Maternal Health Agreement Addenda (MH AA) Changes from 08-09 to 09-10
INSTRUCTIONS: New changes are in bold.
08/09 Re: Clinical (Change #1) III. Scope of Work and Deliverables: Did not have the added change Changes for 09/10 (Change #1) III. Scope of Work and Deliverables: Throughout this document, the following words are defined as follows: “shall” indicates a mandatory program policy; “should” indicates a recommended program policy; and “can” or “may” indicates a suggestion or consideration. (Change #2) III. Scope of Work and Deliverables: 4. The Health Department shall offer Maternity Care Coordination Program (MCCP) services to Medicaid eligible patients. The health department shall have written policies and protocols in place for providing MCC services (and MOW services, if applicable), in accordance with the DMA Clinical Coverage Policies (DMA Clinical Coverage Policy No.: 1M-8, and DMA Clinical Coverage Policy No.: 1M-7) to Medicaid eligible patients, which include the following: (a). Program policies describing program services, record keeping, program eligibility, fees, outreach, and quality assurance. (b). Program procedures describing referral process, initial visit, MCCP Intake Screening form completion and submission, subsequent visits, follow-up for missed prenatal appointments and MCC contacts, closure, Pregnancy Outcome Summary completion and submission, transfer, and screening/referral to other care coordination programs. (c). Staffing procedures describing verification of staff qualifications, orientation and case conferencing. Reasons for Changes (Change #1) Added for clarification of terms throughout the document and to make FP and MH have similar terms.
Re: MCC (Change #2) III. Scope of Work and Deliverables: 4. The Health Department shall offer Maternity Care Coordination Program (MCCP) services to Medicaid eligible patients. The health department shall have written policies in place for providing MCC services (and MOW services, if applicable) to Medicaid eligible patients. (DMA Clinical Coverage Policy No.:1M-8, and DMA Clinical Coverage Policy No.:1M-7)
(Change #2) To provide an outline and guidance for a detailed, structured policy and procedure manual for agency MCCP staff, regarding specific agency implementation of the DMA Clinical Coverage Policy requirements.
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Re: Clinical (Change #3) III. Scope of Work and Deliverables: 5. The Health Department shall provide the 5A method for tobacco cessation to all pregnant and postpartum women using the 5As (ask, advise, assess, assist, arrange) as recommended by ACOG and referral made to appropriate community resource or the NC Tobacco Use Quit Line at 1-800-QUIT-NOW. (Guidelines for Perinatal Care, Sixth Edition (ACOG), p. 94-96) Re: MCC (Change #4) III. Scope of Work and Deliverables: III. 6. The Health Department shall refer all women receiving MCC services for a postpartum check-up to LHD services (prenatal or family planning clinics) or to a physician. (DMA Clinical Coverage Policy No.:1M-8) Re: Clinical (Change #5) III. Scope of Work and Deliverables: III. 7. The Health Department shall provide or shall make referrals for nutrition consultation, education on infant feeding, childbirth and parenting education for low-income families. These referrals must be documented in the MCC chart or other client record. (ACOG, p.84-92) 6/30/2009
(Change #3) III. Scope of Work and Deliverables: 5. The Health Department shall provide the 5A method for tobacco cessation to all pregnant and postpartum women using the 5As (ask, advise, assess, assist, arrange) as recommended by ACOG and referral made to appropriate community resource or the NC Tobacco Use Quit Line at 1-800-QUIT-NOW. Another resource is the “Guide for Counseling Women who Smoke, March 2008”. (Guidelines for Perinatal Care, p. 94-96)
(Change #3) Added Resource.
(Change #4) III. Scope of Work and Deliverables: Format change: III 6 was taken out and placed under III. 8. NOW is III 8 (m). Now reads: Referral of all women receiving MCC services for a postpartum check-up to LHD services (prenatal or family planning clinics) or to a physician. (Change #5) III. Scope of Work and Deliverables: III. 6. (note format change was #7) The Health Department shall provide or shall make referrals for nutrition consultation, education on infant feeding, childbirth and parenting education for lowincome families. These referrals must be documented in the Maternal Health, MCC or other client record. (ACOG, p.84-92) Health departments that provide childbirth education that is being provided to Medicaid enrollees and billed to Medicaid or
(Change #4) Format change for flow improvement
(Change #5) Revised to add DMA polices especially in regards to Child Ed classes. Medicaid will pay for childbirth education services when Childbirth Educators either meet state-approved childbirth education program requirements or are certified by one the following organizations:
Lamaze International, Inc. (ASPO/LAMAZE)
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provided to non-Medicaid clients as part of your use of Healthy Mothers, Healthy Children funding must provide these services in accordance with the DMA Clinical Coverage Policies (DMA Clinical Coverage Policy 1M-2, Childbirth Education). Childbirth education activities not being billed to Medicaid or funded through Healthy Mothers, Healthy Children funding, such as those supported by funders such as Smart Start, are not subject to these requirements, and may follow the standards agreed upon between the funder and the health department.
International Childbirth Education Association (ICEA) Council of Childbirth Educators (BEST) Academy of Certified Birth Educators and Labor Support Professionals (BABE) Academy of Husband-Coached Childbirth (Bradley Method)
FYI – “The August, 2008 Medicaid Bulletin included an article indicating that effective January 1, 2008 the definition and rate for S9442, Childbirth Education (CBE) had changed. As of January 1, 2008 the definition was changed to 1 unit = 1 hour and the rate were changed to $9.55 per one unit/hour.” Note: rates are retroactive until January 1, 2008. Contact Tonya Daniel @ the WHB with further questions 919-707-5680 (Change #6) Requirement now included in III. 4. for MCCP recipients (See Item 1 above). It is still a requirement for the agency to have a policy regarding follow-up of missed prenatal appointments for Maternal Health patients. However, the requirement for a policy regarding follow-up of missed Maternity Care Coordination appointments has been moved to Section 4, and included in the comprehensive policies for the MCC Program.
Re: MCC (Change #6) III. Scope of Work and Deliverables: III. 9. The Health Department shall have written policies and protocols in place that appropriately address the following: Follow-up of missed prenatal and Maternity Care Coordination appointments (DMA Clinical Coverage Policy No.:1M-8)
(Change #6) III. Scope of Work and Deliverables: III. 8. (note # 9 became # 8 ) The Health Department shall have written policies and protocols in place that appropriately address the following: (a) Follow-up of missed prenatal appointments.
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(Change #7) Re: Clinical III. Scope of Work and Deliverables: III. 9. m. Provision of Rubella (ACOG, p. 324) and recommendation for Varicella (ACOG, p. 327) vaccine post-delivery if patient “not immune”.
(Change #7) III. Scope of Work and Deliverables: III. 8. (was 9. m now 8 “L”) (l) Provision of Rubella (ACOG, p. 324) and Varicella (ACOG, p. 327) vaccine post-delivery if patient not immune.
(Change #7) Best Practice and ACOG Recommendation FYI - Billing Info: Medicaid and MPW will cover (Must provide vaccines within the MPW Postpartum Payment Window of 60 days). Could use state funding Could use state vaccine ONLY for postpartum Teen’s 18 y.o. or under with NO other form of payment for vaccine and CAN NOT bill EVER for state Can bill pt directly but following certain rules: - under 100% FPL can’t bill -101 -185% FPL could bill using a SFS -over 185% could bill per agency policy. Varicella Vaccine CPT code is: 90716 Diagnosis Code: V05.4 As of April 2009 Medicaid reimbursement was $72.44
(Change #8) Re: Clinical III. 9. n. – Not previously addressed
(Change #8) III. 8. n. – New Policy: Use of 17 Hydroxyprogesterone Caproate (17P) for women at risk for developing preterm labor, such as a history of previous spontaneous birth at less then 37 weeks. (ACOG p. 175-176)
(Change #8) ACOG recommends use of 17P to prevent recurrent preterm birth; 17P is available via Medicaid or state appropriations. Is been clinically known to work. This is a policy requirement only: Could have referral in policy to providers who provide 17P, but should also include 1) Identifying proper candidates 2) educating pt’s on 17 P 3) Accessing 17P (providing it themselves or
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referring) If you have issues with your county/provider contact your Regional Nurse Consultant who can assist. is a good website for 17P info and also has info on state billing for 17P. Go to the site, and click on the bottom 17P icon.
www.mombaby.org
(Change #9) III. 10. e. (e) Weight and height for all pregnant women shall be documented at the initial prenatal visit. (ACOG News Release, August 31, 2005; ACOG, p.89)
(Change #10) III. 10. f. Pre-pregnancy weight shall be determined and body mass index (BMI) calculated to identify gestational weight gain recommendations as per the Institute of Medicine guidelines. For obesity class III patients (BMI 40+), gaining less than the minimum weight gain recommendation may be appropriate. (ACOG, p. 89-93; 191-192
(Change #9) III. 9. c. (c) Weight and height for all pregnant women shall be documented at the initial prenatal visit (ACOG News Release, August 31, 2005; ACOG, p.89) and weight plotted on prenatal weight gain chart at routine visits. Nutrition consultation should be offered to all obese women; pre-pregnancy BMI> 30. (ACOG, p.89; 191-192) This may be accomplished, for example, by a referral to WIC. (Change #10) III. 9. d. Pre-pregnancy weight shall be determined and body mass index (BMI) calculated to identify gestational weight gain recommendations as per the Institute of Medicine guidelines. (ACOG, p.90; 191-192) For obesity class III patients (BMI 40+), gaining less than the minimum weight gain recommendation may be appropriate. (ACOG, p. 89-93; 191-192)
(Change #9) Recent ACOG clinical guideline regarding pregnancy and obesity.
(Change #10) Added Reference
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(Change #11) III. 10. d. Nutrition screening shall be performed by a nurse, nutritionist, physician or physician extender at first visit. Based on this screening, an appropriate care plan or referral to a Registered Dietitian (RD) or a Licensed Dietitian/Nutritionist (LDN)*will be documented by the initial exam. (ACOG, p. 89-93) *(Licensed by the North Carolina Board of Dietetics)
(Change #11) III. 9. f. Nutrition screening shall be performed by a nurse, nutritionist, physician or physician extender at first visit. Based on this screening, an appropriate care plan or referral to a Registered Dietitian (RD) or a Licensed Dietitian/Nutritionist (LDN)* will be documented by the initial exam. (ACOG, p. 89-93) *(Licensed by the North Carolina Board of Dietetics) When Medical Nutrition Therapy is provided, nutrition counseling (assessment and management) shall be performed as per DMA guidelines, by a Registered Dietitian (RD) or a Licensed Dietitian/Nutritionist (LDN)*. *Licensed by the North Carolina Board of Dietetics/Nutrition (Medical Nutrition Therapy (MNT). (DMA Clinical Coverage Policy No. 1-I January 2008). Nutrition counseling, or a referral, is provided for patients with any high risk condition listed below. (Medical Nutrition Therapy (MNT) as per DMA Clinical Coverage Policy No. 1-I January 2008). A nutrition care plan and appropriate follow-up is documented for each identified nutrition problem: (1) Conditions which impact on length of gestation or birth weight where nutrition is the underlying cause such as severe anemia (Hgb<10gm/d1 or Hct <30%); underweight preconceptionally (<19.8 BMI) complicated by inadequate weight gain during pregnancy, and intrauterine growth restriction, very young maternal age (under the age of 16), multiple gestation, substance use. (2) Metabolic disorders such as diabetes, thyroid dysfunction, maternal PKU or other inborn errors of metabolism.
(Change #11) Updated Medical Nutrition Therapy (MNT) DMA policy. Must be done ONLY if billing for MNT (Medical Nutrition Therapy). Placed here to remind people first that if you are doing MNT you could bill for it, and 2nd to inform everyone that DMA has added #6 (obesity) and #7 (Document history of…) to the list of billable MNT services. For LHD and non-Medicaid pt’s that don’t bill Medicaid, they still must provide nutrition referral, have a care plan if keeping pt’s or do proper referral to high risk clinics as indicated in III. 9. f.
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(3) Chronic medical conditions such as cancer, heart disease, hypertension, hyperlipidemia, inflammatory bowel disease, malabsorption syndromes or renal disease. (4) Autoimmune diseases of nutritional significance such as systemic lupus erythematosus. (5) Eating disorders such a severe pica, anorexia nervosa or bulimia nervosa. (6) Obesity. (7) Documented history of a relative of the first degree with cardiovascular disease and/or possessing factors that significantly increase the risk of cardiovascular disease, such as sedentary lifestyle, elevated cholesterol, smoking, high blood pressure, and higher than ideal body weight. (Change #12)
(Change #12) The following are format changes only: III. 10. (h) now is III. 9 (g) III. 10. (i) now is III. 9 (h) III. 10. (j) now is III. 9 (i) III. 10. (k) now is III. 9 (j) III. 10. (l) now is III. 9 (K) III. 10. (m) now is III. 9 (l) III. 9. (k) moved now III. 9. (m) (Change #13) III. 10. q. Screening for Gonorrhea on initial visits and repeated in the third trimester if<25 years of age (10A NCAC 41A.0204 (e), CDC-MMWR, (September 22, 2006/V. 55/No. RR14) (ACOG, p. 332-333).
(Change #12) Formatting was change to include all services under #9 and all labs under #10
(Change #13) III. 10. d. Screening for Gonorrhea on initial visits and repeated in the third trimester if<25 years of age or > 25 years old and participating in high risk behaviors such as a new partner, multiple partners, little or no prenatal care, recent STD or substance use .(10A NCAC 41A.0204 (e), CDC-MMWR, (August 4, 2006/V. 55/No. RR-14) (ACOG, p. 332-334)
(Change #13) Updated from ACOG to include high risk individuals 25 y.o. and older
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(Change #14) III. 10. r. Screening for Chlamydia on the initial visit and repeated in the third trimester if less than 25 years of age (CDC-MMWR; Sexually Transmitted Disease Treatment Guidelines September 22, 2006; 10A NCAC 41A.0204(e); ACOG, p. 101, 334335) (Change #15) III. 10. x. Urine culture specific for GBS will be done at initial visit, and repeated if needed. (ACOG, p. 328, 374) Women with any quantity of GBS bacteria during pregnancy should be treated according to current standards of care for urinary tract infection in pregnancy. (MMWR, August 16, 2002, V. 51, No. RR-11, p. 11; ACOG, p. 327-330) (Change #16) III. 10. cc. Screening for Group B Strep at 3537 weeks. (ACOG, p. 326-330; MMWR, August 16, 2002, V. 51, #RR-11) Re: MCC (Change #17) III. 10. dd. The Health Department shall complete the Pregnancy Outcome Summary for all Maternal Health
(Change #14) III. 10. e. Screening for Chlamydia on the initial visit and repeated in the third trimester if less than 25 years of age or > 25 years old and participating in high risk behaviors such as a new partner, multiple partners, little or no prenatal care, recent STD or substance use . (CDC-MMWR; Sexually Transmitted Disease Treatment Guidelines August 4, 2006; 10A NCAC 41A.0204(e); ACOG, p. 101, 332-334) (Change #15) III. 10. k. Urine culture specific for GBS will be done at initial visit, and repeated if needed. (ACOG, p. 328, 374) Women with any quantity of GBS bacteriuria during pregnancy should be treated according to current standards of care for urinary tract infection in pregnancy and no 35-37 week cultures done if diagnosed with positive GBS bacteriuria during the current pregnancy. (MMWR, August 16, 2002, V. 51, No. RR-11, p. 11; ACOG, p. 327-330)
(Change #14) Updated from ACOG to include high risk individuals 25 y.o. and older
(Change #15) Amplifies existing ACOG and 2002 CDC recommendation re GB strep. They should have NO cultures if already diagnosed with GBS in the urine because is considered systematic and therefore automatically requires treatment in L &D. This clarification may also help decrease unnecessary spending.
(Change #16) III. 10. p. Screening for Group B Strep at 35-37 weeks if no GBS bacteria diagnosed in current pregnancy. (ACOG, p. 326-330; MMWR, August 16, 2002, V. 51, #RR-11) (Change #17) III. 11. The Health Department shall complete the Pregnancy Outcome Summary for all Maternal Health patients, within 30 days of discontinuation of services and
(Change #16) Amplifies existing ACOG and 2002 CDC recommendation re GBS.
(Change #17) Delete text was duplicative of current requirements of DMA MCCP policy. The Pregnancy Outcome Summary must still be completed for all Maternity Care
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patients, including MCC clients, within 30 days of discontinuation of services and submit this summary through the Health Services Information System (HSIS) (DMA, Clinical Coverage Policy No.: 1M-8, pg.7 HSIS User’s Manual, 5.L-1 Revised July 1, 1991) Re: Clinical (Change #18) III. 11. b. (fourth bullet) Practices to promote health maintenance; balanced nutrition (ideal calorie intake and weight gain); exercise safety* and daily activity; travel; alcohol and tobacco consumption, caution about drugs (illicit, prescription, and nonprescription); use of safety belts; sauna and hot tub exposure; vitamin and mineral toxicity; prevention of HIV infection and other STDs; environmental exposure; and nausea and vomiting during pregnancy.
submit this summary through the Health Information System (HIS) (HIS User’s Guide Revised 12/07)
Coordination clients, but the requirement for the POS to be completed is included in DMA Clinical Coverage Policy and will be monitored through the use of the MCCP Audit Tool.
(Change #18) III. 13. c. (fourth bullet) Practices to promote health maintenance; balanced nutrition (ideal calorie intake and weight gain); exercise safety* and daily activity; travel; alcohol and tobacco consumption, caution about drugs (illicit, prescription, and non-prescription); use of safety belts; sauna and hot tub exposure; vitamin and mineral toxicity; prevention of HIV infection and other STDs; environmental exposure; and nausea and vomiting during pregnancy. *Warning signs to terminate exercise while pregnant include: chest pain, vaginal bleeding, dizziness, headache, decreased fetal movement, amniotic fluid leakage, muscle weakness, calf pain or swelling, preterm labor, or regular uterine contractions (ACOG, p. 94) (Change #19) III. 13 c. (Seventh bullet) Advise on avoiding eating certain fish with high levels of mercury, including shark, swordfish, king mackerel and tilefish (ACOG, p.90-92) and advise not to eat unpasteurized cheese and milk; hot dogs or luncheon meats (unless they are steaming hot); refrigerated smoked seafood, pâtés or meat spreads. (ACOG, p. 331)
(Change #18) Recent ACOG definition of exercise safety inserted to provide clarity.
(Change #19) III. 11 b. (Seventh bullet) Advise on avoiding eating certain fish with high levels of mercury, including shark, swordfish, king mackerel and tilefish (ACOG, p.9092) and advise not to eat hot dogs or luncheon meats unless they are steaming hot and to avoid unpasteurized soft cheeses. (ACOG, p. 331)
(Change #19) Updates on ACOG’s recent clarification of unsafe foods.
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(Change #20) Re: MCC (for the rest of this document) III. 14 The maternity nurse supervisor, MCC, and HBI supervisors and SIDS Counselors shall have active electronic mail membership and direct access to the Internet. HMHC funds can be used to finance and maintain hardware, software and subscription linkage to current local market values. The Internet connection enables participation in Women’s Health Branch List Serves,
access to other technical resources and to maternal health materials.
(Change #20) (Change #20) III. 16 - Number III. 14 became III. 16 The word “supervisor” was added after The maternity nurse supervisor, MCC supervisor, HBI “MCC” for clarification purposes. supervisor and SIDS Counselors shall have active electronic mail membership and direct access to the Internet. HMHC funds can be used to finance and maintain hardware, software and subscription linkage to current local market values. The Internet connection enables participation in Women’s Health Branch List Serves, access to other technical resources and to maternal health materials.
(Change #21) III. 16 a. Public Health Social Worker/Maternity Care Coordinator Training All new Maternity Care Coordinators must complete provider training as required by the DMA Policy for the MCCP (DMA Clinical coverage Policy No.: 1M-8). Regional social work consultants must be notified within 30 days of hiring new staff.
(Change #21) III 16 a. - this information was deleted from 09/10 MH AA. 18 a. The following requirement was added to the 09/10 MH AA under 18 a. Maternity Care Coordinator Staffing and Training (a) The Staff Change Notification Form shall be completed and submitted to the Baby Love Program Manager within 30 days of staff change including: hiring new staff, position vacancy, position elimination, or other MCC position change. Additionally, the Regional Social Work Consultant shall be notified of new staff within 30 days of hire date.
(Change #21) MCC training is a requirement of DMA MCCP policy and will be monitored through the use of the MCCP Audit Tool. The timely submission of the Staff Change Notification Form to both the Baby Love Program Manager and the Regional Social Work Consultant is required in order for WHB staff to facilitate compliance with DMA MCCP training requirements and to maintain an up-to-date statewide directory of all MCCP supervisors, managers, and providers.
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(Change #22) III 16 b. All new Maternity Care Coordinator social workers and Health and Behavior Intervention Licensed Clinical Social Workers (LCSWs), without previous public health experience or education, are recommended to complete within one year of hire date, the Introduction to Principles and Practices of Public Health Training. (Change #23) III. 17 a. Maternal Outreach Worker Training All new Maternal Outreach Workers shall complete provider training as required by the DMA Policy for MOW services. (DMA Clinical Coverage Policy No.: 1M-7) Regional social work consultants must be notified within 30 days of hiring new staff.
(Change #22) III 16 b changed to III 18 b. All new Maternity Care Coordinator social workers and Health and Behavior Intervention Licensed Clinical Social Workers (LCSWs), without previous public health experience, are required to complete within one year of hire date, the Introduction to Public Health in North Carolina online course, http://www.sph.unc.edu/oce.
(Change #22) Effective July 1, 2008, the “Introduction to Principles and Practices of Public Health” face-to-face training series was discontinued and was replaced with the new online course “Introduction to Public Health in North Carolina.” This course is changed from recommended to require for all new MCC social workers and HBI LCSWs that do not have previous public health experience.
(Change #23) III 17 a. This information was deleted from the 09/10 MH AA. 19 a. The following requirement was added to the 09/10 MH AA under 19 a. Maternal Outreach Worker Staffing and Training The Staff Change Notification Form shall be completed and submitted to the Baby Love Program Manager within 30 days of a staff change including: hiring new staff, position vacancy, position elimination, or other MOW position or staff change. Additionally, the Regional Social Work Consultant shall be notified of new staff within 30 days of hire date. (Change #24) (b) All new Maternal Outreach Workers are required to complete within one year of hire date, the Introduction to Public Health in North Carolina online course, http://www.sph.unc.edu/oce.
(Change #23) MOW training is a requirement of DMA MOW policy and is monitored on the Audit Tool for the MOW Program. The timely submission of the Staff Change Notification Form to both the Baby Love Program Manager and the Regional Social Work Consultant is required in order for WHB staff to facilitate compliance with DMA MOW training requirements and to maintain an up-to-date statewide directory of all MOW supervisors, managers, and providers.
(Change #24) (b) All new Maternal Outreach Workers are required to complete the Introduction to Principles and Practices of Public Health Training within one year of hire date.
(Change #24) Effective July 1, 2008, the “Introduction to Principles and Practices of Public Health” face-to-face training series was discontinued and was replaced with the new online course “Introduction to Public Health in North Carolina.” Page 11 of
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