EOCCO September 2024 Provider Newsletter

EOCCO Clinics & Staff,

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

News From EOCCO:

• EOCCO's 2024 workshop
• Fraud, Waste and Abuse (FWA) provider training
• Billing reminder
• EOCCO Non-discrimination notice
• Expanded access to Sublocade is here
• 2025 Community Benefit Initiative Reinvestments (CBIR) applications - now open
• Upcoming training opportunities: social emotional health for children ages 0-5
• Branding migration notice: Livongo to Teladoc
• First tooth lunch and learn
• IET learning collaborative
• SEH learning collaborative

From our partners:

• Upcoming grand rounds
• Oregon DMAP enrollment verification

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's 2024 workshop

Please join us for our annual workshops in Eastern Oregon. We will be stopping throughout our territory to discuss all things Medicaid. These workshops are geared toward clinic front office and billing staff and referral and authorization coordinators. Topics covered will include:

• Member eligibility and plan types
• Prioritized list of covered services
• Referral and authorizations
• Claims
• Incentive measures, and
• Behavioral health

When and where:

• Monday, Oct. 28, 2024, 11:30 a.m. - 1:30 p.m., MDT.
  St. Alphonsus Medical Center. 351 S.W. Ninth St, Ontario, OR 97914.

• Tuesday, Oct. 29, 2024, 10:00 a.m. - 12:00 p.m., PST.
  St. Anthony Hospital. 2801 St. Anthony Way, Pendleton, OR 97801

Virtual options via Microsoft Teams:

• Oct. 30, 2024, 9:30 a.m. - 11:30 a.m., PST
• Oct. 31, 2024, 9:30 a.m. - 11:30 a.m., PST

A Microsoft Teams link will be sent out closer to the meeting date to those that register.
Click here for more information and to sign up for the workshops. If you need help or have questions, please do not hesitate to reach out to Noah Pietz (noah.pietz@modahealth.com) or Kelly Watanabe (kelly.watanabe@modahealth.com).

Fraud, Waste and Abuse (FWA) provider training

The Oregon Health Authority requires all CCOs to provide Fraud, Waste and Abuse (FWA) training to its providers on an annual basis. To help us meet that requirement, EOCCO has posted its provider FWA training on the EOCCO website. We are asking all clinics to review the training and complete and return the EOCCO Provider FWA Training Attestation to EOCCOCompliance@eocco.com.

Please note, if you have received this training through a provider workshop or other venue, you do not need to complete this process. If you have any questions, please contact EOCCO’s Compliance Officer, Nick Gross, at EOCCOCompliance@eocco.com.

Billing reminder

As a friendly reminder, all providers are required to submit a claim with all documented conditions or diagnoses for each service that you render to an EOCCO member. This includes members who may have primary insurance (regardless of if primary insurance has paid in full) and clinics who have entered into primary care capitation agreements with EOCCO. Providers are also required to review claim denials and submit corrected claims for services that denied due to billing errors.

For more information on billing please review our EOCCO Provider Manual and for Managed Care Entity (MCE) billing please visit OAR 410-141-3565. If you would like to schedule a meeting with our lead provider relations representative, please reach out to Noah Pietz at 503-265-4786 or eoccoproviderinquiry@modahealth.com.

EOCCO Non-discrimination notice

Just a friendly reminder that EOCCO’s non-discrimination policy and procedures notice can be found on the EOCCO website. You will be notified online anytime major updates are made to the document. EOCCO provides equal access to appropriate facilities, services and treatment for all members. EOCCO complies with all federal and state laws that pertain to member rights. EOCCO cannot treat people unfairly in any of our services or programs because of a person’s age, color, disability, gender identity, marital status, national origin, race, religion, sex or sexual orientation. For more questions regarding EOCCO’s non-discrimination policy or practices, please email EOCCOCompliance@eocco.com.

Expanded access to Sublocade is here

For our EOCCO providers, expanded access to Sublocade is here! EOCCO now covers long-acting injectable buprenorphine (Sublocade) under the pharmacy benefit for its members. Providers will now have the added option to obtain Sublocade through the member’s pharmacy benefit—with delivery of the medication directly to the provider’s office, in addition to obtaining it through buying and billing.

What is Sublocade? 

Sublocade is a prefilled syringe of buprenorphine that is injected by a healthcare provider once monthly. It works as a partial opioid agonist used for maintenance treatment of moderate to severe opioid use disorder in patients who have been initiated on buprenorphine-containing products.

Why has Sublocade coverage changed?

Previously, EOCCO did not cover Sublocade because it is required to be administered in-office by a healthcare professional. In a continuous effort to ensure members have access to safe, effective, and high-value medications, EOCCO updated coverage for Sublocade under the pharmacy benefit for its members. This change addresses the ongoing need for long-acting medication therapy options to treat opioid-use disorders.

How does this affect members?

Providers will no longer be required to buy and bill for this medication. While this remains an option, they can now also obtain Sublocade directly through the member’s pharmacy benefit. The drug will be directly delivered from a REMS-certified pharmacy to the prescribing provider’s office for administration. Since fewer steps are needed to obtain the medication, this means members have improved access to timely care.
Questions? We’re here to help. Click here to learn more about Sublocade prescribing information from the FDA or call our pharmacy customer service team at 888-474-8539.

2025 Community Benefit Initiative Reinvestments (CBIR) applications – now open

EOCCO is pleased to release the 2025 Community Benefit Initiative Reinvestments (CBIR) applications. Applications must be submitted to CBIR@ohsu.edu by Sept. 30, 2024. Applicants may apply for up to $50,000 and must be able to demonstrate how EOCCO members (also known as the Oregon Health Plan) directly benefit. Applications that are selected for funding should start in early 2025 and be one-year long.

There are three types of grant applications:

1. Transformation Application: These projects are aimed at specific incentive measures and opportunities for continuing projects from previous grant cycles.
2. Public Health Department Application: This application allows public health department to propose projects to improve the health and wellbeing of EOCCO members and their communities.
3. New Ideas Application: This application allows applicants to propose novel ideas focused on the topic areas outlined in the application form. Previous topic areas have included workforce strategies, new programs to engage EOCCO members, and new ideas to integrate or improve clinical services to members. This application reopens every six months.

Applicants are required to obtain free technical assistance (TA) as they develop their proposal. Click here for more information and to access the application forms.

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

EOCCO 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 (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 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.

Branding migration notice: Livongo to Teladoc

EOCCO’s Diabetes Self-Management (DSM) program vendor has rebranded, and the name has changed from Livongo to Teladoc Health, effective September 11, 2024. This program is available to members who experience Type I or Type II Diabetes and provides members with a blood glucose meter, unlimited test strips and lancets, as well as health coaching and support, all at no cost.

With this name rebranding, any patient who is currently enrolled in the DSM program will be automatically migrated over from Livongo to Teladoc. Teladoc will send an email to current enrollees to inform them of this change and any action to take.

If a member logs into the previous Livongo account after September 11th, they will be guided through the process of activating the new Teladoc account. If a member has previously enrolled with Livongo, their Livongo profile and data will automatically be securely migrated to their new account. Going forward, members will either use the Teladoc Health website or app for the DSM program. EOCCO materials will be updated to reflect the change from Livongo to Teladoc Health.

The new URL is TeladocHealth.com/Register and questions from members can be directed to Teladoc Health member support at 800-835-2362 (TTY: 855-636-1578).

First Tooth Lunch and Learn event

Please join EOCCO and Advantage Dental for our first ever First Tooth Lunch and Learn! Whether you have done a First Tooth training session in the past and just want a refresher or have not been trained yet, all are welcome to our virtual training session.

Topics will include:

• Education on oral health evaluations for the pediatric population
• Fluoride varnish application techniques
• Billing EOCCO for services
• An opportunity to connect with other clinicians about implementing the First Tooth workflow in your organization

When: Tuesday, Oct. 15, 2024

Time: 12 p.m. - 1:00 p.m. PST

Click here to register for this event! Please note that this training is eligible for CME Category II: 1 Hour
Please contact EOCCOmetrics@modahealth.com with any questions about this event.

IET learning collaborative

Join EOCCO 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.

Date: Tuesday, Nov. 5, 2024Time: 12:00 p.m. - 1:00 p.m. PST

Click here to register for this virtual learning opportunity on the IET incentive measure.

SEH learning collaborative

The Social Emotional Health (SEH) metric is currently a child-level metric that will be used to measure and incentivize improvements based on child-level receipt of clinically recommended behavioral health care services provided by CCO-contracted providers. Efforts will be focused on addressing social-emotional issues that have been identified.

Please join EOCCO and GOBHI for a SEH learning collaborative as we discuss the SEH metric! Topics will address Asset Map data, the 2024 and 2025 specifications, and engaging participants in conversation surrounding barriers and opportunities to improve SEH services across Eastern Oregon.

When: Tuesday, Nov. 12, 2024 from 12:00 p.m. - 1:00 p.m. PST.

Click here to register for this virtual event to learn more about the SEH metric! Please email EOCCOmetrics@modahealth.com with questions about this event.

Upcoming grand rounds

Please note that attendees do not need to register for these sessions. Click this link to join the grand rounds session you'd like to attend.

Call in option (audio only): 971-337-0188, Phone Conference ID: 655 101 639#

September Schedule

• Date: Fri, Sept. 20, 2024
• Topic: Inflammatory Bowel Disease Update
• Speaker: Mark S. Salem, M.D., Assistant Professor — Division of Gastroenterology, Department of Medicine, UCI School of Medicine

October Schedule

• Date: Fri, Oct. 4, 2024
• Topic: MAT (Medication Assisted Treatment) of Opioid Use Disorder in the age of fentanyl
• Speaker: Billie Cartwright, MHS, DBH, PA-C, and Emily Harvey M.D., Bestcare Treatment Services

• Date: Fri, October 11, 2024
• Topic: Menopausal Hormone Therapy - a "Hot" Topic
• Speaker: Kathryn Macaulay, M.D., Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego

• Date: Fri, October 18, 2024
• Topic: Exploring the Essentials of Endoscopic Ultrasound (EUS)
• Speaker: Courtney Walker, D.O., Interventional Gastroenterologist, St. Charles Healthcare

To watch previous Grand Rounds, please visit the St. Charles Health website.  Questions? Email cme@stcharleshealthcare.org

*Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Oregon DMAP enrollment verification

As most Oregon providers know, all providers must be enrolled in Oregon Medicaid DMAP in order to be eligible for payment. To avoid DMAP denials, we recommend verifying the enrollment status of any new providers joining your clinic using the resources listed below. Additionally, EOCCO advises checking providers' enrollment status 30–60 days after they receive an updated license to ensure continued enrollment.

For DMAP enrollment application status updates, visit the Oregon Health Authority Provider Portal. No log in is necessary and this site is updated live.

Click here to view the Oregon Health Authority's full list of active providers. Under the "Weekly Provider Files" section, click on the "Provider File without Tax ID". These files are updated every Tuesday morning.

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