NOVEMBER 2019

News for Providers from HealthPartners Provider Relations and Network Management

INSIDE THIS ISSUE Page

Administrative Information IMPORTANT: Update provider information 1

2019 Clinical Indicators Report 2

Prior authorization reminder 2

NEW Prior authorization for mental health 2

HealthPartners provider resource materials 2

Who you gonna call… 3

Physician Incentive Plans (PIP) disclosure 3

HealthPartners programs & important information 4

Disclosure of Ownership & Control Interest Form 4

Disclosure of Ownership Form – HealthPartners 5

Fraud, Waste & Abuse 5

Collaborative care model 6

Claim edit reminder 6

Medical Policy updates 7

Pharmacy Medical Policy updates 9

Patient PerspectiveConnecting patients with free DM services 11

Syphilis pregnancy screening guidelines 11

Hepatitis A outbreak 12

Government ProgramsMHCP collection of cost-sharing reminder 13

EventsWebinar: Cervical Cancer Screening 13

PIP Fax Back Form 14

Administrative IMPORTANT – Do you have outreach locations or offer telemedicine services? If you offer outreach or provide telemedicine services, please contact your HealthPartners Service Specialist and provide details so the information can be added to our system. The information you provide to HealthPartners for providers and locations is what members see when they search for care using our online search tool, Find Care. It is critical our members have access to accurate and up-to-date information when seeking care in our networks.

HealthPartners now requires that you notify us of a practitioner leaving your clinic within ten (10) days after departure.

Directory information can be reviewed and edited through our Provider Data Profiles (PDP) tool. Log in at healthpartners.com/provider logon (path: healthpartners.com/provider-public/). If you don’t have access to the PDP application, contact your delegate. After you’ve logged in, your delegate’s information appears in the help center section.

HealthPartners will no longer be using BetterDoctor to update directories, as previously reported.

Information that should be reviewed includes:

• Office location(s) where members can be seen for appointments• Provider name with credentials (MD, DO, etc.)• Specialty(ies)• Location(s) name(s)• Address(es)• Phone number(s)• Clinic hours• Practitioner status for accepting new patients• Clinic services available

If you have further questions regarding updating directory information, please call your HealthPartners Service Specialist.

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2019 Clinical Indicators Report The 2019 HealthPartners Clinical Indicators Report and Technical Supplement will be available online after November 12, 2019. The Clinical Indicators Report features comparative provider performance on clinical measures and consumer satisfaction results. The primary purpose is to provide valid and reliable information for providers to use in their efforts to improve patient care and outcomes. HealthPartners uses this information to support internal quality improvement initiatives, which may include provider incentive and tiering programs. The 2019 Clinical Indicators Technical Supplement includes measurement detail, optimal component rates and trended plan rates over time.

To view the report click HERE, or go to healthpartners.com/quality and click on Clinical Indicators Results (path: https://www.healthpartners.com/provider-public/quality-and-measurement/clinical-indicators/).

Prior authorization reminder Please keep the following in mind when submitting a prior authorization request:

1. Call Member Services to verify member eligibility and to check benefits. 2. Review the coverage policy criteria so you know what clinical information to submit.

• Located on the Provider Portal under Admin Tools, Coverage Criteria. 3. Check to see if there is a prior authorization form for the item you’re requesting.

• Located on the Provider Portal under Admin Tools, Tools and Forms, Forms for Providers. • The prior authorization form assists in providing the relevant information needed for the review. • In addition the forms assist in streamlining the request and review process.

4. Submit only the minimal relevant information necessary for the review to be completed. • This follows the HIPAA minimum necessary standard, as well as the HealthPartners Admin Policies.

Prior authorization for Mental Health Partial Hospitalization Program A new Behavioral Health policy using MCG guidelines (from Milliman) defines coverage criteria for Mental Health Partial Hospitalization Program, effective 1/1/20.

Prior authorization will be required for any partial hospitalization program (with or without lodging) for the treatment of mental health (e.g., H0035, S0120, rev codes 912, 913) when the coverage criteria goes into effect.

This coverage policy will apply to fully insured, self-insured, Medicaid and MSHO plans.

HealthPartners provider resource materials HealthPartners is committed to giving the providers who see our members the support and assistance they need.

HealthPartners has a designated online site labeled Provider Resource Materials (formerly the Provider Training Manual).

Providers can quickly access point-of-contact information and learn about HealthPartners products, administrative and claims policies, medical policy/prior review requirements and much more. Providers will also find helpful information on our Cigna/HealthPartners Strategic Alliance, as well as current and past issues of our Fast Facts newsletter.

If you have any questions about Provider Resource materials or suggestions for future improvements, please contact your HealthPartners Service Specialist.

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Who you gonna call? Despite the proximity of October 31st, we’re not talking about busting ghosts. However, not knowing whom to contact when you need help can be scary in itself. We’ve got you covered.

Go to healthpartners.com/provider and click on Contact us in the upper right hand corner of your screen. In addition to helpful links to common questions, there is a list of contacts for the following:

• Claims• Coverage and benefits• Payer relations and contracting• Credentialing• Dental administration and contracting• Medical management• Behavioral health• Quality measurement and improvement• Pharmacy administration• e-Services

Under the Payer relations and contracting tab, specialty, primary care/hospital and ancillary providers will find names and phone numbers to connect directly with their HealthPartners Service Specialist. You can also submit an inquiry or a request to join our network, or subscribe to Fast Facts.

Physician Incentive Plans (PIP) disclosure The Centers for Medicare and Medicaid Services (CMS) requires health plans to request information from their contracted providers regarding the existence of physician incentive plans. The information should also include any physician incentive plans that exist between your organization and downstream subcontractors.

Physician Incentive Plan disclosure is required even if there are no incentive arrangements or the arrangements have a low level of risk either through referrals or low utilization.

If your information has changed since your organization last submitted this form, please submit the fax back form that’s attached to this edition of Fast Facts to HealthPartners and a Summary Data Form will be sent to you for completion.

Thank you in advance for your assistance in keeping physician incentive plan information up to date. For more information from CMS on Physician Incentive Plans, please click CMS Relationships With Providers and review Section 80. (path: cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c06.pdf)

If you have questions or need more information, please contact your HealthPartners Service Specialist.

Provider Portal YOUR ONE-STOP SHOP If you haven’t familiarized yourself with the HealthPartners Provider Portal, take a minute and see all the helpful information available at your fingertips.

You can do everything from referencing helpful information, such as medical policy updates and clinical resources, to submitting claims, appeals and adjustment requests. Other features include checking claims status, eligibility and benefits, accessing forms and remits, as well as getting credentialed and much more.

Member Services or Claims are available to assist, but reaching out via the Provider Portal will alleviate long wait times.

Check it out at healthpartners.com/provider.

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HealthPartners programs and important information Information is available for your review regarding key HealthPartners programs, policies and procedures, important member information, and other pertinent information at healthpartners.com/provider.

To directly access information about:

• Utilization Management• Pharmaceutical Management Procedures• Click here: Quality Improvement & Utilization Management (path: healthpartners.com/hp/important-information/)

To access information regarding our Disease and Case Management program including how to use Disease Management services and how we will work with your patients in our Disease Management program:

• Click here: Disease and Case Management (path: healthpartners.com/provider-public/disease-and-case-management/)

To access administrative policies including:

• Access to Utilization Management Staff• HealthPartners Affirmative Statement Regarding Incentives• How to Contact a Medical Director regarding Utilization Management• Medical Record Standards• Member Rights & Responsibilities• Member Complaint Processes and Procedures• Utilization Management Coverage Criteria Policies• Click here: Administrative policies (path: healthpartners.com/provider-public/administrative-policies/)

To access information about Credentialing/Enrollment and HealthPartners Credentialing Plan including practitioner’s rights:

• Click here: Credentialing and enrollment (path: healthpartners.com/provider-public/credentialing-and-enrollment/)

To access Confidentiality/Privacy policies:

• Click here: Website privacy policy (path: healthpartners.com/provider-public/privacy/)

• Privacy Practices for Providers (path: healthpartners.com/provider-public/administrative-policies/)

Disclosure of Ownership and Control Interest Form HealthPartners has automated the process for providers to submit their Disclosure of Ownership information. The primary contact on file for your organization will receive an e-mail with a link to the form where there will be information that needs to be verified, updated and attested to, along with a place for a signature and date. The Minnesota Department of Human Services (DHS) and the Centers for Medicare and Medicaid Services (CMS) require health plans, including HealthPartners, to collect information from their contracted providers regarding ownership and control interests, management information, significant business transactions, and the identity of any individuals or entities excluded from participating in government funded health care programs.

If your primary contact has not received the link and submitted a 2019 Disclosure of Ownership and Control Interest Form yet, please click on the link below to print a copy of the form for completion. The form is required to be completed on an annual basis or when changes to ownership occur.

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Disclosure of Ownership Form – HealthPartners If you are a participating provider with other Minnesota payers, any payer will accept this form, so it can be completed once and submitted to any payer with whom you are contracted. INFO (path: healthpartners.com/provider-public/regulatory-requirements/)

Please submit the FORM to HealthPartners in one of the following ways: (path: healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/cntrb_043027.pdf)

Email: Disclosure of Ownership (DisclosureofOwnership@HealthPartners.com)

Fax: 952-853-8708 Mail: HealthPartners Business Analyst – Contracted Care Compliance Mail Stop 21108C 8170 33rd Ave. S. Bloomington, MN 55440

Fraud, Waste, and Abuse As an organization, HealthPartners is committed to working to prevent, detect and report fraud, waste and abuse. It is estimated that health care fraud costs the nation about $68 billion annually — about 3 percent of the nation's $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion. The most common types of health care fraud include:

• Billing for services that were never rendered

• Billing for more expensive services or procedures that were actually provided (“up coding”)

• Performing unnecessary services solely for the purpose of insurance payments

• Misrepresenting non-covered treatments as medically necessary covered procedures

• Falsifying patient diagnosis to justify tests and other procedures

• Billing separately for each step of a procedure, or billing labs separately (“unbundling”)

• Billing the patient for more than the co-pay under the terms of a managed care contract

• Accepting kickbacks for patient referrals

• Waiving patient co-pays or deductibles for medical or dental care and over-billing the insurance carrier or benefitplan

Everyone has the right and responsibility to report possible fraud, waste or abuse. To report suspected fraud, waste or abuse, you may call the HealthPartners Integrity and Compliance Hotline at 1-866-444-3493, or the HealthPartners Fraud and Abuse Hotline at 952-883-5099, or send an e-mail to reportfraud@healthpartners.com.

Please review the Preventing, Detecting & Reporting Fraud, Waste & Abuse policy at HealthPartners Provider Administrative Policies (healthpartners.com/provider-public/administrative-policies/) and share it with others within your organization who may need to be aware of this information. Feel free to call Steve Bunde, Health Plan Compliance Officer, at 952-883-6541 if you have any questions or concerns.

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The Collaborative Care Model (CoCM) The CoCM delivers effective mental health care in primary care with a care team led by the primary care provider (PCP), including a behavioral health care manager and consulting psychiatrist. The following codes for Collaborative Care Model have been turned on and are reimbursed for Commercial and Medicare plans.

CPT Codes 99492, 99493, and 99494 replaced codes G0502, G0503, and G0504, which were no longer valid as of 1/1/2018.

CPT 99492: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, along with the following required elements:

• outreach to and engagement in treatment of a patient directed by the treating physician or other qualified healthcare professional;

• initial assessment of the patient, including administration of validated rating scales, with the development of anindividualized treatment plan;

• review by the psychiatric consultant with modifications of the plan if recommended;• entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate

documentation, and participation in weekly caseload consultation with the psychiatric consultant; and• provision of brief interventions using evidence-based techniques such as behavioral activation, motivational

interviewing, and other focused treatment strategies.

CPT 99493: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, along with the following required elements:

• tracking patient follow-up and progress using the registry, with appropriate documentation;

• participation in weekly caseload consultation with the psychiatric consultant;

• ongoing collaboration with and coordination of the patient's mental health care with the treating physician;

• additional review of progress and recommendations for changes in treatment, as indicated, including medications,based on recommendations provided by the psychiatric consultant;

• provision of brief interventions using evidence-based techniques such as behavioral activation, motivationalinterviewing, and other focused treatment strategies;

• monitoring of patient outcomes using validated rating scales; and

• relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goalsand are prepared for discharge from active treatment.

CPT 99492: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional.

Claim Edit Reminder HPI follows NCCI, CMS and other industry-standard coding edits. These edits are updated from time to time and will be implemented by HPI on or after CMS or other industry standard effective date(s).

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Medical Policy updates – 11/1/2019 MEDICAL AND DURABLE MEDICAL EQUIPMENT (DME) & MEDICAL DENTAL COVERAGE POLICY Please read this list of new or revised HealthPartners coverage policies. HealthPartners coverage policies and related lists are available online at healthpartners.com (path: Provider/Coverage Criteria). Upon request, a paper version of revised and new policies can be mailed to clinic groups whose staff does not have Internet access. Providers may speak with a HealthPartners Medical Director if there are questions about a utilization management decision.

Coverage Policies Comments / Changes

Ankle replacement surgery Effective immediately, prior authorization is no longer required. Policy retired.

Gender Reassignment Surgery

Effective immediately, policy revised as follows:

1. Coverage for breast augmentation male to female is added. Prior authorization isrequired.

2. Coverage for electrolysis/laser hair removal to donor site tissue is added. Priorauthorization is required.

3. Coverage for surgeries to alter the gender-specific appearance of a member who hasundergone or is planning to undergo gender reassignment surgery may be reviewed on acase by case basis as required to treat gender dysphoria as determined by the referringphysician.

Primary hyperhidrosis treatment

Effective immediately, policy retired. Prior authorization is no longer required for Thoracic Sympathectomy.

Tick borne illness – laboratory testing

Effective immediately, policy retired.

Stereotactic radiosurgery and stereotactic body radiation therapy

Effective immediately, prior authorization is no longer required. Policy retired.

Pneumatic compression devices and heat/cold therapy units

Effective 1/1/2020, policy revised as follows:

Criteria for the advanced calibrated pneumatic compression device with calibrated gradient pressure (E0652) have been reorganized and revised. The advanced calibrated device (E0652) will be covered when the current criteria for conservative therapy are met. In addition, there must be documentation that a non-calibrated device (E0650, E0651) has been tried and failed after a documented 4-week trial or there must be documentation of unique clinical circumstances that require specific pressure settings for a localized area of the body.

When criteria are met, all pneumatic compression devices will be approved for a 6-month rental trial period. After 6 months of use, further documentation of consistentuse, as well as clinical effectiveness, is required for continued approval. If approved, thedevice would then be rented until the purchase price is met.

Pneumatic compression devices and heat/cold therapy units – Minnesota Health Care Programs

Effective 1/1/2020, policy revised as follows:

When criteria are met, pneumatic compression devices will be approved for a 6-month rental trial period. After 6 months of use, further documentation of consistent use, as well as clinical effectiveness, is required for continued approval. If approved, the device would then be rented until the purchase price is met.

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Coverage Policies Comments / Changes

Physical, Occupational and Speech-Habilitative Therapy and Feeding/oral function therapy, pediatric for Minnesota Health Care Programs

Effective immediately, prior authorization is no longer required.

Physical and occupational therapy – habilitative

Effective immediately, criteria were added to cover habilitative PT/OT in the home if a member meets the definition of homebound.

Speech therapy – habilitative

Effective immediately, criteria were added to cover habilitative speech therapy in the home if a member meets the definition of homebound.

Reduction mammoplasty Effective immediately, prior authorization is no longer required. Policy retired.

Sleep studies Effective 1/1/20, policy revised as follows:

Overnight electroencephalogram (EEG) (e.g., Sleep Profiler™) is considered investigational when it is conducted to evaluate insomnia or behavioral health conditions. There is not sufficient reliable evidence in the form of high quality peer-reviewed medical literature to establish the safety and efficacy of this procedure or its effect on health care outcomes for these conditions.

Dental services - orthodontics

Effective immediately, policy revised. Cleft palate was removed from the conditions requiring medical necessity review for orthodontics.

Oral appliances for sleep disorders

Effective immediately, prior authorization is no longer required. Policy retired.

Breast Pumps Effective immediately, PA requirements removed for the purchase of a manual breast pump (E0602) or a standard, dual electric breast pump (E0603).

Feeding/oral function therapy, pediatric

Effective 1/1/2020, criteria were added stating that feeding and/or oral function therapy in the home setting is not covered unless member meets the definition of homebound.

Home Health Services Effective immediately, prior authorization is no longer required for home health services for Medicare or Minnesota Senior Health Options (MSHO) members.

Uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea

Effective immediately, prior authorization is no longer required. Policy retired.

Wigs Effective immediately, prior authorization is no longer required. Policy retired. Refer to member’s benefits for coverage.

Contact the Medical Policy Intake line at 952-883-5724 for specific patient inquiries.

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BEHAVIORAL HEALTH

Coverage Policies Comments / Changes

Repetitive transcranial magnetic stimulation (rTMS), Minnesota Health Care Programs

Effective immediately, policy retired. DHS will now allow reimbursement for rTMS. Please refer to the commercial “Repetitive transcranial magnetic stimulation” policy for coverage criteria. Prior authorization is required.

Pharmacy Policy updates – 11/1/2019 HEALTHPARTNERS DRUG FORMULARY – RECENT UPDATES COMMERCIAL UPDATES • Nubeqa (darolutamide) the newest anti-androgen therapy for non-metastatic castration-resistant prostate cancer will

be added to formulary with prior authorization. • Inrebic (fedartinib), Xpovio (selinexor), and Turalio (pexidartinib) have been added to formulary. Both agents require

prior authorization, restricting coverage to FDA approved indications or NCCN 1 or 2A recommendations. • Rozlytrek (entrectinib) has been added to formulary and is now the preferred agent for the treatment of NTRK positive

solid tumors in patients ≥ 12 years old. • All anti-hemophilia blood factor products (e.g., Advate, Eloctate, Alprolix, etc.) will require prior authorization when

provided under the patient’s pharmacy benefit. • Dupixent (dupilumab) will be covered with prior authorization for the newest indication of nasal polyps for patients

who have failed both intranasal steroid use and prior surgery. • Sunosi (solriamfetol) has been added to formulary for patients diagnosed with narcolepsy or obstructive sleep apnea,

who have tried and failed prior use of stimulants such as modafinil and armodafinil. • The self-administered formulation of Nucala is now the preferred interleukin-5 inhibitor for asthma. Patients currently

treated with Fasenra or Cinqair will be required to transition to Nucala upon reauthorization. • Hemlibra criteria have been updated to include treatment of both inhibitor and non-inhibitor hemophilia A patients.

STATE PROGRAM UPDATES OPIOIDS WITH BENZODIAZEPINES • HealthPartners is adding a new safety program for State Program members as part of efforts to reduce opioid

overutilization. These safety edits will limit the concurrent use of opioids with benzodiazepines when prescribed by two or more providers starting October 1, 2019.

• Affected members and their providers are being notified about this change. Providers are asked to review therapy and contact HealthPartners if concurrent use is medically necessary.

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PHARMACY

Coverage Policies Comments / Changes

Benralizumab (Fasenra)

Medical policy will be live on the web by 1/1/20. (path: healthpartners.com/public/coverage-criteria/)

Coverage policy can be found in the medical coverage policy search page, searchable by drug name or billing codes.

• Criteria updated to require prior use of Nucala.• Patients previously treated with Fasenra will be required to

transition to Nucala upon reauthorization.• Patients approved for Fasenra use that are appropriate for

self-administration will be required to transition to the self-administered Fasenra product.

See the coverage policy for full clinical criteria and prior authorization restrictions.

Reslizumab (Cinqair)

Medical policy will be live on the web by 1/1/20. (path: healthpartners.com/public/coverage-criteria/)

Coverage policy can be found in the medical coverage policy search page, searchable by drug name or billing codes.

• Criteria updated to require prior use of Nucala.• Patients previously treated with Cinqair will be required to

transition to Nucala upon reauthorization.

See the coverage policy for full clinical criteria and prior authorization restrictions.

Hereditary Angioedema (HAE) Policy

Medical policy will be live on the web by 1/1/19.(path: healthpartners.com/public/coverage-criteria/)

Coverage policy can be found in the medical coverage policy search page, searchable by drug name or billing codes.

Criteria updates:

• Ruconest restricted to treatment of HAE attacks only.• Cinryze restricted to use for prophylaxis of HAE attacks only.

Additional criteria may apply – see the coverage policy for more information.

Please see the formulary for details and a complete list at HealthPartners Drug Formularies*. For additional information, please contact peter.s.marshall@healthpartners.com.

Click HERE** for quarterly formulary updates and additional information such as Prior Authorization and Exception Forms, Specialty Pharmacy information, and Pharmacy and Therapeutics (P&T) Committee policies, including the Drug Formularies.*

*path for Drug Formularies: healthpartners.com/formulary

**path for quarterly formulary updates: healthpartners.com/provider-public/pharmacy-services/policies-and-forms/

Pharmacy Customer Service is available to providers (physicians and pharmacies) 24 hours per day and 365 days per year.

• Fax: 952-853-8700 or 1-888-883-5434 Telephone: 952-883-5813 or 1-800-492-7259 • HealthPartners Pharmacy Services, 8170 33rd Avenue South, PO Box 1309, Mpls, MN 55440

HealthPartners Customer Service is available from 8 AM - 6 PM Central Time, Monday through Friday, and 8 AM – 4 PM Saturday. After hours calls are answered by our Pharmacy Benefit Manager.

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Patient Perspective Connecting patients with free HealthPartners Disease Management services HealthPartners Disease Management RNs and CDEs provide support and coaching to patients with asthma, CAD, COPD, CHF, diabetes, cancer, low back pain and to women who are pregnant. The team also supports patients with 14 additional rare neurological, pulmonary, rheumatologic and hematologic diseases.

Using fully integrated systems, processes and information platforms, these services have been shown to optimize health and care, reduce hospital admissions and readmissions, and maximize appropriate use of available resources—all while delivering an exceptional experience to patients and physicians.

HOW THE SERVICES WORK

Using personalized health coaching techniques and behavioral strategies including motivational interviewing, health coaching and shared decision making, HealthPartners disease managers provide tailored interventions designed to:

• Enhance self-management of condition • Support medication adherence • Identify and close gaps in condition-specific care • Support the physician’s plan of care • Strengthen the patient’s relationship with their provider and clinic

A multidisciplinary team of registered nurses, registered dietitians, pharmacists, behavioral health specialists and social workers ensure that each patient receives the support and level of service appropriate to their circumstances and in line with their preferences. The team collaborates with the patient’s care team frequently throughout the duration of the patient’s participation in the program, including care plan updates and reports of the patient’s progress towards goals.

We’ve made it easy for you to connect your patients with our services. You can find our online form— Disease, Case & Lifestyle Management Services—under “Forms for Providers,” or you can check it out at healthpartners.com/patientsupport. All you need to do is fill in the required information and click on “submit.” We will take care of the rest.

We appreciate your partnership in meeting the needs of our members. If you have any questions, please contact the HealthPartners Connect team at 952-883-5469 or toll-free at 800-871-9243.

Syphilis Pregnancy Screening Guidelines MINNESOTA DEPARTMENT OF HEALTH (MDH) Rates of the sexually transmitted disease syphilis have been rising in Minnesota since 2013. Of special concern is the rise in early syphilis among women of childbearing age and the increase in the number of cases of congenital syphilis. Babies born to mothers with untreated syphilis can be infected with syphilis and may experience serious, long-term complications. The Minnesota Department of Health (MDH) reported 10 cases in 2018.

In 2016, MDH released new syphilis pregnancy screening guidelines and revised them slightly in February 2019. The Clinical Guidelines for Syphilis issued by MDH, state that providers should screen all pregnant people 2 or 3 times during pregnancy: at the first prenatal visit and early in the third trimester (28-32 weeks gestation). In addition, many pregnant people should be screened at delivery, especially those with the following risk factors:

• No documented syphilis test result from earlier in third trimester

• No or inconsistent prenatal care

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• A sexually transmitted disease diagnosis during the past year

• Current injection or non-injection drug use

• Incarceration during the past year

• Currently experiencing homelessness or unstable housing

• Multiple sexual partners

• Sexual partner with any of the above risk factors

All medical providers who see pregnant people are strongly encouraged to follow these recommendations. It is particularly important that screening happen in the third trimester so that a pregnant person can be treated within a sufficient amount of time so that congenital syphilis can be prevented. Interpreting syphilis test results and determining treatment can be confusing, but MDH can provide assistance. Visit the MDH website for more in-depth information: Syphilis in Pregnancy and Congenital Syphilis (path: health.state.mn.us/diseases/syphilis/hcp/healthcarewomen.html).

Minnesota Department of Health STD/HIV/TB Section 651-201-5414 health.state.mn.us/syphilis 10/11/2019

Hepatitis A outbreak MINNESOTA DEPARTMENT OF HEALTH (MDH) The following communication is from the Minnesota Department of Health regarding the vaccination response to the current hepatitis A outbreak in Minnesota.

In early August 2019, Minnesota declared an outbreak of hepatitis A. As of Friday, October 4, there have been 36 cases. Hepatitis A outbreaks have been occurring across the U.S. since late 2016. (path: cdc.gov/hepatitis/outbreaks/2017March-

HepatitisA.htm)

People at highest risk in this outbreak are:

• People who use injection or non-injection drugs

• People experiencing homelessness or unstable housing

• People who are or have recently been incarcerated

The most effective way to prevent hepatitis A is vaccination. It has been challenging to vaccinate the people at highest risk in this outbreak. Community vaccination efforts outside primary care clinical settings have been effective in reaching high-risk persons, including vaccination in the pharmacy setting. We have been able to offer vaccine at no cost to certain populations, but supplies are limited. We encourage vaccinating partners (when appropriate) to bill health plans after providing vaccine to insured patients.

The Advisory Committee on Immunization Practice (ACIP) (path: cdc.gov/vaccines/acip/) states that anyone who wants to be protected from hepatitis A can get vaccinated, and it is especially important to vaccinate people at highest risk for hepatitis A. Since the Affordable Care Act covers all ACIP-recommended vaccines, we expect more people to be getting vaccinated against hepatitis A in the coming months leading to more claims for health plans.

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Government Programs Important Minnesota Health Care Programs (MHCP) Collection of Cost-Sharing Reminder HealthPartners created a new administrative policy with language that supports expectations around the collection of cost-sharing from Minnesota Health Care Program (MHCP) members. As a reminder, providers are to follow all State and Federal requirements. The acceptance of payment for services or items covered by members’ benefits is not allowed. This includes the acceptance of payments for prescriptions. There are specific exclusions and criteria that must be met before a provider may request or accept payment for services. Please refer to the policy for guidance. If you have additional questions, please contact your HealthPartners Service Specialist.

Events Webinar: Increasing cervical cancer screening

If you have questions regarding the content of this newsletter, please contact the person indicated in the article or call your HealthPartners Service Specialist. If you don’t have his/her phone number, please call 952-883-5589 or toll-free at 888-638-6648. This newsletter is available online at healthpartners.com/fastfacts.

Fast Facts Editors: Mary Jones and David Ohmann

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