Progress Notes June 28th 2016
In this Edition:
Messages from AAP
Medicaid/ Healthy Louisiana (formerly Bayou Health)
Messages from AAP
I write to you with the mass shooting that took place on Sunday in Orlando, Florida, at the forefront of my mind. Each of us is saddened, shocked and horrified at the loss of life; the loss of so many futures, and the families those loved ones left behind who will never completely heal from this.
As pediatric professionals, we often take the difficult situations we encounter in our daily work and use them to fuel solutions for children. We observe firsthand from the cities to the suburbs the toll that poverty takes on children in this country, and we resolve to make combating childhood poverty a strategic priority. We intubate a child who accidentally ingests toxic liquid nicotine, and we resolve to get child-resistant packaging around those products. We witness children struggling with hunger, and we resolve to screen all children for food insecurity and connect them to nutrition assistance programs.
Earlier this week, more than 35 members of the U.S. Senate filibustered for 15 hours and resolved to push their colleagues to vote on gun violence prevention policies. AAP President Benard P. Dreyer, MD, FAAP, and I issued a press release commending these efforts and calling on Congress to do even more.
It’s still not enough. But it’s a start.
I remember the first victim of gun violence I cared for when I ran an emergency department at a hospital in St. Louis. An older brother, finding his father’s revolver in a bedside table, pointed it at his younger 3-year-old brother and fired. Paramedics, who had seen the horrors of the Vietnam War, brought him in, visibly stricken by what they had seen. I can still see the angelic face of that toddler in my mind, and I can also still picture the very little that was left of his chest when I looked down to try and save him. The paramedics and I tried valiantly, but we knew there was nothing we could do. Our tears, prayers and sadness were overwhelming. We simply could not comprehend what had happened. Imagine the impact on this little boy’s family, the parents and brother, forever changed. I have heard similar stories from far too many of you, whether you practice in a community ravaged by a mass shooting, treated a young child who was killed simply for being in the wrong place at the wrong time, or had an adolescent patient use a gun to commit suicide.
Gun violence is an epidemic in our country. It has punctured the sanctity of places of worship, made once safe spaces unsafe, and targeted individuals just for being who they are.
I join many of you who want to push our elected officials to be bolder, to pass comprehensive reforms like assault weapons bans and expanded background checks and to overturn restrictions on gun safety research funding. We will continue to fight for all of these things for as long as it takes. Until then, we will work with members of Congress to take the steps we need to get there.
One step is to support two amendments up for a vote in the Senate early next week: one that would expand requirements for background checks on all gun purchases and another that would make it more difficult for individuals being monitored for terrorism activity to purchase firearms.
- To take action and learn more, visit “Support Common-Sense Proposals to Protect Children from Gun Violence” on the AAP federal advocacy website for an email and talking points to guide your outreach.
- If you’re interested in this and other opportunities to advocate for federal policies, sign up for our Key Contact network by emailing firstname.lastname@example.org.
If you’re a #tweetiatrician like me, you can also speak up online: click here to find your senator’s Twitter handle and consider sending your own message or one of these:
- [insert Sen handle]: I’m a pediatrician and constituent, and I support taking action on #GunViolence.
- [insert Sen handle]: #GunViolence is a public health crisis and a threat to children’s health. I’m a pediatrician and I say #enough
- [insert Sen handle]: As a pediatrician, I urge you to support common-sense proposals to protect children from #GunViolence. #enough
Yesterday, I met with pediatric professionals who are on the Make-a-Wish Foundation Physician Advisory Board. They are heroes. But the children who were killed in their classroom at Sandy Hook Elementary in 2012, the teens who are gunned down every day in pervasive urban violence, the young adults who were killed while dancing with their friends at a nightclub last weekend in Orlando, they never even had a chance to make a wish. So my wish for the friends and family they left behind is this: that in their memory, we can make the world a little bit safer, make it a little bit harder for these kinds of crimes to happen. It will take a long time and it will take a lot of effort, but we as pediatricians are uniquely suited to lead the charge.
If I’ve learned one thing in my 11 months as CEO of the AAP, it’s not to underestimate the power of the pediatrician to fight for what children need. Though it might take longer than we’d like it to, I resolve to join you in fighting for children’s need to be safe where they live, learn and play.
Thank you for all you do.
Karen Remley, MD, MBA, MPH, FAAP
Health care providers should not use live attenuated influenza vaccine (LAIV) in the upcoming 2016-’17 season due to poor effectiveness, a Centers for Disease Control and Prevention (CDC) committee said Wednesday.
Academy leaders say they support the interim recommendation by the CDC’s Advisory Committee on Immunization Practices (ACIP).
“We agree with ACIP’s decision today to recommend health care providers and parents use only the inactivated vaccine for this influenza season,” said AAP President Benard Dreyer, M.D., FAAP.
The AAP recommends children ages 6 months and older be immunized against influenza every year. Previously, the CDC and AAP had recommended either form of flu vaccine – the inactivated influenza vaccine (IIV) that is given by injection and is approved for all patients older than 6 months, or LAIV which is given by intranasal spray and is approved for healthy patients ages 2 through 49 years.
However, new data presented to the ACIP showed that currently only IIV provides protection against flu. The ACIP assessed data from the past three influenza seasons and cited evidence of poor effectiveness of LAIV during this time period.
“We do understand this change will be difficult for pediatric practices who were planning to give the intranasal spray to their patients, and to patients who prefer that route of administration,” said AAP CEO/Executive Director Karen Remley, M.D., M.B.A., M.P.H., FAAP. “However the science is compelling that the inactivated vaccine is the best way to protect children from what can be an unpredictable and dangerous virus. The AAP will be working with CDC and vaccine manufacturers to make sure pediatricians and families have access to appropriate vaccines, and to help pediatricians who have already ordered intranasal vaccines.”
Dr. Dreyer stressed the need for continued immunization against influenza every year.
“Flu vaccine is the best way we have to protect children and being immunized every year significantly reduces the risk of a child being hospitalized due to flu,” he said.
I’m writing with information and resources to help our members make the transition for the upcoming 2016-’17 influenza season in light of the recent recommendation that health care providers should not use live attenuated influenza vaccine (LAIV) due to poor effectiveness. The decision made by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) impacts your practice, and we want to provide timely information to help in your planning. Orders for flu vaccine are pending for many pediatricians’ offices around the country.
As background, on June 22, ACIP voted that, for the upcoming 2016-’17 influenza season, LAIV should not be used. The ACIP is a formal advisory body to the CDC and made up of medical experts and associations. Information about the ACIP’s makeup can be found here. During the days leading up to this vote, the AAP worked closely with the ACIP Influenza Work Group to understand the scientific data on LAIV vaccine effectiveness from this past influenza season, and to view these new data in light of the two previous seasons.
Studies demonstrated that LAIV did not work in the 2013-’14 influenza season when the primary strain was the 2009 pandemic influenza A(H1N1) strain, in 2014-’15 when the primary circulating strain was a drifted A(H3N2) virus, or the 2015-’16 season when the primary circulating strain was again the 2009 pandemic influenza A(H1N1) strain. With knowledge that LAIV had no protective benefit during the past three influenza seasons, ACIP could not recommend its use in the upcoming 2016-’17 influenza season.
By the day of the ACIP vote, the AAP Committee on Infectious Diseases and the Board of Directors all had reached the same conclusion about not using LAIV for the upcoming influenza season.
We have reached out to the manufacturer of LAIV and will be following closely both the need for pediatricians to cancel LAIV orders successfully, and to obtain additional quantities of injectable vaccine. A “Dear HealthCare Provider” letter regarding FluMist with additional information from the manufacturer can be found here. In order to facilitate the timely cancellation of your LAIV orders we have collated available information here, obtained from members and verified with distributors. This website will be updated frequently as more information becomes available.
The absence of an intranasal option is likely to be disappointing for many families. As flu season approaches, we will be sending speaking points for your conversations with patients and families about this change in influenza vaccination practice and providing resources for you to refer to on HealthyChildren.org.
Look to the next issue of AAP News for additional coverage.
Thank you for all you do for children every day. Please reach out to Dr. Roger Suchyta, Associate Executive Director ( email@example.com) if you have additional questions.
On May 11, 2016, the Centers for Medicare and Medicaid Services issued an informational bulletin on coverage of maternal depression screening and treatment. While maternal depression screening coverage is allowed under the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, most state Medicaid programs have not yet acted to implement it.
The AAP has developed Maternal Depression Screening: Medicaid and EPSDT Coverage, a new resource for chapters, to explain the coverage issues, support state advocacy efforts, and provide key coding information.
Please do not hesitate to contact us at firstname.lastname@example.org if you would like additional information or need technical assistance on this issue.
Medicaid/ Healthy Louisiana (formerly Bayou Health)
Louisiana Department of Health to Terminate Alternatives Living from Medicaid Program
Federal indictment leads to action by State
Monday, June 20, 2016 Contact: Samantha Faulkner; 225.342.9010, email@example.com
Baton Rouge, La.— Officials with the Louisiana Department of Health announced they will begin taking steps to terminate Alternatives Living from the state Medicaid program. The action follows a federal indictment handed down today in the United States District Court for the Eastern District of Louisiana that accuses the owners of Alternatives Living of the theft of federal funds and conspiracy to commit theft of federal funds. The indictment was handled by the U.S. Attorney following an investigation by the U.S. Department of Housing and Urban Development.
Located in New Orleans, Alternatives Living provides mental health rehabilitation services, including supports to help individuals live independently in their communities and maintain access to housing. The company also serves a small number of individuals with developmental disabilities through the New Opportunities Waiver, or NOW. The agency serves six NOW clients and between 325 and 350 mental health rehab clients.
The initial action taken by the Department of Health will be to terminate Alternatives Living’s Medicaid provider agreement. It is this agreement that allows an agency to provide and bill for services in the Medicaid program. The action means that Alternatives Living will no longer receive Medicaid payments.
The department will immediately take steps to transition individuals who receive services from Alternatives Living to other providers in the area and ensure their personal safety and medical, social and housing support needs are appropriately met.
Alternatives Living has been subject to previous investigations by the Louisiana Legislative Auditor and the Department of Health’s Surveillance and Utilization Review unit. In this current case, the department has coordinated and worked cooperatively with officials from both the U.S. Department of Housing and Urban Development’s Office of Inspector General and Louisiana’s Office of Inspector General.
Michelle Alletto, deputy secretary of the Department of Health, said the most immediate need is to ensure care for those who are served by Alternatives Living.
“Our priority is the clients who depend on the state of Louisiana for their care and the services that allow them to live independently,” she said. “We will work with those individuals, their families and other providers to ensure a seamless transition to a new provider agency.”
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Fee for Service Provider Notices
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MCO Provider Calls Weekly Format
Beginning in May, the daily noon provider calls related to the integration of mental health and substance use services into Bayou Health will shift to a weekly call on Wednesdays only. The Department of Health and Hospitals (DHH) will co-host the calls with the Managed Care Organizations (MCO) through the middle of September 2016. Each week a different MCO will participate in the calls, giving providers the opportunity to make comments or ask the MCOs questions, and DHH the chance to keep providers up to date with announcements. Providers may continue to email questions or concerns to firstname.lastname@example.org if you are unable to resolve your issue with the MCOs. All provider types are welcome to participate on the calls. The call schedule will be as follows:
• June 29, 2016 – Louisiana Healthcare Connections
• July 6, 2016 – United Healthcare Community Plan
• July 13, 2016 – Aetna
• July 20, 2016 – Amerigroup
• July 27, 2016 – AmeriHealth Caritas
• Aug. 3, 2016 – Louisiana Healthcare Connections
• Aug. 10, 2016 – United Healthcare Community Plan
• Aug. 17, 2016 – Aetna
• Aug. 24, 2016 – Amerigroup
• Aug. 31, 2016 – AmeriHealth Caritas
• Sept. 7, 2016 – Louisiana Healthcare Connections
• Sept. 14, 2016 – United Healthcare Community Plan
All calls will take place from noon until 1 p.m. 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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Healthy Louisiana Informational Bulletins for Providers
Healthy Louisiana has released a new Informational Bulletin for providers today. Informational Bulletin 16-12, “Medicaid Strategy for the Prevention of the Zika Virus in Louisiana.”
The content of this document is produced by the Department of Health and Hospitals and provided for informational purposes only. This information does not supersede any requirements or guidance provided in the contract between the provider and the Managed Care Organization (MCO). Please be sure to verify any areas of concern in the MCO provider manual.
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Health Plan Advisories
Health Plan Advisories are available at http://new.dhh.louisiana.gov/index.cfm/page/1734
|7/1 Dodanim F. Altamirano, MD, FAAP
7/1 Kent Willis, MD
7/2 Johnnie Clark, MD, FAAP
7/3 Michael Robert Brumund, MD, FAAP
7/3 Rebecca Doise, MD, FAAP
7/3 Deiadra Garrett, MD, FAAP
7/3 Martha Haley Pope, MD, FAAP
7/4 Mandy Braud Grier, MD, FAAP
7/4 Joy Baw Tsa, MD, FAAP
7/4 Gerald Brent Whitton, MD, FAAP
7/4 Judith Marie Zatarain, MD, FAAP
7/5 Harish C. Anand, MD, FAAP
7/5 Monika Leah Dietrich, MD
7/6 William Christopher Kethman
7/6 Meade P. O’Boyle, MD, FAAP
7/7 Kenneth James Cruse, MD, FAAP
7/7 Alma Cruz, MD
7/7 Louis Trachtman, MD, MPH, FAAP
7/7 Pamela Erskine Williams, MD, FAAP
7/8 Thiravat Choojitarom, MD, FAAP
7/8 Shaun M. Kemmerly, MD, FAAP
7/8 Rhett Farrell McLaren, MD, FAAP
7/8 Dawn S Zitman, MD, FAAP
7/9 Anna Craig, MD
7/9 Peter William Joslyn
7/10 Richard M Doskey, MD, FAAP
7/10 Gregory Kyle Fulton, MD
7/10 Rahul Kamat, MD
7/10 Gary J Levy, MD, FAAP
7/10 James Louis Reynolds, MD, FAAP
7/10 Kortney West, MD, FAAP
7/11 Whitney Bembry, MD
7/11 Mindy Leigh Calandro, MD, FAAP
7/11 Patrick Jacob Cripe, MD, FAAP
7/11 Toya Dewan George, MD, FAAP
|7/14 Frank Broox Hughes, MD, FAAP
7/14 Vilasini Rekhala, MD
7/14 Russell Wesley Steele, MD, FAAP
7/15 Sarah Beck, MD
7/15 Ngoc Nicole Dinh, DO
7/15 Michael Melek, MD
7/16 Leslie Lyons Brown, MD, FAAP
7/17 Robert E. Feldman, MD, FAAP
7/17 Maya Hills, MD
7/18 Natasha Susana Afonso
7/18 Robert Ira Hart, MD, FAAP
7/18 Rohail Kumar, MBBS
7/19 Eilan Mark Levkowitz, DO
7/21 Ryan Bolotte
7/21 Jennifer Thomas Guidroz, MD, FAAP
7/21 Kristal Elliston Prather
7/23 John L. Moore, MD, FAAP
7/24 Sean Cooney
7/25 Elizabeth Anne Tucker, MD
7/26 Veronica Renee Johnson, MD
7/26 Bari Winik
7/27 Billy D McKellar, MD, FAAP
7/28 Mohamed Badi Salahi Asbahi, MD, FAAP
7/28 Stewart T Ramey, MD, FAAP
7/29 Rebecca Antee Green, MD, FAAP
7/29 Tasha Chantoi Shamlin, MD, FAAP
7/30 Veronica M Thomas, MD, FAAP
7/31 Emily Smith Grezaffi, MD, FAAP
7/31 Samuel Alfred Hickey Jr., MD, FAAP
Please join us in welcoming our newest members 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.
Michael R. Marble, MD, FAAP
Thomas Donald Soltau, MD, FAAP
SUDIA Recipe: Creamy Slow Cooker Butternut Oatmeal
Steel cut oats hold their shape better than rolled or instant oats when cooked this long slow method. Milk helps make the oatmeal super creamy and adds calcium. For special occasions, consider making an oatmeal bar. Put out toppings such as toasted walnuts, low-fat granola, maple syrup and cinnamon butter.
Yield: 10 servings (1 1/4 cup each)
Preparation time: 10 minutes
Cook Time: 8 hours on low
Source: Maureen Callahan, MS, RD
6 cups fat-free milk
3 cups water
2 tablespoons maple syrup
2 teaspoons cinnamon
1/4 teaspoon salt
2 cups steel cut oats
3 cups chopped butternut squash
2 tablespoons butter, cut into small pieces
Cinnamon for garnish
Coat the bottom and sides of a 5 or 6 quart slow cooker with butter. Whisk together first five ingredients (milk through salt) until well blended. Add oats, squash and butter to milk mixture. Stir to blend. Cover and cook on low heat for 8 hours or 4 hours on high. Uncover and stir mixture to incorporate squash and liquids that have risen to the top. Garnish with a sprinkle of cinnamon for serving.
For more information and recipes visit www.southeastdairy.org
Red River Potpourri
August 19-21, 2016
Shreveport Convention Center
Registration details will be forthcoming
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, click here