Correspondence between

All, l’ll be updating the attached HHS timeline as we go forward with our activities in the city of Flint. | can glean some items to include from the daily SitReps and I’m also asking that you provide any additional noteworthy items to me at the end of each week. Please forward to anyone that I’ve not included here. Thanks for your cooperation. Linda B. Dyhena, PAD. Environmental Public Health Director Giision of Environrnental Health Michigan Department of Health & Human Services S17,335.8566 dykermal@ michigan gov xxxEND_PAGE:dhhs02_b0492_1910_1910_1

Thanks. Wi de.

Linda—this is the MDHHS Flint Water timeline, compiled from information discussed during our internal team meeting. The timeline is current through 12-30-15. The most recent update references the provider letter distributed by Medicaid on 12-30-15 -- Blood Lead Guidelines to Address the City of Flint Residents’ Potential Exposure to Lead. At this point, | think it makes sense for your area to be the “keeper of the timeline” and ensure that it is kept up to date, and maintain version control. Let me know if you have any questions. Sue xxxEND_PAGE:dhhs03_b0891_3143_3143_1

Thank you, Corinne, will relay... E

Ps. The plans would need to look child-by-child in the MCIR. They can accumulate names as they look them up but having Bob provide them a weekly file is going to be easier for them. Sent from my iPhone

The MCIR is not a good way for plans to track the lead data in terms of speed. MCIR only shows a view of the lead data that is already in the warehouse for a given child. Providers do not enter lead data into the MCIR. Sent from my iPhone On Dec 30, 2015, at 5:08 PM, Wells, Eden (DHHS) <¥¥ Hi Bob and Nancy, is MCIR a good way for health plans te track their kids lead test results in a timely (real-time) fashion? Would MCIR post the results as fast as you past them to the Warehouse? Eden

The metrics need to be defined but I was hoping that a weekly Medicaid report would align with public health needs. Daisy Peng will probably have to pull the data anyway, especially if not only Medicaid managed care but also Medicaid fee for service data needs to be included in the numerator and denominator. Then there is MIChild which is being wrapped into Medicaid in 2016. I'm not sure which Medicaid-related data Bob Scott has access to. Sent from my iPhone On Dec 28, 2015, at 5:02 PM, Wells, Eden (DHHS) <¥ This needs to be done in coordination with Medicaid, but if a report needs to come out sooner without Medicaid and we can do so, I recommend we do so. Corinne the boss, though! E Sent from my iPhone

Corinne needs to work that out with Medicaid. She's reached out but 1 con’t think she’s haard back yet - she reached out again today.

| will be speaking to him at 4:30, and can. Will this data be part of our weekly reports then? (Now biweekly, but to become weekly asap?)

is there any way Eden can reiterate to Dr. Davis that our Medicaid metric (currently under development} will have Medicaid data in the numerator, not CLPP data?

lagree with this: we'll stay ‘on hold’ until we hear from/receive consent. | think we would want a copy of the consent form for our records, and for GCHD records.

Martha, please see if we have the report on this test and give Courtney a heads up so we can coordinate EBL with CM. I'll be in after an 8:30 medical appointment. Sent from my iPhone Begin forwarded message:

Outstanding Sent from my iPhone

Thanks, Corinne! Sent from my iPhone

Given that this is a research study, the Hurley lab may not be handling the results in the same way as they handle other lead tests. Can the lab be contacted and asked about that, by someone on Dr. Hanna-Attisha's team? If the results are handled under a research protocol, would the results be required to be reported under the Public Health Code, or would they be considered confidential under the terms of the consent form signed by the research participants? In other words, what does the research protocol and the consent form say? | assume/hope the family would would welcome a home intervention, but need to be sure the research protocol re confidentiality isn't being violated. If it appears that way, then someone on the research team should get consent from the family for public health followup, | would think.

Right, of interest is that this is cord blood from a newly born baby....!!! There should be NO lead...

Corinne, please review Matt's email below and my response--- while increased frequency of reporting to weekly is possible, | am not sure of the current time frame for obtaining the Medicaid denominators and if making those weekly works. We can discuss by phone if necessary.

ATTOOO01.htm Sent from my iPhone Begin forwarded message:

le Admin Quarterly PMP Specifications PMR October 20... FY¥ 2016 FIN... Hello, It was great to speak to you all this afternoon regarding Blood Lead Testing, As discussed, f have attached 2 docurnants. The first docurnent is the Blood Lead Testing results page from the October Performance Monitoring Report (PMR} You will notice that while the standard is set at 194, all plans received a pass even if their scores fell below that standard. We discovered fast quarter that the measure was inadvertantly excluding children in the Children’s Special Health Care Services prograrn. That was correct and the plans’ score reflect that change. Because it was an administrative error, we gaye the plans a pass for the quarter. The second document is the PMR specification for the Slood Lead measure. ft includes details about age and enroliment criteria. Please let me know if you have any questions about these documents, but while we are the keepers of the reports, Daisy is the genius behind the queries. You may wish toe forward your questions to all of us and we can determine who has the expertise to answer them. Lastly, | was wondering if any of you could forward the letter/inquiry fram the Governor’s Task Force on this issue. it would be helpful to me to see what the actual ‘ask’ was so} can most effectively contribute. Thanks. Monica

When: Wednesday, December 16, 2015 1:30 PM-2:30 PM (UTC-05:00) Eastern Time (US & Canada). Where: 877-873-8017; 7931338 Scheduling per Corinne Miller’s request. Corinne will dial in as the host. Those located in Capitol View Bldg. are welcome to join the call in her office. 877-873-8017 Passcode: 7931338 Dec 16" (Wed) 1-2PM Thank you! Jasnese Bowlery Executive Secretary te Corinne Miler Sureau of Disexse Control, Prevention and Epidemiology MMehigan Department of Health & Mumen Services 203 Townsend Straat Lansing, Michigan 42923 Phone: (S17) S55-8734 Faw: (S27) 335-8285 << OLE Object: Picture (Device Independent Bitmap) >> xxxEND_PAGE:dhhs03_b0475_1725_1726_2

children FYI E Eden V. Wells, MD, MPH, FACPM Clinical Associate Professor, Epidemiology Director, Preventive Medicine Residency University of Michigan School of Public Health 1415 Washington Heights, Ann Arbor, MI 48109 Tel: 734-647-5306 Fax: 734-936-2084 weeenene n= Forwarded message ----------

Thanks for forwarding! Sent from my iPhone

December 11.pdf Good morning: Attached for your review please find a draft press release to accompany the December 4 report. Please let me know if you have any edits or concerns before 11:30 a.m. Thank you, Jennifer Eisner Public Information Officer Michigan Department of Health and Human Services 5 k@rnichigan gov xxxEND_PAGE:dhhs02_b0124_0405_0405_1

Sorry, | moved that section... sentence struck now on this draft.