Home Provider News & Updates – March 2024

Provider News & Updates – March 2024

Mental Health Access Improvement Act Recognizes LPCs & LMFTs as Medicare Providers

On Jan. 1, 2024, the Mental Health Access Improvement Act closed the gap in federal law that prevented licensed mental health counselors from being recognized as Medicare providers. Under this act, both marriage and family therapists and professional counselors are now eligible to provide services to Medicare beneficiaries and receive reimbursement from Medicare. Please visit the American Association for Marriage and Family Therapy or the American Counseling Association for more information on becoming a Medicare provider.

Samaritan Health Plans looks forward to increasing access to mental health care services for Samaritan Advantage members. If you are interested in partnering with Samaritan Advantage Health Plans, please initiate the process by submitting a request using SHP’s Network Request form. If credentialing is complete, this could be as easy as just signing a new agreement! 

Providers who previously “opted out” of Medicare must cancel their opt-out status before joining the Samaritan Advantage network. To do so, submit a written notice to each Medicare administrative contractor to whom you submitted an initial opt-out affidavit. This notice must indicate that you do not want to extend the application of the opt-out affidavit for another
two-year period. Complete this action no later than 30 days before the end of your current two-year opt-out period. 

Once you have opted back into Medicare, you are eligible to join our network for Samaritan Advantage Health Plans.

InterCommunity Health Network CCO Develops Interpreter Services Resources for Providers

All providers contracted with InterCommunity Health Network Coordinated Care Organization are required to provide language access services, which includes interpretation and translation to people with limited English proficiency and persons who are deaf, hard of hearing or visually impaired. Interpreting services must be performed by certified and qualified interpreters. The interpreters may be on staff or scheduled through an IHN-CCO-approved vendor.

Samaritan Health Plans maintains an informative Language Services webpage packed with information and useful resources to support you in arranging interpreting services for your patients, as well as detailed information on how to report the required data. Please review SHP’s recent webinar for additional information on language access requirements, laws and reporting instructions.

SHP created several printable flyers for IHN-CCO providers and members that may be helpful as office staff and patients navigate this new requirement.

Providers are required to report each use of interpreting services to the state of Oregon. The following data is required for reporting:

  • Servicing provider.
  • Member’s first and last name.
  • Samaritan member ID number.
  • Date of service.
  • Visit type/care setting.
  • Type of interpretation provided (i.e., in person, telephonic, video remote).
  • Language interpreted.
  • If a provider who is fluent in the interpreted language is used (i.e., an “in-language” provider) and whether that provider passed a language proficiency test.
  • If the interpreter was certified or qualified by OHA and the interpreter’s OHA registry number.
  • If the member refused the interpreter services and the reason is for member refusal.

Three options exist to report interpreting services data. Please review the list of options below to determine which will work best for your office or situation:

  • Log in to SHP’s Provider Portal and select “Interpreter Service” from the main menu.
  • Utilize our contracted vendors who will report the data for you.
  • Create an EPIC report for interpreter services if your clinic uses this system and has this option built. All Samaritan Health Services providers will use this option.

If you have questions regarding the meaningful language access CCO metric, please contactIHN-CCO’s Quality and Population Health team at agottfried@samhealth.org, kwalsh@samhealth.org or the SHP Provider Relations team at SHPprovider@samhealth.org.

Samaritan Health Services Updates Epic System for New Language Access Reporting Requirements

Oregon Heath Authority’s permanent rules for House Bill (HB) 2359, which requires the use of OHA-certified or quali

Oregon Heath Authority’s permanent rules for House Bill (HB) 2359, which requires the use of OHA-certified or qualified health care interpreters, went into effect on July 1, 2022. In August 2022, Samaritan Health Services implemented an Epic feature to ensure all OHA-required elements can be provided in reporting. 

On Jan. 1, 2024, OHA modified several of the questions and answers that are now required to report. All Samaritan Health Services providers and staff who document in Epic should be using this method for reporting the use of interpreting services.

Updated questions and answers went live in Eic on Feb. 6. The changes are provided on the Epic Education Resources page and can also be found at the following links:

All SHS staff and clinicians are expected to document the following information when working with patients who are proficient in languages other than English, patients with low literacy skills and patients with disabilities: 

  • Interpreter needed (yes or no).
  • Usage of certified and qualified interpreters.
    • Each encounter needs to be captured with the interpreter ID number.
    • The name of the interpreter (first and last).
    • The language of the interpreter.
  • Usage of non-certified or non-qualified interpreters.
  • Modality of interpreter service (i.e., in person, telephonic,
    video remote).
  • If an provider who is fluent in the interpreted language is used (i.e., an “in-language” provider) and whether that provider passed
    a language proficiency test.
  • If the interpreter was a bilingual staff member.
  • If the member refused the interpreter services and the reason for member refusal.

For SHS technical assistance with this functionality, please contact theSamaritan Health Services providers who need technical assistance with this functionality can contact the Samaritan Information Service Desk at isservicedesk@samhealth.org or 541-768-4911.

Clinical Practice Guidelines Developed, Adopted for Heart Disease & Congestive Heart Failure

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:

  • Heart Disease Guideline.
  • Congestive Heart Failure Guideline. 

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

Medical Coverage Policies Reviewed, Updated for Multiple Applications

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:

  • Advanced Care Planning Policy.
  • Applied Behavioral Analysis Policy.
  • Computer Assisted Surgical Navigational Procedure Policy.
  • Cosmetic and Reconstructive Procedures Policy.
  • Coverage of Routine Care for Members Enrolled in Qualifying Clinical Trials Policy.
  • Drug Testing in the Outpatient Setting Policy.
  • Evaluation of New and Existing Technologies Policy.
  • Genetic Testing Policy.
  • Proprietary Laboratory Analyses Policy.
  • Psychiatric Sub-Acute Admission Policy.
  • Wireless Gastrointestinal Monitoring System (aka “SmartPill”) Policy.

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

Claims & Billing Tips to Improve Efficiency

Claims for Evaluation & Management Codes With Vaccinations
Practitioner evaluation and management office visits that include the administration of one or more vaccinations should be billed on a single claim when performed together on the same date of service. Services split into two or more claims will process with a “clinical edit” and disallow full reimbursement. Please bill modifiers, as appropriate, based on established coding guidelines. By billing these services together, both the provider and Samaritan Health Plans can avoid the additional administrative costs and reprocessing time associated with corrected claim submissions.

Attend the Q1 Provider Webinar

Register for one of Samaritan Health Plans’ quarterly provider webinars to receive provider-related updates and information from SHP and IHN-CCO. If you would like to attend but did not receive an invitation, please email shpprovider@samhealth.org for an invitation to the current session. To ensure receipt of future webinar invitations, please sign up for Provider News at samhealthplans.org/Subscribe.

When: April 3, from 10 to 11 a.m. and April 4, from 1 to 2 p.m.

Where: Virtual Teams meeting.

Lead topic: Understanding Medicare Advantage and Part D star ratings and your role as a provider.

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