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Provider Digest | Volume 107

Date: 01/03/24

Provider Education Webinars: Trillium and Wellcare Musculoskeletal Management Program

Effective February 1, 2024, Trillium and Wellcare are expanding their partnership with National Imaging Associates, Inc. (NIA)* to provide the management and prior authorization of a Musculoskeletal (MSK) Management Program.

This program includes prior authorization for non-emergent MSK procedures including: inpatient and outpatient hip, knee, shoulder, lumbar and cervical spine surgeries. This decision is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

Trillium, Wellcare and NIA welcome providers to attend an upcoming provider education webinar on the NIA MSK Management Program prior authorization process. You will only need to attend one of these educational sessions.

Please register for the session most convenient for you:

For more information, please view this MSK Management Program Provider Webinar Flyer (PDF) and the MSK Program Quick Reference Guide for Physicians/Surgeons (PDF).

Thank you for your partnership in helping our members stay healthy.

* Effective 1/20/2023, National Imaging Associates, Inc. is now a subsidiary of Evolent Health. Evolent Health and its affiliates and subsidiaries collectively referred to as “Evolent.”

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Information for Providers about Lead Testing and Lead Poisoning from Lane County Public Health

Humans have been working with lead, a useful but toxic substance, as far back as 3500 BC. Despite being “old news,” lead has been in the headlines recently.

  • In October 2023, Oregon reduced the lead reference level from 5 ug/dl to 3.5 ug/dl in recognition of the harmful effects of lead at very low levels.
  • In November 2023, the Biden Administration launched an initiative to replace all lead water lines in the U.S. within 10 years.
  • WanaBana, Schnucks-brand, and Weis-brand apple cinnamon fruit puree pouches have been recalled due to high levels of lead. Multiple Oregon children were identified with elevated blood lead levels linked to this product, and more may be found in the coming months.

The apple cinnamon fruit puree story is a dramatic reminder that lead is still in our community. Lead exposure is also unequal. Children living in lower income neighborhoods, which have a legacy of systemic disinvestment, are more likely exposed to lead. In Oregon about 40% of children are insured by the Oregon Health Plan (OHP), but make up 66% percent of elevated lead cases. Testing, and not simply screening, all children insured by OHP at 12 and 24 months is one strategy for addressing this disparity. It is also an OHP requirement.

In Oregon, especially in Lane County, lead testing rates in OHP children are far too low. In 2022, 25.71% of Oregon children insured by OHP were tested between 0 and 12 months. In Lane County, that number was 19.6%. We can do better! The clinical community has an important role to play in reducing harm from lead. There are multiple lead testing options, and offering a capillary or point of care test in clinic may be most convenient for many families. The recommendations from OHA in response to the ongoing fruit puree recall are helpful anytime:

  • Discuss product recalls with a parent and/or caregiver of children and perform a capillary or venous blood lead test on children who have or may have consumed recalled products.
  • Educate families to check their homes and discard any additional pouches of a recalled product.
  • Children with capillary blood lead levels at or greater than 3.5 ug/dl should have a subsequent test with a venous blood sample for confirmation.
  • Perform blood lead testing on all children at 12 and 24 months who are enrolled in the Oregon Health Plan.
  • Consider testing or recommend testing of older children, persons who are pregnant, or other family members who may have also consumed contaminated products since they are not directly marketed for children.

Reducing exposure to lead is an important public health issue and we would like to hear from you – what ideas do you have to increase lead screening rates? In addition, if you have questions about lead testing, please contact Teresa Roark, MPH, Community Health Analyst at teresa.roark@lanecountyor.gov.

Thank you for your partnership!

Patrick Luedtke MD, MPH
Senior Public Health Officer
Lane County Public Health

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NAMI Multnomah Classes & Training Opportunities

NAMI Multnomah, the Multnomah County affiliate for the National Alliance on Mental Illness, is offering a variety of classes and training opportunities in 2024, including:

Veteran Peer-to-Peer Class

Ending the Silence: A Training on Youth Mental Health

  • Information about warning signs, facts and statistics, steps to early intervention, tips on how to reach out and respond, and first-hand experience from a young adult who lives with a mental health condition
  • February 5, 2024
  • Staff who work with youth: 3:30-5:00 p.m.
  • Parents and families of youth: 6:00-7:30 p.m.
  • Online via Zoom
  • Register for Ending the Silence Training
  • Download the Ending the Silence flyer (PDF) for more information

For more classes, trainings and events, visit the NAMI Multnomah website.

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Clackamas County All: Ready Network: Gathering to Map the Positive

Do you use the Ages and Stages Questionnaire (ASQ) or conduct child development screening? Clackamas County's All:Ready Network is hosting a session to help us map the positive and provide insight into what can be improved. We would like to hear how you adapt the ASQ to support a family’s home culture and wisdom. Our discussion will help inform a series of cultural guidance tools for providers in the community and clinic to ensure proper referrals and diagnosis.

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New Circumcision Benefit for Trillium Medicaid Members

Trillium Community Health Plan is committed to collaborating with you to ensure access to high-quality healthcare for the Oregon Health Plan members we serve. As of January 1, 2024, Trillium is covering circumcision CPT codes 54150 and 54160. 

As always, Trillium members who are pregnant have access to Trillium's Start Smart for Your Baby® care management program. It is designed to customize the support and care members need for a healthy pregnancy and baby. This program is available at no cost to members. In addition, members can earn rewards by attending all of their prenatal and postpartum appointments and engaging with their Start Smart for Your Baby® Care Management team. You can find more information at our Start Smart for Your Baby® website.

Thank you for your partnership in helping our members stay healthy. If you have any questions, please contact your assigned Health Plan Provider Relations Representative.

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ADA and Healthcare Webinar Series

The Northwest ADA Center and the Oregon Health Authority are presenting a free 4-part webinar series on the Americans with Disabilities Act (ADA) and healthcare. 

This webinar series will help healthcare providers understand their rights and responsibilities under the ADA. These sessions will cover critical topics such as creating accessible environments, effective communication, reasonable modifications, and much more.

To learn more, visit the ADA and Healthcare Webinar webpage.

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