Perinatal Services. The MCO’s perinatal Health Care Services must ensure appropriate care is provided to women and infant Members from the preconception period through the infant’s first year of life. The MCO’s perinatal health care system must comply with the requirements of the Texas Health and Safety Code, Chapter 32 (the Maternal and Infant Health Improvement Act) and administrative rules codified at 25 T.A.C. Chapter 37, Subchapter M. The MCO must have a perinatal health care system in place that, at a minimum, provides the following services:
1. pregnancy planning and perinatal health promotion and education for reproductive-age women;
Perinatal Services. The HMO’s perinatal health care services must ensure appropriate care is provided to women and infant Members of the HMO from the preconception period through the infant’s first year of life. The HMO’s perinatal health care system must comply with the requirements of the Texas Health and Safety Code, Chapter 32 (the Maternal and Infant Health Improvement Act) and administrative rules codified at 25 T.A.C. Chapter 37, Subchapter M. The HMO must have a perinatal health care system in place that, at a minimum, provides the following services:
1. Pregnancy planning and perinatal health promotion and education for reproductive- age women;
2. Perinatal risk assessment of non-pregnant women, pregnant and postpartum women, and infants up to one year of age;
3. Access to appropriate levels of care based on risk assessment, including emergency care;
4. Transfer and care of pregnant women, newborns, and infants to tertiary care facilities when necessary;
5. Availability and accessibility of OB/GYNs, anesthesiologists, and neonatologists capable of dealing with complicated perinatal problems; and
6. Availability and accessibility of appropriate outpatient and inpatient facilities capable of dealing with complicated perinatal problems. The HMO must have a process to expedite scheduling a prenatal appointment for an obstetrical exam for a TP40 Member no later than two weeks after receiving the daily Enrollment File verifying the Member’s enrollment into the HMO. The HMO must have procedures in place to contact and assist a pregnant/delivering Member in selecting a PCP for her baby either before the birth or as soon as the baby is born. The HMO must provide inpatient care and professional services relating to labor and delivery for its pregnant/delivering Members, and neonatal care for its newborn Members at the time of delivery and for up to 48 hours following an uncomplicated vaginal delivery and 96 hours following an uncomplicated Caesarian delivery. The HMO must Adjudicate provider claims for services provided to a newborn Member in accordance with HHSC’s claims processing requirements using the proxy ID number or State-issued Medicaid ID number. The HMO cannot deny claims based on a provider’s non-use of State-issued Medicaid ID number for a newborn Member. The HMO must accept provider claims for newborn services based on mother’s name and/or Medicaid ID number with accommodations for multiple births, as specified by the HMO. The HMO must notify providers involved i...
Perinatal Services. 4.6.9.1 The Contractor shall ensure that appropriate perinatal care is provided to women and newborn Members. The Contractor shall have adequate capacity such that any new Member who is pregnant is able to have an initial visit with her Provider within fourteen (14) Calendar Days of Enrollment. The Contractor shall have in place a system that provides, at a minimum, the following services: · Pregnancy planning and perinatal health promotion and education for reproductive-age women; · Perinatal risk assessment of non-pregnant women, pregnant and post-partum women, and newborns and children up to five (5) months of age; · Childbirth education classes to all pregnant Members and their chosen partner. Through these classes, expectant parents shall be encouraged to prepare themselves physically, emotionally, and intellectually for the childbirth experience. The classes shall be offered at times convenient to the population served, in locations that are accessible, convenient and comfortable. Classes shall be offered in languages spoken by the Members. · Access to appropriate levels of care based on risk assessment, including emergency care; · Transfer and care of pregnant women, newborns, and infants to tertiary care facilities when necessary; · Availability and accessibility of OB/GYNs, anesthesiologists, and neonatologists capable of dealing with complicated perinatal problems; and · Availability and accessibility of appropriate outpatient and inpatient facilities capable of dealing with complicated perinatal problems.
4.6.9.2 The Contractor shall provide inpatient care and professional services relating to labor and delivery for its pregnant/delivering Members, and neonatal care for its newborn Members at the time of delivery and for up to forty-eight (48) hours following an uncomplicated vaginal delivery and ninety-six (96) hours following an uncomplicated Caesarean delivery.
Perinatal Services. 6.9.1 HMO's perinatal health care services must ensure appropriate care is provided to women and infants who are Members of HMO, from the preconception period through the infant's first year of life. HMO's perinatal health care system must comply with the requirements of Health & Safety Code, Chapter 32 Maternal and Infant Health Improvement Act and 25 TAC ss.37.233 et seq.
6.9.2 HMO shall have a perinatal health care system in place that, at a minimum, provides the following services:
6.9.2.1 pregnancy planning and perinatal health promotion and education for reproductive-age women;
6.9.2.2 perinatal risk assessment of nonpregnant women, pregnant and postpartum women, and infants up to one year of age;
6.9.2.3 access to appropriate levels of care based on risk assessment, including emergency care;
6.9.2.4 transfer and care of pregnant women, newborns, and infants to tertiary care facilities when necessary;
6.9.2.5 availability and accessibility of obstetricians/gynecologists, anesthesiologists, and neonatologists capable of dealing with complicated perinatal problems;
6.9.2.6 availability and accessibility of appropriate outpatient and inpatient facilities capable of dealing with complicated perinatal problems; and
6.9.2.7 compiles, analyzes and reports process and outcome data of Members to TDH.
6.9.3 HMO must have procedures in place to assign a pediatrician to an unborn child prior to birth of the child.
6.9.4 HMO must provide inpatient care for its pregnant/delivering Members and newborn Members in a health care facility, if requested by the mother or is determined to be medically necessary by the Member's PCP, for a minimum of:
Perinatal Services. HMO must have a perinatal health care system in place that, at a minimum, provides the following services:
Perinatal Services. Provide alcohol and drug treatment intervention and treatment services to pregnant and postpartum women who have a substance use, mental health and/or co-occurring disorder.
1. Services shall i. Meet the needs of parenting women as mandated by Perinatal Services Network Guidelines (PSNG); and provided at the family’s convenience and consumer’s needs, Monday through Friday between the hours of 8:30 a.m., and 7:00 p.m.
Perinatal Services. The HMO’s perinatal health care services must ensure appropriate care is provided to women and infant Members of the HMO from the preconception period through the infant’s first year of life. The HMO’s perinatal health care system must comply with the requirements of the Texas Health and Safety Code, Chapter 32 (the Maternal and Infant Health Improvement Act) and administrative rules codified at 25 T.A.C. Chapter 37, Subchapter M. The HMO must have a perinatal health care system in place that, at a minimum, provides the following services:
Perinatal Services. 46 6.10 EARLY CHILDHOOD INTERVENTION (ECI)............................... 47 6.11 SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC) - SPECIFIC REQUIREMENTS.................................... 48 6.12 TUBERCULOSIS (TB)................................................ 49 6.13 PEOPLE WITH DISABILITIES OR CHRONIC OR COMPLEX CONDITIONS........ 50 6.14 HEALTH EDUCATION AND WELLNESS AND PREVENTION PLANS............... 52 6.15 SEXUALLY TRANSMITTED DISEASES (STDs) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV)..................................... 53 6.16
Perinatal Services. Pediatric services;
Perinatal Services. 4.6.9.1 The Contractor shall ensure that appropriate perinatal care is provided to women and newborn Members. The Contractor shall have adequate capacity such that any new Member who is pregnant is able to have an initial visit with her Provider within fourteen (14) Calendar Days of Enrollment. The Contractor shall have in place a system that provides, at a minimum, the following services: Revised 5/19/2008
4.6.9.1.1 Pregnancy planning and perinatal health promotion and education for reproductive-age women;
4.6.9.1.2 Perinatal risk assessment of non-pregnant women, pregnant and postpartum women, and newborns and children up to five (5) months of age;
4.6.9.1.3 Childbirth education classes to all pregnant Members and their chosen partner. Through these classes, expectant parents shall be encouraged to prepare themselves physically, emotionally, and intellectually for the childbirth experience. The classes shall be offered at times convenient to the population served, in locations that are accessible, convenient and comfortable. Classes shall be offered in languages spoken by the Members.
4.6.9.1.4 Access to appropriate levels of care based on risk assessment, including emergency care;
4.6.9.1.5 Transfer and care of pregnant women, newborns, and infants to tertiary care facilities when necessary;
4.6.9.1.6 Availability and accessibility of OB/GYNs, anesthesiologists, and neonatologists capable of dealing with complicated perinatal problems; and
4.6.9.1.7 Availability and accessibility of appropriate outpatient and inpatient facilities capable of dealing with complicated perinatal problems.
4.6.9.2 The Contractor shall provide inpatient care and professional services relating to labor and delivery for its pregnant/delivering Members, and neonatal care for its newborn Members at the time of delivery and for up to forty-eight (48) hours following an uncomplicated vaginal delivery and ninety-six (96) hours following an uncomplicated Caesarean delivery.