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December 2024 Provider News

Date: 12/30/24

In this issue: 

  • General Updates - HCA Behavioral Health Telemedicine FAQ – Effective January 1, 2025, Marketplace – PY 2025 Benefit Coverage Updates, HCA Updates to Telemedicine Policy Billing Guide, Apple Health (Medicaid) Physical Health Audio-Only Procedure Code List Updates, Ambetter from Coordinated Care introducing Availity Editing Services, Enrollment Verification
  • Quality - End of Year Reminder to Update Provider Demographics
  • Payment & Clinical Policy - Monthly Updates
  • Pharmacy Updates - January 1, 2025 Basaglar Formulary Removal, January 1, 2025 90-Day Supply Changes Reminder, Over-the-Counter Contraception for Washington State Pharmacies
  • Apple Health Core Connections - NEW: No-Cost Mentoring and Peer Support for Adopted Youth in 2025
  • Training/Education - End of Year Reminder to Providers to take Annual Cultural Humility Training, Monthly Training Opportunities

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General Updates

HCA Behavioral Health Telemedicine FAQ – Effective January 1, 2025

Effective for dates of service on and after January 1, 2025, the Health Care Authority (HCA) updated the telemedicine policy found on HCA’s Provider billing guides and fee schedules webpage here under Telehealth. Updates include the following:

  • HCPCS code G2012 is being replaced with CPT® code 98016.

*Note: CPT® code 98016 is not applicable to behavioral health providers.

See HCA’s Apple Health (Medicaid) Behavioral Health Policy and Billing FAQ here, effective January 1, 2025, for guidance related to the Service Encounter Reporting Instructions (SERI) guide, Mental Health Services Billing Guide, and Substance Use Disorder Billing Guide.

In addition to clerical edits, HCA made significant content updates clarifying language for the following:

  • What are the requirements for providing services via telemedicine to a Apple Health (Medicaid) client in Washington State?
  • Can I bill and/or submit encounters for behavioral health services via telemedicine or telehealth for a Washington State Apple Health (Medicaid) client who may be temporarily located out of Washington State?

Program-specific telemedicine/telehealth information will be in specific HCA billing guides located on the Provider billing guides and fee schedules webpage here. Email HCA’s Apple Health clinical policy team for any questions related to HCA’s telemedicine policy.

HCA Updates to Telemedicine Policy Billing Guide

On November 1, 2024, HCA notified providers of an update to the Store and Forward section in HCA’s Telemedicine Policy Billing Guide effective for dates of service on and after January 1, 2025. HCA published these changes early to assist providers during the transition of these policies. Since then, HCA became aware of several necessary updates to the guide. The changes include all the following:

  • Added requirements for practitioners billing services provided via telemedicine to a client located in Washington State, including information on interstate compacts licensure
  • Added requirements for the service(s) being rendered including that the service(s) must be clinically appropriate to be provided via telemedicine for that client, on the date of service
  • Removed CPT® codes 99441, 99442, and 99443 from the table in the What evaluation and management services may be provided via telephone or patient portal? section
  • Replaced HCPCS code G2012 with CPT® code 98016 in the What non-evaluation and management services may be provided via a virtual check-in? 

Marketplace – PY 2025 Benefit Coverage Updates

  • New Telehealth Vendor Partners: MD Live & Brightside
    • Note: Our contract with Teladoc continues.
  • Prescription drug continuity of coverage for non-preferred drug prescription refill for an antipsychotic, antidepressant, antiepileptic or other drug prescribed to treat a serious mental illness aligns with Washington Senate Bill 5300.
  • In accordance with Washington Senate Bill 5986, balance billing is prohibited for ground ambulance services within Washington state. Until December 31, 2027, the allowed amount for out-of-network ground ambulance transports on of the following amounts:
    • the locally set rate,
    • where no local rate exists, the lesser of 325% of current Medicare rate or the ground ambulance’s billed charges.
  • In accordance with Washington Senate Bill 6127, benefits for prescribed HIV postexposure prophylaxis medication (at least one covered regimen recommended by the Centers for Disease and Prevention (CDC)) are covered without cost sharing and does not require prior authorization.
  • In accordance with Washington House Bill 1979, benefits for:
    • Asthma inhalers (at least one covered inhaled corticosteroid and at least one inhaled corticosteroid combination product) are covered with a maximum Cost Share of $35 per 30-day supply, not subject to Deductible.
    • Epinephrine autoinjectors (at least one covered epinephrine autoinjector product containing at least two autoinjectors) are covered with a maximum Cost Share of $35, not subject to Deductible.
  • In accordance with Washington Senate Bill 6228, coverage for inpatient and residential substance use disorder treatment will be provided for no less than 14 days from the date of admission for the initial authorization approved by us. Subsequent authorizations approved by us will be provided for no less than 7 days prior to requiring additional utilization review by our staff.
  • Inpatient and outpatient benefits will be provided for up to two months for Medically Necessary pasteurized donor human milk when prescribed by an infant’s pediatrician or licensed pediatric provider stating that the infant is medically or physically unable to receive maternal human milk or participate in breastfeeding or the infant’s mother is medically or physically unable to produce maternal human milk in sufficient quantities.
  • Allergy testing, injections and serum are covered.
  • Penile prostheses, when not medically necessary, is an excluded benefit.
  • Excluded Transplant Benefits (newly added or clarified):
    • Trailer or truck rental (unless pre-approved by us).
    • Parking (unless pre-approved by us).
    • Loss of wages due to time off from work required for transplant for recipient, donor, or companion(s).
    • Moving violations tickets or parking tickets.
    • Any services related to pet care, boarding, lodging, food, and/or travel expenses.
    • Expenses for persons other than the transplant recipient, donor or their respective companion(s).
    • Expenses for lodging when the transplant recipient, donor or their respective companion(s) is staying with a relative, friend or otherwise have free lodging.
    • Any fuel costs/charging station fees for any vehicle, not related to travel to and from the Center of Excellence or our approved facility when there is no network adequacy. (Note: Mileage is reimbursable.)
    • Any tips, concierge, club level floors, and gratuities.
    • Salon, barber, and spa services.
    • Insurance premiums.
    • Cost share amounts owed to the transplant surgeon or facility or other provider.
  • Private duty nursing is excluded from all places of treatment (i.e. inpatient, outpatient, and home locations).
  • Prior authorization is required for sick newborns with a complex health condition or when admitted to a Neonatal Intensive Care Unit (NICU).
  • Definitions for 'mental health disorder' and 'substance use disorder' were updated in the member’s Evidence of Coverage (EOC) to align with federal statutory requirements.

Apple Health (Medicaid) Physical Health Audio-Only Procedure Code List Updates

Effective for dates on and after January 1, 2025, HCA made numerous changes to the Apple Health (Medicaid) Physical Health Audio-Only Procedure Code List including all the following:

  • Added CPT® codes 59610 and 59618 and HCPCS codes G0136, H0004, and H0050
  • Removed CPT® codes 99441, 99442, and 99443.

For a complete list of changes, consult the Change Log at the end of the list.

HCA revised the Telemedicine Policy and Billing Guide and the Apple Health (Medicaid) Physical Health Audio-Only Procedure Code List with these changes, and the revised guide and list may be viewed and downloaded from HCA’s Provider billing guides and fee schedules webpage here.

Ambetter from Coordinated Care introducing Availity Editing Services

In a continuous effort to make it easier to do business with us, Ambetter from Coordinated Care is introducing Availity Editing Services (AES). Starting Jan. 24, 2025, Centene is partnering with Availity to return rejection messages on its behalf via AES messages. These messages will show in your existing workflows. AES will give you an option, but not a requirement, to edit a claim.

AES can identify a claim error upfront and return a message to you for correction before sending the claim on to the plan to be adjudicated. You should review edit messages for potential corrections to the suggested claim line(s). If you make updates to the claim, this may help the claim process correctly the first time, preventing errors, improving payment accuracy, and claims adjudication turnaround time. If, after reviewing the message, you find it does not apply, please resubmit the claim as-is and this will allow a bypass of the edit in cases where it may not be applicable.

This is not intended as a new method to deny a claim, nor does it bypass or replace downstream edits. If you choose to bypass an edit, it is possible that other downstream edits will still function as normal in our claims systems. Remember to “submit” your claim regardless of your choice to edit or bypass. This action is required in order for the claim to be processed in our systems.

If you have a Practice Management System (PMS), you can locate your edits report within your claims workbasket or que reporting. If you submit claims via the Availity portal, any of these rejections will show on your normal reports.

If you submit claims via Availity, learn how to gather your reporting by joining one of Availity’s free webinars to learn additional tips for streamlining your workflow:

  • Send and Receive EDI Files – Training Demo
    • Link.
    • This demo shows users where/how they can access reports in Availity Essentials. On these reports are where they would see edits. Please note: this demo does not say/call it AES however, this is the demo that would show the user how to locate the reports.
  • EDI Reporting Preferences – Training Demo
    • Link.
    • This demo shows users how to setup their EDI Reporting Preferences which needs to be done first by the user’s organization’s Availity Administrator to access the reports in the Send and Receive EDI Files application.

If you need assistance with registering for Availity Essentials, please call Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available Monday through Friday, 8 a.m. – 8 p.m. ET. For general questions, please reach out to your Ambetter from Coordinated Care Provider Engagement Representative.

Enrollment Verification

Patient Has No Insurance? Be sure to check for Apple Health enrollment.

We would like to remind all providers of the responsibility to check each patient, especially those who do not present insurance information, for active Apple Health enrollment.

Checking Eligibility:
There are several easy self-service methods to check a patient’s enrollment in Washington Apple Health through ProviderOne

  • Log into ProviderOne. Click Client Inquiry under the Benefit Tab for search options.
  • Submit an electronic individual or batch 270/271 inquiry to ProviderOne
  • Swipe the client services card using a magnetic card reader.
  • Call the Interactive ProviderOne Interactive Voice Response (IVR) 1-800-562-3022

If Coordinated Care coverage is shown, you may verify ID number and benefits through the following methods:

We remind our Coordinated Care Apple Health members to present their ID card at the time of service, even so, verification of enrollment, regardless of ID card, is important. Per Washington State Administrative Code (WAC 182-502-0160), active Medicaid enrollees may not be billed for covered services unless a valid Agreement to Pay for Healthcare Services (Form HCA 13-879) has been signed prior to services being rendered.

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Quality

Medicaid Quality

End of Year Reminder to Update Provider Demographics:

Free Language Services:

  • Free Language services are available at no cost to members and providers, and include:
  • Telephonic services
  • Oral translation (reading of English material in a members preferred language)
  • In-person non-English interpretation
  • American Sign language
  • Auxiliary aids including alternate formats such as large print and braille
  • Written translations for materials that are critical for obtaining health insurance coverage and access to health care services in non-English prevalent languages

For Help with Member Languages and How to Request Interpreter Services, visit Health Equity Resources at:

For Additional Help with Language Services, call our Provider Customer Contact Center at 1-877-644-4613.

The Coverage to Care (C2C) initiative, developed by the Centers for Medicare & Medicaid Services, helps individuals understand their health coverage and access the primary care and preventive services right for them. Stay informed with the latest news and updates on how C2C continues to connect people to important resources and information.

In addition to regular C2C updates the Volume #4; December 2024 edition highlights how to use C2C after Open Enrollment (OE). C2C resources provide critical information to assist consumers with the next steps after enrolling or changing their plan. Some key materials to review after the enrollment period include:

New C2C Resources

Check out the C2C resources helping consumers understand their coverage and the preventive services available. These resources also help partners and providers serve individuals in their community:

  • Telehealth: What to Know for Your Family (PDF)
    • Learn about the types of care available through telehealth and how you and your family can use this technology for quality care. This resource was updated in September to include broader and more concise language.
  • Telehealth for Providers: What You Need to Know (PDF)
    • Discover useful information for health care providers about telehealth including how to get started, billing considerations for Medicare and Medicaid, when to use telehealth, and more. This resource was also revised in September to be more evergreen following the end of the COVID-19 PHE and conclusion of Medicaid Unwinding in most states.

Now available in eight additional languages (Arabic, Chinese, Haitian Creole, Korean, Russian, Spanish, Ukrainian, Vietnamese) on the C2C site:

Download the translations from these webpages:

Fluoride

Dental cavities are the most chronic disease of childhood. When it occurs, several resources are needed to treat, it is costly, and if left untreated can lead to unnecessary pain and discomfort.

Here is a resource to address fluoride hesitancy (PDF).

Fight Respiratory Illnesses Toolkit for Health Care Providers

Healthcare providers play a significant role in educating and protecting their patients against respiratory illnesses. For the latest Centers for Disease Control guidance, visit this page.

Wellcare Quality

ICD-10 MS-DRGs Version 42.1 Effective April 1, 2025

The Centers for Medicare & Medicaid Services (CMS) is implementing 50 new procedure codes into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective April 1, 2025. For more information, please review the announcement available here.

The Code Tables, Index and related Addenda files for the 50 new procedure codes is available here.

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) April 1, 2025 update will address typographical errors. There will be no new diagnosis codes implemented.

The ICD-10 MS-DRG Version 42.1 Grouper Software, Definitions Manual Table of Contents, and the Definitions of Medicare Code Edits Version 42.1 Manual to accommodate these new procedure codes, effective for discharges on or after April 1, 2025 will be available by February 1, 2025 here.

Diabetic Accessories & Supplies: Prevent Claim Denials

In 2023, CMS found the improper payment rate for glucose monitors was 13.5%, with a projected improper payment amount of $103.2 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF) here Appendices D, G, K, and N). Learn how to bill correctly for these services. Review the Diabetic Accessories & Supplies (including Glucose Monitors) MLN4824456 – Medicare Provider Compliance Tips here, including:

  • Billing codes
  • Denial reasons and how to prevent denials
  • Continuous glucose monitor coverage indications
  • Refill and documentation requirements
  • Resources

Fight Respiratory Illnesses Toolkit for Health Care Providers

Healthcare providers play a significant role in educating and protecting their patients against respiratory illnesses. For the latest Centers for Disease Control guidance, visit this page.

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Clinical & Payment Policy Updates

Clinical Policy Updates

The below policies were updated as part of our regular monthly review in November. The policy changes are effective January 1, 2025. You will find the policies, including a description of the revisions, posted on the policy site.

Policy NumberPolicy TitleLine of Business
WA.CP.MP.38Ultrasound in PregnancyAmbetter
CP.MP.38Ultrasound in PregnancyApple Health
CP.MP.50Drugs of Abuse: 
Definitive Testing
Ambetter
WA.CP.MP.50Drugs of Abuse: 
Definitive Testing
Apple
Health
WA.CP.MP.500Mandibular Advancement DevicesApple Health
CP.MP.22Stereotactic Body Radiation TherapyAmbetter
WA.CP.MP.22Stereotactic Body Radiation TherapyApple Health
CP.MP.144Mechanical Stretching DevicesAmbetter
CP.MP.100Allergy Testing and TherapyApple Health & Ambetter
CP.MP.105Digital EEG Spike AnalysisApple Health & Ambetter
CP.MP.106Endometrial ablationApple Health & Ambetter
CP.MP.134Evoked Potential TestingApple Health & Ambetter
CP.MP.143Wireless Motility CapsuleAmbetter
CP.MP.154Thyroid Hormones and Insulin Testing in PediatricsApple Health & Ambetter
CP.MP.155EEG in Evaluation of HeadacheApple Health & Ambetter
CP.MP.156Cardiac Biomarker Testing for Acute MIApple Health & Ambetter
CP.MP.98Urodynamic TestingApple Health & Ambetter
CP.MP.99Wheelchair SeatingAmbetter
CP.MP.110Bronchial ThermoplastyAmbetter
CP.MP.123Laser Therapy for Skin ConditionsApple Health & Ambetter
CP.MP.139Low-Frequency Ultrasound and Noncontact Normothermic
Wound Therapy 
Ambetter
CP.MP.242Pulmonary Function TestingApple Health & Ambetter
CP.MP.247Transplant Service Documentation RequirementsApple Health & Ambetter

The below policies were updated as part of our regular monthly review in November. The policy changes are effective April 1, 2025. You will find the policies, including a description of the revisions, posted on the policy site. 

Policy NumberPolicy TitleLine of Business
CP.MP.145Electric Tumor Treating FieldsAmbetter
CP.MP.248Facility Based Sleep Studies for Obstructive Sleep ApneaApple Health & Ambetter

The below policies will be archived effective January 1, 2025.

Policy NumberPolicy TitleLine of Business
CP.MP.153H. Pylori TestingApple Health & Ambetter
CP.MP.151Transcatheter Closure of Patent Foramen OvaleApple Health & Ambetter

The below policies were previously announced as revised effective on the date noted. You will find the policies posted on the policy site.

Policy NumberPolicy TitleEffective DateLine of Business
CP.MP.100Allergy Testing and Therapy1/1/25Ambetter
WA.CP.MP.54Hospice Services2/1/25Apple Health
CP.MP.54Hospice Services2/1/25Ambetter
CP.MP.51Reduction Mammoplasty and Gynecomastia Surgery2/1/25Apple Health & Ambetter
CP.BH.200Transcranial Magnetic Stimulation for Treatment Resistant Depression3/1/25Ambetter

Payment Policy Update

The below policies were updated as part of our regular monthly review in November. The policy changes are effective January 1, 2025. You will find the policies, including a description of the revisions, posted on the policy site.

Policy NumberPolicy TitleLine of Business
WA.PP.501Provider Preventable ReadmissionsApple Health
CC.PP.073Sepsis DiagnosisApple Health & Ambetter
CC.PP.145Severe MalnutritionApple Health & Ambetter

 

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Pharmacy

January 1, 2025 Basaglar Formulary Removal- Ambetter

Starting January 1, 2025, Basaglar will be removed from the formulary and Semglee will be the preferred alternative. Basaglar and Semglee are both insulin glargine, but they are not interchangeable with one another (i.e. a new prescription is needed). Semglee is an interchangeable biosimilar of Lantus. Basaglar and Semglee are expected to have similar safety and efficacy as they both reference Lantus as the originator product.

Patients currently on Basaglar will need to have a new prescription for Semglee sent to their pharmacy for use starting January 1, 2025.

FAQs

  1. What are Biosimilars?
    • A biosimilar is a biologic drug that is highly similar to the original biologic or “reference product” and has no clinically meaningful differences in terms of safety and efficacy with the reference product. For more information on biosimilars, visit this page.
  2. Are there clinical differences between Basaglar and Semglee
    • Semglee is an interchangeable biosimilar of Lantus whereas Basaglar is an insulin glargine product that was created before the FDA’s biosimilar pathway was established. However, both Semglee and Basaglar used Lantus as the reference product. As such, the clinical safety and efficacy profile is expected to be similar for Basaglar and Semglee.
  3. When should I send in the new Semglee prescription to the pharmacy?
    • Please send in the new prescription to your patient’s pharmacy anytime between now and January 1st with the note “DO NOT FILL UNTIL AFTER 1/1/2025” on the prescription.

      The next time the patient is due for their refill after January 1st, the pharmacy will substitute Basaglar with the Semglee prescription that is on file.
  4. What if my patient need to remain on Basaglar?
  5. Will my patient’s out-of-pocket cost increase because of this formulary change?
    • Semglee will be on the Preferred Brand Tier, the same formulary tier as previous preferred drug, Basaglar so switching from Basaglar to Semglee should not lead to increased patient cost. However, your patient’s cost-share may also depend on other factors like their deductible phase, out-of-pocket maximum, and plan design.
  6. Where can I find the full formulary? What are the other formulary changes for the upcoming plan year?
    • The complete list of formulary changes, 2025 formulary, and other pharmacy resources are published online. Please visit www.ambetterhealth.com. Select your “State,” go to “For Providers,” and then “Drug Coverage” to access the pharmacy resources webpage.

January 1, 2025 90-Day Supply Changes Reminder- Medicaid

Effective January 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.

  • ACARBOSE TABLETS
  • ACIPHEX TABLETS
  • ADDAPRIN TABLETS
  • ADDERALL TABLETS
  • ADDERALL XR CAPSULES
  • AGRYLIN CAPSULES
  • ALENDRONATE SODIUM TABLETS
  • ALEVE TABLETS
  • ALIVE DAILY SUPPORT PRENATAL GUMMIES TABLETS
  • ALIVE PREMIUM PRENATAL DAILY SUPPORT TABLETS
  • ANAGRELIDE HYDROCHLORIDE CAPSULES
  • ANAPROX DS TABLETS
  • ANASPAZ TABLETS
  • ANORO ELLIPTA AERO POWD
  • APTENSIO XR CAPSULES
  • ARAVA TABLETS
  • ARMODAFINIL TABLETS
  • ASPIRIN/DIPYRIDAMOLE CAPSULES
  • ATOMOXETINE CAPSULES
  • ATROPINE SULFATE OPHTH SOLN
  • AZESCO TABLETS
  • BACLOFEN TABLETS
  • BRILINTA TABLETS
  • CADEAU DHA CAPSULES
  • CALCIUM ACETATE CAPSULES
  • CARAFATE TABLETS
  • CATAFLAM TABLETS
  • CELEBREX CAPSULES
  • CENTRUM SPECIALIST PRENATAL CAPSULES
  • CHILDRENS ADVIL SUSPENSION
  • CILOSTAZOL TABLETS
  • CIMETIDINE HCL SOLUTION
  • CINQAIR SOLUTION
  • CITRANATAL B-CALM TABLETS
  • CITRANATAL MEDLEY CAPSULES
  • CLONAZEPAM TABLETS
  • CLONIDINE HCL ER TABLETS
  • CLOPIDOGREL TABLETS
  • C-NATE DHA CAPSULES
  • CONCEPT DHA CAPSULES
  • ERGOLOID MESYLATES TABLETS
  • ETHAMBUTOL HYDROCHLORIDE TABLETS
  • ETODOLAC ER CAPSULES
  • ETODOLAC ER TABLETS
  • FASENRA SOLN
  • FELDENE CAPSULES
  • FENOPROFEN CALCIUM CAPSULES
  • FERRIPROX SOLN
  • FLUDROCORTISONE ACETATE TABLETS
  • FLUORIDEX DAILY RENEWAL CONC
  • FLURBIPROFEN TABLETS
  • FOLIVANE-OB CAPSULES
  • FORTEO SOLN PEN-INJ
  • FOSRENOL TABLETS
  • GUANFACINE HYDROCHLORIDEER TABLETS
  • HYOSCYAMINE SULFATE TABLETS
  • HYOSCYAMINE SULFATE ER TABLETS
  • IBU TABLETS
  • INDOMETHACIN CAPSULES
  • INDOMETHACIN ER CAPSULES
  • IPRATROPIUM BROMIDE NASAL SOLN
  • ISONIAZID TABLETS
  • JENLIVA PRENATAL/POSTNATAL CAPSULES
  • JUXTAPID CAPSULES
  • KETOPROFEN CAPSULES
  • KETOPROFEN ER CAPSULES
  • KOSHER PRENATAL PLUS IRON TABLETS
  • K-PHOS NEUTRAL TABLETS
  • KPN PRENATAL TABLETS
  • LATUDA TABLETS
  • LISDEXAMFETAMINE DIMESYLATE CAPSULES
  • MECLOFENAMATE SODIUM CAPSULES
  • MEFENAMIC ACID CAPSULES
  • MEFLOQUINE HCL TABLETS
  • MEGESTROL ACETATE SUSPENSION
  • MELOXICAM TABLETS
  • METADATE CD CAPSULES
  • METHYLIN SOLN
  • METHYLPHENIDATE HYDROCHLORIDE TABLETS
  • PRENATAL COMPLETE TABLETS
  • PRENATAL ESSENTIALS CAPSULES
  • PRENATAL FORMULA CAPSULES
  • PRENATAL FORMULA A-FREE TABLETS
  • PRENATAL GUMMIES/DHA & FOLIC ACID TABLETS
  • PRENATAL MULTI + DHA CAPSULES
  • PRENATAL MULTI +DHA CAPSULES
  • PRENATAL-U CAPSULES
  • PRENATE TABLETS
  • PRENATE DHA CAPSULES
  • PRENATE ELITE TABLETS
  • PRENATE ENHANCE CAPSULES
  • PRENATE MINI CAPSULES
  • PRENATE PIXIE CAPSULES
  • PRENATE RESTORE CAPSULES
  • PREVIDENT RINSE
  • PRIMACARE CAPSULES
  • PROCHLORPERAZINE MALEATE TABLETS
  • PROMACTA TABLETS
  • PROVIDA OB CAPSULES
  • QUETIAPINE FUMARATE TABLETS
  • QUETIAPINE FUMARATE ER TABLETS
  • QUILLICHEW ER TABLETS
  • QUILLIVANT XR SUSPENSION
  • RAMELTEON TABLETS
  • RENAGEL TABLETS
  • RENVELA TABLETS
  • RIDAURA CAPSULES
  • CONCEPT OB CAPSULES
  • CONCERTA TABLETS
  • CONSTULOSE SOLUTION
  • CREON CAPSULES
  • CVS ESOMEPRAZOLE MAGNESIUM CAPSULES
  • CVS IBUPROFEN INFANTS SUSPENSION
  • CVS LANSOPRAZOLE CAPSULES
  • CVS PRENATAL GUMMIES TABLETS
  • CVS PRENATAL MULTI+DHA CAPSULES
  • CVS WOMENS PRENATAL+DHA CAPSULES
  • CYCLOGYL OPHTH SOLN
  • CYCLOMYDRIL OPHTH SOLN
  • CYSTARAN OPHTH SOLN
  • CYTOTEC TABLETS
  • DABIGATRAN ETEXILATE CAPSULES
  • DAPSONE TABLETS
  • DARUNAVIR TABLETS
  • DAYPRO TABLETS
  • DEFERASIROX TABLETS
  • DEFERIPRONE TABLETS
  • DENTA 5000 PLUS CREAM
  • DENTAGELGEL
  • DERMACINRX PRETRATE TABLETS
  • DEXEDRINE CAPSULES
  • DEXILANT CAPSULES
  • DEXMETHYLPHENIDATE HCL TABLETS
  • DEXMETHYLPHENIDATE HYDROCHLORIDE TABLETS
  • DEXTROAMPHETAMINE SULFATE ER CAPSULES
  • DICLOFENAC SODIUM DR TABLETS
  • DICLOFENAC SODIUM ER TABLETS
  • DIFLUNISAL TABLETS
  • DIPYRIDAMOLE TABLETS
  • DUET DHA 400 CAPSULES
  • EC-NAPROSYN TABLETS
  • ELITE-OB TABLETS
  • ENBRACE HR CAPSULES
  • ENULOSE SOLN
  • METHYLPHENIDATE HYDROCHLORIDE ER TABLETS
  • METHYLPHENIDATE HYDROCHLORIDE ER (LA) CAPSULES
  • MODAFINIL TABLETS
  • MYDRIACYL OPHTH SOLN
  • NABUMETONE TABLETS
  • NAPROSYN TABLETS
  • NAPROXEN TABLETS
  • NAPROXEN SODIUM TABLETS
  • NATACHEW TABLETS
  • NATAL PNV TABLETS
  • NEEVO DHA CAPSULES
  • NEONATAL FE TABLETS
  • NEONATAL/DHA CAPSULES
  • NESTABS TABLETS
  • NESTABS DHA CAPSULES
  • NESTABS ONE CAPSULES
  • NOXAFIL TABLETS
  • NUCALA INJ
  • NUEDEXTA CAPSULES
  • OB COMPLETE ONE CAPSULES
  • OB COMPLETE PETITE CAPSULES
  • OB COMPLETE PREMIER TABLETS
  • OB COMPLETE/DHA CAPSULES
  • OBSTETRIX DHA CAPSULES
  • OBSTETRIX ONE CAPSULES
  • OMEPRAZOLE CAPSULES
  • ONE A DAY WOMENS PRENATAL/DHA CAPSULES
  • ONE A DAY WOMENS PRENATAL1 CAPSULES
  • ONE-A-DAY WOMENS PRENATAL CAPSULES
  • PANTOPRAZOLE SODIUM TABLETS
  • PENTOXIFYLLINE ER TABLETS
  • PIMOZIDE TABLETS
  • PNV PRENATAL PLUS MULTIVITAMIN + DHA CAPSULES
  • PNV TABS 20-1 TABLETS
  • PNV-DHA CAPSULES
  • PNV-OMEGA CAPSULES
  • PNV-SELECT TABLETS
  • PREGEN DHA CAPSULES
  • PREMESISRX TABLETS
  • PRENA 1 TRUE CAPSULES
  • PRENA1 PEARL CAPSULES
  • PRENATAL TABLETS
  • SALSALATE TABLETS
  • SAVELLA TABLETS
  • SELECT-OB TABLETS
  • SELECT-OB+DHA CAPSULES
  • SEVELAMER HYDROCHLORIDE TABLETS
  • STAVUDINE CAPSULES
  • STUART ONE CAPSULES
  • SULINDAC TABLETS
  • TARON-C DHA CAPSULES
  • THALOMID CAPSULES
  • THERANATAL COMPLETE CAPSULES
  • THERANATAL ONE CAPSULES
  • THERANATAL OVAVITE CAPSULES
  • TIZANIDINE HCL TABLETS
  • TOLECTIN 600 TABLETS
  • TOLMETIN SODIUM CAPSULES
  • TOPIRAMATE ER CAPSULES
  • TRISTART DHA CAPSULES
  • TROPICAMIDE SOLUTION
  • ULTRA PRENATAL VITAMINS & MINERALS + DHA CAPSULES
  • VITAFOL FE+ CAPSULES
  • VITAFOL GUMMIES TABLETS
  • VITAFOL ULTRA CAPSULES
  • VITAFOL-OB TABLETS
  • VITAFOL-OB+DHA CAPSULES
  • VITAFOL-ONE CAPSULES
  • VITAMEDMD ONE RX/QUATREFOLIC CAPSULES
  • XIFAXAN TABLETS
  • ZENPEP CAPSULES

Over-the-Counter Contraception for Washington State Pharmacies- Medicaid

  • Participating pharmacies may prescribe Over-the-Counter (OTC) contraception.
  • Apple Health (Medicaid) covers OTC contraception, including most emergency contraception (morning after pill), with or without a prescription for members.
  • An adjudicated pharmacy claim is required for reimbursement.

You can find out which pharmacies are offering it in your community from Birth Control Pharmacies.

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Apple Health Core Connections (AHCC)

NEW RESOURCES FOR ADOPTEES: Coordinated Care has partnered with the Adoptee Mentoring Society to support two initiatives in 2025 for AHCC members who have been adopted from foster care. Please share these no-cost resources with patients who qualify.

  1. Free Virtual 1:1 Mentoring: Adoptees in Washington, ages 12-18, who were adopted out of foster care can access free, virtual 1:1 mentorship. They can sign up by emailing info@adopteementorship.org.
  2. Free Adoptee Lounges (Peer Support Group): The AMS team is hosting four adoptee lounges specific to youth in Washington who were adopted out of foster care, ages 12-18. Each lounge is limited to five youth per session and will be facilitated by Angela Tucker. Adoptee Lounges are similar to a guided peer support group where youth can build community and talk with each other in a safe space about their experiences. These lounges will take place on Jan 13, Apr 14, Jul 14, Oct 13 from 5-6pm PT. To sign up, register using this link.

Coordinated Care is the single managed care organization to administer the Integrated Managed Care Apple Health Foster Care program serving children and youth in foster care, adoption support, guardianship assistance program, alumni of foster care (ages 18-26), children reunified with their parents (one year post-dependency), and youth in the Unaccompanied Refugee Minor program. Coordinated Care’s program is named “Apple Health Core Connections.” For questions or care coordination referrals you can reach us at 1-844-354-9876 or AHCCTeam@coordinatedcarehealth.com. 

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Training/Education

End of Year Reminder to Providers to take Annual Cultural Humility Training:

  • There are multiple cultures interacting in every clinical encounter, including:
  • Physician’s culture
  • Patient’s culture
  • Culture of each person that interacts with the patient from the office staff to nurses to the health plan

Cultural Humility May Improve Patient Care By:

  • Improving health outcome of the patient when healthcare beliefs and cultural background are taken into consideration
  • Building trust
  • Increasing confidence, satisfaction, and follow-up
  • Increasing patient and health plan retention

Access Free Accredited On-Demand Cultural Humility and Unconscious Bias in Healthcare Training at Centene Institute. After Completion, Participants will be able to:

  • 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

Obtain Free 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)

How to Access Free Accredited On-Demand Training at Centene Institute:

  1. Visit CenteneInstititute.com
  2. Create New Account
  3. Start Your Learning

How to Enroll in Courses:

Understanding Youth Substance Use Understanding Youth Substance Use explores the impact and rates of substance use among youth in foster care. It discusses risk factors and protective factors, how substance use effects the brain, different types of substances being used, and common warning signs of use or addiction. Caregivers will leave better able to start conversations with youth on substance use and addiction. Jan 9, 2025, 01:00 PM Register here.

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. Jan 16, 2025, 01:00 PM Register here.

Commercial Sexual Exploitation of Children (CSEC 101) Responding to Sexual Exploitation and Trafficking of Youth was developed by Leslie Briner, MSW of Youth Care; This training will prepare caregivers and service providers to identify, engage and provide support to sexually exploited youth; Introductory topics include definitions, language, landscape of exploitation, identification including “red flags”, victim engagements and interventions. Jan 23, 2025, 01:00 PM Register here.

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. Jan 30, 2025, 01:00 PM Register here.

Suicide Prevention in Youth Provides an overview of the topic of suicide, signs and symptoms in youth, and how professionals and 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. Will include a discussion on self-harm and social media. This training has many resources to utilize, as well as being useful for concerns of suicidal ideation in adults as well. Jan 30, 2025, 12:30 -02:30 PM Register here.

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