Md. Code Regs. 10.67.06.21 - Benefits - Pregnancy-Related Services
A. An MCO shall provide to its pregnant and
postpartum enrollees medically necessary pregnancy-related services, including:
(1) Comprehensive prenatal, perinatal, and
postpartum care, including high-risk specialty care when appropriate;
(2) Prenatal risk assessment and development
of an individualized plan of care that specifies the actions required to
address each identified need and is appropriately modified during the course of
care;
(3) Enriched maternity
services, including:
(a) Prenatal and
postpartum counseling and education;
(b) Basic nutritional education;
(c) Substance abuse treatment, as provided in
Regulation .10 of this chapter;
(d)
Appropriate referrals to services that may improve the pregnancy outcome,
including:
(i) Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC), and
(ii) Healthy Start services;
(e) High-risk nutrition counseling
services for nutritionally high-risk pregnant women;
(f) Appropriate levels of inpatient care,
including emergency transfer of pregnant women and newborns to tertiary care
centers;
(g) Smoking cessation
education and treatment;
(h) Doula
services; and
(i) Home visiting
services.
B.
When an enrollee recovering from childbirth elects to be discharged before 48
hours following a normal vaginal delivery or 96 hours following an
uncomplicated cesarean section, the MCO is responsible for providing:
(1) One home visit scheduled to occur within
24 hours after discharge; and
(2)
An additional home visit as may be prescribed by the attending
provider.
C. When an
enrollee recovering from childbirth and her newborn enrollee remain in the
hospital for at least as long as the period of time provided under §B of
this regulation, the MCO shall provide a home visit as prescribed by the
attending provider.
D. An MCO shall
provide for home visits required by §§B and C of this regulation to
be performed by a registered nurse and in accordance with generally accepted
standards of nursing practice for home care of a mother and newborn child,
including:
(1) An evaluation of the presence
of immediate problems of dehydration, sepsis, infection, jaundice, respiratory
distress, cardiac distress, or other adverse physical symptoms of the
infant;
(2) An evaluation of the
presence of immediate problems of dehydration, sepsis, infection, bleeding,
pain, or other adverse symptoms of the mother;
(3) Collection of a blood specimen for
newborn screening if not previously completed;
(4) Referrals for any medically necessary
continuing health care services; and
(5) Any other nursing services ordered by the
referring provider.
Notes
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