Help us Bust Barriers!
Providers can play a critical role in helping identify barriers preventing youth and families from achieving their full potential. Umpqua Health Alliance and the System of Care are actively seeking regular input from providers in identifying barriers affecting youth and families with the goal of resolution. Barriers can manifest in any area of life. If there is a barrier interfering with members’ health, we want to hear from you. Often members are hesitant to advance their concerns. Unfortunately, this can result in barriers going unresolved. The Barrier Submission Form is our mechanism to identify barriers and work towards a resolution. The Barrier Submission Form and Barrier Submission Process can be found on UHA’s website. It may be submitted by any provider or member, anonymously if preferred. For those of you who have already submitted a Barrier Form, we thank you for helping us identify areas where we can provide assistance to our members and the community.
Psychological Evaluation Prior Authorization Updates
Umpqua Health Alliance (UHA) is utilizing the InterQual clinical criteria set for psychological evaluation. While this is not a new practice, we are applying the criteria in a more consistent and thorough manner. The criteria are more stringent than providers are accustomed to, which is why we have developed a form (UHA Psychological Evaluation Request Form) found on UHA’s website to help guide providers in submitting a referral. The form mirrors the criteria set found in InterQual and if completed fully, will facilitate a smooth referral and greatly enhance the probability of approval.
We have worked with Oregon Health Science University’s (OHSU) Eugene Child Development Resource Center (CDRC) in developing a workflow to ensure a good process in place prior to implementation. How will it work?
• Providers will need to submit the UHA Psychological Evaluation Request Form along with the CDRC referral form.
• The CRDC will then request Prior Authorization (PA) from UHA including the UHA Request Form before moving forward with the referral.
This will allow CDRC to receive prior authorization before they reach-out to the member, minimizing any problems that might otherwise interfere with treatment. Ultimately, this will shift practice to align with best practice, which calls for coordination between primary care and behavioral health throughout the process and a detailed request resulting in better care for the member. Additionally, our Care Coordinators will work with the CDRC and the referring provider on PA’s that are denied to reduce the occurrence of care being denied due to inadequate documentation.
Behavioral Health Referral Matrix Weekly Report
Umpqua Health Alliance (UHA) recently engaged contracted Behavioral Health Providers to collect specific information to create a referral tool. The goal was to provide key information necessary to facilitate behavioral health referrals to providers that best match member’s needs. The referral matrix illustrates the following information: ages accepted, diagnosis treated, services provided, languages spoken, cultural and linguistic considerations, practice location/hours, and ADA accessibility. The Behavioral Health Referral Matrix is available on UHA’s website for members and providers. At the same time UHA re-launched weekly access reporting in the form of a stop-light style report. The combined report is called the BH Referral Matrix Weekly Report and is disseminated directly to providers via email as well as circulated internally within UHA. The current practice is for behavioral health providers to indicate their availability to assess members. Providers can select: Assessment ≤ 7day, Assessment >7, Waitlist, or Closed to Referrals. The information is collected Friday through Monday morning and the report is published on Monday afternoons. This tool is a key component in ensuring members receive the right care, at the right place, at the right time. The hope is that providers will utilize this tool to refer members to in-network behavioral health providers who have skill-sets that match the member’s needs.
You asked, we answered: UHA pharmacy drug coverage changes are now posted online
The UHA formulary (list of covered drugs) and prior authorization (PA) guidelines are updated at least quarterly based on recommendations from the UHA Pharmacy and Therapeutics committee. This committee is composed of physicians and pharmacists from UHA and the community. At the request of some of our providers, we have added a document to the UHA pharmacy website that contains all updates made to the UHA formulary and PA guidelines since January 1, 2020. This document, along with our formulary and PA guidelines, will be updated quarterly and the current versions are posted on the UHA Pharmacy Services webpage: https://www.umpquahealth.com/pharmacy-services/.
UHA is seeking a Physician or other Provider from the community to fill a vacancy in our Pharmacy and Therapeutics Committee
The UHA Pharmacy and Therapeutics (P&T) Committee is a 6-member volunteer, advisory committee of physicians and pharmacists. The mission of the Committee is to encourage safe, effective, and innovative drug policies that promote high value medications for patients served by UHA. Among the key responsibilities, the Committee performs drug use review, determines which drugs and restrictions should be included on our formulary (list of covered drugs), and advises UHA on development and application of criteria and standards for coverage. P&T recommendations are based on evaluation of the available evidence on safety, efficacy and value of prescription drugs. The Committee meets quarterly for two hours and has an option for remote Webex participation. Committee participants are compensated for the time required to attend the meeting and review the materials prior to the meeting. To apply, please contact the Committee Chair, Robin Traver at email@example.com.
Updated Telehealth Appendix
With all of the uncertainty and changes that are happening during this time, UHA is doing their best to provide our panel with resources to answer some of the billing questions. UHA had previously released a telehealth appendix in the SPECIAL EDITION PROVIDER NEWSLETTER – CORONAVIRUS #3 to give some guidance on code coverage and billing requirements. Since this release, UHA has expanded the coverage of telehealth due to the COVID-19 outbreak. The Health Evidence Review Commission (HERC) guidelines have expanded the coverage of audio, video, telephonic, and online services between providers and patients. This includes evaluations, assessments, and consultation office visits. OHA has released an announcement regarding their coverage of telehealth services. For more information, visit their website at https://bit.ly/OHPTelehealthServices.
Please see the most recent telehealth appendix uploaded here: https://www.umpquahealth.com/claims/
More on Psychological Evaluation Tools
As the complexity of psychological practice increases and the reciprocal involvement between psychologists, behavioral health providers, and primary care broadens, the need for guidelines to educate the profession, the public, and the other interested parties regarding desirable professional practice in psychological evaluation matters continues to increase. Guidelines for psychological evaluation criteria are aspirational in intent. They are designed to facilitate the continued systematic development of the profession and to aid in supporting both a higher degree of professional interfacing between providers and simultaneously increase access to specialized services for individuals with the most complex cases.
The development of psychological evaluation criteria seeks to better understand the case-specific questions that testing is anticipated to answer and how it will inform future treatment modalities and interventions while ensuring that alternative resources have been exhausted prior to referral. Psychological evaluation criteria are not intended to be exhaustive and may not be applicable to every professional situation. They are not definitive and they are not intended to take precedence over the judgment of psychologists or other providers who refer for specialized psychological services. The specific goal of the development and implementation of psychological evaluation criteria is to promote proficiency in obtaining psychological expertise when referring patients, ensuring these specialized services are available and accessible to those with the most complex and difficult-to-treat cases.
The following structured instruments are examples of documentation that could be submitted to support the referral: MINI-KID, ADIS, K-SADS, P-ChIPS, DISC, SCID, MINI, SADS. Additionally, a behavioral health assessment related to the presenting symptoms may also be accepted.
Douglas Public Health Network officials are working to address COVID-19 in Douglas County.
Click: http://douglaspublichealthnetwork.org/ for information on how to keep up with the latest local news related to coronavirus, and be sure to request their expanded daily report of COVID-19 related news to be sent to your inbox.
COVID-19 Informational sessions for all health care providers
OHA’s Chief Medical Officer, Dana Hargunani, M.D., will host regular information sessions for Oregon health care providers. Calls are moving from every Tuesday to the 1st and 3rd Thursdays of each month from 12-1 p.m. for as long as needed. See registration links below:
Registration for future Thursdays will be added at https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/DISEASESAZ/Pages/COVID-19.aspx
COVID-19 Response ECHO for Oregon Clinicians – Part II
Sessions will support clinicians, staff and other healthcare professionals looking at Oregon’s response to the pandemic, the state of the science in treatment and prevention, and offer guidance to practices for systems change. Sessions will take place the 2nd and 4th Thursdays of each month from 12-1:15 p.m. from June 11 through September 24.
Oregon clinicians are cordially invited to participate in the second cohort of the COVID-19 Response ECHO for Oregon Clinicians, sponsored by the Oregon ECHO Network. To register, visit: https://connect.oregonechonetwork.org/Series/Registration/278. See attached flyer for additional information
Medications for Alcohol and Drug Use Disorders 101: The Science of Medication Treatment
Date: June 9, 2020
Time: 1:00 pm – 2:00 pm EDT
Presenter: Laura Habighorst, BSN, RN, CAPA, CGRN, Surgical Services Clinical Nurse Educator, North Kansas City Hospital (NKCH)
Target audience: This webcast was developed for judges—whether presiding over state, municipal, general jurisdiction, treatment/specialty courts and/or whether they are law trained or not.
About the webinar: Alcohol and drug use disorders are associated with criminal behavior, arrest, and incarceration. Effective treatments are needed to reduce the burden of alcohol and drug use disorders on public safety and on the public health. Fortunately, there are three medications (Antabuse, acamprosate, and naltrexone) that are FDA-approved for the treatment of alcohol dependence and three medications (methadone, buprenorphine, and naltrexone) that are approved for the treatment of opiate dependence [Learn More].
MAT Waiver Training for APRNs Updated
PCSS has updated its waiver training for Advanced Practice Registered Nurses (APRN)! APRNs are required to take an eight-hour waiver course and an additional 16 hours of training. The 16-hour portion now includes audio recordings. PCSS has also made updates to its eight-hour MAT waiver trainings. The following nurses are eligible to take the waiver training to prescribe buprenorphine for the treatment of opioid use disorder: NP, CNM, CNS and CRNA.
For more information about all of PCSS’s waiver trainings, go to http://www.pcssNOW.org
Two new MAT Waiver Training Options for Emergency Physicians
PCSS now offers two options specifically created for emergency physicians who want to obtain a waiver to prescribe buprenorphine, one of three FDA-approved medications used to treat opioid use disorder. Emergency physicians are on the front line of the opioid healthcare crisis, and to address this, PCSS, in coordination with the American College of Emergency Physicians, is urging all emergency physicians to obtain a waiver, also known as the X-waiver.
Option 1: Request a live or virtual eight-hour training for your organization. PCSS will resume live, in-person trainings following mitigation of COVID-19. Contact firstname.lastname@example.org for more information or request a training.
Option 2: Request a Half and Half training. This format includes a live in-person or virtual component for four hours, followed by four hours of self-paced, online learning. The live or virtual portion allows for interaction between participants and the speaker, and once completed, participants will receive a link to complete the training via self-paced online learning. Contact PCSS for more information or to request a training.