10 Colo. Code Regs. § 2505-10-8.748

Current through Register Vol. 47, No. 24, December 25, 2024

Section 10 CCR 2505-10-8.748 - PRENATAL PLUS PROGRAM

8.748.1DEFINITIONS

Initial Assessment Form means the Prenatal Plus Program risk assessment tool that must be used by all Prenatal Plus Program Providers to further assess and document a client's needs.

Program Eligibility Screening Form means the Prenatal Plus Program eligibility tool that must be used by all Prenatal Plus Program Providers to determine if a client is eligible for Prenatal Plus Program services.

Prenatal Plus Program Provider means an entity or agency that meets the qualifications described in Section 8.748.4 and has been accepted as such by the Department of Health Care Policy and Financing (the Department).

8.748.2PROGRAM PURPOSE

The purpose of the Prenatal Plus Program is to improve the maternal and infant health outcomes of at-risk Medicaid clients by providing comprehensive and coordinated prenatal and early postpartum support services that complement traditional clinical prenatal care. The primary goal of the program is to reduce the incidence of low birth weight babies while also addressing other lifestyle, behavioral, and non-medical aspects of a woman's life that may affect her and/or her baby's health and well-being. By focusing on case management, nutrition counseling and support, psychosocial counseling and support, client education and health promotion, the Prenatal Plus Program seeks to ensure that women have access to the services and information needed to have healthy pregnancies and healthy babies.

8.748.3CLIENT ELIGIBILITY

8.748.3.A To be eligible for services provided through the Prenatal Plus Program, a Colorado Medicaid client shall:

1. Be pregnant (self-declared or medically verified) or in the postpartum period (but participated in the Prenatal Plus Program during the prenatal period); and

2. Be determined by a Prenatal Plus Program Provider using the Program Eligibility Screening Form to be at risk of having a negative maternal and/or infant health outcome(s) due to identified risk factors which shall be further assessed and documented using the Initial Assessment Form.

8.748.4PROVIDER ELIGIBILITY AND QUALIFICATIONS

8.748.4.A Providers wishing to render and be reimbursed for Prenatal Plus Program services, as a condition of being a Prenatal Plus Program Provider, shall:

1. Be a Colorado Medicaid provider enrolled as one of the following Colorado Medicaid Billing Provider Types: Clinic, Federally Qualified Health Center, Rural Health Center, Non-Physician Practitioner Group, Physician, Nurse Practitioner, Certified Nurse-Midwife, or Physician's Assistant;

2. Execute and submit a Prenatal Plus Program addendum to the Colorado Medical Assistance Program Provider Participation Agreement for review and acceptance by the Department; and

3. Manage a Prenatal Plus Program multidisciplinary team(s) of personnel. The multidisciplinary team shall include:

a. A care coordinator(s) who acts as the hub of the multidisciplinary team and is the person primarily responsible for organizing resources and assisting clients in accessing services to meet their individual needs. The care coordinator(s) shall, at minimum, hold a bachelor's degree in a relevant human/social services discipline or be a registered nurse;

b. A registered dietitian(s) who is currently registered with the Commission on Dietetic Registration as a registered dietitian, or a dietetic intern(s) in an internship accredited by the American Dietetic Association and supervised by a registered dietitian who has agreed to serve as a preceptor for the dietetic intern;

c. A mental health professional(s) who, at minimum, is a master's level professional in the field of social work, marriage and family therapy, professional counseling, or other mental health specialty, or an intern(s) in an accredited mental health internship and supervised by a master's level mental health professional; or the Prenatal Plus Program Provider must have a consistent, documented referral relationship with a mental health provider(s) not part of the multidisciplinary team but participating with the Colorado Medicaid Community Mental Health Services Program. Prenatal Plus Program Providers who do not include a mental health professional as part of their multidisciplinary team shall not be eligible for reimbursement of psychosocial counseling and support through the Prenatal Plus Program; and

d. A Colorado Medicaid-enrolled physician, nurse practitioner, certified nurse-midwife, or physician's assistant who is the rendering provider that delegates the provision of Prenatal Plus Program services to the multidisciplinary team.

4. Retain in the record of each client to whom Prenatal Plus Program services are rendered:

a. Identification of qualifying risk factors using the Program Eligibility Screening Form; and

b. A client risk assessment using the Initial Assessment Form.

8.748.5REIMBURSABLE SERVICES

8.748.5.A Services reimbursable through the Prenatal Plus Program include:

1. Nutrition counseling and support provided by the registered dietitian/dietetic intern consisting of the following components which may be provided on an individual basis or in a group setting based on client need:

a. Nutrition screening;

b. General nutrition education;

c. Comprehensive nutrition status assessment; and

d. Nutrition counseling and targeted nutrition education based on client-specific need. Nutrition counseling shall be considered inclusive of nutrition care-planning, goal-setting, monitoring, follow-up, and nutrition care plan revision.

2. Psychosocial counseling and support provided by the mental health professional consisting of the following components which may be provided on an individual basis or in a group setting based on client need:

a. Psychosocial health screening;

b. Comprehensive psychosocial health assessment; and

c. Psychosocial health counseling and support. Psychosocial counseling and support shall be considered inclusive of psychosocial care-planning, goal-setting, monitoring, follow-up, and psychosocial care plan revision.

i. Psychosocial counseling and support does not include clinical psychotherapy services, traditional medication management, or other clinical services specifically related to treatment of a diagnosed mental health disorder. When clinical mental health disorders are identified, including substance use disorders, clients shall be referred to a provider who participates in the Colorado Medicaid Community Mental Health Services Program or a Medicaid-enrolled substance use disorder treatment provider.

3. General client education and health promotion provided by the care coordinator which may be provided on an individual basis or in a group setting based on client need, regarding topics that may include:

a. Basic understanding of the prenatal period

i. Physical and emotional changes related to pregnancy including fetal development;

ii. Healthy and appropriate weight gain during pregnancy;

iii. Healthy prenatal diet and food precautions;

iv. Physical activity precautions and appropriate exercise;

v. Substance use and how it can affect maternal and infant health outcomes;

vi. Sexually transmitted diseases/infections and how they can affect maternal and infant health outcomes;

vii. Bonding with the baby before birth;

viii. Importance of oral hygiene;

ix. Warning signs of preterm labor; and

x. Common terminology;

b. Common concerns related to childbirth and breastfeeding

i. Birth planning, hospital packing/preparation, and attending birth classes;

ii. Pain management options during delivery; and

iii. Benefits of breastfeeding, preparing for breastfeeding and breastfeeding basics;

c. The postpartum period and healthy infancy

i. Postpartum mood disorders ("baby blues" and postpartum depression);

ii. Postpartum recovery issues and adjustment including body changes, self-esteem, and relationship stressors;

iii. Managing stress, day-to-day problem-solving, positive communication techniques, building and using support networks;

iv. Family planning and contraception;

v. Comforting and stimulating infants (including education on shaken baby syndrome risk reduction, recognizing an infant's distress cues, and bonding/attachment postpartum);

vi. Appropriate expectations for infant behavior, sleeping patterns, teething and crying;

vii. Infant health including newborn feeding, immunizations, pediatrician visits, and car-seat safety; and

viii. Environmental risk factors including violence in the home, smoke, substance use and how they can affect infant health; and

4. Targeted case management provided by the care coordinator. Targeted case management is a service provided to assist clients in gaining access to needed medical, social, educational, and other services, and includes the following components:

a. Comprehensive assessment and periodic reassessment of the client's needs to determine the necessity for any medical, educational, social, or other services;

b. Development (and periodic revision) of a specific care plan that is based on the information collected through the assessment that specifies the goals and actions to address the medical, social, educational, and other services needed and identifies a course of action to respond to the assessed needs;

c. Referral and related activities to help the client obtain needed services including activities that help link the client with medical, social, or educational providers, or other programs and services that are capable of providing needed services; and

d. Monitoring and follow-up activities including activities and contacts that are necessary to ensure the care plan is implemented and adequately addresses the client's needs, and which may be with the client, family members, providers, or other entities or individuals.

e. Targeted case management provided by the care coordinator may include, but is not limited to, screening for nutrition and psychosocial risk factors.

f. Note: Targeted case management does not include case management activities that are an integral component of another covered Medicaid service; the direct delivery of an underlying medical, educational, social, or other service to which a client has been referred; activities integral to the administration of foster care programs; or activities for which a client may be eligible that are integral to the administration of another non-medical program.

8.748.6REIMBURSEMENT

8.748.6.A Reimbursement shall be the lower of:

1. Submitted charges; or

2. Fee schedule for Prenatal Plus Program services as determined by the Department.

10 CCR 2505-10-8.748