April 2026 Provider News
Date: 04/29/26
In this issue:
- General Updates - OneHealthPort connection
- Quality - SNS tip sheet, Provider Alert: Preeclampsia Prevention, AAP Measure – Adult Access to Preventive Care, Wellcare Quality Annual Wellness Visit
- Tribal - Resources for Assistance
- Clinical & Payment Policies and Prior Authorization Updates - Latest policy updates, Prior Auth updates
- Wellcare - TFNs
- Apple Health Core Connections - Billing when youth first enter foster care
- Training/Education - Trauma Informed Care: Connections & Healing, Sexual Health in Foster Care and Adoption, Behavioral Health, Reentry, and Systemic Change Webinar
- Pharmacy Updates - NPI Prescriber Enforcement for Pharmacy Claims
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General Updates
Provider Portal Access Update: OneHealthPort Connection Ending April 30th
Effective the evening of April 30, the OneHealthPort connection for all Coordinated Care portals will be retired. Starting May 1, please access the Provider Portal(s) via Availity or by using the direct portal links.
No action is needed prior to May 1, and Provider Portal functionality will remain available.
What you need to do
- Availity. We strongly recommend the use of Availity as a centralized resource to streamline access. Portals for all Coordinated Cares lines of business (Coordinated Care Health, Ambetter, Wellcare) can be accessed within the Payer Spaces section of Availity.
- Continue to access the Provider Portal using the direct portal links.
Questions or need support? The Resources Catalogue within Availity is a great place to start – look under Help and Training in the top right corners. You can always contact your Provider Engagement representative, we’re here to help.
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Quality
Medicaid Quality
Social Need Screening and Intervention (SNS-E)
SNS-E Measure Overview
The percentage of members who were screened, using prespecified instruments, at least once during the measurement year for unmet food, housing and transportation needs, and received a corresponding intervention if they screened positive.
Food Screening: The percentage of members who were screened for food insecurity.
Food Intervention: The percentage of members who received a corresponding intervention within 30 days (1 month) of screening positive for food insecurity.
Housing Screening: The percentage of members who were screened for housing instability, homelessness, or housing inadequacy.
Housing Intervention: The percentage of members who received a corresponding intervention within 30 days (1 month) of screening positive for housing instability, homelessness, or housing inadequacy.
Transportation Screening: The percentage of members who were screened for transportation insecurity.
Transportation Intervention: The percentage of members who received a corresponding intervention within 30 days (1 month) of screening positive for transportation insecurity.
PROVIDER ALERT: PREECLAMPSIA PREVENTION
Preeclampsia is a leading cause of pregnancy‑related morbidity and mortality. The Washington State Maternal Mortality Review Panel and the Centers for Disease Control and Prevention (CDC) report that up to 80% of pregnancy‑related deaths are preventable. Preeclampsia affects approximately 1 in 25 pregnancies in the United States and disproportionately impacts Black individuals, contributing to persistent maternal health disparities.
Low‑Dose Aspirin: Evidence‑Based Prevention
For pregnant individuals at increased risk, low‑dose aspirin has been shown to:
- Reduce the risk of preeclampsia by 15%
- Reduce the risk of preterm birth by **20%**¹
These findings align with recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF).
Washington State Collaboration
The Washington State Perinatal Collaborative (DOH), in partnership with March of Dimes and the Society for Maternal‑Fetal Medicine, is promoting provider awareness through the Low Dose, Big Benefits initiative.
Provider Action
- Assess preeclampsia risk early in pregnancy
- Discuss low‑dose aspirin with patients who meet risk criteria
- Encourage shared decision‑making
Resources
- Campaign information
- Free patient education materials available for a limited time through WA DOH
Questions: waperinatalcollaborative@doh.wa.gov
¹ Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: U.S. Preventive Services Task Force Recommendation Statement, JAMA
AAP Measure – Adult Access to Preventive Care
The Adult Access to Preventive/Ambulatory Health Services (AAP) measure tracks adults age 20 and older who receive at least one qualifying ambulatory or preventive care visit.
- Medicaid & Medicare: At least one visit each year
- Commercial: At least one visit every three years
- Measure applies to appropriate outpatient preventive and ambulatory care settings
Wellcare Quality
Please see link for updates on Annual Wellness Visit
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Tribal
Resource for Assistance
IHCPs have access to a dedicated email inbox for inquires regarding all lines of business at Coordinated Care (Medicaid, Marketplace/Exchange, and Medicare Advantage). Please don’t hesitate to reach out to IndianHealthCareProviderAssistance@coordinatedcarehealth.com and the team monitoring the inbox will assist or connect you with the appropriate contacts to resolve your questions.
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Clinical & Payment Policies and Prior Authorization Updates
Clinical Policy Updates
The following policies are updated as of the listed Effective Date.
Policies are posted on the Coordinated Care of Washington Policy webpage. Evolent policies are available here and will be accessible via the Evolent landing page found on the Coordinated Care Prior Authorization webpage.
New to List? | Policy # | Policy Title | Line of Business | Change Type | Effective Date |
| CP.BH.105 | Applied Behavioral Analysis Documentation Requirements | Apple Health, Ambetter | Revised | 5/1/2026 |
X | CP.MP.105 | Digital EEG Spike Analysis | Apple Health, Ambetter | Revised | 5/1/2026 |
X | CP.MP.130 | Fertility preservation | Apple Health | Revised | 5/1/2026 |
X | CP.MP.141 | Nonmyeloablative Allogeneic Stem Cell Transplants | Apple Health, Ambetter | Revised | 5/1/2026 |
X | CP.MP.163 | Total Parenteral Nutrition and Intradialytic Parenteral Nutrition | Apple Health, Ambetter | Revised | 5/1/2026 |
| CP.MP.168 | Biofeedback | Ambetter | Revised | 5/1/2026 |
X | CP.MP.180 | Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea | Ambetter | Revised | 5/1/2026 |
| CP.MP.185 | Skin Substitutes for Chronic Wounds | Ambetter | Revised | 5/1/2026 |
| CP.MP.190 | Outpatient Oxygen Use | Ambetter | Revised | 5/1/2026 |
X | CP.MP.249 | Omisirge (omidubicel): Nicotinamide-modified allogeneic hematopoietic progenitor cell therapy | Apple Health, Ambetter | Revised | 5/1/2026 |
X | CP.MP.36 | Experimental Technologies | Apple Health | Revised | 5/1/2026 |
X | CP.MP.40 | Gastric Electrical Stimulation | Apple Health, Ambetter | Revised | 5/1/2026 |
| CP.MP.91 | Obstetrical Home Health Care Programs | Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Prenatal Diagnosis Pregnancy Loss | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Oncology Cancer Screening and Surveillance | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG General Approach to Genetic and Molecular Testing | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Hematologic Malignancy | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Hereditary Cancer | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Preimplantation Genetic Testing | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Prenatal and Preconception Carrier Screening | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Oncology Solid Tumor Molecular Diagnostics | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Ophthalmology | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Cardiovascular | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Dermatology | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Gastroenterology | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Hematology | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Otolaryngology | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Prenatal Screening | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Orthopedics | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Respiratory | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Immunology and Rheumatology | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Nephrology | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Neurology | Apple Health, Ambetter | Revised | 5/1/2026 |
X | V2.2025 | CG Identity and Forensics | Apple Health, Ambetter | New | 5/1/2026 |
X | V2.2025 | CG Nutrition and Metabolism | Apple Health, Ambetter | New | 5/1/2026 |
X | V2.2025 | CG Endocrinology | Apple Health, Ambetter | New | 5/1/2026 |
X | V2.2025 | CG Transplant | Apple Health, Ambetter | New | 5/1/2026 |
X | V2.2025 | Toxicology and Pharmacogenetics Version A | Ambetter | Revised | 5/1/2026 |
| WA.CP.MP.117 | Peripheral and Percutaneous Electrical Nerve Stimulation | Apple Health, Ambetter | Revised | 5/1/2026 |
X | WA.CP.MP.130 | Fertility Preservation | Ambetter | Revised | 5/1/2026 |
X | WA.CP.MP.36 | Experimental Technologies | Ambetter | Revised | 5/1/2026 |
X | WA.CP.MP.510 | Tinnitus Treatment | Apple Health, Ambetter | Revised | 5/1/2026 |
X | WA.CP.MP.517 | Testosterone Testing | Apple Health, Ambetter | Revised | 5/1/2026 |
X | WA.CP.MP.520 | Tympanostomy Tubes | Apple Health, Ambetter | Revised | 5/1/2026 |
| CP.BH.124 | ADHD Assessment and Treatment | Apple Health, Ambetter | Revised | 6/1/2026 |
| CP.MP.38 | Ultrasound in Pregnancy | Apple Health | Revised | 6/1/2026 |
| WA.CP.MP.38 | Ultrasound in Pregnancy | Ambetter | Revised | 6/1/2026 |
| ECG_7000 | Evolent - Radiation Therapy Services | Ambetter | New | 6/1/2026 |
| ECG_7001 | Evolent - Proton Beam Radiation Therapy and Neutron Beam Radiation Therapy Services | Ambetter | New | 6/1/2026 |
X | CC.PP.073 | Sepsis Diagnosis | Apple Health, Ambetter | Revised | 7/1/2026 |
X | CP.MP.102 | Pancreas Transplantation | Apple Health, Ambetter | Revised | 7/1/2026 |
X | CP.MP.162 | Tandem Transplant | Apple Health, Ambetter | Revised | 7/1/2026 |
Prior Authorization Updates
Future changes to Pre-Authorization requirements are noted below.
Utilize our Pre-Auth Check tool for real time response to pre-authorization requirements.
Code | Description | Line of Business | Effective Date | Notes |
76965 | Ultrasonic guidance for interstitial radioelement application | Ambetter | 6/1/2026 |
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77011 | Computed tomography guidance for stereotactic localization | Ambetter | 6/1/2026 |
|
77262 | Therapeutic radiology treatment planning; simple | Ambetter | 6/1/2026 |
|
77262 | Therapeutic radiology treatment planning; intermediate | Ambetter | 6/1/2026 |
|
77263 | Therapeutic radiology treatment planning; complex | Ambetter | 6/1/2026 |
|
77280 | Therapeutic radiology simulation-aided field setting; simple | Ambetter | 6/1/2026 |
|
77285 | Therapeutic radiology simulation-aided field setting; intermediate | Ambetter | 6/1/2026 |
|
77290 | Therapeutic radiology simulation-aided field setting; complex | Ambetter | 6/1/2026 |
|
77293 | Respiratory motion management simulation (List separately in addition to code for primary procedure) | Ambetter | 6/1/2026 |
|
77295 | 3-dimensional radiotherapy plan, including dose-volume histograms | Ambetter | 6/1/2026 |
|
77299 | Unlisted procedure, therapeutic radiology clinical treatment planning | Ambetter | 6/1/2026 |
|
77300 | Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician | Ambetter | 6/1/2026 |
|
77301 | Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications | Ambetter | 6/1/2026 |
|
77306 | Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s) | Ambetter | 6/1/2026 |
|
77307 | Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s) | Ambetter | 6/1/2026 |
|
77316 | Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) | Ambetter | 6/1/2026 |
|
77317 | Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s) | Ambetter | 6/1/2026 |
|
77318 | Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s) | Ambetter | 6/1/2026 |
|
77321 | Special teletherapy port plan, particles, hemibody, total body | Ambetter | 6/1/2026 |
|
77331 | Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician | Ambetter | 6/1/2026 |
|
77332 | Treatment devices, design and construction; simple (simple block, simple bolus) | Ambetter | 6/1/2026 |
|
77333 | Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus) | Ambetter | 6/1/2026 |
|
77334 | Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts) | Ambetter | 6/1/2026 |
|
77336 | Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy | Ambetter | 6/1/2026 |
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77338 | Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan | Ambetter | 6/1/2026 |
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77370 | Special medical radiation physics consultation | Ambetter | 6/1/2026 |
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77387 | Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed | Ambetter | 6/1/2026 |
|
77399 | Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services | Ambetter | 6/1/2026 |
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77402 | Radiation treatment delivery; Level 1 (eg, single-electron field, multiple-electron fields, or 2D photons), including imaging guidance, when performed | Ambetter | 6/1/2026 |
|
77407 | Radiation treatment delivery; Level 2, single-isocenter (eg, 3D or IMRT), photons, including imaging guidance, when performed | Ambetter | 6/1/2026 |
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77412 | Radiation treatment delivery; Level 3, multiple isocenters with photon therapy (eg, 2D, 3D, or IMRT) or a single-isocenter photon therapy (eg, 3D or IMRT) with active motion management, or total skin electrons, or mixed-electron/photon field(s), including imaging guidance, when performed | Ambetter | 6/1/2026 |
|
77417 | Therapeutic radiology port image(s) | Ambetter | 6/1/2026 |
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77427 | Radiation treatment management, 5 treatments | Ambetter | 6/1/2026 |
|
77431 | Radiation therapy management with complete course of therapy consisting of 1 or 2 fractions only | Ambetter | 6/1/2026 |
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77432 | Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session) | Ambetter | 6/1/2026 |
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77435 | Stereotactic body radiation therapy, treatment management, per treatment course, to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions | Ambetter | 6/1/2026 |
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77470 | Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral or endocavitary irradiation) | Ambetter | 6/1/2026 |
|
77499 | Unlisted procedure, therapeutic radiology treatment management | Ambetter | 6/1/2026 |
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77750 | Infusion or instillation of radioelement solution (includes 3-month follow-up care) | Ambetter | 6/1/2026 |
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77761 | Intracavitary radiation source application; simple | Ambetter | 6/1/2026 |
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77762 | Intracavitary radiation source application; intermediate | Ambetter | 6/1/2026 |
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77763 | Intracavitary radiation source application; complex | Ambetter | 6/1/2026 |
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77767 | Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel | Ambetter | 6/1/2026 |
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77768 | Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions | Ambetter | 6/1/2026 |
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77770 | Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel | Ambetter | 6/1/2026 |
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77771 | Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels | Ambetter | 6/1/2026 |
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77772 | Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels | Ambetter | 6/1/2026 |
|
77778 | Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed | Ambetter | 6/1/2026 |
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77789 | Surface application of low dose rate radionuclide source | Ambetter | 6/1/2026 |
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77790 | Supervision, handling, loading of radiation source | Ambetter | 6/1/2026 |
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77799 | Unlisted procedure, clinical brachytherapy | Ambetter | 6/1/2026 |
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G0458 | Services, low dose rate (LDR) prostate brachytherapy (insertion of radioactive seeds) | Ambetter | 6/1/2026 |
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E1399 | Durable Medical Equipment (DME), miscellaneous | Apple Health, Ambetter | 8/1/2026 | Prior authorization is required for all requests, regardless of billed amount. Previous billed amount thresholds removed. |
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Wellcare
Reminder: Access Toll-Free Fax Numbers at wellcare.com
Wellcare is sharing an important reminder that our Provider Partners should continue using toll-free numbers (TFNs) to submit faxes for health plan services.
Providers are encouraged to visit wellcare.com/providers, select your state’s Wellcare link or to logon to the secure provider portal to confirm the appropriate TFNs to which faxes should be submitted.
For questions regarding the appropriate use of faxes for Medicare services – or to confirm you have the correct TFN for your faxes, please contact your local Wellcare health plan representative.
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Apple Health Core Connections
Insurance coverage may be delayed when children first enter foster care given the sudden change in circumstance and the communication flow between agencies. Caseworkers and caregivers are provided with an Interim Voucher form which includes information about the child, caseworker, and caregiver. Providers should accept the Interim Voucher as a guarantee of payment for Medicaid services and render appropriate services.
Most children entering foster care will be enrolled in Coordinated Care’s Apple Health Core Connections health plan. Providers will be able to verify coverage in Provider One post-visit if there is a delay in coverage activation. If the individual is enrolled onto Coordinated Care, providers can access the Member ID in the provider portal. If the individual is not ultimately enrolled onto Coordinated Care, the provider can bill Health Care Authority directly as they should have fee-for-service coverage. For any questions or issues regarding enrollment for youth in foster care, please contact fcas@hca.wa.gov.
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Training/Education
Components for Enhancing Career Experience and Reducing Trauma (CE-CERT): Staff retention, burnout and secondary trauma are epidemic for organizations and staff working with exploited and trauma exposed populations. Regrettably the best advice usually offered is: “Do more self-care!” Keeping good staff means more than just ‘surviving’ and ‘not burning-out’. A new evidence-informed model, Components for Enhancing Career Experience and Reducing Trauma (CE-CERT), is a skills-based approach identifying five key clinical practice and supervision skills. Objectives include:
- Increase awareness of how developing experiential engagement around negative emotions plays a role in job satisfaction.
- List five key skills for managing intense affect and reducing post-work agitation.
- Understand how intense negative feelings can be "metabolized" so they do not produce negative and long-term effects.
- Have opportunity to commit to one or more key strategies that will change the participant's way of engaging in their work when they return to direct service activities.
Join this virtual training on May 13, 2026 from 8:30AM – 4:30PM. Providers may receive 6.5 CEUS. Learn more and register here.
Trauma Informed Care: Connections & Healing
Children (like adults) often define themselves through their connections. If they have been moved often, pulled from those they are connected and attached to, is it any wonder they feel and act fragmented from their lives? This in turn potentially opens the door for further trauma and disconnection. This Trauma Informed training discusses ways for caregivers and professionals to help a child develop connections, practical tips on communicating about trauma and help the child build a strength-based understanding of their personal story.
Facilitated by Zia Freeman, MA, LMHC Community Educator with Coordinated Care
May 18, 2026 02:00 – 04:00pm
Sexual Health in Foster Care and Adoption
Sexual Health in Foster Care examines reproductive and sexual health in relationship to Child Welfare System children. Foster and older adopted youth often have higher rates of risky sexual behavior and negative health outcomes, and may experience sexual exploitation. They often become sexually active earlier than their peers, without being emotionally or physically ready to deal with the potential challenges this can create. This training will help participants better understand the sexual health needs of youth with a background of trauma and how they can help meet these needs.
Facilitated by Zia Freeman, MA, LMHC Community Educator with Coordinated Care
May 28, 2026 01:00 – 03:00pm
Rewriting the Narrative: Behavioral Health, Reentry, and Systemic Change Webinar-hosted by UW
On Thursday, May 7, 10:00-11:30 AM (PDT) we will explore “Rewriting the Narrative: Behavioral Health, Reentry, and Systemic Change.”
Successful community reentry after incarceration is about so much more than a return home. It is a critical and complex transition that requires intentional, coordinated support.
Join us for a dynamic 90-minute facilitated panel exploring the intersection of behavioral health and reentry that will feature three panelists with broad and deep experience.
Link to further information and registration.
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Pharmacy Updates
NPI Prescriber Enforcement for Pharmacy Claims
Action Required: In accordance with 42 CFR 438.602(b), all prescribers must be enrolled with the Health Care Authority (HCA). As of April 1, 2026, any prescription submitted by a prescriber or pharmacist not recognized by the HCA will be rejected at pharmacy point of sale, some exceptions may apply. Please visit HCA's website for more information on how to enroll as a provider with the HCA.