This web page was created to support our partners in caring for our members. Our goal is to help create a better understanding of the Oregon Health Authority’s CCO incentive metrics and why they are important, assist with best practices and provide tips for meeting the metrics. These resources will help you and your clinic understand and navigate the OHA incentive metrics.
If you need additional assistance or support, please contact Denise Saboe at [email protected].
OHA Measure Specifications (English)
Tips for meeting this CCO metric:
Q: Do school-based health center visits count for this measure?
A: Yes. SBHCs that are part of a CCO’s provider network may be included in the measure if the SBHC bill/coding is submitted as a claim through the CCO. Visits must meet the requirements of a well-child visit and the documentation is available in the medical record.
Q: Does the patient need to be seen by their assigned PCP?
A: No. The provider does not need to be the assigned PCP. However, the provider must be a PCP per Oregon’s Primary Care Provider Types or an OB/GYN practitioner.
Q: If parents decline to have their child vaccinated, is the child excluded from the metric?
A: No. The child will remain in the denominator, but not the numerator.
Q: What immunization combination does this metric follow?
A: Combo 3 vaccine series.
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Q: Should a patient be screened at every visit?
A: The patient does not require a screening at every visit. If a patient’s smoking or tobacco use status is recorded at multiple visits, only the most recent screening, which has a documented status of smoking or tobacco use or non-use, will be used to satisfy the measure.
Q: Should I report cigarette smoking and/or tobacco use status completed in the prior year?
A: Yes. Any status recorded after Jan. 1, 2022, should be included. However, the recorded status cannot be older than 24 months.
Q: What are the recommended screening tools?
A: OHA does not require use of specific screening tools, only that screening tools are normalized, validated and age appropriate. Implementation of tools is at the provider’s or clinic’s discretion.
Q: Does the depression screening need to happen on the same day as the visit?
A: No. A depression screening performed 14 days prior to the encounter is accepted to allow alternative methods of screenings, such as pre-screenings within EHRs. However, follow-up plans for a positive initial screening must be documented on the date of the encounter.
Q: What score counts as a “positive” screening result?
A: The provider should interpret the age-appropriate screening tool to determine if the result is positive or negative. Where the screening tool includes guidance on interpreting scores, the provider should consult that guidance. There may be instances in which it is appropriate for providers to use their discretion in interpreting whether a result is positive or negative, such as for patient reporting use of topical medicinal marijuana.
Q: Are there any exceptions that would remove a patient from the denominator?
A: Patient reason — Patient refuses to participate.Medical reason(s) — Documentation of medical reason for not screening patient (e.g., cognitive, functional or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status).
Tips for helping IHN-CCO meet this metric:
A: Combo 2 vaccine series.
Q: Can “initiation of treatment” be on the same day as the new SUD diagnosis?
A: Yes, if the services are with different providers.
Q: Is methadone included in the medication lists for this Initiation and Engagement of Substance Use Disorder Treatment measure?
A: Methadone is not included in the medication lists for this measure because methadone for opioid use disorder does not show up in pharmacy claims data. However, methadone for opioid use disorder treatment does count as treatment for this measure and would be captured on medical claims.
Q: What is considered as “other drugs” in this measure?
A: Other drugs include cocaine, cannabis, methamphetamine, hypnotics, sedatives, inhalants, etc.
Q: How are initial SUD diagnoses identified (denominator)?
A: SUD diagnosis codes are identified using claims for services that occurred in the following visit types: outpatient, telehealth, intensive outpatient or partial hospitalization, non-residential substance abuse treatment facility, community mental health center, substance use disorder service, medically managed withdrawal (i.e., detoxification), emergency department, observation, acute or non-acute inpatient discharge, telephone, e-visit or virtual check-in, or an opioid treatment service.
Q: Is tobacco use included in this measure?
A: No. It is not considered one of the diagnosis codes that would qualify someone for this measure.
Q: What patients are not counted in the measure population (denominator)?
A: Patients who use hospice services or elect to use a hospice benefit any time during the year.
Patients with treatment for SUD diagnosis (other than an ED visit or medically managed withdrawal) in the 194 days before the episode.
Patients with a “SUD medication treatment dispensing event” or a “medication administration event” in the 194 days before the episode.
Q: If a provider writes a referral or prescription for a treatment intervention, will this satisfy the numerator?
A: No. The patient must actually receive the intervention treatment and a referral in the patient’s chart does not indicate the patient actually received that treatment. If the referral loop was closed, then the treatment the patient received would satisfy the measure.
Q: Is the patient excluded from the measure if they refuse intervention treatment?
A: No. The purpose of this measure is to educate patients on the importance of receiving intervention treatment for SUD to prevent further health problems.
Q: What is the timeframe for treatment to satisfy the measure?
A: Rate 1 – Treatment must be initiated (as an intervention or medication) within 14 days of the encounter in which the dependence was diagnosed.Rate 2 – There must be two additional interventions or medication for treatment within 34 days of the initiation visit (which should have taken place within 14 days of the diagnosis encounter).
Q: Do you need to meet both initiation and engagement rates to satisfy the measure?
A: Yes. Both the initiation and engagement rates must be met to achieve the measure.
Q: Do I have to use a screening tool to diagnose a patient with SUD for this measure?
A: No. A screening tool is not required to diagnose a patient with SUD. However, it is encouraged to use a standardized screening tool to assess patients’ substance use and abuse at least annually.
Q: Can I close a gap if the 14-day (initiation of SUD treatment) window has passed?
A: No. However, it is important for the provider to be proactive in their patients’ care.
Q: Can two engagement visits be on the same date of service?
A: Yes, but they must be with different providers in order to count as two events.
Note: An engagement visit on the same date of service as an engagement medication treatment event meets the criteria (there is no requirement that they be with different providers).
Q: If the initial visit was an inpatient discharge (or an ED/observation visit that resulted in an inpatient stay), is the inpatient stay considered an “initiation of treatment” and would the patient be compliant?
A: Yes. This would meet the measure for the initiation of treatment.
Q: If “initiation of SUD treatment” is an inpatient admission, when does the engagement period start?
A: The 34-day period for engagement begins the day after final discharge.
Q: Are clinics responsible for reporting?
A: IHN-CCO will work with clinics on collecting sources of interpretation data for reporting purposes. The data providers will need to collect is:
All data can be collected through the Provider Portal in the Interpreter Services tab.
Q: Do clinics need to proactively work on this measure?
A: Yes. Clinics should work to identify patients with language needs and schedule interpretation services with an OHA-certified interpreter or a provider who has passed a language proficiency test for their appointments.
Q: What are clinics responsible for?
A: Ensure each encounter for an interpreter service by an IHN-CCO member is documented in the provider portal with the essential data elements or in the member’s EHR using the proper EPIC tools.
Q: Why must CCOs and providers work with an OHA-certified or qualified interpreter to provide interpreter services?
A: Because of regulatory requirements listed in House Bill 2359, Oregon Revised Statutes 413.550 to 413.559 and Oregon Administrative Rule 410-141-3515(12)(a)-(g). Oregon Revised Statute (ORS) 413.552 findings conclude that Individuals with Limited English Proficiency or are deaf and hard of hearing are at higher risk of experiencing communication barriers within the health care system. The goal is to improve the quality of care, patient experience and health outcomes for Medicaid members with LEP or who are deaf and hard of hearing.
Q: How can I determine or verify that an interpreter is OHA-certified or qualified?
A: All OHA-approved interpreters have a badge that identifies their credentials (OHA-certified or qualified interpreter) and a unique six-digit registry number. You can easily find a health care interpreter through OHA on their health care interpreter registry list portal.
Q: What if a patient declines interpretation services or insists on using a family member?
A: Explain the process and benefits of using certified or qualified interpretation services. If a patient still declines, then document that services were offered and declined in the EHR and/or the provider portal.
Q: What if a provider or staff member (non-certified or qualified) is bilingual?
A: Explain the process and benefits of using certified or qualified interpretation services. If a member still declines, then document that services were offered and declined. Only services provided by bilingual staff or providers who are OHA-certified or who pass a provider language proficiency test will count towards this measure.
Q: How can I become an OHA-approved/certified or qualified interpreter?
A: Details on how to complete the OHA credentialing process, including language proficiency testing and required background checking information for the application process, can be found on OHA’s Equity and Inclusion website at oregon.gov/oha/OEI/Pages/HCI-Certification.aspx.
Q: Does OHA have a registry of certified or qualified interpreters?
A: Yes. By law, certified and qualified interpreters have completed 60 hours of required training, demonstrated language proficiencies, applied for and received certification or qualification letters and identification numbers from OHA. Interpreters who do not meet the above requirements are not approved by OHA and therefore not listed on the mandated state registry. The registry can be found on OHA’s website at hciregistry.dhsoha.state.or.us.
Q: Will a Pap test alone count for the postpartum care visit?
A: Yes. Although a Pap test alone does not count as a prenatal care visit, it is acceptable for the postpartum care measure.
Q: Will ultrasound and lab results count for the postpartum care visit?
A: Ultrasound and lab results alone are not considered a visit. They must be linked to an office visit with an appropriate provider in order to count for this measure.
Q: Will services provided by a dental hygienist count if they are not under supervision of a dentist?
A: Yes. Although the technical specifications state that “services provided by dental hygienists should only be counted when they are under supervision of a dentist,” the OHA does not adopt this requirement because administrative claims data generally does not indicate supervision between health care providers.
Q: Does a “first tooth visit” count as a preventive dental service?
A: Yes. CPT code 99188 (topical fluoride varnish) billed with a first tooth visit on a medical claim does count toward the metric numerator.
Q: Do telehealth visits count toward the metric?
A: Yes. This measure is eligible for telehealth/teledentistry. Some qualifying services such as D1310 ‘nutritional counseling’ and D1330 ‘oral hygiene instructions’ may be delivered in a teledentistry visit but are subject to provider’s determination as to whether required components can be provided equivalent to an in-person visit.
Q: How often is screening required?
A: A screening is required once during the measurement year. A screening is not required at every visit.
A: The approved OHA screening tools are located at oregon.gov/oha/HSD/AMH/Pages/EB-Tools.aspx. Q: Does a brief screen count toward the numerator?
A: A negative brief screen is numerator compliant. If a patient has a positive brief screen, then a full screen must be completed for numerator compliance.
A: The provider should interpret the age-appropriate screening tool to determine if the result is positive or negative. Where the screening tool includes guidance on interpreting scores, the provider should consult that guidance. This is the same approach used to identify positive or negative results for depression screening. There may be instances in which it is appropriate for providers to use their discretion in interpreting whether a result is positive or negative, such as for patients reporting use of topical medicinal marijuana.
Q: Does a referral to treatment need to be completed (patient actually saw the provider to whom the patient was referred)?
A: No. A referral to treatment is numerator compliant when the referral is made and documented in the electronic health record. It is not dependent on referral completion.
Q: What counts as a brief intervention? Is there a time requirement?
A: Brief interventions are interactions with patients that are intended to induce a change in a health-related behavior. They are short, one-on-one counseling sessions ideally suited for people who use substances or drink in ways that are harmful or abusive. Examples of brief interventions include assessment of the patient’s commitment to quit and offer of pharmacological or behavioral support, provision of self-help material or referral to other supportive resources. There is no required time limit for a brief intervention — a brief intervention of less than 15 minutes can count towards this measure.
A: Patient reason – patient refuses to participate.Medical reason(s) – documentation of medical reason for not screening patient (e.g., cognitive, functional or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status).
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