BabyCare

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BabyCare
Department of Medical Assistance Services

• Fall 2006

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BabyCare

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

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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.

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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

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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

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• Maternal Infant Care Coordination
• (MICC)

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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.

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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.

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Primary Care Providers

• All providers must be enrolled as a Medicaid
  provider
  
• Physician
• Nurse Practitioner
• Certified Nurse Midwife

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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.

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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

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Policy Updates for MICC
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Initial Contact forAssessment 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

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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.

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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
  

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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

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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.

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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 clients
  parent/caregiver is completed

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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)

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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

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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.
  

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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

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Expanded Medicaid Servicesfor Pregnant Women

• Patient Education
• Nutrition Services
• Homemaker Services
• Substance Abuse Treatment

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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.

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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.

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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.

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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.

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Medicaid Managed Care Organizations(MCOs)
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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

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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.

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Check Eligibility

• http//virginia.fhsc.com
• MediCall
• 1-800-884-9730
• 1-800-772-9996

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Meet your MCOHigh Risk Maternity and Infant
Programs
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Thank You!

• Ashley Barton, LCSW
• Maternal Child Health Services Coordinator
• 804-371-7824
• MICC_at_dmas.virginia.gov
• www.dmas.virginia.gov