July 2022 Provider News
Date: 07/29/22
In this issue:
- Quality - Wildfire and Asthma 90-Day Medication Refills
- Tribal - DCYF 2022 Conference, American Indian/Alaska Native Protections, Voluntary Psychiatric Hospitalization
- Apple Health Core Connections - Monthly Trainings Available, Behavioral Health Levels of Care One-Pager
- General Updates - Mental Health Assessment for Young Children (MHAYC), Smoking & Tobacco Cessation
- Clinical Policy - Reminders, Monthly Updates
- Training/Education - Trauma-Focused Cognitive Behavioral Therapy, Region 10 Opioid Summit, and more
- Pharmacy Updates - September 1, 2022 Preferred Drug List Changes
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Quality
Wildfire Season
For those impacted by the fires in Washington – status updates and shelter resources can be found here.
Asthma and 90-Day Medication Refills
Moving patients with asthma to 90-day refills may help increase their adherence to maintenance medication.
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Tribal
DCYF 2022 Indigenous Children, Youth, and Families Conference
August 10-11, 2022. Free, virtual conference, open to everyone.
Flyer
American Indian/Alaska Native Protections
Reminder for our network providers that AI/ANs can receive Apple Health coverage without a managed care plan, also known as Fee For Service.
For Indian Health Care Providers
See our Behavioral Health Prior Authorization Reference Guide, which includes how to request voluntary psychiatric hospitalization.
For provider manuals and how to submit appeals see our Provider Resources page.
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Apple Health Core Connections
Coordinated Care is the only managed care organization administering the Integrated Apple Health Foster Care program in collaboration with the Health Care Authority and Department of Children Youth and Families. Our program, Apple Health Core Connections, serves children and youth in foster care, adoption support, alumni of foster care (ages 18-26), children reunified with their parents, and youth in the Unaccompanied Refugee Minor program. Providers and members can reach us at 1-844-354-9876 or AHCCTeam@coordinatedcarehealth.com.
The Coordinated Care Community Education (CE) 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.
Coordinated Care’s Behavioral Health Levels of Care one-pager is a helpful resource that provides an overview of each level of care as well as the roles of healthcare providers, Coordinated Care, and DCYF in supporting youth wellness.
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General Updates
Mental Health Assessment for Young Children (MHAYC)
Scope: Changes to Apple Health Policies regarding MH assessment for children from 0-5 years of age.
Changes: In April 2021, the Washington State Legislature passed 2HB1325. Link to HCA.
Highlights of Changes:
- Enhanced reimbursement: Reimbursement for up to five sessions for assessment, if necessary; Reimbursement of provider travel costs for assessments conducted in home or community settings; Requirement to use the DC:0-5™ diagnostic classification system
Travel Reimbursement:
Provider travel is eligible for reimbursement under a specific and limited set of instances:
- The purpose of conducting a mental health assessment using CPT codes 90791, 90792 or H0031
- For a child aged 0-5 (up till their 6th birthday)
- Session that is conducted in the child/family’s home or in a community setting (Use Place of Service (POS) 03/ School; 04/Homeless Shelter; 12/Home or 99/Other Place of Service)
Getting Reimbursed:
Providers will utilize the A-19 form and include the following:
- The Service Date of the assessment
- The ProviderOne ID
- Addresses of starting and ending point
- Miles from starting point to ending point
- Mileage rate
Invoices can be submitted to: CoordinatedCareFinance@coordinatedcarehealth.com
- All invoices will be validated to claims per eligibility for reimbursement.
- No invoice will be paid without an adjudicated claim
- Invoices must be submitted no later than 60 days from an adjudicated supporting claim
Smoking and Tobacco Cessation
Coordinated Care Apple Health (Medicaid) 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 208-209 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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Clinical Policy
Reminders:
Interventional Pain Management
Left Heart Catheterization
Cardiac Implants
Effective October 1, 2022, interventional pain management, left heart catheterization and cardiac implant services will be reviewed by National Imaging Associates, Inc. (NIA) to determine if the services are medically necessary and covered under Coordinated Care health plans. You will find the policies on the NIA Website. A link is available under “provider resources” on CoordinatedCareHealth.com. Policy names are listed below under Monthly Updates.
CPT codes considered interventional pain management for purposes of this review are: 0213T-0218T, 0228T-0231T, G0260, 27096, 62320-62323, 64479, 64480, 64483, 64484, 64490-64495, 64633-64636. All codes currently require prior authorization, but effective 10/1/22, authorization will be provided by NIA.
CPT codes considered left heart catheterization for purposes of this review are: 93452-93459, 93460-93464, 93565-933568. Prior authorization issued by NIA will be required effective 10/1/22.
CPT codes considered cardiac implants for purposes of this review are: 33221, 33224, 33225, 33231, 33230, 33240, 33249, 33206-33208, 33212, 33213. Prior authorization issued by NIA will be required effective 10/1/22.
Monthly Updates:
The below clinical policies received updates as part of our regular monthly review in July. These policy changes are effective August 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.175 | Air Ambulance | Ambetter |
WA.CP.MP.37 | Bariatric Surgery | Apple Health |
CP.MP.93 | Bone-Anchored Hearing Aid | Apple Health & Ambetter |
CP.MP.94 | Clinical Trials | Apple Health & Ambetter |
CP.MP.115 | Discography | Apple Health & Ambetter |
CP.MP.107 | Durable Medical Equipment, Orthotics and Prosthetics Guidelines | Apple Health & Ambetter |
CP.MP.184 | Home Ventilators | Apple Health & Ambetter |
CP.MP.82 | NICU Apnea Bradycardia Guidelines | Apple Health & Ambetter |
CP.MP.81 | NICU Discharge Guidelines | Apple Health & Ambetter |
CP.MP.49 | Physical, Occupational and Speech Therapy Services | Apple Health & Ambetter |
The below policies were previously announced as revised on the dates noted. You will find the policies posted on the policy site.
| Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.243 | Implantable Loop Recorder (Implantable Cardiac Monitor) | 9/1/22 | Apple Health & Ambetter |
| CP.MP.244 | Liposuction of Lipedema | 10/1/22 | Apple Health & Ambetter |
New NIA Pain Management and Cardiac policies to be effective 10/1/22:
| Policy Number | Policy Title | Line of Business |
NIA_CG_300 | Epidural Spine Injections | Apple Health & Ambetter |
NIA_CG_301 | Paravertebral Facet Point Injections or Blocks | Apple Health & Ambetter |
NIA_CG_302 | Paravertebral Facet Joint Denervation (Radiofrequency Neurolysis) | Apple Health & Ambetter |
NIA_CG_303 | Sacroiliac Joint Injections | Apple Health & Ambetter |
NIA_CG_065 | Heart Catheterization | Apple Health & Ambetter |
NIA_CG_322 | Pacemaker | Apple Health & Ambetter |
NIA_CG_321 | Implantable Cardioverter Defibrillator (ICD) | Apple Health & Ambetter |
NIA_CG_320 | Cardiac Resynchronization Therapy | Apple Health & Ambetter |
Coordinated Care Pain Management policies to be archived 9/30/22:
| Policy Number | Policy Title | Line of Business |
CP.MP.164 | Caudal or Interlaminar Epidural Steroid Injections for Pain Management | Apple Health & Ambetter |
CP.MP.165 | Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management | Apple Health & Ambetter |
WA.CP.MP.171 | Facet Joint Interventions for Pain Management | Apple Health |
CP.MP.171 | Facet Joint Interventions for Pain Management | Ambetter |
CP.MP.166 | Sacroiliac Joint Interventions for Pain Management | Apple Health & Ambetter |
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Training/Education
Visit Centene’s Clinical Provider Training website to find webinars 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 to find a complete listing.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment for children and adolescents impacted by trauma and their parents or caregivers. Research shows that TF-CBT successfully resolves a broad array of emotional and behavioral difficulties associated with single, multiple and complex trauma experiences. Coordinated Care with Roy Van Tassell, MS LPC, a certified TF-CBT trainer, will train three cohorts of behavioral health clinicians who commit to treating Apple Health Core Connections members in an out-of-home foster care placement. Trainings are 5 hours each day for 3 days. Coordinated Care offers this valuable EBP training at no cost to providers (an approximate value of $1000). Following the training, clinicians have the opportunity to continue receiving support toward full certification through the TF-CBT Consultation Call Program consisting of twice-monthly, one-hour group conference calls for six months. Clinicians who registered commit to completing the TF-CBT Consultation Call Program. Coordinated Care will host a 4th cohort of TF-CBT August 24-26, 2022. Space is limited for this training, however, please reach out to Lindsey.C.Greene@coordinatedcarehealth.com if you would like to be added to the interest list for future cohorts.
Region 10 Opioid Summit. The virtual summit is an opportunity for professionals from Alaska, Idaho, Oregon, Washington, Indian Nations, urban Indian health programs, and recognized American Indian organizations to meet and explore ways to address the opioid crisis. August 3-4, 2022. Register here.
NWATTC Webinar: Recruitment and Retention Strategies for Culturally Specific Behavioral Health Staff. Presenters: Fernando Pena (Executive Director of NW Instituto Latino), Jerrod Murray (Painted Horse Recovery). In this session, Jerrod and Fernando will share their understanding of the systemic barriers that impact Indigenous and Latinx communities when it comes to the behavioral health workforce. They will share some strategies they have used to recruit, retain and support their respective teams. August 31, 2022, 12-1pm. Register here.
Harborview Behavioral Health Institute Conference. Re-Imagining Behavioral Health: Race, Equity and Social Justice. The 2-half day virtual conference will explore the intersectionality of substance use disorders, mental health, and social justice. The event is designed to empower individuals and teams who want to advance health equity and support diversity and inclusion in behavioral health care. September 29-30, 2022. Learn more and register here.
As of July 16, 2022, 988 is the new suicide and crisis lifeline. Providers and clinics can help spread the word. SAMHSA has added downloadable print files for wallet cards, magnets, and posters to its 988 Partner Toolkit.
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Pharmacy Update
Effective September 1, 2022, Cyclobenzaprine HCL 7.5 MG tablets will no longer be preferred. Please see list below of potential alternatives.
DRUG NAME | POTENTIAL ALTERNATIVES |
Cyclobenzaprine HCL 7.5MG Tablet
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