The landscape of perinatal care for Medicaid beneficiaries is significantly improved through initiatives like the Medicaid Maternity Care Program, modeled after the successful enhanced primary care case management (PCCM) program developed by Community Care of North Carolina (CCNC). This program reflects a partnership between NC Medicaid, CCNC, community stakeholders, healthcare providers, local health departments, and the Division of Public Health (DPH), all working together to ensure healthier pregnancies and births.
Key Aspects of the Medicaid Maternity Care Program
This program, often referred to as the Pregnancy Medical Home (PMH), is designed to provide comprehensive support to pregnant individuals enrolled in Medicaid. It’s crucial to understand that the Medicaid Maternity Care Program is not limited to those under the Medicaid for Pregnant Women (MPW) category. Eligibility extends to any pregnant Medicaid beneficiary whose aid program covers pregnancy services. This inclusive approach ensures that a wider population can benefit from enhanced maternity care.
A cornerstone of the Medicaid Maternity Care Program is its focus on care management. All participating pregnant Medicaid beneficiaries receive care management services, which can be described as population management aimed at promoting healthy pregnancies. For those identified as high-risk, the program offers intensive case management services. Dedicated case managers play a vital role in closely monitoring these high-risk pregnancies through consistent communication with both the healthcare provider and the patient. This proactive monitoring is essential for fostering healthy birth outcomes and addressing potential complications promptly.
Provider Participation and Program Requirements
For healthcare providers to participate in the Medicaid Maternity Care Program, and thus offer enhanced services to their Medicaid patients, they must agree to specific program guidelines. These guidelines are designed to improve the quality of maternity care and include several key commitments:
- Eliminating Elective Deliveries Before 39 Weeks: Participating providers must ensure, through agreements with all professional staff, that no elective deliveries are performed before 39 weeks of gestation. This practice is crucial for ensuring the optimal health and development of newborns.
- Reducing Cesarean Section Rates: The program encourages providers to actively work towards decreasing the rate of cesarean sections, particularly among women who are giving birth for the first time (nulliparous women), aligning with national guidelines for safe and effective childbirth practices.
- Comprehensive High-Risk Screening and Care Planning: A critical component is the completion of a high-risk screening for every pregnant Medicaid beneficiary entering the program. Furthermore, providers are expected to integrate the resulting plan of care with local care and case management services, ensuring a coordinated and supportive approach.
- Open Chart Audits: To maintain program integrity and quality assurance, participating providers must agree to open chart audits, allowing for review and feedback to continually improve care delivery.
In return for adhering to these program expectations and contributing to the enhanced Medicaid Maternity Care Program, providers receive several significant benefits and incentives:
- Exemption from Prior Approval for Ultrasounds: The administrative burden is reduced through the exemption from prior approval requirements for ultrasounds, streamlining the process for necessary prenatal imaging.
- Initial High-Risk Screening Fee: Providers receive a $50 incentive for completing the high-risk screening tool at the initial visit, acknowledging the importance of early risk assessment.
- Postpartum Visit Incentive: A $150 incentive is provided for each postpartum visit per Medicaid beneficiary, emphasizing the significance of follow-up care after delivery for both maternal and infant health.
- Increased Vaginal Delivery Rate: Providers also benefit from an increased reimbursement rate for vaginal deliveries, further supporting and incentivizing best practices in maternity care.
It’s important to note that participation in the Medicaid Maternity Care Program is not exclusive to obstetric providers. Providers who bill global, package, or individual pregnancy procedures are eligible to participate, as long as they commit to fulfilling the program requirements. This broad eligibility ensures that a wide range of healthcare professionals can contribute to and benefit from this initiative.
For more detailed information, providers can refer to the Clinical Coverage Policy 1E-6, Pregnancy Medical Home.
Accessing Resources and Further Information
To facilitate effective implementation and understanding of the Medicaid Maternity Care Program, a range of resources and forms are readily available:
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Pregnancy Risk Screening Forms: Available in both English and Spanish, these forms are essential tools for providers in identifying and addressing potential risks early in pregnancy.
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Informative Presentations: Several presentations offer valuable insights into the program:
Contact Information for Inquiries
For any questions or further clarification regarding the Medicaid Maternity Care Program, individuals and providers are encouraged to reach out to the following contacts:
- Contact Information for CCNC Networks: Accessible via Contact Information for CCNC Networks.
- NC Medicaid Clinical Section:
- Phone: 888-245-0179
- Fax: 919-715-0051
By leveraging these resources and points of contact, stakeholders can effectively engage with and benefit from the Medicaid Maternity Care Program, ultimately contributing to improved maternal and infant health outcomes within the Medicaid system.
