Care Management for High-Risk Pregnancy Sample Clauses

Care Management for High-Risk Pregnancy. (a) LHDs shall accept referrals from Health Plan for care management for high-risk pregnancy services. (b) LHD shall refer potentially Medicaid-eligible pregnant women for prenatal care and Medicaid eligibility determination, including promoting the use of presumptive eligibility determination and other strategies to facilitate early access to Medicaid coverage during pregnancy. (c) LHD shall contact patients identified as having a priority risk factor through claims data (Emergency Department utilization, antepartum hospitalization, utilization of Labor & Delivery triage unit) for referral to prenatal care and to engage in care management. (d) LHD shall review and enter all pregnancy risk screenings received from Pregnancy Management Program providers covered by the pregnancy care managers into the designated care management documentation system within five calendar days of receipt of risk screening forms. (e) LHD shall utilize risk screening data, patient self-report information and provider referrals to develop strategies to meet the needs of those patients at highest risk for poor pregnancy outcome. (f) LHD shall accept pregnancy care management referrals from non-Pregnancy Management Program prenatal care providers, community referral sources (such as Department of Social Services or WIC programs), patient self-referral, and provide appropriate assessment and follow up to those patients based on the level of need. (g) LHD shall review available Health Plan data reports identifying additional pregnancy risk status data, including regular, routine use of the Obstetric Admission, Discharge and Transfer (OB ADT) report, to the extent the OB ADT report remains available to LHD. (h) LHD shall collaborate with out-of-county Pregnancy Management Program providers and Care Management for High-Risk Pregnancy teams to facilitate cross-county partnerships to ensure coordination of care and appropriate care management assessment and services for all patients in the target population. (i) LHD shall conduct a prompt, thorough assessment by review of claims history and medical record, patient interview, case review with prenatal care provider and other methods, on all patients with one or more priority risk factors on pregnancy risk screenings and all patients directly referred for care management for level of need for care management support. (j) LHD shall utilize assessment findings, including those conducted by the Health Plan, to determine level of need for care ...

Care Management for High-Risk Pregnancy. To the extent Participating Provider is a Local Health Department (“LHD”) offering care management for high-risk pregnancy, this Section applies. Care Management for High-Risk Pregnancy refers to care management services provided to a subset of high-risk pregnant women by LHDs (Section VII, M(4)).

Care Management for High-Risk Pregnancy. Interventions i. LHD shall provide care management services in accordance with program guidelines, including condition-specific pathways, utilizing those interventions that are most effective in engaging patients and meeting their needs. This includes face-to-face encounters (practice visits, home visits, hospital visits, community encounters), telephone outreach, professional encounters and/or other interventions needed to achieve Care Plan goals. ii. LHD shall provide care management services based upon level of patient need as determined through ongoing assessment. iii. LHD shall develop person-centered Care Plans, including appropriate goals, interventions and tasks. iv. LHD shall utilize NCCARE360 to identify and connect members with additional community resources. v. LHD shall refer the identified population to childbirth education, oral health, BH or other needed services included in the Member’s BH I/DD Tailored Plan Network. vi. LHD shall document all care management activity in the care management documentation system.

Care Management for High-Risk Pregnancy. In the event that PO is a Local Health Department (LHD) carrying out care management for high-risk pregnancy: A. PO/LHD shall accept referrals from the BH I/DD Tailored Plan for Care Management for High-Risk Pregnancy services. B. PO/LHD shall refer potentially Medicaid-eligible pregnant women for prenatal care and Medicaid eligibility determination, including promoting the use of presumptive eligibility determination and other strategies to facilitate early access to Medicaid coverage during pregnancy. C. PO/LHD shall contact patients identified as having a priority risk factor through claims data (emergency department utilization, antepartum hospitalization, utilization of Labor and Delivery triage unit) for referral to prenatal care and to engage in care management. D. PO/LHD shall review and enter all pregnancy risk screenings received from Pregnancy Management Program providers covered by the pregnancy care managers into the designated care management documentation system within five