Practice Tactics
2026 Prior Authorization Timeline Changes
Beginning Jan. 1, 2026, turnaround timelines for standard medical and behavioral health prior authorization requests will decrease to seven days. A 14-day extension may be applied when additional information is needed to complete the determination. These changes are designed to support timely access to care while ensuring appropriate clinical review.
HRSN Benefit and Process Changes for 2026
Beginning Jan. 1, 2026, several updates will take effect for Health-Related Social Needs (HRSN) benefits. These changes adjust timelines, benefit names, application requirements, and clinical eligibility. The goal is to ensure members with the highest needs receive timely support.
Turnaround Timelines
The standard processing time will decrease to seven days. A 14-day extension may be approved when additional documentation is required.
Benefit Name Changes
To improve clarity for members and providers, HRSN benefits will receive updated names:
- HRSN Climate will be renamed Home Changes for Health.
- HRSN Home Modifications/Remediations will be renamed Home Changes for Safety.
Application Requirements
Requests for rent or utility support must include:
- Completed application forms
- Income verification for all adults in the household
- A signed lease agreement
Incomplete requests will be dismissed, and members will be notified.
Eligibility Requirements
Applications will no longer be accepted by fax. Submissions may be delivered by email or in person.
Clinical eligibility criteria will be tightened to prioritize members with the greatest needs.
Advance Directives: OAR Requirements and UHA Policy
Providers must follow Oregon Administrative Rules (OARs) and UHA policy to consistently collect, document, upload, and share advance directives. At each new encounter and at regular intervals, providers must confirm whether a patient has an advance directive, store the most current version in the EHR, and ensure that it follows the patient during transitions in care. Valid directives must be honored or, if a provider cannot comply, the patient must be transferred without delay.
OAR Requirements for Advance Directives
Offer Written Information
Providers must offer written advance directive information to adult patients and document whether the patient accepts or declines the materials.
Document Status in the Medical Record
The medical record must reflect one of the following:
- A completed advance directive
- A documented refusal
- A note that materials were offered
- A request for more information
Honor Valid Directives
Providers must follow valid directives unless a legal exception applies. If unable to comply for ethical, policy, or personal reasons, the provider must arrange a timely transfer or reassignment.
Share Information During Transitions
When patients are admitted, transferred, or discharged, providers must share the most recent advance directive or document that no directive is available.
UHA Policy Expectations for Care Coordination
Ask, Document, and Upload
Providers should ask about advance directive status at each new patient encounter and at regular intervals. Copies must be uploaded to the EHR in a location accessible to the entire care team.
Support Patient Understanding
Providers should explain advance directives in simple language and allow time for questions. The intent is to support informed, unpressured decision-making.
Coordinate Across Settings
The most current directive must accompany the patient during transfers, admissions, discharges, or referrals to prevent gaps in communication.
Resolve Conflicts Promptly
If a directive conflicts with the proposed treatment plan, providers should communicate quickly with the patient or surrogate. Care coordination or case management teams may be consulted to resolve concerns.
Promote Consistency and Respect
Advance directives are essential clinical documents. All UHA-contracted providers should know where they are stored in the EHR, how to verify them, and how to follow them.
Workflow Best Practices for Providers
- Ask early and revisit the discussion during major health changes.
- Keep copies updated, legible, and easy to access.
- Clearly flag changes or updates in the record.
- Involve care coordination when situations are unclear.
- Encourage patients to review directives with family or chosen decision-makers.
Why Advance Directives Matter
Advance directives help ensure that patients receive care that reflects their values and priorities when they cannot communicate their wishes. They reduce confusion, prevent unwanted treatment, and support smooth communication between clinics, hospitals, long-term care facilities, and behavioral health partners.
UHA care coordination staff can assist with patient questions or transition planning. Updated templates and patient handouts are available upon request.
Support and Resources
Phone: 541-229-4842
Email: casemanagement@umpquahealth.com
2025–2026 Benefit Plan Updates
Several benefit plan changes will take effect between November 2025 and January 2026. These updates include code additions, code terminations, and revised prior authorization requirements for specific services.
Effective Nov. 24, 2025
J0736 – Injection, clindamycin phosphate, 300 mg
Prior authorization is no longer required for any provider.
J0737
Prior authorization is no longer required for any provider.
S0077 – Injection, clindamycin phosphate, 300 mg
This code has been removed from the benefit plan because it was terminated on June 30, 2023, according to HCPCData.com.
Effective Dec. 1, 2025
97151 – Behavior Identification Assessment
No prior authorization required.
H0020 – Alcohol and/or Drug Services; Methadone Administration and/or Service
No prior authorization required.
Effective Jan. 1, 2025
PT/OT/ST Visit Limits
Beginning Jan. 1:
- Non-EPSDT members may receive 8 visits per calendar year without prior authorization (in network, with above-the-line diagnosis).
- EPSDT members may continue to receive 30 visits per calendar year (in network, with above-the-line diagnosis).
- All below-the-line diagnoses and out-of-network providers require prior authorization.
THW Connections Corner
2025 THW Program Progress and 2026 Goals
CY2025 marked major progress for the Traditional Health Worker (THW) Program in Douglas County. UHA expanded THW capacity across all worker types, with the greatest growth in community-based settings. The program strengthened local partnerships, increased utilization, and built the foundation for continued advancement in CY2026.
Key Accomplishments in CY2025
- Launched the Health System Learning Collaborative.
- Established the Douglas County THW Advisory Group.
- Developed and distributed the THW Integration and Utilization (I&U) Survey.
- Expanded the THW network through foundational training and use of the legacy clause.
- Increased THW utilization in community-based settings.
- Improved communication through newsletter contributions and the creation of a THW-specific newsletter.
- Formed a community workgroup to develop foundational training curriculum
Goals for CY2026
- Strengthen community-building efforts within the THW provider network.
- Implement a THW satisfaction survey for members.
- Explore value-based initiatives that connect THW work to quality measures.
- Improve response rates for the THW I&U survey.
- Explore contracting and payment models that better support community-based THWs.
- Develop and submit the THW foundational curriculum to OHA for approval.
- Continue CY2025 initiatives, including the THW Advisory Group and the Health System Learning Collaborative.
CME for Thee
Winter 2026 Oregon ECHO Programs
The Oregon ECHO Network offers interactive, case-based education for healthcare professionals across the state, using the “All Teach, All Learn” model to build clinical skills and community connection. Programs are offered at no cost and include free continuing medical education (CME) credits.
Why Participate
The ECHO model helps providers:
- Improve care for patients with complex conditions
- Earn no-cost CME credits
- Build community with peers across Oregon
- Receive support and guidance on challenging cases
Winter 2026 ECHO Programs
- Adult Mental Health II
- Autism and ADHD in Adults
- Social Needs
- Pharmacological Weight Management in Primary Care
- Alzheimer’s and Beyond: Advancing Dementia Care
- Palliative Care in Primary Care
- Chronic Pain and Opioids
- Foundations of SUD Care II
- Substance Use Disorder Prevention and Early Intervention
- Substance Use Disorders in Emergency Departments
- Pain Management and SUD in Dental Settings
Communities of Practice (ongoing):
- Psychiatry
- Hepatitis C
- Addiction Medicine
Register Now
Providers can pre-register or learn more:
OHA Health Care Interpreter Rule Changes
The Oregon Health Authority’s Health Care Interpreter Program will host a one-hour webinar on January 15, 2026, to review recent rule changes, available resources, and updates to the statewide interpreter registry. The session includes a panel discussion featuring health care providers and certified health care interpreters.
This webinar is designed for health care providers who work on language access, interpreter coordination, or compliance with interpreter service standards.
Event Details
Date: January 15, 2026
Time: 7:30–8:30 a.m. PT
Format: Virtual (Zoom)
Registration:
Hosted by: OHA Health Care Interpreter Program
Program Contacts
For questions about the webinar or the OHA Health Care Interpreter Program, contact:
Clinical Corner
New Guidelines for Evaluating and Managing Gastroparesis
The American Gastroenterological Association (AGA) has issued updated, conditional recommendations for evaluating and managing gastroparesis. This summary highlights key diagnostic and treatment guidance based on low- and very-low-certainty evidence.
Background
Gastroparesis is characterized by nausea, vomiting, early satiety, and delayed gastric emptying. Symptoms may overlap with other gastrointestinal disorders, and treatment options remain limited. The new AGA guideline provides clinicians with practical recommendations to standardize evaluation and management.
Key Evaluation Recommendations
- Rule out mechanical obstruction with upper endoscopy.
- Use a 4-hour gastric emptying study as the preferred diagnostic test.
- Avoid 2-hour gastric emptying studies, which are less accurate.
- Review the medication list for agents that impair gastrointestinal motility.
- Consider as-needed antiemetics for symptom control.
- Optimize glycemic control in patients with diabetes mellitus.
First-Line Pharmacologic Treatment
The guideline supports two first-line medications and provides practical prescribing guidance. All recommendations are conditional and based on low or very low certainty.
Metoclopramide
- Can be used as first-line pharmacologic treatment.
- Discuss possible adverse effects, including tardive dyskinesia.
- Evaluate effectiveness at 4- to 8-week intervals.
- Attempt drug holidays every 8 to 12 weeks when possible.
Erythromycin
- May also be used as a first-line treatment.
- Prescribe liquid formulations (40–150 mg orally before meals).
- Avoid tablet formulations, which are only available in higher doses.
- Because tachyphylaxis is common, consider drug holidays such as 3 weeks on and 1 week off.
Medications Not Recommended as First-Line
The guideline advises against the routine first-line use of the following agents, although they may be appropriate in select clinical scenarios:
- Domperidone
- Prucalopride
- Aprepitant
- Nortriptyline
- Buspirone
- Cannabidiol
This summary is based on:
- Staller K et al. AGA clinical practice guideline on management of gastroparesis.
Gastroenterology. 2025 Oct;169:828. - Brett MS. New Guidelines for Evaluating and Managing Gastroparesis, summarizing Staller K et al. in Gastroenterology, October 2025.
Advanced Illness Care Through Housecall Providers
Umpqua Health is partnering with Housecall Providers to offer enhanced support for members living with serious or advanced illnesses. This service complements the care members already receive from their primary care and specialty teams.
Housecall Providers is a nonprofit health organization with nearly 30 years of experience delivering in-home medical care to individuals who are medically complex, homebound, or unable to access traditional care settings.
About the Advanced Illness Care Program
The Advanced Illness Care (AIC) program provides specialized, person-centered support to help members manage complex health conditions. The program focuses on reducing symptom burden, improving comfort, and helping patients maintain the highest possible quality of life.
Eligible members may receive home visits or phone consultations at no cost. The AIC team works closely with the member’s existing providers to ensure communication, coordination, and alignment with the individual’s goals of care.
Care Team
The multidisciplinary AIC team includes:
- Nurses
- Social workers
- Community health workers
- Spiritual counselors
This team-based approach addresses clinical, emotional, practical, and spiritual needs that commonly arise with advanced illness.
What the Program Offers
Members enrolled in the AIC program may receive:
- Pain and symptom management
- Guidance on disease progression, medications, and treatment options
- Counseling and emotional support
- Care coordination with the member’s PCP and specialists
- Support that may reduce emergency department utilization
- Assistance identifying resources for patients and caregivers
The program does not replace existing care. It adds an additional layer of support for members and families who need it most.
Eligible Conditions
AIC is appropriate for members with serious or progressive illnesses, including:
- Cancer
- Heart disease
- Liver or kidney disease
- Chronic lung disease (such as COPD)
- Neurologic disorders (such as Parkinson’s disease or ALS)
- Immune-related conditions (such as HIV/AIDS)
- Other chronic or advanced conditions
How to Refer
Providers may refer members by submitting an Advanced Illness Care Referral Form.
Learn more at: Umpqua Health Palliative Care Services
Community Announcements
No announcements this month.
Network News
Umpqua Health Alliance Network Changes
Termed Providers
The following providers have been removed from the Umpqua Health Alliance network:
| Provider Name | Facility | Termination Date |
| Gordon Hodges, CSWA | Adapt Integrated Health | 10/24/2025 |
| Caitlin Van Wagenen, CSWA | Adapt dba Compass Behavioral Health | 11/05/2025 |
| Lori Hart, PMHNP | Centennial Medical Group | 10/22/2025 |
| Lorraine Matice, CHW | Centennial Medical Group | 10/03/2025 |
| Malori Dixon, LPC | Adapt Integrated Health | 11/04/2025 |
| Jeremy Holst, QHMA-I | Adapt Integrated Health | 11/06/2025 |
| Linda Deacon, MD | PeaceHealth | 10/29/2025 |
| Yanting Rambow, CRNA | PeaceHealth | 11/07/2025 |
| Sonya Byrd, QMHP | Adapt Integrated Health | 11/14/2025 |
| Michael Rodgers, CRM | Adapt Integrated Health | 11/10/2025 |
| Nathan Hamm, DMD | Hamm Dentistry, LLC | 08/10/2024 |
| Mark Hamm, DMD | Hamm Dentistry, LLC | 08/10/2024 |
New Providers
The following providers have joined the Umpqua Health Alliance network:
| Provider Name | Facility | Effective Date |
| Judy Black, MD | Evergreen Family Medicine | 07/14/2025 |
| Matthew Stark, PAC | Evergreen Family Medicine | 03/04/2025 |
| Ethan Burdman, PAC | PeaceHealth | 10/27/2025 |
| Tiffany Cordova, LCSW | PeaceHealth | 10/27/2025 |
| Ashley Sweeney, NP | PeaceHealth | 10/17/2025 |
| Judy Gabehart-Geant, LPC | Adapt Integrated Health | 11/11/2025 |
| Amber Gray, LPC | Adapt Integrated Health | 11/17/2025 |
| Kira Lathrop, LPC | Adapt Integrated Health | 11/11/2025 |
| Katrina West, PCA | Adapt Integrated Health | 02/12/2025 |
| Rachel Ochoa, RN, QMHA-R | Adapt Integrated Health | 11/13/2025 |
| Rachael Fowler, QMHP-R | Adapt Integrated Health | 09/15/2025 |
| Kelsea Knee, QMHA-R | Adapt Integrated Health | 10/13/2025 |
| Megan Locker, QHMA-R | Adapt Integrated Health | 09/24/2025 |
| Calvin Burch, PSS-YS | Adapt Integrated Health | 10/13/2025 |
| Chandra Faison, QMHP-R | Adapt Integrated Health | 05/12/2025 |
| Heather Robinson, PCA | Adapt Integrated Health | 11/03/2025 |
| Kimberly Smith, QMHP-R | Adapt Integrated Health | 10/29/2025 |
| Kayla Kelly, RN | Adapt Integrated Health | 08/13/2024 |
| Carolyn Starnes, RN | Adapt Integrated Health | 04/07/2025 |
| Cassidy Koehler, RN | Adapt Integrated Health | 10/10/2025 |
| Julie Bearup Wyatt, RN | Adapt Integrated Health | 09/10/2025 |
| Stephanie Bueckert CRM | Adapt Integrated Health | 10/01/2025 |
| Lynn Hill, PSS-AMH, PSS-AA | Adapt Integrated Health | 10/13/2025 |
| Ralph Morones, PSS-AA, PSS-MH | Adapt Integrated Health | 10/13/2025 |
| Obadiah Watkins, QMHA-R | Adapt Integrated Health | 06/09/2025 |
| James Wells, CRM | Adapt Integrated Health | 12/09/2024 |
| Holly Yellowhammer, QMHP-R | Adapt Integrated Health | 12/16/2024 |
| Kari Carey, RN, QMHP-R | Adapt Integrated Health | 09/24/2025 |
| Angela Christianson, PHARM | PeaceHealth | 10/09/2025 |
| Jodi Nelson, PHARM | PeaceHealth | 06/10/2025 |
| Jennifer Walker, PHARM | PeaceHealth | 06/03/2025 |
On the Lookout
New Evidence on Vaping and Pregnancy Risks
Until recently, data on the effects of vaping during pregnancy—particularly the impact of nicotine-free e-liquids—was limited. A new murine study published in October 2025 offers important early evidence on potential developmental and neurocognitive harms.
The study examined in-utero exposure to e-cigarette vapor (both nicotine-containing and nicotine-free) and followed offspring from birth through early adulthood.
Key findings included:
- Offspring exposed in utero to both nicotine and nicotine-free e-liquids demonstrated increased weight gain, memory impairment, and behavioral challenges.
- Brain tissue analyses showed neuroinflammation, advanced cellular senescence, reduced SIRT1, and elevated beta-amyloid and NADPH oxidase 1—markers linked to oxidative stress and pathways associated with neurodegenerative disease.
- Exposure to nicotine-free e-liquid alone produced significant effects, challenging assumptions that “nicotine-free” vaping is a safer alternative during pregnancy.
- Device power and heat settings mattered: higher-power exposures (30 W) produced greater impairment compared with lower-power settings (5 W), suggesting that heating intensity may play a critical role in toxicity.
While this research was conducted in a murine model and cannot be directly generalized to humans, it adds to a growing body of evidence highlighting potential risks of vaping—nicotine-containing or not—during pregnancy.
As the authors conclude:
“We should not assume that vaping during pregnancy is either ‘safe’ or even ‘safer’ than smoking until we understand the long-term effects to both users and those indirectly exposed, such as in utero exposure during pregnancy.”
Read the full study:
Mills A, Corbin D, Dakhallah D, Chantler PD, Olfert IM. Nicotine influence on cerebrovascular and neurocognitive function with in utero electronic cigarette exposure. J Physiol. 2025. https://doi.org/10.1113/JP289175
Dental Digest
Top Causes of Vision Problems in Children
School-based vision screenings can help identify children who may have vision problems, but they do not provide a complete evaluation of eye health. Comprehensive eye exams with an optometrist are recommended to detect and address conditions early.