April 5, 2016 Progress Notes
Medicaid/Bayou Health
- FFS Edits on elbasvir/grazoprevir (Zepatier®) for La. Medicaid Pharmacy Program
- MCO Provider Calls to Continue Through April
- Bayou Health Informational Bulletins
- Health Plan Advisories
- Happy April Birthdays
- Welcome New Members
- SUDIA Recipe: Ricotta Pesto Crostini
Upcoming Events:
- Pediatric Jambalaya XIII | 4/23/16 | Lafayette, LA
- Red River Potpourri | 8/19-21/16 | Shreveport, LA
Download a pdf version of this edition
HPV Education Events- Baton Rouge & New Orleans
Join us for one of the two events listed below. Dr. Melinda Wharton from the CDC will be presenting.
HPV vaccine: why we must and how we can do better
When: April 12th, 2016
Location: Renaissance Hotel | 7000 Bluebonnet Blvd. | Baton Rouge
Registration: https://wharton-hpv.eventbrite.com
Target audience: An educational program for healthcare and immunization professionals intersted in HPV and improving vaccination rates.
Objectives:
- Describe trends in adolescent immunization coverage in the United States during the period 2006-2014
- Identify which groups are currently recommended by ACIP to routinely receive HPV vaccination.
- Identify at least one strategy which could be implemented in your practice or work setting to improve HPV vaccine coverage.
Agenda:
6:00 – 6:30 pm Registration and Dinner
6:30 – 6:45 pm Welcome & Introductions
6:45 – 7:45 pm Presentation by Dr. Wharton
7:45 – 8:00 pm Q&A and Evaluations
Continuing Education Credits: This activity has been submitted for AMA PRA Category 1 Credit™
Co-Sponsors:
– – – – – – – –
When: April 13th, 2016
Time: 8:00 AM – 9:00 AM
Location: Children’s Hospital Auditorium | 200 Henry Clay Avenue | New Orleans, LA 70118
If you can’t make it to Children’s Hospital please join us online. Register no later than April 08, 2016 by 4:30 PM CST to join remotely.
https://attendee.gotowebinar.com/register/8599812977128376580
Presented by:
Collaborators
Dr. Melinda Wharton, MD, MPH
Dir. of Immunization Services Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Call for Chapter Award Nominations
Please submit nominations to Ashley Politz via email by April 29th
Charles M. Vanchiere Child Advocacy Award: This award is given to recognize special efforts to improve the health of children in Louisiana by increasing their access to needed health care.
Dr. Charles M. “Buzzy” Vanchiere was a private pediatrician in Lake Charles, Louisiana, for nearly 30 years, and a tireless advocate for children’s services. He pushed the private sector to accept Medicaid patients when the state first allowed them to bill for screening and diagnostic services. He was president of the LA Chapter of AAP at the time that the federal State Child Health Insurance Legislation was enacted and he was a major force in assuring that Louisiana took advantage of this new opportunity to cover children. He served on medical committees in his parish, in the state and for the American Academy of Pediatrics. He organized and led the Pediatric Society of Southwest Louisiana and the LSU Pediatric Alumni Association. He chaired the Pediatric Advisory Committee for Medicaid and was a member of the Blue Cross Physician Executive Committee. He was also active in the “Children’s Miracle Network” and received it “Miracle Makers” award in 1995 for outstanding service to that program. Dr. Vanchiere died in the year 2000 at the young age of 60 and the Chapter established this award in his name to honor outstanding child advocates.
Bettina C. Hilman Award for Services to Special Needs Children: This award is given to a pediatrician that has provided significant services for special needs children in the state.
Dr. Bettina Hilman is a renowned authority on pediatric cystic fibrosis. After graduating summa cum laude from Centenary in 1949, Dr. Hilman earned a Master of Science degree from Tulane and then earned her MD from Louisiana State University in New Orleans. Dr. Hilman is board certified in both Allergy/Immunology and Pediatric Pulmonary Diseases. Following completion of her training, she held positions in clinics, hospitals and universities throughout the United States and lectured throughout the world. She spent a major part of her career as a researcher and faculty member in the Department of Pediatrics at the LSU School of Medicine in Shreveport. While in Shreveport she served as Chief of the Pulmonary and Allergy Section. During her tenure, she established and served as first director of the LSU Shreveport Cystic Fibrosis Center and the Allergy/Immunology fellowship program.
Dr. Hilman held a number of leadership positions in state and national organizations throughout her career and was an active member of the Louisiana Chapter of the AAP. She served as a member of the AAP’s Task Force on Opportunities of Women in Pediatrics in 1978-9. Dr. Hilman was on the editorial boards of a number of journals and served as the editor-in-chief of the journal Pediatric Asthma, Allergy and Immunology for a number of years
Dr. Hilman has been the recipient of numerous awards including the Humanitarian Award for the National Conference of Christians and Jews in 1989, the Shreveport Medical Society Distinguished Service Award in 1996, the William Stewart Distinguished pediatric Alumni Award from LSUHSC-NO in 1996, the Women Who Make a Difference Award in Shreveport in 1997, and was inducted into the Centenary College Alumni Hall of Fame in 1998. The LA AAP presented the David William Van Gelder Distinguished Service Award to Dr. Hilman in 1996 and the Elizabeth Casenelli Award in 2000.
Named in her honor, the Hilman House opened in September 1988 in Shreveport to provide a homelike residence for cystic fibrosis patients and their families to have free housing while undergoing medical treatment at the Cystic Fibrosis Center in Shreveport.
Throughout her career she has been a strong advocate for her patients, for advancing pediatric care, for medical education and for women in medicine.
Chapter Service Award: This award is to recognize a committee or special interest group that has most successfully accomplished its goals and objectives.
Sandra C. Adams Award: recognition of a non-physician in their efforts to improve health of children in Louisiana through advocacy and community involvement.
Sandra C. Adams served as the Executive Director of the Louisiana MCH Coalition from January 1, 1990, when it began, until her retirement on June 20, 2009. The Coalition is a non-profit advocacy organization focused on improving health care for women and children. Ms. Adams was a registered lobbyist at the Louisiana Legislature and worked on a variety of issues including prenatal care, well-child care, adolescent pregnancy, Medicaid eligibility, health insurance reform and comprehensive school health. She concurrently served as Executive Director of the Louisiana Chapter of the American Academy of Pediatrics and managed both the LA AAP Foundation and the LA Perinatal/MCH Foundation.
Her career was shaped by a diverse combination of business, government and non-profit experience in states from coast to coast. After graduation from the University of Maryland, she worked on injury prevention at the US Department of Health and Welfare in Washington, DC. She moved to New York and served as a human resources officer at Bankers Trust Company on Wall Street and then moved to the west coast where she was a financial analyst for Xerox in Los Angeles. After moving to Louisiana, she sought work in the non-profit realm and led community services for the elderly until she was appointed to a term as Executive Director of the Governor’s Office of Elderly Affairs.
Ms. Adams also has an extensive list of volunteer accomplishments including:
- Board of Trustees, Woman’s Health Foundation/Woman’s Hospital (Past Chair)
- Capital Area United Way Board of Directors and Chair of Community Partnership Division (Allocation Process)
- Council for a Better Louisiana (Member of Board and Executive Committee)
- Past President of WRKF, Public Radio
- Founder and first president of La. Senior Olympics
MOTHERS’ MILK BANK OF LOUISIANA AT OCHSNER BAPTIST
One in eight babies is born prematurely and a significant number of mothers with premature babies are not able to breastfeed or produce adequate amounts of milk. Donor milk banking plays an important role in meeting the critical nutritional needs of these babies. In the US and Canada, there are 23 human milk banks and 7 developing banks functioning as depots currently operational under the guidance of the Human Milk Banking Association of North America (HMBABA). Human milk banks collect milk from lactating women who are producing more milk than their baby requires. These donors are interviewed and then have their blood screened prior to being accepted as a donor. The milk is processed (homogenized, pasteurized and cultured) prior to giving to an infant in need.
Ochsner Baptist Hospital has been approved by HMBABA as a Developing Milk Bank, and has already opened a Milk Bank Depot which will collect human milk from pre-screened lactating women and send it to the Mothers’ Milk Bank at Austin, TX for processing. Ochsner Baptist is equipped with a freezer and will accept breastmilk around the clock.
“Donor milk helped my baby thrive,” states Lakita Wickware, who delivered her son, Ray Charles, prematurely at Ochsner Baptist. “Because he came early, my milk had not come in yet and I wasn’t able to breastfeed. The doctor in the NICU told me donor milk was an option. At first I was nervous about giving my son milk from another mother, but you want your baby to be healthy. He needed it and it was a blessing. He’s doing great now.”
Women who are currently breastfeeding infants under one year of age are eligible to be screened at no charge to become breast milk donors. Once screened and accepted, the donor will drop off her frozen milk at Ochsner Baptist where it will be sent to Austin. Research shows that the method of pasteurization used at Austin preserves approximately 70% of the immune factors that help protect babies from illness.
“I encourage those who may have a surplus of breastmilk to become donors,” says current milk bank donor Emily Martin. “You can help other babies become healthy and strong. The process is painless and anything helps. It’s very rewarding to help another family.”
Mothers who would like to donate should contact Laura Tankersley at The Mothers’ Milk Bank at Austin by calling 512-494-0800 or emailing laurat@milkbank.org. The process to donate requires an advance health screening and blood test. All costs for screenings are covered by Austin’s bank. Once screening is complete, women will be able to conveniently drop off frozen breast milk 24/7 at Ochsner Baptist located at 2700 Napoleon Avenue in New Orleans.
For detailed drop off information or to learn more about the developing milk bank visitwww.ochsner.org/mothersmilkbank
To support the milk depot at Ochsner and the development of the only fully functional milk bank in the community, contact Traci Lucas, CFRE, Director of Development for Women and Children at 504-894-2017 ortrack.lucas@ochsner.org.
AAP 2016 AAP Education Award Call for Nominations
The American Academy of Pediatrics is pleased to announce that nominations are being accepted for the 2016 AAP Education Award. This award will recognize one member of the Academy whose career reflects educational contributions that have had a broad and positive impact on the health and well-being of infants, children, adolescents and young adults. The 2015 AAP Education Award was presented to Tina Cheng, MD, MHP, FAAP.
The AAP Education Award Subcommittee encourages you, along with your constituents and colleagues, to submit nominations for this award. The award recipient will receive a commemorative award that is presented at the AAP 2016 National Conference and Exhibition (NCE) in San Francisco, CA.
To submit your nomination, please refer to the Nomination Announcement and Nomination Form which are posted on AAP.org (www.aap.org/cocme). All nominations need to be submitted to Nikki Berry by Friday, April 22, 2016.
Please contact me via email at nberry@aap.org or you can call 847/434-7382 or 800/433-9016, ext. 7382 with questions or for additional information.
Thank you, your assistance in helping to ensure that there is a significant pool of highly qualified candidates is greatly appreciated
Nikki Berry
Manager of Accreditation and Education
American Academy of Pediatrics
141 Northwest Point Blvd, Elk Grove Village, IL 60007
nberry@aap.org
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Medicaid/ Bayou Health
FFS Edits on elbasvir/grazoprevir (Zepatier®) for La. Medicaid Pharmacy Program
(Link to direct post)
MEMORANDUM DATE: March 17, 2016
TO: All Louisiana Fee for Service Medicaid Providers
FROM: Jen Steele, Interim Medicaid Director
SUBJECT: FFS Edits on elbasvir/grazoprevir (Zepatier®) for La. Medicaid Pharmacy Program
Effective March 29, 2016, the Louisiana Medicaid Pharmacy Program in collaboration with the Louisiana Medicaid Drug Utilization Review (DUR) Board has established Point of Sale (POS) edits on elbasvir/grazoprevir (Zepatier®).
Quantity Limits
Pharmacy claims for elbasvir/grazoprevir (Zepatier®) will have quantity limits of 28 tablets every rolling 28 days. Claims will deny at Point of Sale (POS) when quantity limits are exceeded with:
NCPDP reject code 76 (Quantity and/or days’ supply exceeds program maximum) mapped to EOB code 457 (Quantity and/or days’ supply exceeds program maximum)
There are no override provisions through the Point of Sale (POS) system using NCPDP service codes.
Early Refill
Pharmacy claims for elbasvir/grazoprevir (Zepatier®) will not be allowed to process for payment before 89% of the days’ supply has been exhausted. Claims will deny at Point of Sale (POS) when refilled too early with:
NCPDP reject code 88 (DUR Reject Error) mapped to
EOB code 447 ER (Compliance Monitoring/Early or Late Refill)
After consultation with the prescriber to verify the necessity of the early refill, the pharmacist may override the early refill denial by submitting in:
NCPDP 439-E4 field (Reason for Service Code) ER (Overuse/Early Refill) NCPDP 440-ES field (Professional Service Code) M0 (Prescriber Consulted) NCPDP 441-E6 field (Result of Service Code) lG (Filled with Prescriber Approval)
FFS Edits on elbasvir/grazoprevir (Zepatier®)
The pharmacist must document the override codes on the hardcopy prescription or in the pharmacy’s electronic recordkeeping system.
Therapeutic Duplication
Pharmacy claims for elbasvir/grazoprevir (Zepatier®) will deny when the recipient has a claim on file (active or inactive) for boceprevir (Victrelis®), telaprevir (Incivek®), Ombitasvir/paritaprevir/ritonavir (Technivie®), simeprevir (Olysio®), sofosbuvir (Sovaldi®), ledipasvir/sofosbuvir (Harvoni®) , Ombitasvir/Paritaprevir/Ritonavir/Dasabuvir (Viekira®), or Daclatasvir (Daklinza®) within the last 12 months. Also claims for Ombitasvir/paritaprevir/ritonavir (Technivie®), simeprevir (Olysio®), sofosbuvir (Sovaldi®), ledipasvir/sofosbuvir (Harvoni®) , Ombitasvir/Paritaprevir/Ritonavir/Dasabuvir (Viekira®), or Daclatasvir (Daklinza®) will deny when the recipient has a claim on file for elbasvir/grazoprevir (Zepatier®) within the last 12 months with:
NCPDP reject code 88 (DUR Reject Error) mapped to EOB code 482 TD (Therapeutic Duplication)
There are no override provisions through the Point of Sale (POS) system using NCPDP service codes.
Diagnosis Code Requirement
Pharmacy claims for elbasvir/grazoprevir (Zepatier®) will require a diagnosis code of B18.2 in NCPDP field 424-DO (Diagnosis Code). Claims submitted without a diagnosis code at POS with deny with:
NCPDP reject code 39 (Missing or Invalid diagnosis code) mapped to EOB code 575 (Missing or Invalid diagnosis code)
The diagnosis code must be documented on the hardcopy prescription or in the pharmacy’s electronic recordkeeping system. There are no override provisions through the Point of Sale (POS) system using NCPDP service codes.
Physician Prescriber Requirements
The prescribing physician must have a specialty of gastroenterology or infectious disease for any of the Direct Acting Antiviral Hepatitis C Agents to process including elbasvir/grazoprevir (Zepatier®) . Pharmacy claims from prescribers without these specialties will deny with:
NCPDP reject code 71 (Prescriber is not covered) mapped to
EOB code 514 (Prescribing provider does not have prescriptive authority)
There are no override provisions through the Point of Sale (POS) system using NCPDP service codes.
For currently enrolled doctors of osteopathic medicine to update their specialty please refer to form at:http://www.lamedicaid.com/provwebI/Provider_Enrollment/DoctorOsteopathicMedicineSpecialtyChangeForm.pdf
For currently enrolled physicians to update their specialty please refer to form at:
http://www.lamedicaid.com/provwebI/Provider_Enrollment/PhysicianProviderSpecialtyChangeForm.pdf
Age Limits
Pharmacy claims for elbasvir/grazoprevir (Zepatier®) will deny when the recipient is 17 years old or younger at POS with:
NCPDP reject code 60 (Product/Service Not Covered for Patient Age) mapped to EOB code 234 (P/F Age Restriction)
There are no override provisions through the Point of Sale (POS) system using NCPDP service codes.
Compliance associated with program policy will be verified through our Louisiana Medicaid Pharmacy Compliance Audit Program.
Your continued cooperation and support of the Louisiana Medicaid Program efforts to coordinate care and improve health are greatly appreciated.
If you have questions about the contents of this memo, you may contact the Pharmacy Help Desk at (800) 437-9101 or refer to www.lamedicaid.com.
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MCO Provider Calls to Continue Through April
To continue to offer support to providers during the integration of mental health and substance use services into Bayou Health, the Department of Health and Hospitals (DHH) will continue to co-host the calls with the Managed Care Organizations (MCO) through the month of April 2016. The calls will take place Monday through Friday with a different MCO each day. The calls will allow DHH to continue to keep providers up to date with announcements and will allow providers to make comments or ask the MCOs questions. If you email your questions or comments to bayouhealth@la.gov before the call, Medicaid will forward your email to the appropriate MCO. This will allow the MCOs time to prepare a response. All provider types are welcome to participate on the calls. The call schedule will be as follows:
• Monday – Aetna
• Tuesday – Amerigroup
• Wednesday – AmeriHealth Caritas
• Thursday – Louisiana Healthcare Connections
• Friday – United Healthcare
All calls will take place from noon until 1 p.m. There will be no call on Good Friday March 25, 2016.
The call-in information is as follows:
• Call-in #: 1-888-636-3807
• Access Code: 1133472
DHH offers providers numerous avenues for reporting and resolving issues related to Bayou Health. Please refer to Information Bulletin 12-27 posted on www.makingmedicaidbetter.com. This bulletin also includes contact information for each of the MCOs.
For news specifically pertaining to the integration, you can click on the “Behavioral Health” tab onwww.makingmedicaidbetter.com. To automatically receive updates and releases from the Department regarding the integration, subscribe to the “Integrated Health Care” newsletter.
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Bayou Health Informational Bulletins for Providers
Informational Bulletin 16-8: Managing Third Party Liability (TPL) Updates for Medicaid Enrollees
Informational Bulletin 16-7: Professional Services Fluoride Varnish Program Policy
Informational Bulletin 16-6: Billing/Claims Submission Processes for Specialized Behavioral Health Services for Members Enrolled in One or More of The Following: Bayou Health Plan, Magellan or fee for service Medicaid
Informational Bulletin 16-5: Bayou Health Plan Progesterone Billing and Ordering Guide (Revised March 30, 2016)
Informational Bulletins cover a variety of topics related to Bayou Health, and all are available here.
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Health Plan Advisories are available at http://new.dhh.louisiana.gov/index.cfm/page/1734
| 4/1 Joseph Anthony Bocchini Jr., MD, FAAP 4/1 Marvin Mata, FAAP 4/2 Brandi Ducote, MD 4/2 Bernard Francis Ferrer, MD, FAAP 4/2 Amelia Monteiro, MD 4/2 Vickren Pillay, MD 4/2 Carlos Plancarte, MD 4/2 Janet Lyn Ross, MD, FAAP 4/3 Kara Michelle Spinks 4/3 Barry Martin Matthews Starr, MD, FAAP 4/4 Robert Allen Gordon, MD 4/4 LaQuatre Rhodes, DO 4/6 Jill Michael McCall 4/6 Meghan Vial 4/6 Brittany Wagner, DO 4/7 Sudha Ashok Rao, MD, FAAP 4/7 Melanie T Yerger, MD, FAAP 4/9 Michael McAdams Quinn, MD, FAAP 4/10 Amanda Gayle Brown, MD, FAAP 4/10 Connor Marcel Champion 4/10 Molly Doose, MD 4/10 Jane M.S. El-Dahr, MD, FAAP 4/10 Emily Menefee, PA-C 4/12 John Nathan Rhodes, MD, FAAP 4/13 George S Ellis Jr., MD, FAAP 4/13 Nhung Kim Nguyen, MD, FAAP 4/13 Gary Quinton Peck, MD, FAAP 4/14 Harley G Ginsberg, MD, FAAP 4/14 Elizabeth Renee Smith, MD 4/15 Husam Haidar Sukerek, MD, FAAP |
4/17 Osman Mohamad Numair, MD 4/17 Fred Douglas Patterson, MD, FAAP 4/17 Elizabeth Tracy Young, MD, FAAP 4/18 Heather Alicia Daniels, MD 4/18 Gregory J. Gelpi, MD, FAAP 4/18 Stephanie Leigh Mead 4/19 Jessica May, MD 4/19 Patricia M Schneider, MD, FAAP 4/20 Robert Louis Delarosa, DDS 4/21 Marie Manning Harper, MD, FAAP 4/22 Christina Kozycki, MD 4/22 Raj P. Warrier, MD, FAAP 4/23 Jennifer Bentley, MD 4/23 Danielle Ibelema, MD 4/23 Theron Garrick McCormick, MD, FAAP 4/23 Isabel Remedios, MD 4/23 Leonard J. Rolfes, MD, FAAP 4/23 Molly Esther Sonenklar, MD 4/24 Brandace Hider, MD, FAAP 4/24 Kenneth Wayne Leger, MD 4/26 Ellie Fox Wetsman, MD, FAAP 4/27 Robert Jerome Oertling, MD, FAAP 4/27 John T Wilson, MD, FAAP 4/28 Dianne Jones Albrecht, MD, FAAP 4/28 Hunter Hamilton, MD 4/28 Kunal Sonavane, MD 4/29 John S Barbara III, MD, FAAP 4/29 Bradford Jennings Smith, MD, FAAP |
Please join us in welcoming our newest member to the LA Chapter of the American Academy of Pediatrics. There is strength in numbers and we are so glad you have chosen to add your voice to the more than 700 Louisiana Chapter members who are speaking out on behalf of the Children of Louisiana and the profession of Pediatrics.
Kali Broussard
Sean Cooney
Sarah Linnemann
Lauren Hope Nolte
Raymond Gordon Watts, MD, FAAP
Bari Winik
SUDIA Recipe: Ricotta Pesto Crostini
A quick and easy appetizer, perfect for those last-minute dinner invites.
Ease: Easy
Yield: 24 crostini
Preparation time: 20 minutes
Source: Rebecca Egsieker
Ingredients
24 (1/2-inch-thick) slices ciabatta baguette
3/4 cup whole-milk Ricotta cheese
1/4 cup jarred pesto
1 teaspooon kosher salt
1/4 teaspoon black pepper
Olive oil for coating slices of bread
3 ounces thinly-sliced prosciutto
Fresh basil sprigs (optional)
Balsamic syrup (optional)
Directions
Place ciabatta slices on baking sheet, brush with olive oil and bake at 350° for 10 minutes or until lightly toasted. Remove bread from oven, let cool.
Mix ricotta, pesto, salt and pepper in small mixing bowl until well incorporated. Spread each crostini with ricotta and pesto mixture, approximately one tablespoon per slice. Cut or tear prosciutto into small strips and place on top of cheese spread. Place crostini on serving platter. If desired, garnish with fresh basil sprigs and balsamic syrup.
For more information and recipes visit www.southeastdairy.org
Upcoming Events
Pediatric Jambalaya XIII
Our Jambalaya faculty have been confirmed! You don’t want to miss these speakers!
Kathi J. Kemper, MD, MPH
Director, Center for Integrative Health and Wellness
Professor, Pediatrics and Dietetics, College of Medicine
Adjunct Professor, College of Nursing
The Ohio State University
Dennis Styne, MD
Professor, Department of Pediatrics
University of California,
David Medical Center
Register Here | Download the Brochure
The 2016 Pediatric Jambalaya will be held on Saturday, April 23, 2016 at LITE in Lafayette, LA.
Pediatric Jambalaya is a mixture of health care topics which will enhance your pediatric practice. Attendees will receive a maximum of 5.25 AMA PRA Category 1 credits™.
If you have any questions, please contact Ashley Lambert at the Woman’s Foundation.
337-988-1816 ext 122 | ashley@womansfoundation.com
August 19-21, 2016
Shreveport Convention Center
Shreveport, LA
Registration details will be forthcoming
www.womansfoundation.com
Call us for more information 337.988.1816
Red River Potpourri is presented by The Louisiana Chapter of the American Academy of Pediatrics
For all the latest updates, go to: www.laaap.org/2016potpourri