Provider News & Updates – December 2023

Home Provider News & Updates – December 2023

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Oregon Health Authority Promotes Provider-level Strategies to Increase Vaccination Among Children & Adolescents

Immunization Quality Improvement for Providers, known as IQIP, is the Centers for Disease Control and Prevention’s national Vaccines for Children, or VFC, provider-level immunization improvement program. Its purpose is to promote and support the implementation of provider-level strategies by identifying opportunities to help increase vaccination in children and adolescents. These strategies include:

Schedule follow-up or annual vaccination visits while the patient is still at the provider site.
Leverage immunization information systems functionality to improve immunization practice.
Give a strong vaccine recommendation based on the age of the child.
Strengthen vaccination communications.
Implement state or local public health priorities.

Benefits of IQIP include helping clinics meet Coordinated Care Organization incentive measures related to childhood and adolescent vaccination coverage, strengthening partnerships with other clinics in your community and OHA, streamlining immunization workflows, increasing patient satisfaction and a healthier community for our patients.

Providers who offer VFC at their clinics have free access to an Oregon IQIP consultant through the OOHA. Their contact information is provided below. Please refer to Oregon’s interactive VFC map for information on and locations of VFC-certified sites. This map includes clinics that also participate in the Vaccines Access Program and are VFC-certified sites that also offer vaccines to uninsured or underinsured adults through the program.

For more information about Oregon’s IQIP program, please contact any of the below:

Lauren Enciso, MPH
Oregon IQIP Consultant & Public Health Educator
Oregon Health Authority Public Health Division
[email protected]

OHA main helpdesk: 800-980-9431
[email protected]

To learn more about the IQIP program, please visit the CDC website.

If you have questions or require support, please email IQIP directly at [email protected].

Samaritan Choice Plans & InterCommunity Health Network Provide Maternity Case Management for At-risk Members

As part of the Oregon Health Authority’s Intensive Care Coordination program, known as ICC, Samaritan Health Plans provides a maternity case management program for pregnant women identified as being at risk for pregnancy-related complications, premature birth, behavioral health issues and prenatal hospitalizations.

Our case managers are experienced registered nurses, social workers and community health workers. At the time of enrollment in our Maternity Case Management program, we conduct an in-depth maternity assessment, provide ongoing prenatal education and collaborate with the member’s health care team to ensure that any gaps in care, behavioral health needs or educational opportunities are addressed. Additionally, our staff assists members in addressing obstacles to care, including housing, transportation and food insecurity. We help locate supportive resources in their community and ensure they understand the breadth of benefits provided by their health insurance. Care coordination is also available for low-risk pregnancies for members needing assistance navigating care and resources.

One feature of the ICC program is the Interdisciplinary Care Team. This team includes the member, provider representatives and engaged community partners. This group meets online via Teams at least once monthly and serves as a platform for consistent communication between the member, their health care providers and any community partners involved to facilitate the establishment, prioritization and achievement of patient treatment goals. These meetings reduce duplicative efforts and promote a comprehensive understanding of the member’s circumstances among the entire team. Our goal is to foster collaborative teamwork to ensure the best possible outcome for the patient.

This program is voluntary and members have the freedom to opt out at any time. Participation does not affect benefits available through InterCommunity Health Network Coordinated Care Organization or Samaritan Choice Plans. If you believe that one of your patients would benefit from SHP’s ICC program, please contact our Case Management team via email at [email protected] or by phone at 541-768-4877. Additionally, our primary fax number is 541-768-9766. For further information, we encourage you to visit our provider website at samhealthplans.org/Providers.

Oregon Health Authority Clarifies Vision Benefits Offered to InterCommunity Health Network CCO Members

Beginning Jan. 1, 2023, the Oregon Health Authority increased vision benefits for members of Oregon’s Coordinated Care Organizations. Vision providers should be aware of these benefit changes to better serve their patients’ vision care needs. InterCommunity Health Network CCO provides the vision benefits outlined below.

Individuals under age 21, pregnant adults and adults up to 12 months postpartum are covered for:

Routine and/or medical eye exams, as needed.
Corrective lenses and accessories, as needed.

Non-pregnant adults, age 21 and older are covered for:

Routine eye exams, not to exceed one every 24 months.
Medical eye exams, as needed.
Corrective lenses and accessories for certain medical eye conditions only.

Examples of medical eye conditions are aphakia, keratoconus or post-cataract surgery.

Clinical Practice Guidelines Developed & Adopted for Osteoporosis & Tobacco Cessation

Samaritan Health Plans develops and adopts evidence-based clinical practice guidelines, also known as CPGs. The CPGs are meant to assist providers in making decisions about appropriate health care for specific clinical circumstances. They are also intended to improve the quality and consistency of care provided to members. Each CPG developed and adopted by SHP is endorsed by a physician champion and adopted by SHP’s Quality Management Council.

The QMC recently adopted the following CPGs:

Osteoporosis guideline.
Tobacco Cessation guideline.

To review all CPGs, please visit the Care Management webpage and click the down arrow to view the Clinical Guidelines section. There you will find medical, behavioral health and dental health guidelines.

Medical Coverage Policies Reviewed, Updated for Outpatient Drug Testing & Applied Behavioral Analysis

In the absence of primary clinical criteria, Samaritan Health Plans develops medical coverage policies to communicate decisions about coverage and benefits for various medical services. Medical coverage policies are reviewed annually. SHP has reviewed and updated the following medical coverage policies:

Drug Testing in the Outpatient Setting policy.
Applied Behavioral Analysis policy.

To review all medical coverage policies, please visit Care Management webpage and click the down arrow to view the medical coverage policies section.

Important Updates & Reminders

Samaritan Advantage to Rename Two of Its Health Plans for 2024

Beginning in 2024, SHP will change the names of two Samaritan Advantage plans. Samaritan Advantage Conventional Plan will become Samaritan Advantage Valor and Samaritan Advantage Special Needs Plan will become Samaritan Dual Advantage. There will be no changes to group or ID numbers for members who are already enrolled in these plans and remain enrolled for 2024. Members will receive new ID cards prior to Jan. 1, 2024. However, if a member presents an ID card that has an old plan name, the billing information on the card can still be used to submit a claim.

Provider-Administered Drugs Now Authorized Through Optum Specialty Fusion

As of Aug. 1, 2023, all prior authorization requests for select outpatient and provider-administered specialty and oncology drugs must be submitted through the Optum Specialty Fusion platform. For more information, please visit samhealthplans.org/Authorizations. If you have questions or concerns regarding access to Optum Specialty Fusion or if you need assistance with troubleshooting the platform, please contact Optum’s Customer Care at 800-385-3593.