Correspondence between

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.

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)

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...

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.

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.

OK. Great. Thanks Rashmi.

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

Good afternoon, everyone - as part of the MDHHS Action plan regarding Flint water, we wanted to share with you the attached Provider letter, with several resource documents that accomnanied the letter. The letter was distributed by email to local Physicians on Gctober 30", by the Genesee County Health Department. For our colleagues in Medicaid, could we please ask your assistance in sharing the Provider letter and resources with your contacts at the Medicaid Heaith Plans that currently or will be working in Flint and Genesee County, and the surrounding areas? in turn, it would he helpful if the clans could share these with their enrolled providers. We want te assure that the materials reach any providers who may be seeing Flint families and their children. These materials are also available at the following website: www michigan. gov/flintwater Many thanks for any assistance you can give with distributing these materials, Please share any questions you have, or you receive, with Rashrni and 1 Nancy << File: >> << File: >> << File: >> << File: HealthyDiet_504857_7.pdf >> xxxEND_PAGE:dhhs03_b0612_2056_2058_2 002058 EH re >> FZ Hie 2005+00221_Ledead-iint Biynier >> xxxEND_PAGE:dhhs03_b0612_2056_2058_3

Wes Ok thanks. I'm sending to Linda Dykema to verify with the figure she may have because it was a higher figure at ane time. Linea, See Nancy’s notes below on the 163 EBL investigations, At one time, you had a different figure based on your analysis, Can you verify what figure you have. Thanks, Rashmi

Wes The 163 number carne off of the GCHD Case Management reporting sheet thay sent te us this week. xxxEND_PAGE:dhhs03_b0600_2025_2028_1 002026 im not sure where they got that number. i have to call and clarify with them tomorrow {Karen is away for a farnily avert}. Bob has 151 for the April 2014 ~ September 2015 dates. Updates to his list are as follows (not sure about prior toe 10/26}: Total of 162 as of 10/26/15 Total of 166 as of 11/2/45 Total of L?7Las of 11/9/15 Total of 180 as of 11/16/15 1 can see some improvements we reed to make to our CM reporting sheet, perhaps the form contributed te confusion onnumbers? Will find out tornorrow. Sorry {don’t have a resolution for you tonight. All| can suggest is to go with the 163 for now, ard we'll have it cleared up for next week ~ I'm OK with that because iPanything, the 163 number is too low, net too high (e.g. it will go up next web, mot down}. Nancy

Wes Kay thanks. Sent from my iPhone

investigations/composite with a couple bullets from Wes Nancy, Do you know if the figure on children with EBL got sarted out? Rashmi

Nancy, | was on a call with Genesee County Health Dept this afternoon and wanted you to check in that you were working on getting data from the GCHD and reporting out how many were tested, how many followed up, etc. They (GCHD) will need to report out on these weekly when we do our call. Also, |am ona call with CDC and GCHD — | was told about this 2Pm call at 1:30Pm. It appears that others have commented that the parent letter and attachments are too high a readability. CDC has comments on this too. They will provide a lead dictionary to explain the terms. | explained we have reviewed and created these document on the standard of a 6" grade reading level. They still thought that was too high. We also asked them to send info on water specifically. So, more to come on this or we may be asked to revise some of our materials. Rashmi xxxEND_PAGE:dhhs03_b0575_1983_1983_1

11-9-15.xls; RTF NE.PDF; Talking Importance: High Nancy and Eden, We have gotten requests from GCHD and the USDA on how we are handling the requests for Ready to Feed Formula. We will like to send these docurnents to GCHD to use as a resource and USDA as information on what we are doing for outreach and requests for RTF. As you can see, cur WIC staff was consistent on the talking points document to ensure they include info that went out to the wider population through parent and provider letters. i wanted to give you both an opportunity to review first before ti send to our communications office. Please let me know if you have any questions or comments. Thanks, Rashirnl

FYI Sent from my iPhone Begin forwarded message: