Tufts Health Public Plans FEBRUARY 2017 Provider News This issue includes information for Tufts Health Public Plans products (including Tufts Health Direct, Tufts Health Together and Tufts Health Unify). For information pertaining to Tufts Health Plan Commercial (including the Tufts Health Freedom Plan), Tufts Medicare Preferred HMO and Tufts Health Plan Senior Care Options products, refer to the Tufts Health Plan Provider Update newsletter. Contact Us 60-DAY NOTIFICATIONS Phone: 888.257.1985 Preferred Drug List Changes for Tufts Health Together Business hours: Monday through Friday, Effective April 1, 2017, there are changes to thePreferred Drug List for Tufts Health Together. 8 a.m. to 5 p.m., excluding holidays Update to prior authorization requirements for Elidel (pimecrolimus), Entresto (sacubitril/ By mail: valsartan), Gralise (gabapentin extended-release), Horizant (gabapentin enacarbil), Tufts Health Plan P.O. Box 9194 Promacta (eltrombopag) and tacrolimus ointment Watertown, MA 02471-9194 Effective for prior authorization requests submitted on or after April 1, 2017, Tufts Health Together will apply new criteria to prior authorization requirements for coverage of Elidel (pimecrolimus), Entresto (sacubitril/valsartan), Gralise (gabapentin extended- release), Horizant (gabapentin enacarbil), Promacta (eltrombopag) and tacrolimus ointment. Register Your Email for The prior authorization criteria will apply to new starts. The prescribing provider must request prior authorization through the medical review process subject to the pharmacy Provider Update medical necessity guidelines for Entresto (sacubitril/valsartan), gabapentin medications Tufts Health Public Plans is now (including but not limited to Gralise [gabapentin extended-release] and Horizant [gabapentin distributing its provider newsletter by enacarbil]), Promacta (eltrombopag) and topical immunomodulators (including but not email.* To receive Provider Update, all limited to Elidel [pimecrolimus] and tacrolimus ointment). To submit a prior authorization contracting providers and anyone else request, please fill out the Massachusetts Standard Form for Medication Prior Authorization who wishes to receive future issues Requests and fax or mail it to the pharmacy utilization management team as directed via email must complete the online on the form. registration form at tuftshealthplan.com/ provider/news. Addition of prior authorization requirements for Carafate suspension (sucralfate Please let all providers in your suspension) and Ulesfia lotion (benzyl alcohol) organization know about this change and Effective for fill dates on or after April 1, 2017,Tufts Health Together will require prior encourage each provider to register to authorization for coverage of Carafate suspension (sucralfate suspension) and Ulesfia lotion receive future issues by email. Office staff (benzyl alcohol). If you feel your Tufts Health Together members should continue taking may also register a provider on his or her Carafate suspension or Ulesfia lotion, you must request prior authorization through the behalf by using the provider’s name, email medical review process subject to the pharmacy medical necessity guidelines for Carafate address and NPI, and by indicating the suspension (sucralfate suspension) or pediculocide medications, respectively. To submit a division(s) of Tufts Health Plan with which prior authorization request, please fill out the Massachusetts Standard Form for Medication the provider participates. Prior Authorization Requests and fax or mail it to the pharmacy utilization management team as directed on the form. Please note that requests for a prior authorization will not be * To request copies of this newsletter, reviewed until the effective date of April 1, 2017. please call the provider services team at 888.257.1985. Drug moving to noncovered status Scan here with your Effective April 1, 2017, polyethylene glycol packets will no longer be routinely covered for smartphone to sign up Tufts Health Together. Please note polyethylene glycol powder will continue to be covered. and for the latest issue of If you feel your Tufts Health Together members should continue this medication, you must Provider Update: submit an exception request for coverage through our medical review process. To submit an exception request, please fill out the Massachusetts Standard Form for Medication Prior Authorization Requests and fax or mail it to the pharmacy utilization management team as directed on the form. Please note that requests for an exception will not be reviewed until the effective date of April 1, 2017. 5830 02017

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tuftshealthplan.com/provider | 888.257.1985 1 Preferred Drug List Changes for Tufts Health Direct Effective April 1, 2017, there are changes to thePreferred Drug List for Tufts Health Direct. Update Your Practice Information Drugs moving to noncovered status Providers are reminded to regularly Effective April 1, 2017, Asacol HD (mesalamine delayed-release tablets) will no longer be notify Tufts Health Public Plans of any routinely covered for Tufts Health Direct. If you feel your Tufts Health Direct members should changes to their contact or member continue this medication, you must submit an exception request for coverage through our panel information, such as a change in medical review process. To submit an exception request, please fill out the Massachusetts their ability to accept new patients, street Standard Form for Medication Prior Authorization Requests and fax or mail it to the address, phone number or any other pharmacy utilization management team as directed on the form. Please note that requests change that affects their availability to for an exception will not be reviewed until the effective date of April 1, 2017. members. For Tufts Health Public Plans to remain compliant with regulatory Addition of prior authorization requirements for nonpreferred topical corticosteroids requirements, it is important that these Effective for fill dates on or after April 1, 2017,Tufts Health Direct will require prior changes be communicated in writing as authorization for coverage of nonpreferred topical corticosteroids. The prior authorization soon as possible and that members have criteria will apply to new starts. For a member to start treatment with a nonpreferred access to the most current information in topical corticosteroid, the prescribing provider must request prior authorization through the the Provider Directory. medical review process subject to the pharmacy medical necessity guidelines for topical In addition, we include, as an element corticosteroids. To submit a prior authorization request, please fill out the Massachusetts of our Provider Directory, whether a Standard Form for Medication Prior Authorization Requests and fax or mail it to the participating provider has taken cultural pharmacy utilization management team as directed on the form. Please note that requests competency training, based in part on for a prior authorization will not be reviewed until the effective date of April 1, 2017. Centers for Medicare & Medicaid Services requirements. Please go to Drugs moving to excluded status tuftshealthplan.com/provider/ Effective April 1, 2017, Ultravate X (halbetasol 0.05% cream and lactic acid 10% cream kit) cultural-form to update us when will be excluded from the pharmacy benefit forTufts Health Direct. Exclusion from coverage you have completed any cultural means that Tufts Health Public Plans will no longer consider medical review requests for competency training. exceptions, and coverage will not be available for Ultravate X (halbetasol 0.05% cream and lactic acid 10% cream kit). How to update your information: You can check your current practice Continuing Coverage During an Appeal information by going to the Find a Effective for dates of service on or after April 1, 2017, Tufts Health Public Plans will Doctor, Hospital, or Pharmacy tool. If that define “continuing care” forTufts Health Together members as care that has previously information is not correct, please update been authorized with an initial date and a last-covered date. A request for authorization it as soon as possible by completing for coverage beyond the last-covered day is a new request and will not be eligible for the Medical Provider Information reimbursement during an appeal. Form or Behavioral Health Provider Information Form. Provider information This decision is based in part on guidance provided by CMS. See 81 Fed. Reg. 27497, 27636 forms are available in the forms section (May 6, 2016). of the Provider Resource Center at Changes to Medical Necessity Guidelines tuftshealthplan.com/provider. Send your form via fax to 857.304.6311 or via email to Effective April 1, 2017, there are changes to the medical necessity guidelines referenced [email protected] below. Refer to the Provider Resource Center at tuftshealthplan.com/provider as noted on the form. (select: Tufts Health Public Plans, Guidelines, Medical Necessity Guidelines) for more information about each guideline.

Therapeutic lenses Tufts Health Public Plans will require a change in prescription for therapeutic lenses to be covered with the current qualifying conditions. Clarifying language for coverage frequency of therapeutic lenses has also been added to the coverage guidelines section of the medical necessity guidelines for Therapeutic Lenses. This change applies to Tufts Health Direct and Tufts Health Together.

Laser vision correction surgery Tufts Health Public Plans will no longer routinely cover laser vision correction surgery for convenience. This change is documented in the limitations section of the medical necessity guidelines for Laser Vision Correction Surgery. This change applies to Tufts Health Direct and Tufts Health Together.

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tuftshealthplan.com/provider | 888.257.1985 2 Manual wheelchairs Tufts Health Public Plans does not routinely cover purchase of a manual wheelchair for use Tufts Health Provider Connect, as a backup mobility device when the member’s primary mobility device is in need of repair a Great Tool! or when the manual wheelchair is needed for the convenience of the member and/or the member’s caregiver(s). This prior authorization requirement is documented in the medical Use our convenient self-service tool at necessity guidelines for Manual Wheelchairs. This change applies to Tufts Health Direct only. tuftshealthplan.com/providerconnect to: • Submit behavioral health outpatient Power operated vehicles (POV) authorization requests Tufts Health Public Plans will allow seating and home evaluations (for the purpose of • Enter medical inpatient admission prescribing the POV and evaluating the use of a POV in the member’s home) to be notifications performed by an occupational therapist, physical therapist and/or assistive technology professional. The ability to transport the POV will no longer be required. In addition, • Upload care plans and notes Tufts Health Public Plans will no longer routinely cover Group 2 (K0806, K0807, K0808) • Confirm member eligibility POVs and will not cover POVs in addition to the member’s primary mobility device. This • Add a new claim and check the status change is documented in the medical necessity guidelines for Power Operated Vehicles of an existing claim (POVs). These changes apply to Tufts Health Direct only. • Check referral and authorization status Power wheelchairs • Get useful provider resources and forms Tufts Health Public Plans will allow seating and home evaluations (for the purpose of • Use “Provider Resources” under the prescribing the POV and evaluating the use of a POV in the member’s home) to be Reference tab for instructions on performed by an occupational therapist, physical therapist and/or assistive technology entering an authorization, and more professional. The ability to transport the power wheelchair will no longer be required. In addition, Tufts Health Public Plans will no longer cover Group 4 (KO868-K0886) power • Run an Explanation of Payment and wheelchairs and will not cover power wheelchairs in addition to the member’s primary other reports mobility device. This change is documented in the medical necessity guidelines for Power • Look up ICD-10 codes Wheelchairs. These changes apply to Tufts Health Direct only. • Receive email alerts and registration Transgender surgical procedures notifications for new users

Tufts Health Public Plans has added clarifying language regarding hair removal to the If you have any questions, call us at limitations section of the medical necessity guidelines for Transgender Surgical Procedures. 888.257.1985. A link to the medical necessity guidelines for Reconstructive and Cosmetic Surgery has also been added. These changes apply to Tufts Health Direct and Tufts Health Together.

Reconstructive and cosmetic surgery Recommended Browsers for Tufts Health Public Plans has added additional criteria regarding hair removal by laser or tuftshealthplan.com electrolysis for members who meet criteria for planned transgender surgery. A link to the medical necessity guidelines for Transgender Surgical Procedures has also been added. This If you are using an outdated or change is documented in the medical necessity guidelines for Reconstructive and Cosmetic unsupported web browser, certain Surgery. These changes apply to Tufts Health Direct and Tufts Health Together. features on Tufts Health Plan’s public website may be unavailable. For an Lower limb prosthesis – micro knee improved user experience, we Tufts Health Public Plans will no longer routinely cover adjustable lower limb sockets. This recommend upgrading your browser to change is documented in the medical necessity guidelines for Lower Limb Prostheses – the latest version of Mozilla Firefox or Micro Knee. This change applies to Tufts Health Direct and Tufts Health Together. Google Chrome.

Noncovered investigational services V-Go Disposable Insulin Delivery System (no specific code available) has been added to the medical necessity guidelines for Noncovered Investigational Services. This change applies to Tufts Health Direct and Tufts Health Together.

Frequency Limitation for Nitric Oxide Expired Gas Determination Effective for dates of service on or after April 1, 2017, Tufts Health Public Plans will no longer routinely cover nitric oxide expired gas determination (CPT 95012) when billed more than six times in a 365-day time period by an allergist or pulmonologist, whether by a single allergist or pulmonologist individually or multiple ones collectively. This change applies to Tufts Health Direct, Tufts Health Together and Tufts Health Unify.

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tuftshealthplan.com/provider | 888.257.1985 3 Claim Edits Effective April 1, 2017 Clinical Practice New drug and biological edits for Tufts Health Together Guidelines Online Effective for dates of service on or after April 1, 2017, Tufts Health Public Plans will not Providers can find clinical practice reimburse for histrelin implant (Supprelin LA) (J9226) if billed without a diagnosis of central guidelines online in the Provider Resource precocious puberty for Tufts Health Together members. Center at tuftshealthplan.com/provider. Effective for dates of service on or after April 1, 2017, Tufts Health Public Plans will not reimburse for histrelin implant (Supprelin LA) (J9226) when billed for Tufts Health Together Disease Management members over the age of 12. Program Effective for dates of service on or after April 1, 2017, Tufts Health Public Plans will not Disease management is our clinical and reimburse for lanreotide (J1930) when billed without an FDA-approved indication or an quality management of certain chronic approved off-labeled indication forTufts Health Together members. conditions. Visit our disease management program web page to learn more about Density claim edits our program and how to refer members Effective for dates of service on or after April 1, 2017, Tufts Health Public Plans will deny DXA directly to a program. Our disease (bone density study) when the only diagnosis on the claim is osteoporosis screening and the management program can help member is either a female under 65 years of age or a male under 70 years of age. Tufts Health Direct and These changes apply to Tufts Health Direct, Tufts Health Together and Tufts Health Unify. Tufts Health Together members with asthma, diabetes, chronic obstructive Correct Coding Reminder pulmonary disease and/or heart failure. A diabetes program is also offered to As a routine business practice, claims are subject to payment edits that are updated from Tufts Health Unify members. time to time and generally based on Centers for Medicare & Medicaid Services (CMS) guidelines, specialty society guidelines, regulations, evaluation of drug manufacturers’ package label inserts and the National Correct Coding Initiative (NCCI). Procedure and diagnosis codes undergo periodic revision by CMS, the American Medical New Fax Numbers Association and NCCI. As these revisions are made public, Tufts Health Public Plans will Some Tufts Health Public Plans fax update its system to reflect the changes. If you have any questions, call us at888.257.1985 . numbers changed in 2016. To ensure Change in Psychological and Neuropsychological Testing you have the correct fax number and most recent version of our forms, please Effective for dates of service on or after April 1, 2017, there are changes to the medical visit our Provider Resource Center at necessity guidelines used to review requests for psychological and neuropsychological tuftshealthplan.com/provider. testing and assessment. In addition, the existing medical necessity guidelines for psychological and neuropsychological testing will be split into two separate documents. Coverage guidelines for psychological and neuropsychological testing will also change in both documents. The existing request form will continue to be used for all requests for psychological testing and/or neuropsychological testing, regardless of whether the request is for psychological testing and/or neuropsychological testing. These changes apply to Tufts Health Direct and Tufts Health Together and are documented in the medical necessity guidelines for both Psychological Testing and Assessment and Neuropsychological Testing and Assessment.

Pediatric Fax Number Change Effective April 1, 2017, the current fax line used forTufts Health Direct and Tufts Health Together pediatric requests will be retired. Requests for medical outpatient and inpatient services for all Tufts Health Direct and Tufts Health Together members should be faxed to 888.415.9055. As of April 1, 2017:

857.304.6309 will be retired 888.415.9055 will be used

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tuftshealthplan.com/provider | 888.257.1985 4 Tufts Health Provider Connect Portal Changes In May 2017, Tufts Health Public Plans will be integrating a new medical management system Did You Know… into our secure provider portal, Tufts Health Provider Connect. With the same single sign-on Visit the Pharmacy section of you use today to determine eligibility, view claims and authorization status, you will have the Tufts Health Plan’s public provider option to seamlessly enter our new medical management system to complete a request for website at tuftshealthplan.com/provider inpatient and/or outpatient services, attach documentation and then receive a determination for the most current pharmacy benefit online. The screens used to input requests for Tufts Health Public Plans members will change. information, including tier changes, We will provide training on the use of the effected screens before the roll-out in May 2017. online formularies and descriptions If you are not already using the portal for your hospital admissions or outpatient requests, of pharmacy management programs. please consider using Tufts Health Provider Connect to take advantage of this technology. Pharmacy information on our website is updated regularly. Check pharmacy updates for postings of formulary changes, notification of new pharmacy PLAN UPDATES programs and information about drug recalls and alerts from the FDA or drug Submitting the Standard Form for Medication Prior manufacturers. Authorization Requests Also available on our website is other As previously communicated and effective for dates of service on or after February 1, important business information, such 2017, providers are required to use the Massachusetts Standard Form for Medication Prior as updates to our Quality Improvement Authorization Requests finalized by the Massachusetts Division of Insurance for all coverage Program and progress to meeting goals, determination and exception requests, as outlined in Chapter 176O, Section 25 of the complex case management (CCM) Massachusetts General Laws. information including access to CCM, disease management programs and Tufts Health Public Plans has implemented the use of the Massachusetts Standard Form for services, Clinical Practice Guidelines, Medication Prior Authorization Requests for Tufts Health Direct and Tufts Health Together Utilization Management Criteria/ members. Guidelines, the Provider Manual, and Providers are encouraged to attach any additional supporting documentation relevant to the Member’s Rights and Responsibilities. medical necessity criteria to the standard form (as indicated on the form). Providers should Copies of the above information can also submit the form using the existing mail and fax channels as indicated on our Massachusetts be mailed upon request by calling the Standard Form for Medication Prior Authorization Requests web page and the chart below. provider services team at 888.257.1985. This chart indicates which forms are to be used for Tufts Health Public Plans products:

Tufts Health Direct Tufts Health Together Tufts Health Unify Form Massachusetts Standard Massachusetts Standard Universal Pharmacy and Form for Medication Prior Form for Medication Prior Programs Request Form Fax Authorization Requests Authorization Requests 617.673.0956 617.673.0988 617.673.0988 Mail Tufts Health Plan Attn: Pharmacy Utilization Management Department 705 Mount Auburn Street Watertown, MA 02472

Before submitting the applicable form to Tufts Health Public Plans, providers should refer to Tufts Health Public Plans’ coverage policies, member benefits and pharmacy medical necessity guidelines, available in the Provider Resource Center at tuftshealthplan.com/provider. Before submitting prior authorization requests to Tufts Health Public Plans and before rendering services, providers are reminded to check the member’s ID card to identify the plan in which the member is enrolled. Providers also should check member benefits and cost-share amounts using Tufts Health Provider Connect or other self-service channels, even for members seen on a regular basis. If you have any questions, call us at 888.257.1985.

tuftshealthplan.com/provider | 888.257.1985 5 Standard Hepatitis C and Synagis Prior Improving the PCP-Member Connection Authorization Forms Tufts Health Public Plans recognizes the importance of the ease Chapter 176O, section 25, of the Massachusetts General Laws with which members access primary care. Our members can see requires, among other things, that health insurance carriers use any primary care provider (PCP), including nurse practitioners and standard prior authorization forms when reviewing requests for covering providers, within the Tufts Health Public Plans network, hepatitis C and Synagis for commercial products, including regardless of whether the PCP is listed as the member’s PCP of Tufts Health Direct. record in Tufts Health Public Plans’ system. The Mass Collaborative, an organization of health plans, provider Nevertheless, Tufts Health Public Plans is committed to maintaining organizations and professional associations, is developing these accurate PCP information for each member. If you are treating a standard prior authorization request forms. Once they have been member regularly and you do not see that member listed on your approved by the Massachusetts Division of Insurance (DOI), these member panel in our system, please notify us so we can update our forms will be used by all health plans and will standardize the prior records appropriately. Having up-to-date PCP information supports authorization process for providers. the care management and continuity of care processes. It also enhances the accuracy of member panel reporting. You can access The effective date of these forms and other pertinent details are your member panel via Tufts Health Provider Connect. dependent upon the DOI’s bulletin release. More information will become available in the coming months. To update PCP information on a member’s behalf, please download the Primary Care Provider (PCP) Selection/Change Form available in This change will apply to all providers in Massachusetts. the forms section of the Provider Resource Center at tuftshealthplan.com/provider and fax the completed form Standard Form for Imaging Prior Authorization to 857.304.6310. Requests This information applies to all Tufts Health Public Plans products As previously communicated, effective for prior authorization (Tufts Health Direct, Tufts Health Together and Tufts Health Unify). requests submitted on or after November 1, 2016, and based on a This information does not apply to Steward Health Care Network or bulletin issued by the DOI, Tufts Health Public Plans, in collaboration Cambridge Health Alliance members. with NIAMagellan, our radiology benefit manager, will begin accepting standardized prior authorization forms for Notice of Observation Treatment and Implication Tufts Health Direct and Tufts Health Together members for the for Care Eligibility Act following imaging services: Beginning August 6, 2016, the Centers for Medicare & Medicaid • Cardiac imaging Services (CMS) implemented requirements associated with the • CT/CTA/MRI/MRA Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE). The NOTICE Act requires hospitals and critical • PET-PET CT access hospitals (CAHs) to provide written notification and a verbal These forms are available in the forms section of the Provider explanation to individuals receiving observation services in an Resource Center and on the NIAMagellan website at radmd.com. outpatient setting for more than 24 hours. They can be submitted via fax to NIAMagellan at 888.656.6648. Effective for dates of service on or after March 8, 2017, and as part of In addition to the standard forms, providers can continue to submit the NOTICE Act, the written notification must include the reason(s) prior authorization requests through radmd.com or by calling the individual is not receiving acute-level inpatient care from the NIAMagellan at 866.642.9703. hospital or CAH, as well as an explanation of any implications, such as cost-share requirements and post-hospitalization eligibility for Habilitative PT, OT and ST Services coverage of skilled nursing facility services under Medicare. Providers must also submit notification to their patient and/or their authorized Tufts Health Public Plans has determined certain diagnoses to be representative no later than 36 hours after observation services are habilitative in nature. Effective January 1, 2017, habilitative physical initiated. The notification must be signed by the patient and/or their therapy, occupational therapy and speech therapy services are authorized representative to acknowledge receipt. Hospitals and authorized for treatment of these diagnoses when clinical coverage CAHs must use the standard CMS notice form, Medicare Outpatient guidelines are met. Observation Notice (MOON), when submitting notification. For more information, refer to the medical necessity guidelines for These requirements apply to inpatient facilities that are treating Habilitative Services; Physical Therapy, Occupational Therapy and Tufts Health Unify members. Speech Therapy (Tufts Health Direct) and Outpatient Rehabilitation (Tufts Health Together) in the Provider Resource Center at For more information about the NOTICE Act and for the current tuftshealthplan.com/provider. version of the MOON form, refer to the CMS website.

ThyroSeq Coverage Update Tufts Health Public Plans now requires prior authorization for coverage of ThyroSeq. This is documented in the medical necessity guidelines for Genetic and Molecular Diagnostic Testing. This applies to Tufts Health Direct and Tufts Health Together.

tuftshealthplan.com/provider | 888.257.1985 6 Update to Process for Resubmitting Rejected Importance of Antidepressant Medication Claims Appearing on Your Electronic Claims Adherence Acknowledgment Report (277 file) Research has shown that up to 68 percent of patients diagnosed If you submit claims via direct EDI submission, we will send you with depression discontinue their antidepressant medications an electronic claims acknowledgment report (277 file). Previously, within three months of it being prescribed.1 Failure to adhere to claims that were listed as rejected on your 277 file would require antidepressant medication is one of the leading causes of relapse you to correct and resubmit them on paper for processing. We are and recurrence.2 pleased to inform you that you can now update and resubmit a In 2016, Tufts Health Public Plans began reaching out to rejected claim electronically via the direct EDI submission without certain members who our records show have been prescribed having to resubmit on paper. This applies to claims that appear as antidepressant medications in order to educate them on the benefits rejected on your 277 file. of medication adherence and to identify and remove barriers to Please note that timely filing limits have not changed. EDI-rejected adherence. Highlights from our data to date show that of the claims still must be resubmitted within 90 days from the date of 833 members who responded: service, or within 60 days from the date of the 277 file. • 30.71 percent of members reported they are not currently taking their antidepressant medication HEDIS Medical Record Collection Starts • 26.71 percent of members reported their providers’ instructions for in February taking their antidepressant medication are not clear As required by the National Committee for Quality Assurance • 9.29 percent of members reported they sometimes stop taking (NCQA), Tufts Health Public Plans will start collecting medical their antidepressant medication when they feel better record information for the 2017 Healthcare Effectiveness Data and Information Set (HEDIS) audit in February. HEDIS is one of the ways • 9.14 percent of members reported they sometimes do not take we measure the quality of care you provide to our members, and it is their antidepressant medication as prescribed and also noted they a very important activity for all NCQA-accredited health plans. sometimes forget to take their antidepressant medication

In addition, we are also collecting medical records for measures Common barriers to medication adherence include: required by the Centers for Medicare & Medicaid Services and the Executive Office of Health and Human Services in accordance with • Fears or concerns about treatment, including side effects the One Care demonstration program. • Feeling medication is not needed once symptoms have subsided Your assistance in the timely submission of your medical records is • Not understanding how antidepressants work (e.g., they are imperative. If you have any questions about HEDIS or the medical not addictive) record collection process, please contact our quality measurement • Logistical, economic or cultural barriers and reporting team at 888.257.1985. Please take the following steps to help educate and improve Tufts Health Unify Expansion in Lowell medication adherence for your patients with depression: Beginning February 1, 2017, Tufts Health Unify is expanding into the • Discuss the importance of taking antidepressant medication as greater Lowell area. For a full list of cities and towns, please reference prescribed for successful treatment the table below. • Schedule follow-up appointments with patients City/Town Zip Codes • Identify and address barriers to medication adherence and discuss Billerica 01821, 01822 with patients Chelmsford 01824 Did you know? Dracut 01826 Our integrated care management team has varied professional Lowell 01850, 01851, 01852, 01853, 01854 training and experience in behavioral health, nursing, nutritional North Billerica 01862 counseling, respiratory therapies and community health work. Our North Chelmsford 01863 team is diverse and represents a wide range of cultural and linguistic backgrounds, which enables us to effectively interact with our Tewksbury 01876 members, remove cultural barriers, adapt to unforeseen challenges Tyngsborough 01879 and provide access to health care services. We use translation Westford 01886 services per members’ preferences to effectively collaborate with them and their caregivers. We encourage you to refer members Tufts Health Unify, our One Care plan for people ages 21 – 64, who might benefit from any of our integrated care management integrates care for people who are eligible for both Medicare and programs by calling us at 888.257.1985. Medicaid services. One Care was established by MassHealth and the Centers for Medicare & Medicaid Services to streamline delivery and Sources: financing of care for patients who typically receive services from 1Tamburrino, M. B., Nagel, R. W., Chahal, M. K., & Lynch, D. J. (2009). both agencies (dual eligibles). “Antidepressant medication adherence: A study of primary care For more information about Tufts Health Unify, please visit our plan patients.” Primary Care Companion Journal of Clinical Psychiatry, overview web page and refer to Chapter 9 of our Provider Manual. 11 (5), 205–211. 2Ho, Siew Ching, et al. “Clinical and economic impact of non- adherence to antidepressants in major depressive disorder: A systematic review.” Journal of Affective Disorders, 193 (2016): 1–10.

tuftshealthplan.com/provider | 888.257.1985 7 Community Relations News Clinical Practice and Preventive Health Tufts Health Public Plans welcomes Angeliny Ortega as the new Guidelines community outreach representative serving Central and Western Tufts Health Public Plans encourages providers to review the Massachusetts. Angie is available to answer questions about our following clinical practice and preventive health guidelines. These programs, support your community events and activities and help guidelines were recently reviewed and approved: us in our mission to improve the health and wellness of the diverse • Osteoporosis communities we serve. • Focused update on new pharmacological therapy for heart failure To find your community relations representative and to learn more about what our team is up to, please visit our In the Community • Neonatal web page. • Opioid prescribing We Are Looking for Consumer Advisory • Preventive health guidelines (USPSTF and Bright Futures) Council Members • Human immunodeficiency virus (HIV) We’re looking for members who are willing to participate in our These guidelines apply to all Tufts Health Public Plans products Consumer Advisory Council. Participants should be: (Tufts Health Direct, Tufts Health Together and Tufts Health Unify) • Tufts Health Together members and are based on the review of clinical evidence developed by • Age 18 or older nationally recognized organizations. • Able to travel to our office in Watertown For additional information about these as well as other Tufts Health Public Plans clinical practice and preventive health • Available twice a year for a two-hour meeting guidelines, refer to Clinical Practice Guidelines in the Provider Resource Center at tuftshealthplan.com/provider. This group meets twice a year and offers our members the opportunity to voice their opinions about their health plan, ask questions and learn about important program updates. It also gives members unique opportunities to influence our member experience. Participants will receive a stipend for their time. If you have interested Tufts Health Together members, please email [email protected] for more information.

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