February 2022 Provider News
Date: 02/28/22
In this issue:
- Quality Updates - National Cancer Prevention Month, Heart Health Month, Lead Poisoning Screening, Asthma and 90 Day Refills
- Apple Health Core Connections - General Update
- Clinical Policy Updates - February Policies
- Training/Education - HCA trainings, NWMHTTC Conference: Advancing Early Psychosis Care in the United States, Exploring the Consequences of Bias and Structural Racism on Service Disparities in Autism
- Pharmacy Update - April 1, 2022 Preferred Drug List Changes
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Quality
National Cancer Prevention Month, February
Research shows up to 50% of cancer cases and deaths are preventable with the knowledge available today. Prevention and early detection are important, proven and effective strategies to help patients.
Heart Health Month, February
Nearly half of U.S. adults have hypertension, or high blood pressure, and only about 1 in 4 of those individuals has their hypertension under control. Hypertension is a major preventable risk factor for heart disease and stroke, which are the first and fifth leading causes of death in the United States, respectively. Remind your patients to practice healthy living habits, like being physically active, to help prevent high blood pressure.
Lead Poisoning Screening - EPSDT
All children 12 – 24 months of age should be tested for the risk of lead poisoning. This testing is a Federally mandated preventative health benefit. Uses traditional, folk, or ethnic remedies or cosmetics. (Examples: Greta, Azarcon, Ghasard, Ba-baw-san, Sindoor and Kohl).
Asthma and 90 Day Refills
Moving members with asthma to 90-day refills may increase their medication adherence. Coordinated Care provides members with 90 day supplies through our preferred mail order pharmacy, CVS Caremark, or any contracted pharmacy.
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Apple Health Core Connections
Coordinated Care is the single managed care organization to administer the Integrated Managed Care Apple Health Foster Care program in collaboration with the Health Care Authority and Department of Children Youth and Families. This program serves children and youth in foster care, adoption support, alumni of foster care (ages 18-26), and children reunified with their parents. Coordinated Care’s program is named “Apple Health Core Connections.” You can reach us at 1-844-354-9876 or AHCCTeam@coordinatedcarehealth.com
The Coordinated Care Community Education Team serves providers and their staff with training to support the needs of the Medicaid population. The CE Team can offer training on topics such as Adoption Success, Trauma Informed Care, ACEs, Resilience, and Secondary Trauma and Self Care. To request more information or to schedule no-cost training please email: communityeducation@coordinatedcarehealth.com
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Clinical Policy Updates
National Imaging Associates, Inc. (NIA), reviews certain requests to see if they are medically necessary and a covered service under Coordinated Care health plans. NIA has announced changes to policy CG-062, CT Coronary Angiography, will be effective May 1, 2022. You will find the policy, including a description of the revisions, on the NIA Website. A link is available on our Prior Authorization page.
The below policies received updates as part of our regular monthly review in February. These policy changes are effective March 1, 2022. You will find the policies, including a description of the revisions, posted on the policy site.
| Policy Number | Policy Title | Line of Business |
|---|---|---|
WA.CP.MP.515 | Fecal Microbiota Transplantation | Apple Health |
WA.CP.MP.525 | Catheter Ablation for SVTA | Apple Health |
WA.CP.MP.510 | Tinnitus Treatment | Apple Health |
WA.CP.MP.526 | Stem Cell Therapy for Musculoskeletal Conditions | Apple Health |
WA.CP.MP.524 | Whole Exome Sequencing | Apple Health |
WA.CP.MP.95 | Gender Affirming Procedures | Ambetter |
CP.MP.22 | Stereotactic Body Radiation Therapy | Apple Health & Ambetter |
CP.MP.62 | Hyperhidrosis Treatments | Apple Health & Ambetter |
CP.MP.177 | Video Electroencephalography (V-EEG) | Apple Health & Ambetter |
CP.MP.190 | Oxygen Use and Concentrators | Ambetter |
CP.MP.206 | Skilled Nursing Facility Leveling | Apple Health & Ambetter |
The below policy was updated as part of our regular monthly review in February. This policy change is effective June 1, 2022. You will find the policy, including a description of the revisions, posted on the policy site.
| Policy Number | Policy Title | Line of Business |
|---|---|---|
CP.MP.173 | Implantable Intrathecal or Epidural Pain Pump | Apple Health & Ambetter |
The below policy is archived effective March 1, 2022. If prior authorization is required, review will be based on InterQual criteria.
| Policy Number | Policy Title | Line of Business |
|---|---|---|
CP.MP.179 | Antithrombin III (Atryn, Thomate) | Apple Health & Ambetter |
The below new policy was previously announced to be effective on the date noted. You will find the policy posted on the policy site.
| Policy Number | Policy Title | Effective Date | Line of Business |
|---|---|---|---|
CP.MP.202 | Orthognathic Surgery | 3/1/22 | Apple Health & Ambetter |
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Training/Education
Visit Centene’s Clinical Provider Training website to find webinar events available to all Coordinated Care providers. Webinars are on clinical behavioral health topics and usually offer free continuing education hours. Click on the “National Provider Webinars” button on the right side of the page and scroll down to find a complete listing.
Health Care Authority has scheduled numerous trainings for Apple Health mental health clinicians and allied professionals on new policy changes that require Apple Health mental health professionals to use the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0 – 5™) when assessing and diagnosing children from birth through age five. Visit the HCA DC: 0-5 website to sign up for an upcoming webinar.
The NWMHTTC is hosting the 4th Annual National on Advancing Early Psychosis Care in the United States: Harnessing Resiliency in a Changing World. This national, virtual conference will offer a wide variety of topics related to early psychosis care designed for the full mental health care team. March 10-11. Register here.
The UW SMART Center and the NWMHTTC is hosting Dr. Brian Boyd presents: Exploring the Consequences of Bias and Structural Racism on Service Disparities in Autism. March 23, 2022, 8:30-9:45am. Register here.
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Pharmacy Update
Effective April 1, 2022, certain medications will no longer be preferred by Coordinated Care. Please see list below as well as potential alternatives.
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