September 2021 Provider News
Date: 09/30/21
In this issue:
- Apple Health Core Connections - Child welfare training resources
- General Updates - Medicare PA and clinical policy
- Smoking and Tobacco Cessation
- Training/Education - Upcoming webinars and training resources
- Pharmacy - Synagis
- Behavioral Health - Discussing Naloxone with members and rural grant opportunities
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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.
UPDATES/RESOURCES:
Join the CEBC for a webinar on, Our Most Challenging Clients: Fetal Alcohol Spectrum Disorders in Child Welfare on October 13, 2021 from 1:00pm-2:30pm. Register here.
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General Updates
Medicare Utilization Management Updates
Prior Authorization updates and changes for 2020 Medicare PA list. This is effective starting 1/1/2022.
| Service Category | Services/Procedures |
| Behavioral Health Services | Added: Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment |
| Durable Medical Equipment (DME) | Revision: “Wheelchairs, Custom” and “Wheelchairs, Power” changed to “Wheelchairs, Custom & Power” Deletion: Wound Vacuum (Negative Pressure) Devices |
| Surgeries, regardless of place of service | Deletion: “Oral Surgery” removed from “Temporomandibular Joint Surgery” Added: Transcatheter implantation of wireless pulmonary artery pressure sensor |
Clinical Policy Updates
The below policies received updates as part of our regular monthly review in September. These policy changes are effective October 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.518 | Carotid Artery Stenting | Apple Health |
WA.CP.MP.12 | Vagus Nerve Stimulation | Apple Health |
CP.MP.21 | Vagus Nerve Stimulation | Ambetter |
CP.MP.58 | Intestinal and Multivisceral Transplant | Apple Health & Ambetter |
CP.MP.102 | Pancreas Transplantation | Apple Health & Ambetter |
CP.MP.120 | Pediatric Liver Transplant | Apple Health & Ambetter |
CP.MP.132 | Heart-Lung Transplant | Apple Health & Ambetter |
CP.MP.138 | Pediatric Heart Transplant | Apple Health & Ambetter |
CP.MP.162 | Tandem Transplant | Apple Health & Ambetter |
CP.MP.88 | Sickle Cell Disease Observation | Apple Health & Ambetter |
CP.MP.92 | Acupuncture | Ambetter |
CP.MP.93 | Bone-anchored Hearing Aid | Apple Health & Ambetter |
CP.MP.107 | Durable Medical Equipment (DME) | Apple Health & Ambetter |
CP.MP.128 | Optic Nerve Decompression Surgery | Apple Health & Ambetter |
CP.MP.133 | Posterior Tibial Nerve Stimulation for Voiding Dysfunction | Ambetter |
CP.MP.134 | Evoked Potential Testing | Apple Health & Ambetter |
CP.MP.166 | Sacroiliac Joint Interventions for Pain Management | Apple Health & Ambetter |
CP.MP.167 | Intradiscal Steroid Injections for Pain Management | Apple Health & Ambetter |
CP.MP.169 | Trigger Point Injections for Pain Management | Apple Health & Ambetter |
CP.MP.175 | Air Ambulance | Ambetter |
CP.MP.181 | Polymerase Chain Reaction Respiratory Viral Panel Testing | Apple Health & Ambetter |
CP.MP.206 | Skilled Nursing Facility Leveling | Apple Health & Ambetter |
WA.CP.MP.522 | Varicose Vein Treatment | Apple Health |
CP.MP.146 | Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins | Ambetter |
The below policy will be retired effective October 1, 2021.
Policy Number | Policy Title | Line of Business |
CP.MP.88 | Sickle Cell Disease Observation | Apple Health & Ambetter |
The below policies have revisions effective January 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 |
CP.MP.31 | Cosmetic and Reconstructive Procedures | Apple Health & Ambetter |
CP.MP.165 | Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management | Apple Health & Ambetter |
CP.MP.170 | Nerve Blocks for Pain Management | Apple Health & Ambetter |
The below new policies were previously announced to be effective on the dates noted. Find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.210 | Repair of Nasal Valve Compromise | 10/1/21 | Apple Health & Ambetter |
CP.MP.209 | GI Pathogen Nucleic Acid Detection Panel Testing | 11/1/21 | Apple Health & Ambetter |
Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.87 | Inhaled Nitric Oxide | 12/1/21 | Apple Health & Ambetter |
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Smoking and Tobacco Cessation
Coordinated Care (Apple Health) and Apple Health Core Connections (Foster Care) have smoking and tobacco cessation programs. For our members who are ready to quit, we have health coaches to provide support.
Members may refer themselves or providers can refer members to these programs by calling the numbers below:
Washington Apple Health (Medicaid) – 1-866-274-5791
Apple Health Core Connections (Foster Care) – 1-844-882-3827
Tobacco cessation medications are outlined on pages 203-204 of the Preferred Drug List (PDL) located on our website under Pharmacy. A prior authorization is required for some of these medications.
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Training/Education
- AWHP MCO Provider Resources Page - Coordinated Care encourages providers to visit the Association of WA Health Care Plans MCO Provider Resources at https://www.wahealthcareplans.org/mco-resources. As a MCO member of AWHP, Coordinated Care is committed to ensuring providers have appropriate resources to deliver integrated care to Medicaid members across the state. Training and resources for providers are continuously developed by MCOs and shared on this site.
- 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.
- Join the 2021 Mental Health Conference hosted by the Seattle Children’s Partnership Access Line on October 2, 2021 from 8am-12:30pm. CME available. Topics include: ADHD, post partum anxiety, and autism. Register here.
- The Washington State MCOs are hosting a webinar titled, Youth Behavioral Health Care Continuum for Youth with Apple Health (Medicaid) on October 13, 2021 from 12-1pm. Register here.
- Join the Bree Collaborative for, Falling Into Place: Aligning Payer Strategies for Population Health on October 14, 2021 from 10am-11:30am. Register here.
- Learn about, Integrating Suicide Prevention into the SBIRT Model. October 19, 2021 11am-12:30pm. Register here.
ARTICLES & RESOURCES:
Read the COVID-19 Student Survey results. Students in Washington State schools between 6th and 12th grades were surveyed in March 2021 on their worries about the COVID-19 pandemic, mental health, substance use, and their school experiences.
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Pharmacy Update - Synagis 2021/2022 season
The Health Care Authority, Apple Health Fee-For-Service (FFS) and Managed Care Organizations (MCO), have updated the Synagis 2021/2022 season to begin 9/13/2021.
For Synagis coverage criteria, please visit the Synagis page on our site. For questions, please call 1-877-644-4613.
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Behavioral Health
What is Naloxone?
Naloxone (often referred to by brand name Narcan) is a medication used to reverse the often deadly effects of an opioid poisoning. Naloxone is now widely carried by first responders, including law enforcement and medical responders due to the rising number of opioid poisonings in Washington State and nationally. Naloxone comes in intranasal spray and injectable forms.
Who should carry Naloxone? Anyone who takes illicit or prescription opioids. Anyone who uses any illicit drugs, as these can often contain the opioid fentanyl. Anyone who regularly works or interacts with people who use opioids. ANYONE!
Why should we promote Naloxone access for our members?
- It’s SAFE: The use of Naloxone in a suspected opioid poisoning won’t harm the recipient, even if the person is not actually suffering from an opioid poisoning. Naloxone should always be used if there’s any suspicion of opioid poisoning. It’s also important to get 9-1-1 on the phone and get paramedics on the way as a first step, even if there is Naloxone on hand.
- It’s EFFECTIVE: The CDC looked at a 20-year span (1996-2015) during which the National Harm Reduction Coalition distributed Naloxone to 150,000 people. Over that time, 27,000 lives were saved as a result of Naloxone use in the event of an opioid poisoning. Numbers are likely even more dramatic now as a result of wider availability of Naloxone and higher frequency of opioid poisonings linked to illicit fentanyl.
- It’s CONVENIENT: To pick up Naloxone from a pharmacy, one does not need a prescription. They can bring this standing order into any pharmacy that carries Naloxone. There are also several organizations state-wide that are licensed to dispense Naloxone to the public. You can find a locator here. For our clients in King County, they can also get Naloxone mailed to them [more info here].
- It’s FREE: Our members on our Apple Health plan can get Naloxone at no cost from a pharmacy or Naloxone distribution program.
Other quick safety tips for discussing drug use with members:
- Never use alone: Using drugs alone puts people at higher risk for fatality if something goes wrong because there’s no one there to call 9-1-1 or administer Naloxone. Tell members if they can’t find someone to use with them, they can utilize the Never Use Alone Hotline number at 800-484-3731.
- Don’t mix: Mixing substances always puts someone at a higher risk of overdose due to increased potency or potentially fatal cross-effects of different drug classes.
- Good Samaritan Law: Washington State has the Good Samaritan Law, which prevents someone from being arrested or prosecuted for misdemeanor drug possession or use if they seek medical help for someone experiencing a drug poisoning.
Emergency Rural Health Care Grants - Overview
This program is designed to help broaden access to COVID-19 testing and vaccines, rural healthcare services, and food assistance through food banks and food distribution facilities. This program offers two tracks of funding:
- Track One: Recovery Grants provide immediate relief to address the economic conditions arising from the COVID-19 emergency. Grant funds must be used in relation to the COVID-19 pandemic and to support immediate health care needs, to help prepare for a future pandemic event, or to increase access to quality health care services and improve community health outcomes. Grant awards range from $25,000 - $1 million.
- Track Two: Impact Grants advance ideas and solutions to solve regional rural health care problems to support the long-term sustainability of rural health care. Long-term sustainability is defined as “improved health outcomes, improved access to quality health care, and creating and maintaining sustainable economic development for small communities.” Grant funds must be used in relation to the COVID-19 pandemic. Grant awards range from $5 million - $10 million.
Eligible applicants include:
- Public bodies
- Community-based nonprofits
- Federally-recognized Tribes
Track One Deadline: Each Rural Development state office will conduct a review, rating, and selection from complete applications received by 4 p.m. local time on October 12, 2021. USDA will continue to accept Track One: Recovery Grant applications on a continual basis after October 12, 2021 until all funds are exhausted.
Track One: Recovery funds must be used in correlation with the COVID-19 pandemic, and to support immediate health care needs, to help prepare for a future pandemic event, to increase access to quality health care services, or to support food assistance through food banks and food distribution facilities.
Grants range from $25,000 - $1 million. Grant funds are limited to an applicable percentage of eligible project costs (up to 75 percent) based on population and the median household income of the population served.
USDA anticipates providing about $350 million in Track One: Recovery funding.
Track Two Deadline: Impact applications must be received by the applicable Rural Development Office by 4 p.m. local time on October 12, 2021. Track Two: Impact applications received after October 12, 2021 will not be considered. Track Two: Impact Grant applicants must also establish a network or group of entities that consist of health care provider organizations, economic development entities, federally-recognized Tribes or institutions of higher learning (which may include academic health and research institutes).
Facilities and projects must be located in – and primarily serve – rural areas. Rural areas including cities, villages, towns, townships, and federally-recognized Tribal lands with no more than 20,000 residents as determined by the latest U.S. Census Data are eligible for this program.
The grants can cover up to 75 percent of eligible project costs based on population and median household income of the population to be served.
The WA State contact for both of these programs is:
Trudy Teter, Acting State Director
1835 Blacklake Boulevard SW, Suite B
Olympia, WA 98512-5715
Voice: (360) 704-7700
Fax: (360) 704-7742