Common use of Identification and Assessment of Pregnant Women Clause in Contracts

Identification and Assessment of Pregnant Women. The Contractor shall implement methods to promptly identify members who become pregnant. All identified pregnant women shall have a comprehensive risk assessment completed. The Contractor shall offer all identified pregnant women care coordination services, either care management or complex case management. Identified pregnant women who opt out of care coordination services will receive, at a minimum, monthly contacts from the Contractor through the end of the pregnancy. If the Contractor is unable to contact the pregnant woman during the monthly EXHIBIT 1.A SCOPE OF WORK attempt, the Contractor shall contact the member’s provider and make other attempts, including the use of Community Health Workers, to physically make contact. These contacts must be documented by the Contractor and available for State review as requested. The Contractor shall provide all pregnant women assessed as utilizing either tobacco or tobacco products information regarding the availability of tobacco cessation services through the Indiana Quitline. Further, FSSA has implemented a Notification of Pregnancy (NOP) process that encourages MCEs and providers to complete a comprehensive risk assessment (i.e., an NOP form) for pregnant members. The Contractor shall comply with the policies and procedures set forth in the IHCP Provider Bulletin regarding the NOP process dated February 21, 2023 (BT202312), and any updates thereto. The provider will be responsible for completing the standard NOP form, including member demographics, any high-risk pregnancy indicators, and basic pregnancy information. The member’s pregnancy must be less than thirty (30) weeks gestation at the time of the office visit on which the NOP is based. The Contractor receiving the NOP shall contact the member to complete a comprehensive pregnancy health assessment within twenty-one

Identification and Assessment of Pregnant Women. The Contractor shall implement methods to promptly identify members who become pregnant. All identified pregnant women shall have a comprehensive risk assessment completed. The Contractor shall offer all identified pregnant women care coordination services, either care management or complex case management. Identified pregnant women who opt out of care coordination services will receive, at a minimum, monthly contacts from the Contractor through the end of the pregnancy. If the Contractor is unable to contact the pregnant woman during the monthly EXHIBIT 1.A SCOPE OF WORK attempt, the Contractor shall contact the member’s provider and make other attempts, including the use of Community Health Workers, to physically make contact. These contacts must be documented by the Contractor and available for State review as requested. The Contractor shall provide all pregnant women assessed as utilizing either tobacco or tobacco products information regarding the availability of tobacco cessation services through the Indiana Quitline. Further, FSSA has implemented a Notification of Pregnancy (NOP) process that encourages MCEs and providers to complete a comprehensive risk assessment (i.e., an NOP form) for pregnant members. The Contractor shall comply with the policies and procedures set forth in the IHCP Provider Bulletin regarding the NOP process dated February 21May 22, 2023 2014 (BT202312BT201425), and any updates thereto. The provider will be responsible for completing the standard NOP form, including member demographics, any high-risk pregnancy indicators, and basic pregnancy information. The member’s pregnancy must be less than thirty (30) weeks gestation at the time of the office visit on which the NOP is based. The Contractor receiving the NOP shall contact the member to complete a comprehensive pregnancy health assessment within twenty-oneone (21) calendar days of receipt of completed NOP form from the provider. The Contractor shall also gather clinical data from relevant health information exchanges to supplement claims data mining, NOPs, and self-reports of pregnancy. Only one assessment should be completed per member per pregnancy. NOP requirements and conditions for payment are set forth in the Hoosier Care Connect Policies and Procedures Manual.