Dear Providers,

It has come to the DONS’ attention that renewal preauthorizations have been submitted to include holiday hours, specifically nursing services authorized for participants whose caregivers are employed.

Please note that verification must have been provided at the initial authorization noting that the caregiver (s) work schedule includes holidays. If not, the Program is unable to reimburse for these hours in accordance with COMAR 10.09.53 unless appropriate verification is submitted.

The Program will reimburse for awake and overnight nursing services, etc rendered on holidays. (This email specifically addresses nursing services authorized for the participant’s care in the absence of the participant’s working caregiver(s).)

If you have questions, please call or email me at your earliest convenience.

Thank you,

Dawnn Williams, Chief
Division of Nursing Services (DONS)
Department of Health and Mental Hygiene (DHMH)
201 West Preston Street, Rm 130
Baltimore, Maryland 21201
Tel: 410-767-1448

FOR IMMEDIATE RELEASE – June 23, 2015 – Dublin, Ireland – Medtronic (NYSE: MDT) announced that on May 8, 2015, it began notifying hospitals and distributors worldwide that affected lots of its Covidien Shiley(TM) tracheostomy tubes were formed with a wider-angle bend than standard models manufactured after November 29, 2012.

The recall is limited to the product codes and associated lot numbers listed in the table below. If you are unable to determine the lot number of any of the product codes and size listed in the table, then those products should be treated as if they are within the affected lot numbers.

To read more, click here to continue to article from the FDA.

There has been an increase in reports of Bedbugs around Maryland in the recent months. To ensure that everyone knows what these pesky pests are and to prevent them from popping up, please read and follow these recommendations.

What they are:

 Bedbugs are small oval non-flying insects that belong to the insect family, Cimicidae, which includes three species that bite people. Adult bedbugs reach 5-7mm in length, while nymphs (juveniles) are as small as 1.5mm. Bedbugs feed by sucking blood from humans or animals.

Adult bedbugs are reddish brown in color and appear bright red after feeding. The wings of bedbugs are vestigial, so they cannot fly. However, they are able to crawl rapidly. Temperatures between 70F-80F are most favorable for bedbugs, allowing them to develop into adults most rapidly and produce up to three generations per year.

Bedbugs are found all over the world. Bedbugs were common in the US before WWll and became rare after widespread use of the pesticide DDT began in the 1940s and 1950s. They remained prevalent in other areas of the world, and in recent years, have been increasingly observed again in the US. Increases in immigration and travel from the developing world as well as restrictions on the use of stronger pesticides may be factors that have led to the relatively recent increase in bedbug infestations. While bedbugs are often reported to be found when sanitation conditions are poor or when birds or mammals (particularly bats) are nesting on or near a home, bedbugs can also live and thrive in clean environments. Crowded living quarters also facilitate the spread of bedbugs.

Where to find them:

Bedbugs can live in any area of a home and can reside in tiny cracks in furniture as well as on textiles and upholstered furniture. They tend to be most common in areas where people sleep and generally concentrate in beds, including mattresses, box springs and bed frames. They do not infest the sleeping surfaces of beds as commonly as cracks and crevices associated with the bed frame and mattress. Other sites where bedbugs often reside include curtains, edges of carpet, corner inside dressers and other furniture, cracks in wallpaper (particularly near the bed), and inside the spaces of wicker furniture.

Since bedbugs can live for months or even longer under favorable conditions without feeding, they can also be found in vacant homes. Bedbugs live in any articles of furniture, clothing, or bedding so they or their eggs may be present in used furniture or clothing. They spread by crawling and may contaminate multiple rooms in a home or even multiple dwellings in apartment buildings. They may also be present in boxes, suitcases, or other goods that are moved from residence to residence or from a hotel to a home. Bedbugs can live on clothing from infested homes and may be spread by a person unknowingly wearing infested clothing

Bedbug Bites:

Bedbugs bite and suck blood from humans. Bedbugs are most active at night and bite any exposed areas or skin while an individual is sleeping. The face, neck, hands and arms are common sites for bedbug bites. The bite itself is painless and is not noticed. Small, flat, or raised bumps on the skin are the most common sign; redness, swelling, and itching commonly occur. If scratched, the bite areas can become infected. A peculiarity of bedbug bites is the tendency to find several bites lined up in a row. Infectious-disease Specialists refer to this series of bites as the “breakfast, lunch, and dinner.”

The majority of bedbug bites are not serious. The only known serious consequences are severe allergic reactions, which have been reported in some people who have been bitten.

Typically, no treatment is required for bedbug bites. If itching is severe or if an allergic reaction to the bites occurs, topical steroid creams or oral antihistamines may be used for symptom relief. Home remedies can include over-the-counter preparations and antihistamines to combat itching. Secondary bacterial infections that develop over heavily scratched areas may require antibiotics.

You can look to see if you can identify the rust-colored fecal stains, egg cases, and shed skins (exuviae) in crevices and cracks on or near beds. A sweet, musty odor is sometimes present. You should also look at other areas such as under wallpaper, behind picture frames, in couches and other furniture, in bedsprings and under mattresses, and even in articles of clothing. While fecal stains and skin casts suggest that bedbugs have been present, these do not confirm that the infestation is still active. Observing the bedbugs themselves is definitive confirmation that an area is infested.

How to get rid of them:

You may require professional assistance from a pest-control company in determining whether your home contains bedbugs.

Getting rid of bedbugs is not an easy process, and most cases of bedbug infestation will require treatment by a pest-control expert. Bedbugs can survive for up to a year without feeding, so they may persist even in unoccupied rooms. A variety of low-odor sprays, dusts, and aerosol insecticides can be used to eradicate bedbugs. These must be applied to all areas where the bugs are observed as well as spaces where they may crawl or hide. The pest-control expert may recommend certain forms of deep-cleaning such as scrubbing infested surfaces with a stiff brush to remove eggs, dismantling bed frames and furniture, filling cracks in floors, walls, and moldings, encasing mattresses within special bags labeled for bedbugs, or using a powerful vacuum on cracks and crevices. The vacuum bag must be sealed in a plastic bag and disposed of in an outdoor container. A pest-control company can help you determine if an infested mattress can be disinfected or must be discarded. It may be able to be covered with a zippered mattress cover labeled for bedbugs and the zipper tightly sealed after disinfection. The cover should be kept on for at least a year.

Infested items or clutter should be thrown out that cannot be cleaned. They should be sealed tightly in a plastic garbage bag and discarded in an outside container. If the box spring is infested, it may also be placed inside an encasement for a least one year. If wither mattress and/or box spring are thrown out, encase in 6mil plastic and duct tape and label “Bed Bugs” and throw away.

Be very cautious about using pesticides yourself. Pesticides can be hazardous to people and pets. Pesticides alone are rarely effective for bedbug eradication and it is not advised. If you choose to use a pesticide, follow these precautions: Only use pesticides clearly labeled for bedbugs. Never use cockroach spray, or other pesticide that does not list bedbugs on the label. Follow label instructions exactly. Understand that use may build up resistance to the pesticide within the infestation. Never spray pesticides on top of a mattress or sofas, or in areas where children are present. Avoid “insecticide bombs” and “foggers” in your home. These products can spread hazardous chemicals throughout your home and often drive bedbugs into ‘deeper’ hiding places. Sager products such as food-grade diatomaceous earth are no less effective for control than any other residual pesticide. Sleeping with the lights on has not shown to be effective in preventing bedbug bites. Conventional insect and tick repellents are also not useful against bedbugs.

Avoidance of infested areas is the method for prevention of bedbug bites. Recognition of bedbug infestation and proper treatment of affected rooms (usually with the help of a pest-control specialist) is the best way to prevent bedbugs in the home. Sealing the mattress in a bedbug-prevention casing can be beneficial. Bedbug interceptors can be very effective for trapping bedbugs moving to and from beds and other furniture.

You can inspect any hotel room for the presence of the telltale signs of bedbugs. It is important to check the mattress and headboard, and luggage racks. In hotels, keeping your suitcase away from the bed and on a luggage rack can help prevent bedbugs from infesting your luggage. When you return home, inspect your luggage and put clothes immediately into the washer. While washing does not kill bedbugs, drying clothes at high temperature can eliminate bed bugs and their eggs. Clean bedding, linens, curtains, rugs, carpets and clothes. Wash items in hot water and dry them on the highest dryer setting for 60 minutes. Such items also can be placed dry in a dryer on the highest setting for half an hour. Soak delicate clothes in warm water with lots of laundry soap for several hours before rinsing.

At home, do not store luggage under your bed. Ideally, luggage should be stored in a basement or garage. Other tips you can take to reduce the changes of bedbugs infesting your home include removing clutter, vacuuming frequently, and keeping belongings separate when taken to school or work.

Bedbugs can be kept out of home and from spreading infestation by washing clothing and bedding immediately after returning home. Inspect used furniture for bedbugs before bringing it into your home. Never bringing discarded bed frames, mattresses, box springs or upholstered items into your home. Never resell or donate infested furniture. Infested furniture and other items should be marked, destroyed, or made unusable to the extent possible.