The following permanent policy updates are being made for NC Medicaid Direct beneficiaries in the Obstetrical Services and Pregnancy Management Program (PMP) policies, retroactive to Jan. 1, 2023.
- Providers shall complete the Pregnancy Risk Screening Form at the beneficiary’s initial visit and at the visits closest to 28 weeks gestation and 36 weeks gestation. It is recommended that the Pregnancy Risk Screening Form also be completed any time there is a maternal or fetal change in condition necessitating a new risk assessment.
- A Medicaid beneficiary with a priority risk factor present on the pregnancy risk screening form shall be referred for pregnancy care management assessment.
- A copy of the pregnancy risk screening form must be provided to the high-risk case management agency; which will be the Local Health Departments.
- The pregnancy care manager will assist in connecting the beneficiary to a primary care provider of their choice for any future care management service’s needs.
- A beneficiary shall be eligible to receive pregnancy care management services at any time during pregnancy until the last day of the month during which the 60th-day post-delivery occurs.
- The PMP provider can only bill HCPCS codes S0280 (Medical Home Program, comprehensive care coordination and planning, initial plan) for the Pregnancy Risk Screen a maximum of three times and S0281 (Medical Home Program, comprehensive care coordination and planning, maintenance of plan) for the postpartum assessment one time during the gestational period even if there are multiple births. No more than three pregnancy risk screenings (S0280) per pregnancy will be covered.
- In addition to the changes above, IE-6 will no longer offer 17 alpha-hydroxyprogesterone caproate (17p).
Contact
NCTracks Call Center: 800-688-6696