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Provider Digest | Volume 60

Date: 12/07/22

2023 $0 Immunizations on Part D Vaccines for Wellcare Medicare Members

Vaccines play an important role in protecting against disease during every stage of life, and we appreciate your partnership in helping our members stay healthy.

Starting Jan. 1, 2023, per the Inflation Reduction Act (IRA), adult vaccines covered by Part D and recommended by the Advisory Committee on Immunization Practices (ACIP) will be available at $0 for Wellcare By Health Net and Wellcare By Trillium Advantage members. Also, members will not be responsible for an administrative fee.

To improve vaccine access and member experience, please discuss any upfront charges with patients prior to administering Part D vaccines. Providers can process Part D vaccine claims electronically via TransactRx.

To learn more and see a list of some common Part D preventive vaccines covered by Wellcare at no cost, please view the Wellcare 2023 $0 Immunizations flyer.

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Due 12/15/22: Directed Payment Increase Survey Due for Trillium Medicaid Behavioral Health Providers

Effective January 1, 2023, the Oregon Health Authority (OHA) will implement four behavioral health directed payments (BHDP’s) within the CCO contracts that will further the goals and priorities of the Medicaid program. All Trillium Medicaid Behavioral Health/Substance Abuse providers will receive a minimum of a 15% rate increase with possible additional increases based on the four health directed payments:

  1. Tiered Uniform Rate Increase Directed Payment
  2. Co-Occurring Disorder Directed Payment
  3. CLSS Directed Payment
  4. Minimum Fee Schedule Directed Payment

So Trillium can provide the rate increases you deserve, we will be sending our Medicaid Behavioral Health / Substance Abuse providers a Directed Payment Increase Survey. The survey is expected to go out during the week of 12/5/22. Please complete the survey by 12/15/22 so we can send you an accurately calculated rate exhibit Amendment. If we don’t receive the completed survey by the due date, we will send you a rate exhibit Amendment with the standard rate increase of 15% effective 1/1/2023.

For more information, please review OHA's webpage about the Behavioral Health Rate Increase for Medicaid Providers.

If you have any questions, please contact your assigned Health Plan Provider Relations Representative.

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Oregon Health Authority's Health Care Interpreter Registry

We value your partnership in providing culturally and linguistically appropriate services for Trillium Medicaid members. If a member has limited English proficiency (LEP), is non-English speaking, has a hearing impairment, or requests an interpreter, providers must offer or arrange Health Care interpreter (HCI) and translation services for the member. This applies to all provider types, including physical, behavioral health, dental, and non-emergent transportation providers.

Trillium will pay for HCI services provided for Medicaid covered services. If the service is provided by qualified or certified staff, providers can bill Trillium by adding HCPC code T1013 to the claim. If the service is provided by Linguava or Passport, the subcontractors will bill Trillium for the service.

To find a qualified and certified health care interpreter, you can access the Oregon Health Authority's Health Care Interpreter Registry.

You can find more resources by visiting Trillium's Healthcare Interpretation and Translation webpage.

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RSV Guidance and Resources

Respiratory Syncytial Virus (RSV), influenza and other respiratory illnesses are surging in Oregon and throughout the country, especially among infants and young children.

The Western Regional Alliance for Pediatric Emergency Management (WRAP-EM) has compiled just-in-time clinical guidance for respiratory care of children for providers with limited pediatric experience, including High-Flow Nasal Cannula (HFNC) Protocols. Updates will be available at wrap-em.org.

You may also like to access these resources:

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Oregon Behavioral Health Loan Repayment Program

Oregon Health Authority's Behavioral Health Loan Repayment program provides tax-free grants to supplement the behavioral health workforce in underrepresented and underserved areas of Oregon.

Qualified participants will receive tax-free grants to repay qualifying undergraduate and post-graduate loan debt.

Applicants must be currently employed in behavioral health care. For more information on eligibility, visit the Behavioral Health Workforce Initiative web page.

Applicants are encouraged to apply as early as possible to allow time for follow-up requests from OHA.

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