1. Public Health Prenatal Program

2. 2 Prenatal Care Prenatal Care is a Core Public Health Service that is the primary strategy for reducing infant mortality and improving birth outcomes. All LHDs shall establish procedures to appropriately respond to inquiries from pregnant women who call, stop by or have a positive pregnancy test at the LHD. It is not appropriate for LHD staff to say “we do not have a Prenatal Program”. An appropriate response may be, “although the LHD does not provide prenatal services onsite, we can assist you in obtaining prenatal services”.

3. 3 Prenatal Care All LHDs must assure that prenatal care is available for pregnant women in their jurisdiction either directly or through a referral to a qualified prenatal provider. Contracts with providers are the mechanism to fulfill that assurance.

4. 4 Prenatal Care LHDs should assure that basic and medically necessary prenatal services are provided to patients participating in the Public Health Prenatal Program. A description of services is listed in the Administrative References (AR). Prenatal care providers must be licensed in Kentucky and be Board Certified in Obstetrics, Family Practice, or Midwifery. Any midwifery services must be provided by a certified nurse midwife. If prenatal care is not under the direction of an obstetrician, an obstetrician shall be available for consultation.

5. 5 Funding The Core Public Health Block Grant Funds should be used to assure routine prenatal services for those women eligible for the Public Health Prenatal Program. Public Health Prenatal Program Eligibility Requirements: Pregnant women who have income at or below 185% FPL and have no other payor source (i.e., are not Medicaid eligible).

6. 6 Reminders Do… Utilize the FY17 prenatal contract templates (3 types of templates available). Refer to the most recent AR and CCSG for the prenatal matrix and language. Do not… Do not use statements singling out any group and/or race, such as “illegal” to refer to a population of people. Do not use language from previous versions of the Administrative Reference (AR) and/or the Public Health Practice Reference (PHPR) or Core Clinical Service Guidelines (CCSG). Replace any prior AR/CCSG language in last year contracts with the most current language. Do not copy/paste language from the LHD Guidance document into the contract without modifying it for proper context.

7. 7 Types of Prenatal Contracts Below are the three types of contracts often utilized for prenatal services: 1. Contracted On Site Prenatal Services – Prenatal services are provided at the LHD by a prenatal provider. (Template 1) 1. Clinical Provider Referral Agreement – The patient is referred to a prenatal provider for clinical services not performed at LHD. (Template 2) 2. Hospital Outpatient Testing - Prenatal services are provided at a hospital if not available in the LHD or contracted physician office. (Template 3) This is optional depending on local needs.

8. 8 Utilizing the Templates The templates include the REQUIRED LANGUAGE. Do not use prior contracts as your template (changes in language, abbreviations, Presumptive Eligibility, etc.). Suggestions: 1. Copy & paste the appropriate template into the current CH-53M. 2. Add appropriate language from the LHD Contract Guidance document. 3. Delete language that does not apply; revise or add language according to local needs and agreements with Contractor.

9. 9 Required Contract Language All prenatal contracts must include the following: 1. Prenatal care providers must be licensed in Kentucky and Board Certified in Obstetrics, Family Practice, or Midwifery. Any midwifery services must be provided by a certified nurse midwife. If prenatal care is not under the direction of an obstetrician, an obstetrician shall be available for consultation. Providers must act within their legal scope of practice and assure they have professional liability insurance for the services they provide. Copy and Paste into the Provider Credentials & Qualifications section

10. 10 Required Contract Language 2. Prenatal care, regardless of which provider is delivering the care, must follow the most current guidelines of the American College of Obstetricians and Gynecologists (ACOG) and adhere to the Clinical Core Service Guidelines (CCGS) and the Administrative Reference (AR). Copy and Paste into the Provider Credentials & Qualifications section

11. 11 Required Contract Language 3. Contracts must specify compensation for services. [Include in the Compensation/Payment section] The contract templates provide suggestions. 4. Compensation for services to any provider shall be at the current Medicaid rate or a lesser agreed upon amount. Payment is to be considered as “payment in full” for the particular service; the patient shall not be billed for these services. Include in the Compensation/Payment section

12. 12 Optional Contract Language Update Regarding Presumptive Eligibility: PE coverage will last until a Medicaid application is filed and either approved or denied, or the last day of the month following the month of PE determination. Potentially, PE could last up to a maximum of 60 days but not necessarily depending on when the woman’s application is processed and when she applies for full Medicaid.

13. 13 Prenatal Contract Components The finished contract should include the following sections: Contract Description Scope of Work Compensation/Payment Billing Procedures Required Language Boilerplate Language

14. 14 Resources The Clinical Core Service Guidelines (CCGS) Program Description & Maternity Service Matrix is located in the Administrative Reference (AR) The Prenatal Program website located at http://chfs.ky.gov/dph/mch/cfhi/prenatalprogram.htm http://chfs.ky.gov/dph/mch/cfhi/prenatalprogram.htm DMS Physician fee rates can be found at the following CHFS/DMS link: http://chfs.ky.gov/dms/fee.htm under “Physician Fee Service”. Open PDF version and enter the CPT code in the FIND box to locate the fee easily.http://chfs.ky.gov/dms/fee.htm

15. 15 Thank You! Trina Miller DPH Perinatal Nurse Consultant Prenatal Program Coordinator 502-564-2154 ext. 4406 TrinaM.Miller@ky.gov