Rashmi Travis

Importance: High Nancy, Please read and share with your team if you feel it is appropriate. | would consider the source and take with a grain of salt the context and form by which it was sent. If Jennifer has any specific questions, she will send our way. Thanks, Rashmi

Importance: High You need to read this asap

Hi Rashmi, j looked at it. We should talk more in-depth at some point. Naney

Stan, Nancy, and Leslie, Third times a charm. Here’s the power point on Flint water. Apologies in advance if you are getting this multiple times. Rashmi xxxEND_PAGE:dhhs02_b0219_0699_0699_1

Nancy and Stan Please review dr Mona Hanna-attisha's PowerPoint attaches. We may be asked to provide cost estimates to some of these activities. Thanks Rashmi Sent from my iPhone Begin forwarded message: Exont: "Moran, Susan (DHHS)" “MoranSdomichig gal. gov> nan

Sounds good to me. . thanks, everyone Brenda Fink, A.C.S.W. Director, Division of Family and Community Health Michigan Department of Health and Human Services 109 W. Michigan Ave. Lansing, MI 48933 517- 335-8863 -8697

We are following up to provide clarification on this at the 3PM this Thurs. { think itis ok to mention on the Case Management call too. That way, the GCHD hear the sarne message frorn us and we reiterate it with them.

>: ? ichigan.gov>; Fink, Brenda (DHHS) <3 Peeler, Nancy Thanks, Martha. 53a, given that this arqounts to about 15 kids at the most over the course of 2 years, we would recommend te GCHD the following: -We (Bob Scott) will provide kids 6-18 yrs in the detined zip cade and add those to the list already provided to the GCHD -For those kids requiring case management, GCHD will provide case management, bill Medicaid {for those kids who are on Medicaid}, and then use the money we sent via the contract for any differences in costs that are not covered. -f just confirmed with Sue that this would be our recommendation Next steps: -We will discuss with GCHD on our next call -Martha and Nancy will connect with Bob on adding those kids (6-18 yrs} on the list a -Nancy will connect with Karer about educating the nurses at GCHD about this “change” xxxEND_PAGE:dhhs03_b0471_1715_1716_1 001716 if anyone has any questions on the recommendations above, please let me or Nancy know. Thanks, Rashrnl

Nancy, {wil follow up with you directly on this. Thanks, Rashmi

This raises a couple of questions for me, that | anticipate we will receive from GCHD: 1. Is this on a ‘use your discretion’ basis? 2. Or will Bob be adding those children to the list that he sends to GCHD, that the CM is tied to, so that this is an expectation? Within both of the above questions is the question of what it is you want us to monitor in terms of implementation? Right now we are monitoring against the list being provided to them. | appreciate any clarification you can offer. In terms of our follow up - --yes, we will discuss this with the GCHD CM staff. --lam anticipating that we will need to make some modifications to the CM protocol, as there are some required components that apply to young children, but not appropriate for older children (for example, developmental screening). --We may also need to amend the contract language, depending on your response to the above questions. Are there other modifications you anticipate that could impact the contract language, so that we could incorporate those at the same time? Nancy Sent from my iPad On Dec 11, 2015, at 9:39 AM, Travis, Rashmi (DHHS)

Nancy, ho makes gernse te allow the GCHD te provide case managernent for thase beyond the age of &, H they don’t have Medicaid, they can utilize the funding provided to do that. Please corvey that to the nurses and supervisar at GCHD. Let me know if you have any questions. Thanks, Rashrai xxxEND_PAGE:dhhs03_b0382_1488_1490_1 001489

That could certainty be a point af discussion.

So, for children older than 5 yrs of age, tase managermant can occur through Medicaid billing. For those not on Medicaid, would we allow therm to use the “Flint Water” funds if they feel Case Management is critical?

Importance: High Hi Rashmi, in response to your inquiry: e The list being send to GCHD for case management was originally developed based on instructions we received from Administration; Bob and | were asked to include 0-5 year olds with an EBL >=5, living in the identified high risk zip codes (| believe it is zip codes 01-07, but Bob can confirm that detail). To my knowledge, those are still the parameters for the list that is being used. e We estimated the number of children potentially needing case management, and requested an amount of special ‘Flint water’ CM funding, based on the size of this list. e We support the focus on the youngest children because of the disproportionate impact lead exposure has on their growth, learning, and development. This impact starts to decrease dramatically around age 6 because of change in behavior, change in growth and development, etc. e = The current ‘Flint water’ contract language does speak to providing services to children on the list (see attached). e In response to an inquiry from the GCHD CM Supervisor about a child with and EBL of 4, we did agree that there will be unusual circumstances that they encounter, for children not on the list, in which they should use their discretion about providing CM under the ‘Flint water’ contract. | sent them an email to this effect, which | forwarded to you earlier today. xxxEND_PAGE:dhhs03_b0382_1488_1490_2 001490 e Simultaneous to the above activity, the Surveillance staff continue to send GCHD a weekly list of ALL elevated BLLs in the entire county, as required by PH Code. e Children with EBLs older than age 5 are included on that regular weekly list. e Medicaid Policy is in effect for GCHD (any health department) to bill for 2 ‘Nursing Assessment’ visits (e.g. what we call Case Management) for any child with an EBL >= 5. e Therefore, the components are already in place for GCHD to provide and bill for CM for older children (in fact all ages of children, throughout the entire county). The difference is that the activity wouldn’t be part of the ‘Flint water’ contract. e Anissue could be if they identify an older child for whom they feel CM is critical, who is not enrolled in Medicaid. | hope the above information is helpful — please let me know what questions you have. I’m not sure there is a problem or barrier, but if one is identified, I’m confident we can figure out a good way to deal with it! Nancy xxxEND_PAGE:dhhs03_b0382_1488_1490_3

Here's what i sent...

Corinne | just let Linda know that WIC can be available on an as needed basis for education and Ready to Feed. Stan Bien as point of contact and Kristin Hanulcik as back -up. They don't need to attend meetings regularly , but are available as needed. Thanks Rashmi Sent from my iPhone Begin forwarded message:

Hi Rashmi | can be the point of contact and Kristen as a backup. Thanks. Stan think that would work, but if things should comme up, do you want me to provide your name or Kristin’s? Thanks, Rashmi

Hi Rashmi in looking at the chart, and the role of WIC, | prefer not te be included, but can be available only if/as needed. We are not seeing an increase the RTE or any new issues. Qurrole is now minimal, The WiC Clinic is handling the education and info very well, and seerns like things with USDA are calm. if we need to discuss, fet me know. Thanks

3] Star, The Flint Lead Water event has mover into a Project Management phase at this point and it willbe managed uncer the Bureau of Epidemiology. At this point, we will still have weekly calls with the team. But, there was various parts of the project that have been organized in the attached flow chart. | indicated that WIC needs to be involved with the Communications side of things, particularly with the educational materials for WIC cHents and anymore potential questions in regards to Ready to Feed. Who cdo vou want to include as part of this activity? Thanks, Rashrni

Thanks for the update. Sent from my iPhone On Nov 24, 2015, at 4:43 PM, Peeler, Nancy (DHHS) < Yes, older child has been tested, was slightly elevated on the last test. Looks Hke the PCP is tracking that.

OK. Great. Thanks Rashmi.

No. We are just trying to get it in the hands of Flint providers. itis not being widely advertised about Ready to Feed. Other WIC agencies are proceeding as usual, without anyone asking about Ready to Feed, so we don’t want to put it out an the website and confuse others.

Thank you ladies. Wil this information also be posted te the fintwater weboage?

The info that just went out to Genesee Courty Health Dept to share with their WIC providers relates to Ready to Feed Farmula. Attached is what we sent thern. << File: Talking Points_Lead_11-10-15.pdf >> << File: RTF NE.pdf >> << File: WIC Provider Letter_11-24-15.docx >>

with a couple bullets from Wes Hi Rashrnl—- regarding the 163 number you asked me about ~ ve been on the phone with GCHD several times today. f we take their report they sent to Karen on 11/14, it captures information about 171 families. That matches the total number on the list that Bob sent them for that time period. So that is good! can see now where the 163 number carne from. {tis the total of 2 rows from our reporting form, but didn’t include the other two rows listed on the table, that’s the difference. nreviewing the report GCHD sent us, and in looking at the numbers on it, Karen and f realized that we needed to clarify some of the instructions, as they caused confusion on the GCHD end. We have subsequently added more detail, and have shared it back to GCHD to review, give us feedback next Tuesday. aney