February 2021 Provider News
Date: 02/23/21
In This Issue
- Quality - Well Child Visits, Better Patient Outcomes through EBPs
- Apple Health Core Connections - Upcoming workshops and webinars
- Updates/Trainings - UM Prior Auth and Clinical Policy Updates, Documentation needed for Prior Authorizations, UM IP Change in Condition Reminder, COVID-19 Special Edition Faxblast, Washington State Cell Phones Companies providing Lifeline services to eligible clients, HCA Telehealth Webinar, HCA Behavioral Health Facilities (BHF) round three funding application is open, Training for Behavioral Health Providers
- Pharmacy - April 1, 2021 Preferred Drug List Changes
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Notice 1: Quality
The Importance of Well-Child Visits.
2021 brings many new opportunities to clinical practices - more families are willing to make clinic visits for important childhood vaccinations and well-child care. As children begin to go back to school, it is important to remind parents to schedule their Well Child Visits.
Better Patient Outcomes through Evidence Based Practices
This Month: Cognitive Behavioral Therapy (CBT)+ for Behaviors, Anxiety and Depression (EPA Number: 870001331, SERI: 860153000)
Patients who benefit: Cognitive-Behavioral Therapy has proved to be effective in helping people who are being treated for depression, panic/anxiety, addictions, behavior compulsions, eating disorders, schizophrenia, bipolar disorder, mood disorders, phobias, and similar behavioral, emotional, and mental health challenges.
Improves/helps with these outcomes: CBT is a useful tool to address emotional challenges. For example, it may help patients:
- Manage symptoms of mental illness
- Prevent a relapse of mental illness symptoms
- Treat a mental illness when medications aren't a good option
- Learn techniques for coping with stressful life situations
- Identify ways to manage emotions
- Resolve relationship conflicts and learn better ways to communicate
- Cope with grief or loss
- Overcome emotional trauma related to abuse or violence
- Cope with a medical illness
- Manage chronic physical symptoms
Brief description of intervention: Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). Patients work with provider in a structured way, attending a limited number of sessions. CBT helps patients become aware of inaccurate or negative thinking so they can view challenging situations more clearly and respond to them in a more effective way.
CBT can be a very helpful tool in treating mental health disorders, such as depression, post-traumatic stress disorder (PTSD) or an eating disorder. But not everyone who benefits from CBT has a mental health condition. It can be an effective tool to help anyone learn how to better manage stressful life situations.
Cultural adaptations available? YES
If you are a provider practicing an EBP make sure and use the accompanying EPA number when you bill Coordinated Care. EPA numbers are available in the HCA billing guidelines.
If you are a provider practicing an EBP make sure and use the accompanying EPA or SERI number when you bill Coordinated Care.
Mental Health providers should use the Reporting Guide for Evidence-based Practices.
Physical health providers who deliver these services should include the appropriate EPA number from the HCA Provider Billing Guides and Fee Schedules, Mental Health Services.
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Notice 2: Apple Health Core Connections
WEBINARS/TRAININGS:
On January 1, 2019, Coordinated Care became 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
Visit Centene’s Clinical Provider Training website to find upcoming National Provider Webinars. These webinar events are available to any Centene provider, stakeholder, community member and/or staff. Webinars are on clinical topics appropriate for web learning 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. Here are a few coming up in February:
- Screening, Brief Intervention, and Referral to Treatment. Attendees will gain clinical knowledge and skills to implement the use of SBIRT in their practice. This training focuses on screening and referral to treatment for alcohol and substance use in patients in a health care setting. 2 CE hours available for NBCC. March 10, 2021, 8am-10am.
- Moving from Cultural Competence to Cultural Humility. This training is designed to create an understanding of Cultural Humility and how it relates to Cultural Competence. Specific attention will be given to the role of implicit and explicit bias in interpersonal interactions. 2 CE hours for NBCC. March 10, 2021, 12pm-2pm.
- Social Determinants of Health and Mental Health. This training identifies Social Determinants of Health (SDOH) and how they can affect factors such health care utilization and health disparities. 2 CE hours available for NBCC. March 17, 2021. 9am-11am
Child Trends. Black Parents’ Experience of COVID-19: Trauma, Policy Opportunities, and Finding Joy. The COVID-19 pandemic has disproportionately impacted Black families and exposed broken economic, social, educational, and health systems that fail to serve Black communities. While the nation is still in the throes of the pandemic, the roll out of vaccines brings some hope for a safe re-opening of our society. Join Black policy leaders, researchers and parents for a discussion of the trauma experienced by Black families during the pandemic, the policies needed for healing and bringing about equitable systems, and personal approaches to finding joy. February 24, 2021, 10am-11am. Register here.
Bree Collaborative & Fletcher Group Implementation Webinar. Building Recovery Ecosystems: Collaborative Approaches to Health & Housing. We will discuss existing recovery housing systems and programs in Washington State, identify barriers between providers and housing systems, and explore how implementation steps outlined in the Bree Collaborative Opioid Use Disorder Recommendation can translate into better relationships between healthcare delivery and recovery housing systems, and ultimately healthier communities. February 24, 2021, 12pm-1pm. Register here.
The Center of Excellence: LGBTQ+ Behavioral Health Equity presents, Gender Dysphoria Diagnosis & Clinical Considerations for Children & Youth. This webinar is aimed at practitioners interested in building knowledge to serve transgender and gender diverse children and youth. The use of Gender Dysphoria diagnosis in children and adolescents will be analyzed, and participants will learn how to evaluate and treat a child presenting with gender dysphoria. March 8, 2021, 12:30-1:30pm. Register here.
3rd Annual Washington Fatherhood Summit - Resilient Dads: Fathering in Challenging Times. March 16, 17, and 18, 2021. Learn more and register here.
The Association for Addiction Professionals presents: Connecting the Continuum – How Prevention and Social Determinants of Health Connect. In this session, participants will gain an overview of social determinants of health and the connection to prevention, and how existing environmental prevention strategies are effective mobilization tools for improving community health and wellness. March 24, 2021, 12pm-1:30pm. Register here.
Snohomish County Human Services Behavioral Health presents: Helping Children, Families and You Cope with Crisis During the COVID-19. This session, intended for health care providers and other community-based professionals, will summarize the principles of psychological first aid and common reactions that may be seen in any crisis event, including the current pandemic. Practical advice will be shared on how to provide support to children and families during the current pandemic. The session will underscore the need for professional self-care and highlight some of the barriers as well as some potential solutions. May 4, 2021, 9:30am-11am. Register here.
INTERESTING ARTICLES & RESOURCES:
- The AIMS Center is offering All Patients Safe: Suicide Prevention Training for Medical Professionals at no-cost to Washington State providers and client facing staff through November 2021. $25 cost for CME/CNE credit. All Patients Safe offers an engaging and informative option for providers and client-facing staff to become better skilled at suicide prevention. Perspectives of real patients coupled with practical skills help medical providers transfer what they learn to their practice and community. This training meets Washington State's licensure requirements for health care providers to assist in reducing suicide through improved trainings. Learn more and register here.
- Review Harvard University’s Center on the Developing Child’s latest infographic on How Racism Can Affect Child Development.
- Shonkoff, J. et al. (February 2021). Leveraging the biology of adversity and resilience to transform pediatric practice. Pediatrics. 147 (2).
- Child Trends. (February 2021). Youth Programs Can Improve Engagement by Reducing Barriers and Strengthening Relationships.
- The New York Times. (February 2021). Emptying the Dishwasher Can Enrich Kids’ Mental Health
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Notice 3: Updates/Trainings
Enteral Nutrition Prior Authorization Changes coming for all Enteral Formulas starting on June 1, 2020
Starting June 1, 2020, Coordinated Care will require Prior Authorization for enteral nutrition that are administered orally and/or thru a feeding tube. By having this authorization in place, it will help assist with the claims issues that some providers are having when their patients are receiving both oral and tube formula for nutritional support.
Change in Condition Reminder
If a member remains inpatient on medical necessity denied status and has a change in their medical condition (i.e. stroke, cardiac arrest, fall with injury, etc.), providers are able to use the Notice of Change in Condition form (included with the denial letter) to notify Coordinated Care and request a review for medical necessity based on new medical conditions. We request within 5 business days of the identified change back to inpatient status. Please provide notification within 5 business days of the event (change in condition).
References
Washington State Health Care Authority. Enteral Nutrition Billing Guide (PDF).
Revision effective January 1, 2020.
The authorization forms can be found in the Provider Resources section of Coordinatedcarehealth.com & should be faxed to (877) 212-6669, or submitted electronically via the secure provider portal.
Therapy Prior Authorization Changed for all Members 20 years and younger effective 3/1/2020.
As of March 1, 2020, Coordinated Care is now allowing providers to request up to 48 visits for each therapy (PT/OT/ST) for a 6 month span after initial visits have been completed for members that are 20 years and younger.
Fax information received by providers to Coordinated Care for Prior Authorization requests
As a reminder, Coordinated Care does require provider orders with either a handwritten or electronic signature. Also please ensure all clinical including patient identifiers are present in request for HIPAA verification by Coordinated Care.
**Policy Updates Pending UM/CPC Approval.**
NIA Policy Updates
NIA manages complex radiology authorization for both Apple Health and Ambetter. They recently updated the following policies related to rhinosinusitis. You will find the revised policies on the NIA Website. A link is available on our Prior Authorization page.
Policy Number | Policy Title | Line of Business |
|---|---|---|
NIA_CG_009 | NIA - Sinus & Maxillofacial CT Limited or Localized follow up Sinus CT | Apple Health |
NIA_CG_014 | NIA – Orbit, Face, Neck, Sinus MRI | Apple Health |
Clinical Policy Updates
The below policies received updates as part of our regular monthly review in February. These policy changes are effective March 1, 2021. 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.523 | Sleep Apnea Diagnosis and Treatment | Apple Health |
CP.MP.22 | Stereotactic Body Radiation Therapy | Apple Health & Ambetter |
CP.MP.31 | Cosmetic and Reconstructive Procedures | Apple Health & Ambetter |
CP.MP.62 | Hyperhidrosis Treatments | Apple Health & Ambetter |
CP.MP.120 | Pediatric Liver Transplant | Apple Health & Ambetter |
CP.MP.143 | Wireless Motility Capsule | Ambetter |
CP.MP.156 | Cardiac Biomarker Testing for Acute MI | Apple Health & Ambetter |
The below policy is new effective March 1, 2021. The policy does not reflect any change to current practice, but is newly documented.
Policy Number | Policy Title | Line of Business |
|---|---|---|
WA.CP.MP.84 | Cell-Free Fetal DNA Testing | Apple Health |
The below policies are new. They will become effective June 1, 2021. You will find the policies posted on the policy site.
Policy Number | Policy Title | Line of Business |
|---|---|---|
WA.CP.MP.510 | Tinnitus Treatment | Apple Health |
WA.CP.MP.526 | Stem Cell Therapy for Musculoskeletal Conditions | Apple Health |
The below policies were previously announced to be effective on the date noted. You will find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
|---|---|---|---|
WA.CP.MP.524 | Whole Exome Sequencing | 3/1/2021 | Apple Health |
CP.MP.190 | Oxygen Use and Concentrators | 3/1/2021 | Ambetter |
CP.MP.203 | Diaphragmatic/Phrenic Nerve Stimulation | 5/1/2021 | Apple Health & Ambetter |
The below policies were previously announced to have revisions effective on the date noted. You will find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
|---|---|---|---|
CP.MP.100 | Allergy Testing and Therapy | 3/1/2021 | Apple Health & Ambetter |
CP.MP.49 | Physical, Occupational and Speech Therapy Services | 4/1/2021 | Apple Health & Ambetter |
COVID-19 Faxblast on April 16th
Please reference COVID-19 Faxblast Alert that went out on April 16th, 2020 for the most up-to-date information regarding billing, policies and telemedicine in the current pandemic. You can also reference our website Coordinatedcarehealth.com for real-time information.
Washington State Cell Phones Companies providing Lifeline services to eligible clients
Lifeline is the FCC's program to help make communications services more affordable for low-income consumers. Lifeline provides subscribers a discount on monthly telephone service, broadband Internet access service, or voice-broadband bundled service purchased from participating providers.
Lifeline is available to eligible low-income consumers in every state, commonwealth, territory, and on Tribal lands. The Lifeline program is administered by the Universal Service Administrative Company (USAC). USAC is responsible for data collection and maintenance, support calculation, disbursements, and assisting consumers with Lifeline eligibility and enrollment for the program. USAC's website provides additional information regarding the program, including program requirements.
The following Lifeline service providers are active in Washington:
- Access Wireless
- Assurance Wireless
- Budget Mobile
- enTouch Wireless
- Life Wireless
- Safelink Wireless
- Total Call Mobile
- Yourtel Wireless
Below is the list and of cell phone companies and their websites, are Lifeline services providers in WA:
Access Wireless | https://www.freegovernmentcellphones.net/free-cell-phone-providers/access-wireless |
Assurance Wireless | |
Budget Mobile | https://www.freegovernmentcellphones.net/free-cell-phone-providers/budget-mobile |
enTouch Wireless | https://www.entouchwireless.com/states/washington-lifeline-free-phone-service |
Kroger Wireless | |
Life Wireless | https://www.freegovernmentcellphones.net/free-cell-phone-providers/life-wireless |
Q Link Wireless | |
Safe Link | |
Solix/Assurance Wireless | |
Tag Mobile | |
YourTel America | https://www.freegovernmentcellphones.net/free-cell-phone-providers/yourtel-wireless |
How Do Clients Apply For The Lifeline Subsidy?
Federal regulations (47 CFR Part 54, sec. 54.400) allow one Lifeline subsidy per household. This means that client must choose whether they want the subsidy applied to a landline or cell phone.
Landline – The client contacts their local landline phone service provider and requests a Lifeline Application. Upon determination of this client’s eligibility, the local phone company will apply Lifeline subsidy to the client’s phone bill.
Cell phone – The client must apply with one of 9 Lifeline cell phone providers in Washington. Upon completion of a phone company’s application and determination of the client’s eligibility for Lifeline services, the client will receive a cell phone by mail.
Health Care Authority (HCA) Telehealth Webinar
Telehealth has become an important way for providers to continuing providing services in the context of the COVID-19 pandemic. HCA is holding this webinar to:
- Provide an overview of telehealth for Apple Health (Medicaid)
- Discuss billing and policy
- Discuss tools you can use
- Answer questions that may be concerning you
Who is the webinar for?
The webinar is for any Apple Health provider that wants to learn more about how to effectively offer these services.
When is it, and how do I register?
The webinar will be held Thursday, April 30, 2020 at noon (Pacific). Participants can register directly.
You can also register by visiting HCA’s COVID-19 information page. You will see several webinars in our resource section. This webinar is titled: Apple Health (Medicaid) telehealth policy.
Behavioral Health Facilities (BHF) round three funding application is open
The Department of Commerce is soliciting applications from eligible behavioral health facility organizations. Awardees will receive funds to implement behavioral health capital projects.
A total of $6 million is available for this round in two categories:
- $4 million is provided solely for competitive community behavioral health grants to address regional needs.
- $2 million is provided solely for enhanced service facilities (ESF) for long-term placement of patients discharged or diverted from the state psychiatric hospitals and that are not subject to federal funding restrictions that apply to institutions for mental diseases.
The Behavioral Health Facilities (BHF) Program’s competitive funding rounds are open to nonprofits, public entities, tribes and for-profit businesses. Nonprofit and for-profit business applicants must be registered in the state of Washington.
The new Behavioral Health Supplemental Data Guide 4.2 has been posted on HCAs website along with the Summary of Changes 4.1 – 4.2.
Both documents can be accessed using the following link.
- National Council for Behavioral Health
A SAMHSA sponsored webinar presented by the National Council for Behavioral Health, will take place Wednesday, March 3, 2021 at 1 pm Eastern Time called “Addressing the Adverse Impacts of COVID-19 on Children with Serious Emotional Disorders”.
Since March 2020, children across the country have been isolated at home participating in distance learning. The impacts academically, socially and emotionally have been staggering, particularly for children with pre-existing serious emotional disorders and their families. There has been a reduction in referrals to child protective services, an increase in isolation, depression, anxiety, and a decrease in engagement which can lead to lower academic success. What do all of these things mean in the short-term and the long-term? What can be done to attempt to mitigate some of these adverse effects? Join our Roundtable Discussion as we provide information and answer your questions.
By the end of the roundtable discussion, participants will be able to:
- Understand the impact of distance learning on academic outcomes
- Explain the social-emotional impacts of distance learning
- Describe two trauma-informed, resilience-oriented strategies to address the impacts
Presenters
- Linda Henderson-Smith, Ph.D., LPC, Director, Children and Trauma-informed Services, National Council for Behavioral Health
- Pamela Black, MA, Educational Consultant, Trauma Sensitive Education, LLC
When in the seminar room, the Adobe Connect Log-in screen appears, select "Enter as a Guest," enter the name and state of the participant in the "Name" field (Ex. Jane Doe-AK) and click on "Enter Room." For attendees, this is a “listen only” webinar. Should they need to dial in, the instructions are on the note pad in the seminar room.
- Training for Behavioral Health Providers in Washington State.
Register now for virtual training
Available from March through June 2021
The Northwest ATTC is pleased to announce a series of training opportunities offered from March 2021 through June 2021. Nine different options are being offered to the Washington State behavioral health workforce. These include: stand-alone virtual training workshops; workshops with a series of follow-up sessions; and individualized coaching sessions focused on high-priority subject areas. CEUs are available for these courses that are offered free of charge to behavioral health providers, counselors, supervisors, managers, and other clinicians and healthcare staff involved in the treatment of those with substance use disorders.
Participants are encouraged to register early for virtual workshops. Please only sign up for training or training series to which you can truly and fully commit your time. The registration links can be found at the end of each course offering.
Trainings Being Offered
- Motivational Interviewing (MI) for Individual Service Planning (ISP)
- Wellness and Stress Reduction Learning Sessions
- Clinical Supervision Immersion Project
- Cognitive Behavioral Therapy (CBT) for Treatment of those with Alcohol/Substance Use Disorder(s)
- Motivational Interviewing (MI) Learning Series
- DIRECTORS & MANAGERS: Rapid Implementation of Family & COD supports in SUD settings
- Combining MI and CBT with Follow-up Coaching Sessions
- Trauma-Informed Supervision
- Engaging Families and Family Systems
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Notice 4: Pharmacy
Effective 04/01/2021, certain medications will no longer be preferred by Coordinated Care. Please see list of medications below. Impacted members will be notified of these changes.
EFFECTIVE DATE | DRUG NAME | POTENTIAL ALTERNATIVES |
|---|---|---|
04/01/2021 | Aptensio XR and Methylphenidate XR Capsules | Guanfacine ER Tablets, Methylphenidate ER Capsules (CD), Methylphenidate ER Tablets, or Methylphenidate ER Capsules (LA)
|
04/01/2021 | Methylphenidate Chewable Tablets | Methylphenidate Tablets or Solution |
04/01/2021 | Aripiprazole Oral Solution Saphris SL Tablets | Aripiprazole Tablets Risperidone ODT Tablets Olanzapine ODT Tablets |
04/01/2021 | Fanapt Tablets Paliperidone ER Tablets Rexulti Tablets
| Aripiprazole Tablets, Clozapine Tablets, Olanzapine Tablets, Quetiapine Tablets, Risperidone Tablets, or Ziprasidone Capsules |
04/01/2021 | Trokendi XR Tablets | Topiramate Capsules Carbamazepine ER Tablets Levetiracetam ER Tablets |
04/01/2021 | Diastat Rectal Gel Delivery System | Generic Diazepam Rectal Gel Delivery System |
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Remember to check the Provider News section of the Coordinated Care website to refer back to previous fax notices as well as many other informational updates!
To be removed from these notices or to request to be added to our email list for these notices, please reply to CoordinatedCareProvider@centene.com.
Thank you for being our partner in care and helping us collectively improve the health of our members. Please reach out to your Provider Services team if you have questions about any of these announcements or need more information.
Coordinated Care Provider Services: (877) 644-4613.