May 2024 Provider News
Date: 05/28/24
In this issue:
- General Updates - Ascension Cybersecurity Incident Provider Accommodations, Change Healthcare Cyberattack Update, Coordinated Care Maternal Healthcare/ Start Smart for Baby (SSFB), Clinical Data Repository (CDR)
- Quality - ADHD Follow Up on Kids, Asthma and 90 Day Medication Refills, Mammograms (HEDIS Measure), Telehealth, Antidepressant Medication Management (HEDIS Measure)
- Payment & Clinical Policy - Monthly Updates
- Pharmacy Update - Hyaluronic Acid, New Biopharmacy/Buy-bill Prior Authorization Fax Number, July 1, 2024 Preferred Drug List (PDL) Changes, Non-Contracted Drugs Update- Apple Health Expansion, Non-Contracted Drugs Update- Medicaid
- Wellcare - Clinical Practice and Preventive Health Guidelines
- Apple Health Core Connections - Foster Care Awareness Month: Resources and Information to Share
- Training/Education - Deep dive into prevention ethics: Ethical obligations and the SPF, Catalyst for Change Webinar Series, LGBTQ+ Cultural Fluency Training 101, and more
______________________________________________________________________________________
General Updates
Ascension Cybersecurity Incident Provider Accommodations
Thank you for being a participating provider with Coordinated Care of Washington. We understand that Ascension’s recent cybersecurity incident has disrupted several of its operational systems and processes. To ensure member access and continuity of care as Ascension works to address impacted systems and processes, we are extending the following accommodations to Ascension providers beginning 5/8/2024 through 6/8/2024 or Ascension’s remediation date – whichever date is sooner. Barring earlier remediation, Coordinated Care of Washington will assess the need for continued flexibilities on 6/8/2024 and update you accordingly.
- Prior authorization (PA) for home health and post-acute care requests for discharging members is waived. For skilled nursing and inpatient rehabilitation requests, Coordinated Care of Washington will authorize five (5) business days upon notification of admission by the receiving facility. Home health will be approved for the initial certification period upon receipt of the retrospective request from the home health agency. Please prioritize use of in-network facilities and agencies.
- Authorizations for Ascension that are currently in process, but pending additional clinical information, will be reviewed using available information obtained telephonically.
- Coordinated Care of Washington will allow reconsideration of Ascension claims denied due to no authorization. Timely notification will be waived during the accommodations time period set forth above. Prior authorizations will be reviewed retrospectively for medical necessity appropriateness.
- Coordinated Care of Washington reserves the right to retrospectively review all provided services for medical necessity.
We appreciate Ascension’s continued partnership in providing our members with safe, timely and appropriate care during this time. If you have any additional questions, please contact Provider Services at 877.644.4613.
Change Healthcare Cyberattack Update
Medicaid members can receive free credit monitoring from United Health Group in the wake of the Change Healthcare cyberattack.
In February, Change Healthcare, a large healthcare company, was hit by a cyberattack. This company touches the electronic health records of one-in-three Americans and is responsible for processing half of all health care claims in the country. Because of the size of this company, it is likely that many Medicaid members’ personal data may have been compromised in this attack. United Health Group (the parent company of Change Healthcare) recently confirmed that protected health information (PHI) and personally identifiable information (PII) were stolen in the attack. However, it will take several months before Change Healthcare is able to identify and notify impacted individuals. In the meantime, United Health Group is offering two years of free credit monitoring to any American who calls and requests it via their Change Healthcare call center: 1-866-262-5342. Communicators may wish to make this information about free credit monitoring available to Medicaid members.
If you have any questions, please contact Christina Hinchman and cc to TAC_CCW HCA Contacts ccw_hca_contacts@centene.com.
Coordinated Care Maternal Healthcare/Start Smart for Baby (SSFB)
No two pregnancy journeys are the same. Coordinated Care offers customized care and specialized resources to support members and their babies every step of the way. We partner with First 5 Fundamentals’ Family Connect program to expand postpartum nurse support, and we were the first plan to offer 24/7 access to virtual doula services to our members.
Our maternal health programs are designed to address SDOH during pregnancy and childbirth when it’s critically important to ensure a healthy start. For members who struggle with addiction, our Healthy Beginnings pilot program offers immediate access to substance use disorder treatment to help improve health outcomes. We also helped fund Maddie’s Place, a recovery nursery designed especially for babies experiencing withdrawal due to prenatal substance exposure.
Our Start Smart for Your Baby program provides members with necessities like a no-cost car seat and breast pump, as well as access to a case manager for extra support.
WA Start Smart for Baby WASSFB@CENTENE.COM or Call 1-877-644-4613 and ask for the SSFB program staff.
Postpartum and newborn resources.
Visit Perinatal Support Washington here for more resources or call 1-888-404-7763.
More resources available here.
Attention Midwives: WA state HCA has a goal to increase access to midwives and midwifery models of care for Medicaid covered lives. If you are a Midwife (CNMs and LMs) have clients who are currently pregnant, have Coordinated Care coverage and/or have delivered in the last year. Please share this Flyer and the survey LINK with them.
Your clients may be eligible for a $50.00 Amazon gift card for sharing their experience.
Clinical Data Repository (CDR)
The Washington State Health Care Authority (HCA) requires providers seeing Apple Health members, who have an ONC (Office of the National Coordinator) – certified EHR, and who have received Promoting Interoperability funding to send care summaries from their EHR to the CDR.
The CDR is a secure, cloud database managed by OneHealthPort, who has hosted the state’s health information exchange (HIE) since 2009.
______________________________________________________________________________________
Quality
Medicaid Quality
ADHD Follow Up on Kids
Children with new prescription for ADHD medication should receive a follow up visit within 30 days of starting the medication.
Asthma and 90 Day Medication Refills
Moving members with asthma prescriptions to 90-day medication refills may increase their maintenance medication adherence.
Mammograms (HEDIS Measure)
The HEDIS measure assesses women ages 50-74 who had at least one mammogram to screen for breast cancer in the past 2 years.
Telehealth
Telehealth increases access to physicians and specialists to help patients receive the right care, at the right place, at the right time.
More information:
Antidepressant Medication Management (HEDIS Measure)
The HEDIS measure assess adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on their antidepressant medications.
______________________________________________________________________________________
Payment & Clinical Policy Updates
Clinical Policy Updates
The below policies were updated as part of our regular monthly review in April. The policy changes are effective June 1, 2024. 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.501 | Continuous Glucose Monitor | Apple Health |
WA.CP.MP.503 | Private Duty Nursing Services | Apple Health |
WA.CP.MP.505 | Microprocessor-Controlled Lower Limb Prosthetics | Apple Health |
WA.CP.MP.517 | Testosterone Testing | Apple Health |
WA.CP.MP.520 | Tympanostomy Tubes | Apple Health |
CP.MP.36 | Experimental Technologies | Ambetter |
WA.CP.MP.36 | Experimental Technologies | Apple Health |
CP.MP.46 | Ventricular Assist Devices | Ambetter |
WA.CP.MP.46 | Ventricular Assist Devices | Apple Health |
CP.MP.50 | Drugs of Abuse: Definitive Testing | Ambetter |
WA.CP.MP.50 | Drugs of Abuse: Definitive Testing | Apple Health |
CP.MP.62 | Hyperhidrosis Treatments | Apple Health & Ambetter |
CP.MP.102 | Pancreas Transplantation | Apple Health & Ambetter |
CP.MP.162 | Tandem Transplant | Apple Health & Ambetter |
CP.MP.163 | TPN and Intradialytic Parenteral Nutrition | Apple Health & Ambetter |
CP.MP.250 | Lantidra (donislecel); Allogeneic pancreatic islet cellular therapy | Apple Health & Ambetter |
The below policy was updated as part of our regular monthly review in April. The policy change is effective July 1, 2024. You will find the policy, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
WA.CP.MP.521 | Behavioral Health Wraparound Support (BHWS), previously Behavioral Health Personal Care Services | Apple Health |
The below policies were updated as part of our regular monthly review in April. The policy changes are effective September 1, 2024. You will find the policies, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
CP.MP.40 | Gastric Electrical Stimulation | Apple Health & Ambetter |
CP.MP.91 | Obstetrical Home Health Care Programs | Ambetter |
CP.MP.132 | Heart-Lung Transplant | Apple Health & Ambetter |
CP.MP.141 | Non-Myeloablative Allogenic Stem Cell Transplants | Apple Health & Ambetter |
CP.MP.185 | Skin and Soft Tissue Substitutes for Chronic Wounds | Ambetter |
WA.CP.MP.185 | Skin and Soft Tissue Substitutes for Chronic Wounds | Apple Health |
The below policies were previously announced as revised 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.22 | Stereotactic Body Radiation Therapy | 7/1/24 | Apple Health & Ambetter |
CP.MP.62 | Hyperhidrosis Treatments | 7/1/24 | Apple Health & Ambetter |
CP.MP.82 | NICU Apnea Bradycardia Guidelines | 7/1/24 | Apple Health & Ambetter |
CP.MP.173 | Implantable Intrathecal or Epidural Pain Pump | 7/1/24 | Apple Health & Ambetter |
CP.MP.190 | Oxygen Use and Concentrators | 7/1/24 | Ambetter |
CP.MP.243 | Implantable Loop Recorder (Implantable Cardiac Monitor) | 7/1/24 | Apple Health & Ambetter |
CP.MP.248 | Facility Based Sleep Studies for Obstructive Sleep Apnea | 7/1/24 | Apple Health & Ambetter |
Payment Policy Updates
Coordinated Care is committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of an additional review process that will taking place beginning on or after 9/1/2024.
Description of Changes | Lines of Business |
Inpatient claims will be reviewed internally for DRG validation prior to utilizing external vendors. Medical records will be requested for selected claims and should be sent according to the instructions on the request correspondence. | Medicare, Medicaid, Marketplace
|
Enforcement of National Coverage Determination (NCD) guidelines when diagnostic lab testing services are billed only with a diagnosis that is not covered per the NCD. | Marketplace |
Enforcement of Correct Coding Guidelines regarding DME Orthosis and incorrect usage of modifiers. | Medicare |
Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.
______________________________________________________________________________________
Pharmacy Updates
Hyaluronic Acid Coverage Change Reminder
Effective 7/1/2024, as instructed by the Washington State Health Care Authority, Coordinated Care will no longer cover hyaluronic acid products. This is based upon the review of evidence performed by the Health Technology Clinical Committee.
Code | Description of Codes |
J7320 | Hyaluronan or derivitive, GenVisc 850, for intra-articular injection, 1 mg |
J7321 | Hyaluronan or derivative, hyalgan, Supartz or VISCO-3, for intra-articular injection, per dose |
J7322 | Hyaluronan or derivative, Hymovis, for intra-articular injection, 1 mg |
J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose |
J7324 | Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose |
J7325 | Hyaluronan or derivative, synvisc or Synvisc-One, for intra-articular injection, 1 mg |
J7326 | Hyaluronan or derivative, Gel-One, for intra-articular injection, per dose |
J7327 | Hyaluronan or derivative, Monovisc, for intra-articular injection, per dose |
J7328 | Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg |
J7332 | Hyaluronan or derivative, Synojoynt, for intra-articular injection, 1 mg |
J7332 | Hyaluronan or derivative, TRILURON, for intra-articular injection, 1 mg |
NEW FAX NUMBER Effective 5/28/24: Biopharmacy/Buy-bill Prior Authorization- Ambetter only
Effective 05/28/24, Biopharmacy/Buy-bill Prior Authorization requests for Ambetter will have a new fax number: 833-364-2511.
July 1, 2024 Preferred Drug List (PDL) Changes
Effective July 1, 2024, the following drugs will no longer be preferred. A prior authorization will be required.
EFFECTIVE DATE | DRUG NAME | PREFERRED ALTERNATIVE |
07/01/2024 | Catapres-TTS Patch Weekly 24HR (Brand) | Clonidine TD Patch Weekly 24HR (Generic) |
07/01/2024 | Lorazepam Intensol Concentration | Lorazepam Concentrate (Generic for Lorazepam Intensol), Lorazepam Injection, or Lorazepam Tablets |
07/01/2024 | Advair Diskus (Brand) | Fluticasone Propionate/Salmeterol (Generic for Advair Diskus) |
07/01/2024 | Advair HFA (Brand) | Fluticasone Propionate/Salmeterol HFA (Generic for Advair HFA) |
07/01/2024 | Xiidra Ophthalmic Solution 5% | Cyclosporine, Restasis, or Restasis Multidose |
Non-Contracted Drugs Update - Apple Health Expansion
For Apple Health Expansion, the following drugs will need to be billed to the Health Care Authority (HCA) effective July 1, 2024. For more information, please contact the HCA at 800-562-3022.
|
|
Non-Contracted Drugs Update - Medicaid
Effective July 1, 2024, the following drugs will need to be billed to the HCA. For drugs that currently require prior authorization (PA), please submit PA requests to the HCA on or after January 1, 2024. For more information, please contact the HCA at 800-562-3022.
- Molnupiravir (Lagevrio)
- Nirmatrelvir-Ritonavir (Paxlovid)
- Adamts13 Recombinant-KRHN (Adzynma)
- Cyclosporine (Cyclosporine)- Injectable
- Cyclosporine (Sandimmune)- Injectable
- Cyclosporine (Cyclosporine)- Oral
- Cyclosporine (Sandimmune)- Oral
- Cyclosporine Modified (for Microemulsion) (Cyclosporine Modified)
- Cyclosporine Modified (for Microemulsion) (Gengraf)
- Cyclosporine Modified (for Microemulsion) (Neoral)
- Lymphocyte Immune Globulin, Anti-Thymocyte Globulin (Equine) (Atgam)
- Lymphocyte Immune Globulin, Anti-Thymocyte Globulin (Rabbit) (Thymoglobulin)
- Mycophenolate Mofetil HCL (Cellcept Intravenous)
- Mycophenolate Mofetil (Cellcept)
- Mycophenolate Mofetil (Mycophenolate Mofetil)
- Mycophenolate Sodium (Mycophenolic Acid DR)
- Mycophenolate Sodium (Myfortic)
- Everolimus (Immunosuppressant) (Everolimus)
- Everolimus (Immunosuppressant) (Zortress)
- Sirolimus (Rapamune)
- Sirolimus (Sirolimus)
- Tacrolimus (Astagraf XL)
- Tacrolimus (Envarsus XR)
- Tacrolimus (Prograf)- Oral
- Tacrolimus (Prograf)- Injection
______________________________________________________________________________________
Wellcare
Clinical Practice and Preventive Health Guidelines
Here is the link to the most recent grid.
Back to Top
______________________________________________________________________________________
Apple Health Core Connections (AHCC)
May is National Foster Care Awareness Month! Coordinated Care is proud to share a new issue brief and accompanying video on our comprehensive work to support Washington’s foster care population, which feature our partnerships with Hope Sparks, Treehouse, Children’s Village and Community Health Care.
With thousands of children, youth and young adults in foster care in Washington state, it is critical that we work together to provide holistic, accessible care for this population in need of support. As the only health plan serving youth and young adults in foster care statewide, Coordinated Care is proud to partner with incredible providers, including our Foster Care Centers of Excellence, to build a healthier future for all Washingtonians. And, we work closely with the State, including the Department of Children, Youth and Families and the Washington State Health Care Authority, to take a trauma-informed approach and drive holistic health for our members.
Coordinated Care will be sharing social media posts all month long to raise awareness of youth and families impacted by foster care. Please repost and share about YOUR role as a key partner in serving kids in foster care in our state.
Thank you for all that you do to improve the health and well-being of kids and families impacted by child welfare in our community!
______________________________________________________________________________________
Training/Education
Deep dive into prevention ethics: Ethical obligations and the SPF Based on the success of our previous series of the same name, we continue to address the need for ongoing ethics training with our 2024 series. In six interactive virtual sessions, participants will focus on taking a deep dive into the principles of the Code of Ethics for Prevention Specialists with special focus on how these principles apply when implementing the Strategic Prevention Framework (SPF). Each session will focus on a different principle. (See schedule below.) After a short presentation, participants will work together in small groups to look at how that principle can be applied by our prevention workforce while implementing the SPF June 6, 2024, 7:30am – 9:00pm Register here.
Catalyst for Change Webinar Series: Analytics for the intersection of equity and value In healthcare, you cannot have quality without equity. In today's healthcare landscape, harnessing data to promote equity and drive value has become more critical than ever. Transformative change that centers equity needs to be driven by a multifaceted approach that encompasses collecting, analyzing and applying data insights. In this webinar we will explore how data can support efforts to provide more equitable, high value care through presentations from different stakeholder groups within our healthcare ecosystem. June 12th, 12:00pm – 1:30pm Register here.
LGBTQ+ Cultural Fluency Training 101 LGBTQ+ Cultural Fluency Training (a.k.a. Safe Zone) provides participants with the fundamentals of awareness, language, and experience on the best practices to support LGBTQ+ people and their allies. Participants will define common LGBTQ+ terminology, learn the importance of inclusive language, and participate in activities that offer experience in minimizing conflict and harm. June 29, 2024 10am – 1pm Register here.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to Care This webinar will help improve understanding of the distinct healthcare needs of the LGBTQ+ community while focusing on patients who are nearing the end of life. Attendees will learn how to provide equitable, respectful, affirming, and clinically appropriate care to the LGBTQ+ adult regardless of sexual orientation, gender identity, or gender expression. By improving knowledge, comfort with LGBTQ+ needs, and terminology, attendees are equipped to prevent suffering and establish patient trust with clinicians. June 5, 2024 10am – 11am Register here.
ATTENTION PROVIDERS AND NURSES:
COMPLETE ON-DEMAND TRAINING FROM (ACCREDITED) CENTENE INSTITUTE AT NO COST TO YOU: Once you’ve signed up for a free account, you’ll be able to access the catalog of virtual courses and start training today. Complete the course and receive attendance credit for free.
HOW TO ENROLL:
Once you’ve signed up for a free account, click on “Enroll Now” to access the course of your choice. For help, please email: Centene_Institute@centene.com.
CULTURAL HUMILITY AND UNCONSCIOUS BIAS IN HEALTHCARE:
This course examines cultural humility and unconscious bias in healthcare and explores how these two items intersect with the goal of health equity for all. Complete this course from Centene Institute and receive AMA PRA Category 1 Credit(s)™ 0.50 Credit (0 hour and 30 minutes).
FOLLOW THE LINK TO ENROLL AND ACCESS THE COURSE.
LEARNING OBJECTIVES:
- Define unconscious bias and its impact on patient health outcomes.
- Analyze how cultural humility can improve patient care, safety, and experience.
- Explore the intersectionality between unconscious bias, cultural humility, and health equity.
RECEIVE CREDIT:
- Attendance Credit 0.50 Credit (0 hour and 30 minutes)
- ANCC 0.50 Credit (0 hour and 30 minutes)
- IPCE 0.50 Credit (0 hour and 30 minutes)
- AMA PRA Category 1 Credit(s)™ 0.50 Credit (0 hour and 30 minutes)
View the complete Catalog from Centene Institute here.
Additional Free Provider Education Resources:
- Clinical Provider Training
- Implicit Bias Training Course
- Improving Cultural Competency for Behavioral Health Professionals
- Racism, Bias, and Other Determinants of Health: Issues and Actions
- Tribal Sovereignty and the Indian Health Care System
Visit Coordinated Care’s Health Equity Resources Page for helpful information about:
- Member Languages
- How to Request Interpreter Services
- Other Language Resources
- Provider Training