ln EPSDT baby care

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BabyCare: 

BabyCare Fall 2006 Department of Medical Assistance Services

BabyCare: 

BabyCare Overview/Purpose Providers MICC Policy Updates Expanded Prenatal Services Role of CSBs and MICC Medicaid MCO High Risk Maternity and Infant Programs

Overview of BabyCare : 

Overview of BabyCare High risk pregnant mothers and high risk infants may receive intensive case management services which will be referred to as Maternal and Infant Care Coordination (MICC). Pregnant women (regardless of enrollment in MICC) are eligible for additional services called “Expanded Prenatal Services”.

The Purpose of BabyCare: 

The Purpose of BabyCare To reduce infant mortality and morbidity To ensure provision of comprehensive services to pregnant women and infants up to age two

Who can provide BabyCare? : 

Who can provide BabyCare? Community Health Centers Local Health Departments Rural Health Clinics Home Health Agencies Personal Care Agencies Local Departments of Social Services Community Service Boards

Slide6: 

Maternal Infant Care Coordination (MICC)

What is MICC?: 

What is MICC? MICC is the intensive care coordination/case management with goals to improve birth outcomes by ensuring pregnant women and infants receive all the services they need. Service elements include the risk screen, assessment, service planning, coordination and referral, follow-up and monitoring, and education and support services.

Eligibility for MICC : 

Eligibility for MICC Pregnant Women and infants up to age 2 who are enrolled in Medicaid Fee for Service FFS, FAMIS FFS and FAMIS MOMS.

Primary Care Providers: 

Primary Care Providers All providers must be enrolled as a Medicaid provider: Physician Nurse Practitioner Certified Nurse Midwife

Role of the Primary Care Provider: 

Role of the Primary Care Provider ID potential or existing problems Maternal Risk Screen DMAS 16 Infant Risk Screen DMAS 17 (Only the Primary Care Provider is responsible for filling out and signed the risk screen.) Referral to a MICC program. Assist in the development of the service plan as needed.

MICC Care Coordinators: 

MICC Care Coordinators Registered Nurse – must be licensed in VA and have a minimum of 1 year experience in community health nursing Social Worker – B.S.W. or M.S.W. and a minimum of 1 year experience in a health care setting Both RN and SW must have 1 year experience working with women and infants Agencies must be enrolled as BabyCare Provider

Policy Updates for MICC: 

Policy Updates for MICC

Initial Contact for Assessment & Enrollment: 

Initial Contact for Assessment & Enrollment Collateral contact initiated within 15 days Telephone contact with client, PCP and/or family members Client is opened to MICC once care coordinator initiates first contact (face-to-face or collateral). Face-to-face contact must occur with client within 30 days of referral

Extension for Visits: 

Extension for Visits If face-to-face contact is not completed within first 30 days, an extension of 30 days will be granted. If not able to engage client in services after this extension, close client and notify PCP and client via letter of closure.

Initial Contact Billing Requirements: 

Initial Contact Billing Requirements Can be reimbursed for care coordination for this period Completed Risk Screen (DMAS 16 or 17) MICC Record (DMAS-50) with sections #21 and #81 completed Medical record must have all attempted contacts documented

Refusal of Enrollment: 

Refusal of Enrollment If assessment visit was completed and client/family refused enrollment, provider may be reimbursed for assessment visit. Complete and submit MICC Record (DMAS-50) with demographic section, #81 and #82. Risk Screen May be reimbursed for Assessment, Care Coordination and mileage

Mileage FYI: 

Mileage FYI New code and rate for mileage with dates of service beginning July 1, 2006 S0215 = $ 0.33/mile Mileage will not be reimbursed unless the system has a paid care coordination claim. Mileage may not be billed until a successful face-to-face visit with the client is completed.

Follow-Up Monthly Contacts: 

Follow-Up Monthly Contacts After initial face-to-face completed and client is open to MICC, minimum monthly contact (collateral or face-to-face) must be completed Visit schedule should meet needs of client and identified in service plan Monthly care coordination may be reimbursed if successful face-to-face or telephonic contact with maternal client or infant client’s parent/caregiver is completed

Monthly Contacts cont.: 

Monthly Contacts cont. In event that care coordinator cannot establish contact with MICC client during a given month, an extension of one month will be granted to attempt to engage client/family to resume services. If no successful contact in two consecutive months, close case and notify PCP and client via letter of closure of case. Complete and submit Outcome Report (DMAS-53 or 54)

Admission Packet: 

Admission Packet Letter of Agreement DMAS-55 or DMAS-55-S (Spanish) Risk Screen Maternity DMAS-16 Infant DMAS-17 Maternal Infant Care Coordination Record DMAS-50

Admission Packet: 

Admission Packet Submit within 45 days of completion of MICC assessment Date on MICC Record (#21) will be used as the begin date. Do not submit Care Coordination or Mileage claims until DMAS has provided notification of enrollment.

Closure to MICC: 

Closure to MICC Care Coordinator must complete Outcome Report (DMAS-53 or 53) within 30 days of case closure DMAS will notify provider of closure date Do not need to close if client is enrolled in MCO

Expanded Medicaid Services for Pregnant Women: 

Expanded Medicaid Services for Pregnant Women Patient Education Nutrition Services Homemaker Services Substance Abuse Treatment

Education Classes: 

Education Classes Preparation for Childbirth (S9442) Patient Education Classes (S9446) Health and Nutrition Safety (Home and Car) Growth and Development Others as listed in manual, Appendix C Service Limit of six per procedure code Programs must be approved for Medicaid reimbursement.

Nutritional Services: 

Nutritional Services All pregnant women are expected to receive basic nutrition information from their medical care providers or the WIC program. Specialized Nutritional Services include: Nutritional Assessment (1) Nutritional Counseling (1) Counseling Follow Up (1) Provider must be Registered Dietician (R.D.) or person with a masters degree in nutrition or clinical dietetics.

Homemaker Services: 

Homemaker Services Homemaker Services Includes those services necessary to maintain household routine for pregnant women, primarily in third trimester, who need bed rest (as ordered by Physician). RN or LPN must provide supervision to the homemaker aides. Homemaker duties may be performed by a companion, homemaker, nursing assistant or home health aide.

Substance Abuse Treatment for Pregnant and Postpartum Women: 

Substance Abuse Treatment for Pregnant and Postpartum Women Residential and Day Treatment Services Services for Substance Abuse Treatment for Pregnant and Postpartum Women are captured in the Community Mental Health Rehabilitative Services Manual Chapter IV pages 35 – 40. Last revised 11/15/04.

Medicaid Managed Care Organizations (MCOs): 

Medicaid Managed Care Organizations (MCOs)

Virginia Administrative Code: 

Virginia Administrative Code MCOs are required to provide or arrange for services for pregnant women and children up to age 2 as described in the Virginia Adminsistrative Code. 12VAC30-50-410. Case management services for high risk pregnant women and children. (Does not include home visitation requirement.) http://leg1.state.va.us/lis.htm

Managed Care Organizations: 

Managed Care Organizations MCOs have their own high risk maternal and infant programs; however, may contract out with other agencies to provide case management and home visitation services. Providers must verify eligibility each month to know current benefit plan.

Check Eligibility: 

Check Eligibility http://virginia.fhsc.com MediCall 1-800-884-9730 1-800-772-9996

Meet your MCO High Risk Maternity and Infant Programs: 

Meet your MCO High Risk Maternity and Infant Programs

Slide33: 

Ashley Barton, LCSW Maternal Child Health Services Coordinator 804-371-7824 MICC@dmas.virginia.gov www.dmas.virginia.gov Thank You!

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