DATE: FEBRUARY 21, 2011
Manual: Aged, Blind, And Disabled Medicaid Manual
Change No: 03-11
To: County Directors of Social Services
Effective: March 1, 2011
DMA in partnership with Community Care of North Carolina (CCNC) and other community stakeholders has created a program that provides pregnant Medicaid recipients with a pregnancy medical home (PMH). The goal is to improve the quality of perinatal care (the period immediately before and after birth) given to Medicaid recipients thereby ensuring healthy pregnancies and improving birth outcomes. This will be done by modeling the PMH after the enhanced primary care case management (PCCM) program developed by CCNC.
All pregnant Medicaid recipients receive care management (population management). Care/population management provides education on self management to improve on perinatal care and healthy birth outcomes. High-risk pregnant women in a PMH receive additional care management services. The level of service provided is based on the individual’s identified needs. Care managers closely monitor the pregnancy through regular contact with the physician and patient to promote a healthy birth outcome.
In addition, as of March 1, 2011, the Maternity Care Coordination Program will change to a new service called Pregnancy Care Management (PCM). The current Maternity Care Coordination Program will end as of February 28, 2011. The Pregnancy Care Management Program (PCM), just like the Maternity Care Coordination Program is designed to ensure healthy pregnancies and healthy babies. PCM services will be provided by Pregnancy Care Managers working at local health departments or other provider agencies just as they are now.
The Pregnancy Medical Home (PMH) Program is not a mandatory program. However, county caseworkers must explain the program, provide a list of participating doctors, assist and encourage a pregnant Medicaid recipient to participate in the PMH program.
Medicaid recipients participating in the PMH program are not linked to the PMH providers that they choose as with CCNC/CA participants. However, PMH participants may also have a CCNC/CA provider.
The following manual sections have been changed to include references and basic eligibility information for the Pregnancy Medical Home (PMH) program.
Include the definitions of Pregnancy Medical Home (PMH), Perinatal, and Medical Home.
This policy is effective 03/01/11. Apply this change to applications taken and redeterminations started on or after 03/01/11, as well as to those presently in process.
NOTE: The PMH handout mentioned in the policy is being finalized and will be posted on the DMA Forms website when completed. A terminal message will be sent when the handout is available on line.
If you have any questions regarding this information, please contact your Medicaid Program Representative.
Craigan L. Gray, MD, MBA, JD,
(This material was researched and written by Sandi Morrow, Medicaid Program Consultant, Medicaid Eligibility Unit)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.