Skip to Main Content

Provider Digest | Volume 156

Date: 02/05/25

Trillium Medicaid Continuous Glucose Monitors Policy

Effective December 1, 2024, Trillium Community Health Plan created a DME benefit for Continuous Glucose Monitors for Medicaid members. This benefit is in alignment with Oregon Health Authority requirements in Oregon Administrative Rule 410-141-3843 to be no less than the amount, duration and scope for the same services furnished under the Pharmacy Benefit. The Trillium policy for Continuous Glucose Monitors (OP.CP.MP.502) will be available to download from our website on February 21, 2025.

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

______________________________________________________

Virtual Training: Population Health Foundations

The Northwest Regional Primary Care Association is offering an 8-session virtual training on "Population Health Foundations." 

In this foundational session of the Population Health Academy, participants will gain a comprehensive introduction to population health principles and strategies essential for advancing community health outcomes. Participants will leave this training equipped with the tools and resources to deliver more effective patient-centered care, the ability to leverage data for risk stratification and quality improvement, and gain valuable insights to align their care model for success in value-based payment reform.

    ______________________________________________________

    Effective February 1, 2025: Trillium Re-Opens Applications for Medicaid Flexible Services Requests

    Trillium will accept new applications for flexible services requests for Medicaid members beginning February 1, 2025.

    Flexible services are items or services that support a Medicaid member’s health, though are not covered by the Oregon Health Plan or processed through standard medical billing. While the Oregon Health Authority does not require coordinated care organizations to offer flexible services, Trillium opts to make flexible services available to our members as part of our ongoing commitment to increase access to care.

    Flexible services funding may be used to pay for non-covered healthcare services including physical health, mental health, behavioral health, oral health, and tribal-based services. Flexible services must increase desired health outcomes and be grounded in evidence-based medicine or widely accepted best clinical practice.

    Examples of flexible services requests include:

    • Rental assistance or sober living facilities for members who don’t qualify through the Health-Related Social Needs housing benefit
    • Climate devices for members who don’t qualify through the Health-Related Social Needs climate benefit
    • Move-in expenses
    • Community Warehouse furniture
    • Hotel stays for high-risk/post-hospital discharge or during climate emergencies
    • Utilities
    • Gym/pool access
    • Phones or tablets to access care
    • New baby supplies (cribs, strollers, car seats)
    • Clothing and shoes for members experiencing homelessness

    Examples of items or services that do not qualify for flexible services:

    • Request for reimbursement
    • Copayments, medical payments, out-of-network provider payments and any other items or services covered under your health plan
    • Mortgage payments and homeowners insurance
    • Car payments, car insurance and car repairs
    • Credit card payments and loan payments
    • Fees: Pet, legal, collection, guardianship

     
    How to help a Trillium member apply for flexible services
    Providers, community partners, and member representatives can complete and submit a flexible services application on behalf of a Trillium member:

    Trillium members can also complete and submit the flexible services request form (PDF). If they need help, they can call Trillium Member Services at 1-877-600-5472 and ask to speak with a community health worker.

    Thank you for your patience and for your partnership in helping our members stay healthy! If you have any questions, please contact your Trillium Provider Engagement Representative.

      .______________________________________________________