May 2025 Provider News
Date: 05/29/25
In this issue:
- General Updates - Washington’s Medicaid Transformation Project – Reentry Initiative Overview, Availity Essentials enhancements going live July 21st
- Quality - DOH urges Measles, Mumps, and Rubella (MMR) vaccine, KED HEDIS Measure Overview
- Clinical & Payment Policy - Policy updates
- Prior Authorization Updates - Prior authorization for Apple Health members
- Wellcare - Medical Quality Update
- Apple Health Core Connections - Free Training and Resources for Supporting Adoptees
- Training/Education - Supporting LGBTQIA+ Youth in Foster Care, Suicide Prevention, Commercial Sexual Exploitation of Children
- Pharmacy Updates - ADHOC and July 1, 2025 Preferred Drug List Changes
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General Updates
Availity Essentials enhancements going live July 21st
Authorization and Authorization Inquiry Enhancements
Providers who work with Ambetter from Coordinated Care, Coordinated Care, Wellcare, and Wellcare by Health Net can now update or correct outpatient authorizations in a pended status, reducing delays and resubmissions. To learn more and see which health plans are affected, log in to the Availity portal and view News and Announcements.
Washington’s Medicaid Transformation Project – Reentry Initiative Overview
What is the Reentry Initiative?
The Reentry Demonstration Initiative (Reentry Initiative) is a new Apple Health (Medicaid) initiative under the Medicaid Transformation Project (MTP). It provides essential, prerelease services for individuals leaving incarceration. Under this initiative, incarcerated individuals who are Apple Health-eligible will receive a set of services up to 90 days before their release. These services will ensure a person’s health and successful reentry to their community.
When will the Reentry Initiative services begin?
Interested facilities have the option to participate in one of three cohorts – groups of participating facilities – that will go live at different times.
- Cohort 1: Go live July 1, 2025
- Cohort 2: Go live January 1, 2026
- Cohort 3: Go live July 1, 2026
What is changing?
Prior to the Reentry Initiative – and for non-participating facilities – Apple Health may only provide reimbursement for an incarcerated individual’s inpatient hospitalization services 24 hours or longer. This federal requirement is known as the Medicaid Inmate Exclusion Rule.
The Reentry Initiative creates an exception to the Medicaid Inmate Exclusion Rule and allows reimbursement for a limited scope of reentry services within 90-days pre-release. This is in addition to the existing inpatient hospitalization benefit.
Starting in July 2025, facilities participating in the Reentry Initiative will continue to suspend an individual’s Medicaid coverage and:
1) Reentry Initiative program requirements will apply to these facilities
2) Providers will be reimbursed for limited reentry benefits provided to individuals during the 90-day prerelease period
3) Providers will continue to be reimbursed for inpatient hospital stays lasting greater than 24 hours, regardless of when hospitalization occurs during an incarceration
What services will the Reentry Initiative provide?
This initiative will support and fund the delivery of targeted prerelease services to Apple Health-eligible adults and youth in state prisons, jails, and youth carceral facilities. HCA will require participating facilities to support the first three Reentry Initiative Benefit services below. The remaining four services are optional, and facilities may implement them individually.
- Reentry Targeted Case Management (rTCM)
- Medications for opioid use disorder (MOUD) and medications for alcohol use disorder (MAUD)
- 30-day supply of medications and medical supplies at release
- Medications during the prerelease period
- Lab and radiology
- Services by community health workers with lived experience
- Physical and behavioral clinical consultations
Which Washington carceral facilities are participating in the Reentry Initiative?
HCA maintains a list of approved and prospective carceral facilities (PDF) on their Reentry Initiative webpage. This includes state prisons, county/city jails, Tribal jails, and youth correctional facilities.
Where can I learn more?
Future training webinars will be scheduled at a later date in collaboration with the HCA’s Reentry Initiative Third Party Administrator (TPA). In the meantime, additional information can be found through the resources below:
- Coordinated Care’s Reentry Initiative Email Inbox - Reentry_Support@coordinatedcarehealth.com
- HCA’s Reentry Initiative Webpage
- Carceral Facilities Invitation to Participate (PDF)
- Tribal Jails Invitation to Participate (PDF)
Coordinated Care Provider Manual Update
Updates will be made to the Provider Manual on 7/1/2025 to reflect the changes stemming from the Reentry Initiative. Please use this link after the 7/1/2025 update to find the latest version of the Provider Manual in the Apple Health (Medicaid) Manual and Guides Section.
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Quality
Medicaid Quality
DOH urges Measles, Mumps, and Rubella (MMR) vaccines amidst national outbreak
Contact: DOH Communications - doh-pio@doh.wa.gov
Childhood immunization rates in Washington state have dropped since the COVID-19 pandemic, putting communities at risk for outbreaks
OLYMPIA – As the measles outbreak in the United States surpasses 800 confirmed cases across 24 states, including a fifth case reported this week in Washington state, the Washington State Department of Health (DOH) is urging parents and caregivers to make sure their children are protected from the disease by getting two doses of the Measles, Mumps, and Rubella (MMR) vaccine. Adults are also strongly encouraged to verify their own measles vaccination status by checking their immunization records online, or by speaking with their provider to make sure they’re fully protected.
“I’m worried that some data show that Washington kindergartners have lower rates of MMR coverage than Texas or New Mexico – both of which are struggling with a measles outbreak,” said Dr. Tao Sheng Kwan-Gett, State Health Officer, DOH. “Besides causing fever and rash, measles can sometimes cause life-threatening pneumonia and brain inflammation. The MMR vaccine is our best defense against measles, and we need to get more people up to date on vaccination to prevent a similar outbreak in Washington.”
This week also marks National Infant Immunization Week an observance created by the Centers for Disease Control and Prevention (CDC) that highlights the importance of protecting children two years and younger from vaccine-preventable diseases. Children should receive their first dose of the MMR vaccine between 12 and 15 months of age (PDF) and a second dose between 4 to 6 years old.
Some cases of measles have occurred in infants who were too young to receive the MMR vaccine and traveled with their families to countries where there is a higher risk of measles. Parents planning travel to such places with an infant 6 to 11 months of age should check with their health care provider to see if an early dose of MMR vaccine can be given to prevent measles infection during travel. The dose must be given at least two weeks before departure for the best protection, and the infant will still need to start the regular two dose series between 12 and 15 months of age.
Adults who have received two documented doses of the MMR vaccine do not need to receive additional doses. It is especially important that high-risk adults, such as healthcare professionals, college students, people with Human Immunodeficiency Virus (HIV) infection, or those preparing for international travel, confirm they’ve previously received two doses to be fully protected.
In 2000, the CDC declared measles eliminated from the United States after high vaccination rates stopped the spread of the disease within the country, and the only cases came from contracting it abroad. However, declining vaccination rates in recent years – especially since the beginning of the COVID-19 pandemic – have aided the disease’s recent spread.
Videos of Dr. Kwan-Gett discussing the importance of the MMR vaccine are available on DOH’s social media channels. Additional recorded materials are available upon request. For access to this content, media can contact DOH-PIO@doh.wa.gov.
Asthma and 90 Day Medication Refills
Moving members with asthma prescriptions to 90-day medication refills may increase their maintenance medication adherence.
Chlamydia screening
Providers are encouraged to perform chlamydia screening every year on every 16 to 24-year-old female identified as being sexually active.
Inform patients that chlamydia screening can be performed through a urine test. Offer this as an option for patients.
Add Chlamydia screening as a standard lab for women 16‒24 years old. Use well-child exams and well-women exams for this purpose.
Place chlamydia swab next to Pap test or pregnancy detection materials.
Meet with teens and young adults separately from their parents to allow open conversation.
Advise members during wellness visits or when they are seen for birth control to get screened for chlamydia.
KED HEDIS Measure Overview
The percentage of members 18–85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year.
The goal is to inform all providers of these routine kidney function tests that need to be completed for patients with diabetes.
Applicable CPT II coding as deemed appropriate and applicable by Providers and clinic staff when completing screening tests to assist in administrative collection and gap closures.
Breast Cancer Screening/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.
Colorectal cancer screening
Spread the word about the importance of getting regular colorectal cancer screenings, starting at age 45 years. Share the National Cancer Institute’s article to help people learn about prevention, treatment, and more.
Wellcare Quality
KED HEDIS Measure Overview
The percentage of members 18–85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year.
The goal is to inform all providers of these routine kidney function tests that need to be completed for patients with diabetes.
Applicable CPT II coding as deemed appropriate and applicable by Providers and clinic staff when completing screening tests to assist in administrative collection and gap closures.
Breast Cancer Screening/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.
Colorectal cancer screening
Spread the word about the importance of getting regular colorectal cancer screenings, starting at age 45 years. Share the National Cancer Institute’s article to help people learn about prevention, treatment, and more.
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Clinical & Payment 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, 2025. 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.175 | Air Ambulance | Ambetter |
WA.CP.BH.529 | CBHS - Supportive Supervision | Apple Health |
WA.CP.MP.504 | Elective Delivery Prior to 39 Weeks | Apple Health |
WA.CP.MP.501 | Continuous Glucose Monitoring | Apple Health |
CP.MP.184 | Home Ventilators | Apple Health & Ambetter |
WA.CP.BH.528 | HRSN - Intensive Behavioral Supportive Supervision | Apple Health |
CP.MP.144 | Mechanical Stretching Devices for Joint Stiffness and Contracture | Ambetter |
WA.CP.MP.503 | Private Duty Nursing | Apple Health |
The below policies were updated as part of our regular monthly review in April. The policy changes are effective September 1, 2025. You will find the policies, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
CP.BH.500 | Behavioral Health Treatment Documentation Requirements | Apple Health |
HIM.CP.BH.500 | Behavioral Health Treatment Documentation Requirements | Ambetter |
WA.CP.MP.513 | Cardiac Stents | Apple Health |
WA.CP.MP.502 | Cochlear Implants | Apple Health |
CP.MP.50 | Drugs of Abuse: Definitive Testing | Ambetter |
WA.CP.MP.505 | Microprocessor-Controlled Lower Limb Prosthetics | Apple Health |
CP.MP.147 | Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention | Ambetter |
WA.CP.MP.185 | Skin Substitutes | Apple Health |
CP.MP.185 | Skin Substitutes for Chronic Wounds | Ambetter |
CP.MP.247 | Transplant Service Documentation Requirements | Apple Health & Ambetter |
The below policies are new effective September 1, 2025. You will find the policies posted on the policy Web site.
Policy Number | Policy Title | Line of Business | |
CP.MP.50 | Drugs of Abuse: Definitive Testing | Apple Health | |
WA.CP.MP.513 | Cardiac Stents | Ambetter | |
WA.CP.MP.502 | Cochlear Implants | Ambetter | |
WA.CP.MP.505 | Microprocessor-Controlled Lower Limb Prosthetics | Ambetter | |
The below policy will be archived effective August 31, 2025.
Policy Number | Policy Title | Line of Business |
WA.CP.MP.50 | Drugs of Abuse: Definitive Testing | Apple Health |
The below policies were previously announced as revised 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.62 | Hyperhidrosis treatments | 5/1/25 | Apple Health & Ambetter |
CP.MP.107 | Durable Medical Equipment (DME) and Orthotics and Prosthetics Guidelines | 5/1/25 | Apple Health & Ambetter |
CP.MP.180 | Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea | 5/1/25 | Ambetter |
WA.CP.MP.237 | CG Oncology Algorithmic Testing | 5/1/25 | Apple Health |
WA.CP.MP.219 | CG Genetic Testing Exome and Genome Sequencing | 5/1/25 | Apple Health |
V1.2025 | Concert Genetics Policies | 5/1/25 | Apple Health & Ambetter |
CP.BH.104 | Applied Behavior Analysis | 7/1/25 | Apple Health & Ambetter |
CP.BH.105 | Applied Behavioral Analysis Documentation Requirements | 7/1/25 | Apple Health & Ambetter |
WA.CP.MP.515 | Fecal Microbiota Transplantation | 7/1/25 | Apple Health |
CP.MP.121 | Homocysteine Testing | 7/1/25 | Apple Health & Ambetter |
CP.MP.82 | NICU Apnea Bradycardia Guidelines | 7/1/25 | Apple Health & Ambetter |
CP.MP.81 | NICU Discharge Guidelines | 7/1/25 | Apple Health & Ambetter |
WA.CP.MP.526 | Stem Cell Therapy for Musculoskeletal Conditions | 7/1/25 | Apple Health |
CP.MP.162 | Tandem Transplant | 7/1/25 | Apple Health & Ambetter |
WA.CP.MP.510 | Tinnitus Treatment | 7/1/25 | Apple Health |
CP.MP.163 | Total Parenteral Nutrition and Intradialytic Parenteral Nutrition | 7/1/25 | Apple Health & Ambetter |
CP.MP.55 | Assisted Reproductive Technology | 8/1/25 | Ambetter |
CP.BH.201 | Deep Transcranial Magnetic Stimulation (TMS) for OCD | 8/1/25 | Ambetter |
CP.MP.132 | Heart-Lung Transplant | 8/1/25 | Apple Health & Ambetter |
WA.CP.MP.69 | Intensity-Modulated Radiotherapy | 8/1/25 | Apple Health |
CP.MP.57 | Lung Transplant | 8/1/25 | Apple Health & Ambetter |
WA.CP.MP.517 | Testosterone Testing | 8/1/25 | Apple Health |
WA.CP.MP.520 | Tympanostomy Tubes | 8/1/25 | Apple Health |
The below genetic testing policies were previously announced to be updated effective May 1, 2025. You will find the policies, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
V1.2025 | CG Aortopathies and Connective Tissue Disorders | Apple Health & Ambetter |
V1.2025 | CG Cardiac Disorders | Apple Health & Ambetter |
V1.2025 | CG Dermatologic Conditions | Apple Health & Ambetter |
V1.2025 | CG Epilepsy Neurodegenerative and Neuromuscular Conditions | Apple Health & Ambetter |
V1.2025 | CG Exome and Genome Sequencing for the Diagnosis of Genetic Disorders | Ambetter |
V1.2025 | CG Eye Disorders | Apple Health & Ambetter |
V1.2025 | CG Gastroenterologic Disorders Non-cancerous | Apple Health & Ambetter |
V1.2025 | CG General Approach to Genetic Testing | Apple Health & Ambetter |
V1.2025 | CG Hearing Loss | Apple Health & Ambetter |
V1.2025 | CG Hematologic Conditions Non-cancerous | Apple Health & Ambetter |
V1.2025 | CG Hereditary Cancer Susceptibility | Apple Health & Ambetter |
V1.2025 | CG Immune Autoimmune and Rheumatoid Disorders | Apple Health & Ambetter |
V1.2025 | CG Kidney Disorders | Apple Health & Ambetter |
V1.2025 | CG Lung Disorders | Apple Health & Ambetter |
V1.2025 | CG Metabolic Endocrine Mitochondrial Disorders | Apple Health & Ambetter |
WA.CP.MP.230 | CG Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Apple Health |
V1.2025 | CG Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Ambetter |
WA.CP.MP.231 | CG Prenatal Cell-Free DNA Testing | Apple Health |
V1.2025 | CG Prenatal Cell-Free DNA Testing | Ambetter |
V1.2025 | CG Oncology Algorithmic Testing | Ambetter |
V1.2025 | CG Oncology Cancer Screening | Apple Health & Ambetter |
V1.2025 | CG Oncology Circulating Tumor DNA Tumor Cells Liquid Biopsy | Apple Health & Ambetter |
V1.2025 | CG Oncology Cytogenetic Testing | Apple Health & Ambetter |
V1.2025 | CG Oncology Molecular Analysis Solid Tumors & Hematolgic Malignancies | Apple Health & Ambetter |
WA.CP.MP.232 | CG Pharmacogenetics | Apple Health |
V1.2025 v.A | CG Pharmacogenetics (Version A) | Ambetter |
V1.2025 | CG Preimplantation Genetic Testing | Apple Health & Ambetter |
V1.2025 | CG Prenatal and Preconception Carrier Screening | Apple Health & Ambetter |
V1.2025 | CG Prenatal Diagnosis Pregnancy Loss | Apple Health & Ambetter |
V1.2025 | CG Skeletal Dysplasia Rare Bone Disorders | Apple Health & Ambetter |
The below new policies were previously announced effective on the dates noted. You will find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
WA.CP.MP.510 | Tinnitus Treatment | 7/1/25 | Ambetter |
WA.CP.MP.526 | Stem Cell Therapy for Musculoskeletal Conditions | 7/1/25 | Ambetter |
WA.CP.MP.515 | Fecal Microbiota Transplantation | 7/1/25 | Ambetter |
WA.CP.MP.69 | Intensity-Modulated Radiotherapy | 8/1/25 | Ambetter |
WA.CP.MP.517 | Testosterone Testing | 8/1/25 | Ambetter |
WA.CP.MP.520 | Tympanostomy Tubes | 8/1/25 | Ambetter |
The below policy was previously announced as being archived on the date noted.
Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.69 | Intensity-Modulated Radiotherapy | 7/31/25 | Ambetter |
Payment Policy Updates
The below payment policy was updated as part of our regular monthly review in April. The policy change is effective June 1, 2025. You will find the policy, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
CC.PP.206 | SNF Leveling | Apple Health & Ambetter |
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Prior Authorization Updates
The following skin substitutes will require prior authorization for Apple Health members effective September 1, 2025:
Code | Description |
C9363 | Skin substitute (Integra Meshed Bilayer Wound Matrix), per sq cm |
Q4100 | Skin substitute, not otherwise specified |
Q4103 | Oasis burn matrix, per sq cm |
Q4108 | Integra matrix, per sq cm |
Q4122 | DermACELL, Dermacell AWM or DermACELL AWM Porous, per sq cm |
Q4123 | AlloSkin RT, per sq cm |
Q4126 | MemoDerm, DermaSpan, TranZgraft or Integuply, per sq cm |
Q4127 | Talymed, per sq cm |
Q4134 | Hmatrix, per sq cm |
Q4135 | Mediskin, per sq cm |
Q4136 | E Z Derm, per sq cm |
Q4138 | BioDFence DryFlex, per sq cm |
Q4140 | BioDFence, per sq cm |
Q4143 | Repriza, per sq cm |
Q4147 | Architect, Architect PX, or Architect FX, extracellular matrix, per sq cm |
Q4149 | Excellagen, 0.1 cc |
Q4150 | AlloWrap DS or dry, per sq cm |
Q4153 | Dermavest and Plurivest, per sq cm |
Q4157 | Revitalon, per sq cm |
Q4161 | Bio-connekt wound matrix, per sq cm |
Q4162 | WoundEx Flow, BioSkin Flow, 0.5 cc |
Q4163 | Woundex, bioskin, per sq cm |
Q4164 | Helicoll, per sq cm |
Q4165 | Keramatrix or Kerasorb, per sq cm |
Q4167 | Truskin, per sq cm |
Q4168 | AmnioBand, 1 mg |
Q4169 | Artacent wound, per sq cm |
Q4173 | Palingen or Palingen Xplus, per sq cm |
Q4174 | PalinGen or ProMatrX, 0.36 mg per 0.25 cc |
Q4176 | Neopatch or therion, per sq cm |
Q4177 | FlowerAmnioFlo, 0.1 cc |
Q4179 | FlowerDerm, per sq cm |
Q4180 | Revita, per sq cm |
Q4181 | Amnio Wound, per sq cm |
Q4182 | Transcyte, per sq cm |
Q4183 | Surgigraft, per sq cm |
Q4184 | Cellesta or Cellesta Duo, per sq cm |
Q4190 | Artacent AC, per sq cm |
Q4191 | Restorigin, per sq cm |
Q4193 | Coll-e-Derm, per sq cm |
Q4194 | Novachor, per sq cm |
Q4198 | Genesis Amniotic Membrane, per sq cm |
The following services were previously announced as requiring prior authorization effective July 1, 2025.
Line of Business | Code | Description |
Ambetter | J1439 | Injection, ferric carboxymaltose, 1 mg |
Apple Health | 37229 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy |
Apple Health | 37227 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral, with transluminal stent placement(s) and atherectomy |
Apple Health | 42145 | Palatopharyngoplasty |
Apple Health | E2402 | Negative pressure wound therapy electrical pump, stationary or portable |
Apple Health | L1833 | Knee orthosis, adjustable knee joints, positional orthosis, rigid support, off-the-shelf |
Apple Health | L0650 | Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), lateral strength provided by rigid lateral frame/panel(s), off-the-shelf |
Apple Health | L0648 | Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, off-the-shelf |
Apple Health | L0637 | Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, prefabricated item, customized to fit |
Due to changes in reimbursement and benefit limitations for Apple Health members which were effective April 1, 2025, we will no longer require prior authorization for G0481 (Definitive Drug Testing, 8-14 Drug Classes) effective July 1, 2025. Please remember that the benefit limit for definitive drug testing is now 12 total services per year.
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Wellcare
Please click here for the upcoming Medical Clinical Policy Updates, for Wellcare that will be going into effect August 1, 2025.
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Apple Health Core Connections
FREE Adoption Competency Training for Mental Health Professionals
The National Adoption Competency Mental Health Training Initiative (NTI) is a free and web-based training to enhance the capacity of child welfare and mental health professionals to effectively address the complex mental health needs of children in foster care, moving to permanency through adoption or guardianship or living with their adoptive or guardianship families. NTI seeks to enhance casework and clinical practices to improve well-being and long-term stability outcomes for children and families. It was developed by the Center for Adoption Support and Education (C.A.S.E.) and is funded through cooperative agreements with the Children’s Bureau.
NTI Training for Mental Health Professionals (30 hours) was designed for behavioral/mental health professionals in public and private agency, community-based, or residential settings, as well as private practitioners. NTI provides foundational knowledge to more effectively address the unique adoption-related issues that arise throughout the lifespan of the adoptive or guardianship/ kinship family. This includes work with children and youth in foster care, adoptees, birth families, adoptive/kinship families. This training is approved by the National Association of Social Workers (NASW) and National Board of Certified Counselors (NBCC) for 26.5 continuing education credits for individuals who enroll though C.A.S.E. on the C.A.S.E. LMS (Use Enrollment Key: NTIMHP2021) and pass the module post-tests at 80%. Participants who successfully complete all modules and pass all the module post-tests (80% passing) will receive a certificate of completion.
Upon completion of the training, clinicians are encouraged to send the information to C.A.S.E. to be added to their Adoption Competence National Directory.
Adoptee Mentoring Society Information Session: June 18th from 12:30-1:30pm in Tacoma
Join Coordinated Care on June 18th at 12:30pm at our office located at 1145 Broadway Suite 700 in Tacoma! Angela Tucker, widely renown speaker, author and founder of Adoptee Mentoring Society, will be sharing about no-cost, virtual individual and group support for youth in Washington (ages 12-18) adopted from foster care available through 2025 due to partnership with Coordinated Care.
One-on-one virtual mentorship offers adoptees a space to explore their adoption story with trained adult mentors (also adopted) who listen, support, and provide resources. These sessions empower adoptees to shape their own narratives while discussing identity, birth family, race, gender, and more. Equally important, mentorship creates space for joy—sharing hobbies, laughter, and everyday moments. Through these meaningful connections, adoptees gain confidence, clarity, and a sense of belonging. This is a great resource for clinicians to share with young clients who have been adopted.
In addition to meeting Angela Tucker, we will be raffling off a signed copy of her book, You Should be Grateful. Light refreshments will be provided. This event is open to the public, including providers, child welfare professionals, child advocates, caregivers, adoptive families, etc. For more information, contact AHCC Program Manager, Katie Ferguson, at Katherine.Ferguson@CoordinatedCareHealth.com.
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Training/Education
Supporting LGBTQIA+ Youth in Foster Care This curriculum was developed through Amara with input from Coordinated Care and guidance from many community organizations. This training is for caregivers and professionals who work in the child welfare setting. Monday June 9th 3:30pm Register.
Suicide Prevention Provides an overview of the topic of suicide, signs and symptoms, and how caregivers should respond in times of crisis. The training will dive into the rates of youth suicide, risk factors, and proactive steps to take for prevention. Monday June 16th 10:00 am Register.
Commercial Sexual Exploitation of Children (CSEC 102) And Boys Too… This workshop was developed by Norene Roberts who was instrumental in the writing of And Boys Too, a discussion paper published by ECPAT USA in 2013. This training dives into the prevalence of commercial sexual exploitation of young boys, reasons why boys are often overlooked as victims, health outcomes for male survivors, and tactics for addressing this issue. Wednesday June 18th 10:00 am Register.
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Pharmacy
April 2025 Preferred Drug List Changes
Effective April 25, 2025, the drugs listed below will be non-preferred. Impacted members will be notified of this change and granted an authorization until June 15, 2025.
Drug Class | Drug Name | Preferred Alternative(s) |
Antidiabetics: DPP4 Inhibitors | Januvia Tablet | Sitagliptin Tablets (generic for Zituvio) |
Antidiabetics: DPP4 Inhibitors | Janumet Tablet | Sitagliptin/Metformin HCL Tablets (generic for Zituvimet) |
Antidiabetics: DPP4 Inhibitors | Janumet XR Tablet | Sitagliptin/Metformin HCL Tablets 24HR (generic for Zituvimet XR) |
July 1, 2025 Preferred Drug List Changes
Effective July 1, 2025, the drugs listed below will be non-preferred or will require a prior authorization (PA). Impacted members will be notified prior to this change.
Drug Class | Drug Name | Preferred Alternative(s) |
Oncology Agents: Tyrosine Kinase Inhibitors- Oral | Sprycel Tablet | Dasatinib Tablet (generic for Sprycel) |
Antidiabetics: GLP1 Agonists | Byetta Pen | PA required |
Antidiabetics: GLP1 Agonists | Exenatide | PA required |
Antidiabetics: GLP1 Agonists | Bydureon BCise | PA required |
Antidiabetics: GLP1 Agonists | Liraglutide | PA required |
Antidiabetics: GLP1 Agonists | Victoza Pen | Liraglutide (generic for Victoza) PA required |
Drugs that Need to be Billed to Health Care Authority
Effective July 1, 2025, the following drugs below will need to be billed to the Health Care Authority (HCA). For more information, please contact the HCA at 800-562-3022.
- Chenodiol (Chenodal)
- Chenodiol (Ctexli)
- Cholic Acid (Cholbam)
- Cysteamine Hcl (Cystadrops)
- Cysteamine Hcl (Cystaran)
- Elafibranor (Iqirvo)
- Liraglutide (Saxenda)
- Mifepristone (Mifeprex)
- Mifepristone (Mifepristone)
- Obeticholic Acid (Ocaliva)
- Seladelpar Lysine (Livdelzi)
- Ursodiol (Reltone)
- Ursodiol (Ursodiol)
- Ursodiol (Urso Forte)
90-Day Supply Changes
Effective July 1, 2025, the following drugs below will no longer be available as a 90-day supply. Members may still be able to obtain up to a 34-day supply at a time.
- Akten Gel (ML)
- Alcaine Drops
- Altacaine Drops
- Amicar Tablet
- Aminocaproic Acid Vial, Solution, & Tablet
- Buspirone Tablet
- Bydureon Bcise Auto Injct.
- Byetta Pen Injctr.
- Cardene I.V. (Piggyback)
- Cleviprex Vial
- Cuprimine Capsule
- Cyklokapron Ampul & Vial
- Depen Tablet
- Dilatiazem Vial Port & Vial
- Diltiazem Hcl-0.7% Nacl Plast. Bag
- Diltiazem-D5w Plast. Bag
- D-Penamine Tablet
- Droperidol Vial
- Droxidopa Capsule
- Exenatide Pen Injctr.
- Fareston Tablet
- Hydroxyzine Hcl Tablet, Solution, & Vial
- Hydroxyzine Pamoate Capsule
- Liraglutide Pen Injctr.
- Mounjaro Pen Injctr.
- Nicardipine Hcl Vial, Ampul, & Syringe
- Nicardipine Hcl-0.9% Nacl Piggyback
- Nitroglycerin Oint. (G)
- Northera Capsule
- Orserdu Tablet
- Ozempic Pen Injctr.
- Penicillamine Tablet & Capsule
- Proparacaine Hcl Drops
- Rectiv Oint. (G)
- Ribavirin Tablet & Capsule
- Rybelsus Tablet
- Soliqua 100-33 Insuln Pen
- Soltamox Solution
- Sotyktu Tablet
- Syprine Capsule
- Tamoxifen Citrate Tablet
- Tetrabenazine Tablet
- Tetracaine Hcl Drops
- Toremifene Citrate Tablet
- Tranexamic Acid Vial, Ampul, & Tablet
- Tranexamic Acid-Nacl Piggyback
- Trientine Hcl Capsule
- Trulicity Pen Injctr.
- Verapamil Hcl Vial, Ampul, & Syringe
- Victoza 2-Pak & 3-Pak Pen Injctr.
- Vistaril Capsule
- Xenazine Tablet
- Xultophy 100-3.6 Insulin Pen
- Zeposia Capsule DS PK
J1439 Injectafer (ferric carboxymaltose) Update- Ambetter
Effective July 1, 2025, J1439 Injectafer (ferric carboxymaltose) will require prior authorization.
HCPCS | Generic Name | Brand Name | Medical PA | Pharmacy PA | Impact Description |
J1439 | FERRIC CARBOXYMALTOSE | INJECTAFER | Yes | n/a | Effective 7/1/25 |