Payment will be made for prenatal and postpartum medical
care, health education, and transportation to receive prenatal and postpartum
services. Payment will be made for enhanced perinatal services for persons
determined high risk. These services include additional health education
services, nutrition counseling, social services, and one postpartum home visit.
Maternal health centers shall provide trimester and postpartum reports to the
referring physician. Risk assessment using Form 470-2942, Medicaid Prenatal
Risk Assessment, shall be completed at the initial visit during a Medicaid
member's pregnancy. If the risk assessment reflects a low-risk pregnancy, the
assessment shall be completed again at approximately the twenty-eighth week of
pregnancy. If the risk assessment reflects a high-risk pregnancy, referral
shall be made for enhanced services. (See description of enhanced services at
subrule 78.25(3).)
(1)
Provider
qualifications.
a. Prenatal and
postpartum medical services shall be provided by a physician, a physician
assistant, or a nurse practitioner employed by or on contract with the center.
Medical services performed by maternal health centers shall be performed under
the supervision of a physician. Nurse practitioners and physician assistants
performing under the supervision of a physician must do so within the scope of
practice of that profession, as defined by Iowa Code chapters 152 and 148C,
respectively.
b.
Reserved.
c. Education services and
postpartum home visits shall be provided by a registered nurse.
d. Nutrition services shall be provided by a
licensed dietitian.
e. Psychosocial
services shall be provided by a person with at least a bachelor's degree in
social work, counseling, sociology, psychology, family and community services,
health or human development, health education, or individual and family
studies.
(2)
Services covered for all pregnant women. Services provided may
include:
a. Prenatal and postpartum medical
care.
b. Health education, which
shall include:
(1) Importance of continued
prenatal care.
(2) Normal changes
of pregnancy including both maternal changes and fetal changes.
(3) Self-care during pregnancy.
(4) Comfort measures during
pregnancy.
(5) Danger signs during
pregnancy.
(6) Labor and delivery
including the normal process of labor, signs of labor, coping skills, danger
signs, and management of labor.
(7)
Preparation for baby including feeding, equipment, and clothing.
(8) Education on the use of over-the-counter
drugs.
(9) Education about HIV
protection.
c. Home
visit.
d. Transportation to receive
prenatal and postpartum services that is not payable under rule
441-78.11 (249A) or
441-78.13 (249A).
e. Dental hygiene services within the scope
of practice as defined by the dental board at 650-paragraph
10.5(3)"b."
(3)
Enhanced services covered for
women with high-risk pregnancies. Enhanced perinatal services may be
provided to a patient who has been determined to have a high-risk pregnancy as
documented by Form 470-2942, Medicaid Prenatal Risk Assessment. An
appropriately trained physician or advanced registered nurse practitioner must
be involved in staffing the patients receiving enhanced services.
Enhanced services are as follows:
a. Reserved.
b. Education, which shall include as
appropriate education about the following:
(1)
High-risk medical conditions.
(2)
High-risk sexual behavior.
(3)
Smoking cessation.
(4) Alcohol
usage education.
(5) Drug usage
education.
(6) Environmental and
occupational hazards.
c.
Nutrition assessment and counseling, which shall include:
(1) Initial assessment of nutritional risk
based on height, current and prepregnancy weight status, laboratory data,
clinical data, and self-reported dietary information.
(2) Ongoing nutritional assessment.
(3) Development of an individualized
nutritional care plan.
(4) Referral
to food assistance programs if indicated.
(5) Nutritional intervention.
d. Psychosocial assessment and
counseling, which shall include:
(1) A
psychosocial assessment including: needs assessment, profile of client
demographic factors, mental and physical health history and concerns,
adjustment to pregnancy and future parenting, and environmental
needs.
(2) A profile of the
client's family composition, patterns of functioning and support
systems.
(3) An assessment-based
plan of care, risk tracking, counseling and anticipatory guidance as
appropriate, and referral and follow-up services.
e. A postpartum home visit within two weeks
of the child's discharge from the hospital, which shall include:
(1) Assessment of mother's health
status.
(2) Physical and emotional
changes postpartum.
(3) Family
planning.
(4) Parenting
skills.
(5) Assessment of infant
health.
(6) Infant care.
(7) Grief support for unhealthy
outcome.
(8) Parenting of a preterm
infant.
(9) Identification of and
referral to community resources as needed.
(4)
Vaccines. In order to be
paid for the administration of a vaccine covered under the Vaccines for
Children (VFC) Program, a maternal health center must enroll in the VFC
program. Payment for the vaccine will be approved only if the VFC program stock
has been depleted.
This rule is intended to implement Iowa Code section
249A.4.
