Correspondence among

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

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.

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:

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:

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 ----------

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.

{think that paragraph came fram Eden and i wasn’t sure how to edit sof left it alone. Some of it seems to go with the HAN language. Eden?

Importance: High lam 10 minutes late because | took a call from EPA re the thallium poisoning case...Eden I'll fill you in later. Attached is a compilation of everything | received re response to the Task Force letter with 3 introductory paragraphs. Thanks to everyone who provided verbiage! Linda D. Dyfema, PAD. Environmental Public Health Director Division of Environmental Health Michigan Department of Health & Human Services 517.335.8566 dykemal@imichigen gov xxxEND_PAGE:dhhs03_b0208_0798_0798_1

Medicaid/Blood Lead Testing and Provider combined. E

Importance: High Despite the fact that we don’t have the modified letter, Nick requested that we pull together our responses to this draft document. Nick/Geralyn would Hke this by tornarrow, so can we all get our drafts to Linda Dykerna by noon tornerrow for consolidation.

Utilize----my z key sticks here at home

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.

All- A reporter with Bridge Magazine is requesting the statewide 2014 (and if possible, 2015} CLPPP data. Bob sent me the attached county-level info for 2014 which | have net shared yet, as it’s not the final report. We would like to touch base to make sure the data has been finalized and reviewed by epi before it's posted online. Eden ~ we'll reach out to you in the morning to discuss the media request. Beyond the data, the reporter is also interested in discussing home lead investigations. Jennifer Eisner Public information Officer Michigan Department of Health and Human Services Office: 517-241-2112 or [email protected] : Cell

Sounds fine ta me.

Yes, that is why they are different. You can't sum the ones de-duplicated by quarter to come un with @ calendar year total, The ones Patti sent now are de-chiplicated by calendar year and quarters can be summed.

Sounds good. 1H check the final release by the final report te make sure everything is in fine. Angela xxxEND_PAGE:dhhs02_b0168_0503_0505_1 000504