1: May 8 @ Good Shepherd-Hermiston - from 8:30 a.m.-3:30 p.m. PST
Training opportunity 2: May 9 @ EOU-La Grande - from 8:30 a.m.-3:30 p.m. PST
Lunch provided!
Questions? Contact contact@bluemountainearlylearninghub.org
Register here: bmelh.org/training
New OHA certified/qualified health care interpreter registry file
The November 2024 Oregon Health Authority (OHA) Health Care Interpreter Registry file is now available on the EOCCO Incentive Measure webpage under “Language Access.”
Features:
- A list of all active OHA-certified or qualified health care interpreters in Oregon
- Downloadable for reference and records
Search the registry online: OHA Health Care Interpreter Registry
Questions?
Questions related to incentive measures, health equity, traditional health workers, SDoH, and HIT - Please email EOCCOMetrics@modahealth.com
Questions related to claims and payment information - Please email EOCCOProviderInquiry@modahealth.com
Need to verify if your provider or group NPI is active? Please use OHA’s verification tool
Need to register your practitioner, group or facility? You can find forms on EOCCO.com/Providers/becomeaprovider
If you would like to be added or removed from the email list, please let us know at finn.gornick@modahealth.com
