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Provider Digest | Volume 105

Date: 12/13/23

2024 Formulary Changes for Wellcare By Health Net and Wellcare By Trillium Advantage

On January 1, 2024, some drugs will no longer be covered on our Medicare Part D Plan formulary(ies). To assist our providers, we have compiled a list of the most commonly prescribed drugs being removed along with the drug’s 2024 formulary alternative(s). Please refer to the lists at the links below to identify the most appropriate options for your patients:

View Wellcare By Health Net 2024 Formulary Changes

View Wellcare By Trillium Advantage 2024 Formulary Changes

If you determine that it is necessary for your patient to continue to receive the non-formulary drug in 2023, you will need to submit a Coverage Determination request on or after December 15, 2023..

Request forms are located on our website on the Coverage Determinations and Redeterminations for Drugs page on the health plan website or you can call to request authorization. 

 If you have any questions, please contact Medicare Pharmacy Services at 1-800-867-6564.

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Reminder: Lane County Trillium Medicaid Behavioral Health Provider Availability Survey

In the Lane County CCO region, Trillium Behavioral Health has transitioned from monthly phone calls to an online survey to assess provider availability and your program openings. This will streamline the process for you as well as ensure we are able to provide members with the most accurate provider information. You should expect to receive the survey link via email on the first Monday of every month.

As always, we deeply appreciate the valuable work that you are doing for our Trillium members and our community at large. At the top of each survey, you will find contact information for Emma St. Clair and Erinn Stevens. Please reach out to both of them directly if you have any questions or concerns. We look forward to partnering with you on this new process!

Complete the Lane County Trillium Behavioral Health Provider Availability Survey

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Administration of Behavioral Health Services Transitions to Health Net & Wellcare By Health Net in January 2024

Beginning in January 2024, behavioral health services for Health Net Commercial members and Wellcare By Health Net Medicare members will no longer be administered by MHN, Health Net's behavioral health administrator. Instead, these services will be arranged by Health Net and Wellcare By Health Net. Members will not experience any changes to their behavioral health benefits as a result of this change. 

Certain functions, such as eligibility and benefit checks, claims submission, referrals, prior authorizations, provider portal and websites, and more may be affected. For more information, please visit our Behavioral Health Services Transition webpage.

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

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2024 Medicaid Behavioral Health Provider Directed Payment Attestation/Increase

Effective January 1, 2024, the Oregon Health Authority (OHA) is implementing the annual attestation process required for all BH providers for the four behavioral health directed payments (BHDPs) within the CCO contracts that further the goals and priorities of the Medicaid program. All Trillium Medicaid Behavioral Health/Substance Abuse providers who submitted OHA attestations in 2023 are required by OHA to resubmit 2024 attestations to CCOs in order to continue qualifying for certain BH Directed Payment rate tier increases.

For 2024, providers will want to review the criteria for each category again to confirm if they qualify for 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

To be eligible for a 2024 tier rate increase, OHA asks that Medicaid providers complete the "Primarily Medicaid Provider Attestation" found on their Behavioral Health Rate Increase webpage.

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

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Clinical Documentation Improvement (CDI) Webinars

Trillium, Health Net and Wellcare invite providers to attend upcoming CDI webinars on "2024 CMS Model and ICD-10 Updates." Each webinar includes an overview of Risk Adjustment (RA) and Hierarchical Condition Categories (HCCs). To register, please click on the Zoom link next to the webinar you would like to attend.

2024 CMS Model and ICD-10 Updates

Thank you for your partnership!

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