Debbie Eggleston

Thank you Dr. Eggleston for bringing the group together. Meridian looks forward to working with all of you on this initiative. Happy Holidays! Kellie Rice Meridian Health Plan Director of Network Development 1 Campus Martius, Suite 700 Detroit, MI 48226 p. 313-324-3700 x21485 fr IMPORTANT: This email may contain confidential information, some or all of which may be protected health information as defined by the federal Health Insurance Portability & Accountability Act (HIPAA) Privacy Rule (45 C.F.R. Part 160; Subparts A and E of Part 164). This message is intended for the exclusive use of the individual or entity to whom it is addressed and may contain information that is proprietary, privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient (or an employee or agent responsible for delivering this email to the intended recipient), you are hereby notified that any disclosure, dissemination, distribution or copying of this information is strictly prohibited and may be subject to legal restriction or sanction. Please notify the sender by telephone at (313) 324-3700 to arrange the return or destruction of the information and all copies.

Importance: High On behalf of the Departrnent, thank you again for your participation in this morning’s call addressing the Flint Lead exposure, if seerns cach plan is actively working to inform beneficiaries and mroviders on this issue. in turn, the Bepartrnent will work te kaep the plans informed of the progress af lear testing in Flint. Please be sure to let us know hon we can be of help to you in your effarts. Finally, we will notify each of you with the date far the provider gathering Gr, Wells mentioned will take place in January. We may need your assistance in assuring Providers are made aware of this meeting as weil. xxxEND_PAGE:dhhs02_b1246_4701_4703_1 004702 Again, thank you and best wishes for the holidays. Bebbie Debera H. Eggleston, M.D. Chief Medical Director Michigan Medicaid/Medical Services Administration /Office of Medical Affairs Michigan Department Health and Human Services 400 S. Fine, 6" floor P.O. Box 20479 Larising, Mi 48906 {o} (527) 335-5181 "Confidentiality Notice: This message, including any attachments, is intended solely for the use of the above named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information contained in this e-mail is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message."

Importance: High This is a reminder of tomorrow’s meeting to discuss the Flint lead exposure. December 22" at 8:00AM. Conference call phone number# Access Code:! Dr. Wells will be leading the discussion. We have a rough agenda as follows: i. Update on the Flint fead exposure /status 2. State’s message to providers and others ( should we include the message you sent to the health department?) 3. Discussion of strategies the health plans right take to improve testing. The provider package and patient information is all posted at: waw.michigan gov/fintwater. Looking forward to talking with you tomorrow. Deb xxxEND_PAGE:dhhs02_b1246_4701_4703_2 004703 Debera H. Eggleston, M.D. Chief Medical Director Michigan Medicaid/Medical Services Administration /Office of Medical Affairs Michigan Department Health and Human Services 400 S. Pine, 6'" floor P.O. Box 30479 Lansing, MI 48909 (o) (517) 335-5181 Fax (517) 335-7959 "Confidentiality Notice: This message, including any attachments, is intended solely for the use of the above named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information contained in this e-mail is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message." xxxEND_PAGE:dhhs02_b1246_4701_4703_3

Debbie, Please review the proposed outline for the provider meeting in Flint. On the planning team (memberS TBD) I have staffs

MEdicaid? HI Dr. Eggleston, Just closing a loop: Molina HP is working with GCHD to set up two Flint school lead testing fairs in January. However, they are still telling GCHD (Toni, CC’d) that they have to submit a request to Medicaid to do so. Just thought | would close a loop if there is one with this email. Eden Eden V. Wells, MD, MPH, FACPM Chief Medical Executive Michigan Department of Health and Human Services 201 Townsend St., 5" Floor CVB Lansing, MI 48913 xxxEND_PAGE:dhhs02_b0442_1786_1787_2

3 bullet down..what’s the first word supposed to be?

OK, is this good to get moving through our communications group? we can do a HAN early Monday if we can get approval by GCHD regarding case management referral number down..--- Current draft, but my fonts went wacky, is what | have right here: Dear Provider, Michigan Medicaid Early Periodic Screening, Diagnosis and Treatment (EPSDT) guidelines require children to be tested for blood lead poisoning at 12 months and 24 months, and between the ages of 36-72 months if not previously tested (hito://www mech state. mis oct). Due to the enhanced public health issue of an increased risk for lead exposure in the City of Flint, providers are advised to follow enhanced guidelines for lead testing in children: e Providers should screen ALL children (regardless of Medicaid/insurance status) aged 0-6 years of age exposed to Flint city drinking water after April 2014. Note: this includes all children younger than 1 year and children between the ages of 3-6 years. e Ifthe child has already been screened within the time period of April 2014-present by a capillary test, healthcare providers should follow-up on any elevated levels >Smcg/dl to ensure confirmatory venous testing is conducted. e Utlie the standard Blood Lead Level (BLL) Quick Reference for Primary Care Providers 22739 xxxEND_PAGE:dhhs02_b0421_1578_1581_1 001579 + All clients with blood lead levelS¢SiMeWal SEs Ne eee WE fuoibere e Providers should inquire about use of a drinking water filter and/or bottled water in all clients residing in city limits. e Healthcare providers should inquire about other potential sources of lead in the household per current recommendations (see: https://www.michigan. e The enhanced lead testing guidelines should be followed until the public health advisory is no longer in effect, as determined by the Geneseee County Health Department. e Resources are available at: \ ich) i

Yes, we need to run it by the health department. i mentioned in an earlier e-mail that the provider reference sheet {baseri on AAP guidelines} that is on the Flint water website indicates referral to case management. It would be helpful, i think, to have a phone number for providers so they can contact case managemant. They should already have this number for the LHD but resetition is nota problern in relation to some of this information.

with link added---- where should this go now?? xxxEND_PAGE:dhhs02_b0421_1578_1581_2 001580

Dear Flint Healtheare Provider, Michigan Medicaid Early Periodic Screening, Diagnosis and Treatment (EPSDT) guidelines require children to be tested for blood lead poisoning at 12 months and 24 months, and between the ages of 36-72 months if not previously tested (hito://www mech state. mis oct). Due to the enhanced public health issue of an increased risk for lead exposure in the City of Flint, providers are advised to follow enhanced guidelines for lead testing in children: e Providers should screen all children aged 0-6 years of age exposed to Flint city drinking water after April 2014. Note: this includes all children younger than 1 year and children between the ages of 3-6 years. e Ifthe child has already been screened within the time period of April 2014-present by a capillary test, healthcare providers should follow-up on any elevated levels >Smcg/dl to ensure confirmatory venous testing is conducted. e Providers should inquire about use of a drinking water filter and/or bottled water in all clients residing in city limits. e Healthcare providers should inquire about other potential sources of lead in the household per current recommendations (see MI Testing Strategy document xxxxxxxxx) e The enhanced lead testing guidelines should be followed until the public health advisory is no longer in effect as determined by the Geneseee County Health Department. e Resources are available and wy mich:

Before being sent to communications committee, a draft--thoughts?: Dear Flint Healthcare Provider, Current lead testing is required for all Medicaid and WIC recipients at ages 1 and 2 years statewide. Due to the enhanced public health issue of an increased risk for lead exposure in the City of Flint, healthcare providers enhance screening for lead poisoning: e Providers should screen all children aged 0-6 years of age exposed to Flint city drinking water April 2014. e This recommendation is expanded to include Flint children aged younger than 1 year and children between the ages of 3-6 years. e Ifthe child has already been screened within the time period of April 2014-present by a capillary test, healthcare providers should follow-up on any elevated levels >Smcg/dl to ensure confirmatory venous testing is conducted. xxxEND_PAGE:dhhs02_b0421_1578_1581_3 001581 Previiders sheldd inquise abexit use of a drinking waiter fitter and/or bettted water in all clients residing in city Hinritse Healtheare providess shoudd inquire about otter potential sourees of lead in thre heusePetd per eurent reeormrniditions ee Ml Testing Straegy detUMRAL woCeowse) TPIS policy is in place until drinkiag wetker is d2@TTRSU safe to drink by the Gereseee County Health Depaartment. Resourees are availaitife abaemancecounonnns ard wavw michigan gov/fintwater xxxEND_PAGE:dhhs02_b0421_1578_1581_4