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Provider Digest | Volume 59

Date: 11/30/22

Diabetes Awareness Month: Eye Exam for Patients with Diabetes

Diabetes can damage patients’ eyes and cause vision loss or blindness. People with diabetes can be affected by diabetic retinopathy, macular edema, cataracts and glaucoma. It’s important that your patients with diabetes get regular eye exams. Below is information about the “Eye Exam for Patients with Diabetes” metric and some resources to help guide your efforts.

Eye Exam for Patients with Diabetes (EED)

  • Members 18–75 years of age with diabetes (type 1 and type 2).

Numerator Compliance:

  • Negative Result:
    • Prior (2021) or current measurement year (2022).
    • “No diabetic retinopathy or no changes in retinopathy” cannot be included in one sentence to indicate a negative result since it is not specific enough.
  • Positive Result:
    • Compliant for current measurement year only (2022).

 Bilateral Eye Enucleation: “History of Bilateral Eye Enucleation”

  • Any time in patient history through December 31.
  • Indicates both eyes have been removed.
  • This is not exclusion criteria and is numerator compliant.

CDC: Diabetes State Burden Toolkit:

Use this tool to learn about the health, economic, and mortality burden of diabetes in your state.

Patient Materials and Resources from the CDC:

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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 have sent our Medicaid Behavioral Health/Substance Abuse providers a Directed Payment Increase Survey. 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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RSV Guidance from the Tri-County Health Departments

RSV activity continues to increase across Oregon and the country, severely straining pediatric emergency departments and hospitals. RSV can cause severe disease in both young children and the elderly.

Providers can help by:

  • creating more same-day appointments for sick children
  • teaching caregivers of children with respiratory symptoms how to clean out the nose, assess hydration, and assess work of breathing. See these educational resources.
  • emphasizing the importance of hand hygiene, frequent disinfection of surfaces, and avoiding touching the face as important ways to slow the spread of RSV.
  • only testing for RSV or influenza in the outpatient setting if it will inform management.
  • providing education and direction to patients who are ill with undifferentiated respiratory symptoms.
  • actively supporting ongoing vaccination efforts.
  • modeling good infection control precautions.

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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