EOCCO June 2024 Provider Newsletter

EOCCO Clinics & Staff,

Welcome to the June 2024 issue of the EOCCO monthly newsletter. Below is a preview of the articles you will find in this month's email:

• EOCCO Timely Access to Care survey
• EOCCO IET learning collaborative
• Oregon Health Plan (OHP) Bridge program launches July 1, 2024
• Oregon Medicaid DMAP enrollment web form
• OHA supporting LGBTQIA2S+ youth with summer resource list
• Health related social needs (HRSN): climate device requests
• Health related social needs (HRSN): provider training
• Interested in becoming an HRSN service provider?
• Language access technical assistance needs survey for providers
• Important change: provider reconsiderations
• EOCCO Social Needs Screening and Referral Metric webinar
• Technical assistance for colorectal, cervical and breast cancer screening and prevention
• EOCCO doula referral form now available
• Upcoming training opportunities: social emotional health for children ages 0-5
• Veradigm risk coding for Medicare and ACA plan beneficiaries

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

EOCCO Timely Access to Care Survey

The 2024 bi-annual Timely Access to Care survey is now live. Your participation in completing this survey is appreciated! We are continually working on ways to improve network adequacy, access to care and ensure that our members can get their care in an appropriate and timely manner. This survey will help us identify member wait times for getting an appointment, wait times in the provider's office and other member access needs. We may contact you if we have questions about your responses.

As a reminder, participating providers must provide timely access to medically appropriate and culturally responsive covered services. EOCCO members should be seen, treated or referred within the following time frames:

• Physical Health:
  • Emergency Care: Immediately or referred to an emergency department depending on member’s condition
  • Urgent Care: Within 72 hours or as indicated in initial screening
  • Well Care: Within four weeks, or as otherwise required by applicable care coordination rules, including OAR 410-141-3860 through 410-141-3870

Questions? Please contact Noah Pietz at eoccoproviderinquiry@modahealth.com

EOCCO IET learning collaborative

EOCCO presents: a learning collaborative on Initiation and engagement of substance use disorder treatment (IET). Join us for a virtual learning opportunity on the Initiation & Engagement of Substance Use Disorder Treatment (IET) incentive measure. Providers and staff at any EOCCO-contracted physical and behavioral health practices are welcome.

When: Tuesday, July 23, 2024, 12 - 1 p.m.

Register here for this learning opportunity.

Questions? Please email: EOCCOmetrics@modahealth.com

Oregon Health Plan (OHP) Bridge program launches July 1, 2024

OHP Bridge is a new benefit for adults with income above the traditional OHP Plus limit to help avoid coverage gaps. This includes medical (pharmacy included), dental, non-emergent medical transportation (NEMT) and behavioral health benefits. Note: this benefit does not include health related social needs (HRSN). Beginning in July, OHP Bridge will cover adults up to age 65 who:

• Have income up to 200% of the FPL
• Do not have access to affordable insurance, and
• Have an eligible citizenship or immigration status to qualify

Starting July 1, 2024, OHP Bridge will be open for applications. Members can visit Oregon’s ONE system or use HealthCare.gov to apply for OHP Bridge coverage. Please visit Oregon Health Authority’s OHP Bridge page for more information or to get copies of OHA’s outreach campaign materials.

Oregon Medicaid DMAP enrollment web form

We are pleased to announce the launch of our new online web form for enrolling with Oregon Medicaid DMAP, available now on the EOCCO Become a Provider webpage. This new form is designed to streamline the application process for facilities, groups and individual providers by allowing for direct and seamless submission to our operations team for processing and submission.

Please be aware that starting November 1, 2024, the existing PDF forms currently used for printing, faxing and emailing will be discontinued and no longer available.

If you experience any difficulties with the new web form and need assistance or have any questions, please reach out to us at ProviderDMAPApps@modahealth.com.

OHA supporting LGBTQIA2S+ youth with summer resource list

As summer begins, the Oregon Health Authority (OHA) is working with other state agencies, counties, Tribal nations, communities and advocacy groups to ensure that LGBTQIA2S+ youth have access to support and resources to promote their safety and inclusion. Community, peer and family support is crucial to the well-being and mental health of young LGBTQIA2S+ people and OHA has provided a list of local, state and national resources to help youth and families, including in Eastern Oregon.

In our service area, the Eastern Oregon Center for Independent Living (EOCIL) provides safe spaces, resources, empowerment and community building for two-spirit and LGBTQIA+ communities residing in 13 eastern Oregon counties.

Please see OHA's news release for more information on statewide and national resources to support LGBTQIA2S+ youth.

Health related social needs: climate device requests

You can now request climate devices for eligible EOCCO members. Climate devices can be requested for EOCCO members that are on either CCOA or CCOB (medical benefit through EOCCO) and are a part of one of the groups listed below:

• Adult or youth released from incarceration in the past 12 months
• Adult or youth discharged from Institutions for Mental Disease (IMDs) in the past 12 months
• Individual who is currently or who has previously been in the Oregon child welfare system
• Individual transitioning from Medicaid-only to dual eligibility (Medicaid and Medicare) status within the next three months or past nine months
• Individual who is homeless or at-risk of becoming homeless
• You will need the member's Medicaid ID and address where they would like the device mailed in order to complete the form.

Click here to request a device.

Health related social needs: OHA-hosted provider training series

The next health related social needs (HRSN) service provider training will be on Tuesday, June 25, 2024, from 1–2:30p.m. These monthly trainings provide technical assistance for organizations that want to become HRSN service providers for Open Card/fee-for-service. In this session, we will be offering office hours for you to ask questions, get answers from our subject matter experts, and learn more about the resources available for HRSN providers.

When: Tuesday, June 25, 2024, from 1-2:30 p.m.

Where: Register via Zoom (Spanish interpretation and closed captioning available)

If you need any help or accommodations to participate, please email 1115Waiver.Renewal@odhsoha.oregon.gov

To find recordings and slides of past provider trainings, please visit OHA's HRSN provider training website.

Ready to get started as an HRSN provider?

To begin the process of enrolling as an HRSN service provider:

1. Complete this application.
2. Once you've completed the application, please email the Provider Enrollment Team at Provider.Enrollment@odhsoha.oregon.gov letting them know that you submitted an application to become an HRSN Service Provider. This will ensure that your application can be processed sooner.

If you have additional questions about enrolling as an HRSN Service Provider, please see the Provider Enrollment Guide, call the OHA Provider Enrollment team at 800-336-6016, option 6, or email the team at Provider.Enrollment@odhsoha.oregon.gov.

Interested in becoming an HRSN service provider?

EOCCO is actively developing a network of HRSN providers. These organizations will offer HRSN services in a culturally and linguistically appropriate, responsive and trauma-informed manner. All contracted HRSN providers must meet specific provider qualifications.

1. Become a Medicaid HRSN provider by visiting our Become a Provider page. Even if you are already registered, re-enroll as an HRSN provider type:

• HRSN Provider Type 68.
• Specialty code 680 climate
• Specialty code 681 outreach/engagement
• Taxonomy 171WH0202X

2. Email EOCCO to request an HRSN provider contract at HRSNQuestions@eocco.com.

3. Serve as an HRSN provider for EOCCO.

4. Get a referral and provide HRSN services. (See the Outreach and engagement services and Climate services sections below to learn more.)

5. Send EOCCO a bill or invoice for payment.

• You must send a bill to EOCCO within 120 calendar days of delivering services or equipment.
• You’ll receive payment within 30 days of sending your bill.
• If your bill is returned to you, correct and resend it within EOCCO’s required timeframe. You can call EOCCO with any questions or concerns.
• EOCCO will provide more information on submitting bills and invoices for payment throughout the contracting process.

6. Stay enrolled or disenroll.

• Stay enrolled with Oregon Medicaid.
• Disenroll if you no longer want to provide HRSN services. Please contact EOCCO if you no longer want to serve as a contracted provider.

Read the HRSN Provider Journey to learn more about the process and qualifications to becoming an HRSN provider.

Outreach and engagement services

You can encourage people to start the process by:

• Working with CCOs to conduct outreach to potential eligible members. Members may also reach out to you directly to learn more.
• Helping members find their CCO if they’re not a part of EOCCO. If they are Open Card members, you can refer them to OHP Open Card.
• Filling out and sending HRSN request forms to CCOs. Find EOCCO’s HRSN request form on our member-facing Health-Related Social Needs page.
• Alternatively, using your own form. It must include the eligible person’s name, contact information and the HRSN services they need. People can self-attest to the questions on the form. EOCCO highly recommends using our online climate device request form to request climate devices or HRSN services.
• Helping people fill out the information sharing authorization form that gives EOCCO permission to share member information with HRSN providers to deliver services.
• Documenting these activities and your time spent on them in order to send for payment later.
• Getting notification that services are approved or denied. EOCCO members will hear from EOCCO if they are approved for HRSN services within 14 days of completing the HRSN screening.
  • If approved, EOCCO will contact the person and refer them to providers for services.
  • If denied, EOCCO will contact the person by mail. You can help people request an appeal or hearing or refer them to an OHP ombudsperson. You can also help them check if they can receive the same or similar services through EOCCO’s HRS/Flex program.

HRSN service providers assisting members in requesting HRSN services will also receive notifications regarding the approval or denial status of their requests. Additionally, they will be notified upon the administration of the service or device. This process is referred to as a "closed-loop referral."

Climate services

Climate services fall into two categories:

1. Getting referral services from the CCO

• EOCCO will contact you to provide HRSN services to people. You will let EOCCO know if you can or cannot immediately fulfill these requests.

2. Delivering services and notifying EOCCO

• Contacting people to deliver or coordinate delivery of services or equipment within 30 days of getting a referral, and notifying the CCO by phone, email or fax within 14 days of delivery.
• Helping with repairs and replacements of climate devices.
• Helping people get their devices repaired or replaced through the manufacturer and/or their care coordination team if you ordered the device for the member.
• If applicable, answering basic questions and helping people with proper care and use of their climate devices. You should do this before getting replacements, to reduce waste. If you ordered the device, you can review details related to device restrictions, failures, warranties and the replacement process.
  Invoicing and fee schedules

You can view the HRSN devices fee schedule for climate-related supports.

Questions?

If you have any questions about becoming an HRSN Service provider or contracting with EOCCO for HRSN Services, please email HRSNQuestions@eocco.com

Language access technical assistance needs survey for providers

The Transformation Center and Equity & Inclusion Division of OHA wants to understand what technical assistance providers need to deliver quality interpretation services to people who prefer a language other than English and persons who are deaf or hard of hearing.

OHA is looking for clinicians, front-line office staff and others who deliver physical, behavioral, or dental health care services to OHP members to talk with them for 25 minutes sometime in late June or July.

Conversation topics will include:

• What state law requires regarding interpretation services
• What happens in your office when interpretation services are requested
• What works well and what challenges you face providing interpretation services
• How the quality of interpretation services affects patient visits
• How you bill for interpretation services
• What specific resources or consultants you would recommend

To find out if your clinic qualifies to help with this needs assessment, please fill out this language access needs assessment, which should take two minutes to complete. Thank you!

For questions, please contact Sarah Wetherson, OHA Senior Medicaid Advisory Committees and Quality Improvement Analyst, at sarah.e.wetherson@oha.oregon.gov, 503-793-1920 (text or voice). 

Important change: provider reconsiderations

With the change of provider reconsiderations now only accepted for denial of post-service claims, EOCCO is sharing the most recently updated process and procedures. Please review the following highlights for this new process to ensure a smooth transition:

• Any denial of service not yet received (pre-service) will need member consent before an appeal can be started and reviewed. Remember, a provider’s rights to appeal only pertain to denied, post-service claims.
• Peer-to-peer (P2P) consultations can only be conducted for advice and not with the intent to change the initial determination.
• If the initial decision resulted in a denial of services, a Notice of Adverse Benefit Determination (NOABD) will be mailed to the member and service provider. The member must initiate the appeal or provide consent for a provider to submit an appeal on their behalf.
• To prevent delays in the review process, please ensure that all relevant information is included with the request to facilitate a smooth process for all parties.
• If there is additional information you would like us to consider after a NOABD has been issued, member consent will need to be obtained, and an appeal will need to be initiated. You may submit additional information by faxing it to 503-412-4003.
• If a member initiates an appeal, the EOCCO appeals staff will contact you to request any additional information needed for the review. Please respond promptly, as this request is time sensitive.

If at any time there are questions, we are here to help. Don't hesitate to contact us at 503-243-3962 or toll-free 877-605-3229. We can also be reached by email at medical@modahealth.com.

EOCCO Social Needs Screening and Referral Metric webinar

Please join us for an upcoming webinar hosted by EOCCO and the Oregon Rural Practice-Based Research Network (ORPRN): Social Determinants of Health (SDOH) Screenings in Clinics - How to Get Started.

All are welcome to attend! The content of this webinar may be most useful for clinics and public health departments who are at the beginning stages of implementing, or are thinking about implementing, SDOH Screenings. We will discuss:

• The OHA SDOH metric and why it is important
• OHA approved screening tools
• Data collection, screening workflow and reporting strategies
• Staff training resources
• Resources to provide to your patients
• Guest speaker Winding Waters Clinic will share their experience and lessons learned from doing SDOH screenings in their clinics the past few years
• Q and A’s

Date: Tuesday, June 25, 2024

Time: 12–1 p.m. Pacific Time

Location: Virtual meeting via Zoom. Register in advance for this meeting (required):

After registering, you will receive an email from Zoom containing information about joining the meeting. Any questions, or need accommodation(s) to meaningfully participate in the meeting? Please contact: Mikayla Briare at Mikayla.Briare@modahealth.com.

Technical assistance for colorectal, cervical and breast cancer screening and prevention

These programs aim to raise colorectal, cervical and breast cancer screening rates in primary care clinics by supporting evidence-based approaches in practices. Participating clinics will receive tailored technical assistance with quality improvement efforts related to colorectal, cervical and breast cancer screening with program activities taking place from July 2024 – June 2025. Clinics new to the program can receive up to $10,000 for participation in the screening project. It is sponsored by OHA in partnership with ORPRN, Kaiser Permanente Center for Health Research and Native American Rehabilitation Association of the Northwest (NARA).

To learn more, please contact Brittany Badicke at badicke@ohsu.edu.

EOCCO doula referral form now available

EOCCO has created a birth doula referral form for providers to refer patients seeking support during pregnancy or labor from a birth doula. Birth doulas offer personal, non-medical assistance to pregnant individuals and their families throughout pregnancy, childbirth, and postpartum. EOCCO will facilitate connecting patients with a birth doula in their area. For questions, please email THW@eocco.com.

Upcoming training opportunities: social emotional health for children ages 0-5

EOCCO and Greater Oregon Behavioral Health, Inc. (GOBHI) will be hosting two upcoming training sessions focused on social emotional health needs assessment and supporting children ages 0-5 and their families. These trainings will be sponsored by EOCCO/GOBHI (at no cost to the participants) and facilitated by the organization DC Zero to Three.

The training opportunities include:

1. Clinical training (3 days). For qualified mental health professionals who are (or would be) providing assessment, treatment planning, and service delivery for children ages 0-5.

• Dates: Oct. 28, 29 and 30, 2024, from 9 a.m. - 1 p.m. PST
• Maximum cohort size: 50 people

2. Overview training (4 hours). For qualified mental health associates, peer support specialists, leadership, administrators and support staff who are critical in supporting and developing the capacity to assess and work with children ages 0-5.

• Date: Nov. 7, 2024, from 9 a.m. - 1 p.m. PST
• Maximum cohort size: 60 people

If you any clinicians or staff are interested in participating in either of these training opportunities, please complete and submit the DC 0-5 training interest form. You will be contacted by GOBHI with additional information and next steps on registering for these trainings.

Veradigm risk coding for Medicare and ACA plan beneficiaries

What’s Your Type? Veradigm is offering a webinar on coding and documentation for diabetes and other endocrine disorders. Improve your practice’s submission of the most prevalent risk-adjustable condition and its associated manifestations. Learn documentation essentials for correctly coding juvenile onset diabetes, type I and II diabetes, secondary diabetes, and diabetes due to genetic defects or post procedure.

Please click the link below to register for a webinar time:

• Tuesday, June 25, 2024, at 5:30 a.m. PST
• Tuesday, June 25, 2024, at 9:30 a.m. PST
• Thursday, June 27, 2024, at 5:30 a.m. PST
• Thursday, June 27, 2024, at 9:30 a.m. PST

Use “Summit” as the Health Plan Partner code when registering for this webinar.

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