Pregnancy Related Requirements. The Health Plan shall provide the most appropriate and highest level of quality care for pregnant enrollees. Required care includes the following: a. Florida's Healthy Start Prenatal Risk Screening – The Health Plan shall ensure that the provider offers Florida's Healthy Start prenatal risk screening to each pregnant enrollee as part of her first prenatal visit. As required by s. 383.14, F.S., s. 381.004, F.S., and Rule 64C-7.009, F.A.C. (1) The Health Plan shall ensure that the provider uses the DOH prenatal risk form (DH Form 3134), which can be obtained from the local CHD. (2) The Health Plan shall ensure that the provider keeps a copy of the completed screening instrument in the enrollee's medical record and provides a copy to the enrollee. (3) The Health Plan shall ensure that the provider submits the completed DH Form 3134 to the CHD in the county where the prenatal screen was completed within ten (10) business days of completion of the screening. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract (4) The Health Plan shall collaborate with the Healthy Start care coordinator within the enrollee's county of residence to assure delivery of risk-appropriate care. b. Florida's Healthy Start Infant (Postnatal) Risk Screening Instrument – The Health Plan shall ensure that Florida hospitals contracting with the Health Plan electronically file the Florida Healthy Start Infant (Postnatal) Risk Screening Instrument (DH Form 3135) and the Certificate of Live Birth with the CHD in the county where the infant was born within five (5) business days of the birth. Health Plans that contract with birthing facilities not participating in the Department of Health electronic birth registration system shall ensure that the provider files required birth information with the CHD within five (5) business days of the birth, keeps a copy of the completed DH Form 3135 in the enrollee's medical record and mails a copy to the enrollee. c. Pregnant enrollees or infants who do not score high enough to be eligible for Healthy Start care coordination may be referred for services, regardless of their score on the Healthy Start risk screen, in the following ways: (1) If the referral is to be made at the same time the Healthy Start risk screen is administered, the provider may indicate on the risk screening form that the enrollee or infant is invited to participate based on factors other than score; or (2) If the determination is made subsequent to risk screening, the provider may refer the enrollee or infant directly to the Healthy Start care coordinator based on assessment of actual or potential factors associated with high risk, such as HIV, Hepatitis B, substance abuse or domestic violence. d. The Health Plan shall refer all infants, children up to age five (5), and pregnant, breast-feeding and postpartum women to the local WIC office. (1) The Health Plan shall ensure providers provide: (a) A completed Florida WIC program medical referral form with the current height or length and weight (taken within sixty (60) calendar days of the WIC appointment); (b) Hemoglobin or hematocrit; and (c) Any identified medical/nutritional problems. (2) For subsequent WIC certifications, the Health Plan shall ensure that providers coordinate with the local WIC office to provide the above referral data from the most recent CHCUP. (3) Each time the provider completes a WIC referral form, the Health Plan shall ensure that the provider gives a copy of the form to the enrollee and keeps a copy in the enrollee's medical record. e. The Health Plan shall ensure that providers give all women of childbearing age HIV counseling and offer them HIV testing. See Chapter 381, F.S. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract (1) The Health Plan shall ensure that its providers offer all pregnant women counseling and HIV testing at the initial prenatal care visit and again at twenty-eight (28) and thirty-two (32) weeks. (2) The Health Plan shall ensure that its providers attempt to obtain a signed objection if a pregnant woman declines an HIV test. See s. 384.31, F.S. (3) The Health Plan shall ensure that all pregnant women who are infected with HIV are counseled about and offered the latest antiretroviral regimen recommended by the U.S. Department of Health & Human Services (Public Health Service Task Force Report entitled Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States). f. The Health Plan shall ensure that its providers screen all pregnant enrollees receiving prenatal care for the Hepatitis B surface antigen (HBsAg) during the first prenatal visit. (1) The Health Plan shall ensure that its providers perform a second HBsAg test between twenty-eight (28) and thirty-two (32) weeks of pregnancy for all pregnant enrollees who tested negative at the first prenatal visit and are considered high-risk for Hepatitis B infection. This test shall be performed at the same time that other routine prenatal screening is ordered. (2) All HBsAg-positive women shall be reported to the local CHD and to Healthy Start, regardless of their Healthy Start screening score. g. The Health Plan shall ensure that infants born to HBsAg-positive enrollees receive Hepatitis B Immune Globulin (HBIG) and the Hepatitis B vaccine once they are physiologically stable, preferably within twelve (12) hours of birth, and shall complete the Hepatitis B vaccine series according to the vaccine schedule established by the Recommended Childhood Immunization Schedule for the United States. (1) The Health Plan shall ensure that its providers test infants born to HBsAg-positive enrollees for HBsAg and Hepatitis B surface antibodies (anti-HBs) six (6) months after the completion of the vaccine series to monitor the success or failure of the therapy. (2) The Health Plan shall ensure that providers report to the local CHD a positive HBsAg result in any child age 24 months or less within twenty-four (24) hours of receipt of the positive test results. (3) The Health Plan shall ensure that infants born to enrollees who are HBsAg-positive are referred to Healthy Start regardless of their Healthy Start screening score. h. The Health Plan shall report to the Perinatal Hepatitis B Prevention Coordinator at the local CHD all prenatal or postpartum enrollees who test HBsAg-positive. The Health Plan also shall report said enrollees’ infants and contacts to the Perinatal Hepatitis B Prevention Coordinator. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract (1) The Health Plan shall report the following information – name, date of birth, race, ethnicity, address, infants, contacts, laboratory test performed, date the sample was collected, the due date or estimated date of confinement, whether the enrollee received prenatal care, and immunization dates for infants and contacts. (2) The Health Plan shall use the Practitioner Disease Report Form (DH Form 2136) for reporting purposes. i. The Health Plan shall ensure that the PCP maintains all documentation of Healthy Start screenings, assessments, findings and referrals in the enrollees’ medical records.
Appears in 2 contracts
Samples: Standard Contract (Wellcare Health Plans, Inc.), Standard Contract (Wellcare Health Plans, Inc.)
Pregnancy Related Requirements. a. The Health Plan shall must provide the most appropriate and highest level of quality care for pregnant enrolleesEnrollees. Required care includes the following:
a. (1) Florida's Healthy Start Prenatal Risk Screening – - The Health Plan shall ensure that the provider Provider offers Florida's Healthy Start prenatal risk screening to each pregnant enrollee Enrollee as part of her first prenatal visit. As required by s. Section 383.14, F.S., s. 381.004, F.S., and Rule 64C-7.009, F.A.C.
(1a) The Health Plan shall ensure that the provider Provider uses the DOH prenatal risk form (DH Form 3134), which can be obtained from the local CHD.
(2b) The Health Plan shall ensure that the provider keeps Provider retains a copy of the completed screening instrument in the enrolleeEnrollee's medical record Medical Record and provides a copy to the enrolleeEnrollee.
(3c) The Health Plan shall ensure that the provider Provider submits the completed DH Form 3134 to the CHD in the county where in which the prenatal screen was completed within ten (10) business days Business Days of completion of the screening. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contractcompletion.
(4d) The Health Plan shall collaborate with the Healthy Start care coordinator within the enrolleeEnrollee's county of residence to assure delivery of risk-risk appropriate carecare is delivered.
b. (2) Florida's Healthy Start Infant (Postnatal) Risk Screening Instrument – - The Health Plan shall ensure that Florida hospitals contracting with the Health Plan electronically file Provider completes the Florida Healthy Start Infant (Postnatal) Risk Screening Instrument (DH Form 3135) and with the Certificate of Live Birth with and transmits the documents to the CHD in the county where in which the infant was born within five ten (510) business days Business Days of the birthcompletion. The Health Plans that contract with birthing facilities not participating in the Department of Health electronic birth registration system Plan shall ensure that the provider files required birth information with the CHD within five (5) business days of the birth, keeps Provider retains a copy of the completed DH Form 3135 in the enrolleeEnrollee's medical record Medical Record and mails provides a copy to the enrolleeEnrollee.
c. (3) Pregnant enrollees Enrollees or infants who do not score high enough to be eligible for Healthy Start care coordination may be referred for services, regardless of their score on the Healthy Start risk screen, in the following ways:
(1a) If the referral is to be made at the same time the Healthy Start risk screen is administered, the provider Provider may indicate on the risk screening form that the enrollee Enrollee or infant is invited to participate based on factors other than score; or
(2b) If the determination is made subsequent to risk screening, the provider Provider may refer the enrollee Enrollee or infant directly to the Healthy Start care coordinator based on assessment of actual or potential factors associated with high risk, such as HIV, Hepatitis hepatitis B, substance abuse or domestic violence.
d. (4) The Health Plan shall refer all infantspregnant women, children breast-feeding and postpartum women, infants and Children/Adolescents up to age five (5), and pregnant, breast-feeding and postpartum women ) to the local WIC office.
(1a) The Health Plan shall ensure providers provide:
(ai) A completed Florida WIC program medical referral form Medical Referral Form with the current height or length and weight (taken within sixty (60) calendar days Calendar Days of the WIC appointment);
(bii) Hemoglobin or hematocrit; and
(ciii) Any identified medical/nutritional problems.
(2b) For subsequent WIC certifications, the Health Plan shall ensure that providers Providers coordinate with the local WIC office to provide the above referral data from the most recent CHCUP.
(3c) Each time the provider Health Plan completes a WIC referral formReferral Form, the Health Plan shall ensure that the provider Provider gives a copy of the form WIC Referral Form to the enrollee Enrollee and keeps retains a copy in the enrolleeEnrollee's medical recordMedical Record.
e. (5) The Health Plan shall ensure that providers give the Providers provide all women of childbearing age HIV counseling and offer them HIV testing. See Chapter 381, F.S. WellCare of Florida, Inc., Medicaid HMO Non-Reform ContractF.S.
(1a) The Health Plan shall ensure that its providers Providers, in accordance with Florida law, offer all pregnant women counseling and HIV testing at the initial prenatal care visit and again at twenty-eight (28) and to thirty-two (32) weeks.
(2b) The Health Plan shall ensure that its providers Providers attempt to obtain a signed objection if a pregnant woman declines an HIV test. See s. Section 384.31, F.S.F.S. and 64D-3.019, F.A.C.
(3c) The Health Plan shall ensure that all pregnant women who are infected with HIV are counseled about and offered the latest antiretroviral regimen recommended by the U.S. Department of Health & Human Services (U.S. Department of Health & Human Services, Public Health Service Task Force Report entitled Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States. To receive a copy of the guidelines, contact the DOH, Bureau of HIV/AIDS at (000) 000-0000, or go to xxxx://xxxxxxxx.xxx.xxx/guidelines/).
f. (6) The Health Plan shall ensure that its providers Providers screen all pregnant enrollees Enrollees receiving prenatal care for the Hepatitis B surface antigen (HBsAg) during the first (1st) prenatal visit.
(1a) The Health Plan shall ensure that its providers the Providers perform a second (2nd) HBsAg test between twenty-eight (28) and thirty-two (32) weeks of pregnancy for all pregnant enrollees Enrollees who tested negative at the first (1st) prenatal visit and are considered high-risk for Hepatitis B infection. This test shall be performed at the same time that other routine prenatal screening is ordered.
(2b) All HBsAg-positive women shall be reported to the local CHD and to Healthy Start, regardless of their Healthy Start screening score.
g. (7) The Health Plan shall ensure that infants born to HBsAg-positive enrollees Enrollees shall receive Hepatitis B Immune Globulin (HBIG) and the Hepatitis B vaccine once they are physiologically stable, preferably within twelve (12) hours of birth, birth and shall complete the Hepatitis B vaccine Xxxxxx series according to the recommended vaccine schedule established by the Recommended Childhood Immunization Schedule for the United States.
(1a) The Health Plan shall ensure that its providers Providers test infants born to HBsAg-positive enrollees Enrollees for HBsAg and Hepatitis B surface antibodies (anti-HBs) six (6) months after the completion of the vaccine series to monitor the success or failure of the therapy.
(2b) The Health Plan shall ensure that providers Providers report to the local CHD a positive HBsAg result in any child age 24 aged twenty-four (24) months or less within twenty-four (24) hours of receipt of the positive test results.
(3c) The Health Plan shall ensure that infants born to enrollees Enrollees who are HBsAg-positive are referred to Healthy Start regardless of their Healthy Start screening score.
h. (8) The Health Plan shall report to the Perinatal Hepatitis B Prevention Coordinator at the local CHD all prenatal or postpartum enrollees Enrollees who test HBsAg-positive. The Health Plan also shall report said enrolleesEnrollees’ infants and contacts to the Perinatal Hepatitis B Prevention Coordinator. WellCare of Florida, Inc., Medicaid HMO Non-Reform ContractCoordinator at the local CHD.
(1a) The Health Plan shall report the following information – - name, date of birth, race, ethnicity, address, infants, contacts, laboratory test performed, date the sample was collected, the due date or estimated date of confinementEDC, whether or not the enrollee Enrollee received prenatal care, and immunization dates for infants and contacts.
(2b) The Health Plan shall use the Practitioner Disease Perinatal Hepatitis B Case and Contact Report Form (DH Form 21361876) for reporting purposes.
i. (9) The Health Plan shall ensure that the PCP maintains all documentation of Healthy Start screenings, assessments, findings and referrals in the enrolleesEnrollees’ medical recordsMedical Records. The Health Plan shall ensure quick access to Enrollees’ Medical Records in the Provider Contract.
(10) The Health Plan shall provide the most appropriate and highest level of quality care for pregnant Enrollees, including, but not limited to, the following:
(a) Prenatal Care - The Health Plan shall:
(i) Require a pregnancy test and a nursing assessment with referrals to a physician, PA or ARNP for comprehensive evaluation;
(ii) Require Case Management through the gestational period according to the needs of the Enrollee;
(iii) Require any necessary referrals and follow-up;
(iv) Schedule return prenatal visits at least every four (4) weeks until the thirty-second (32nd) week, every two (2) weeks until the thirty-sixth (36th) week, and every week thereafter until delivery, unless the Enrollee’s condition requires more frequent visits;
(v) Contact those Enrollees who fail to keep their prenatal appointments as soon as possible, and arrange for their continued prenatal care;
(vi) Assist Enrollees in making delivery arrangements, if necessary; and
(vii) Ensure that all Providers screen all pregnant Enrollees for tobacco use and make certain that the Providers make available to the pregnant Enrollees smoking cessation counseling and appropriate treatment as needed.
Appears in 2 contracts
Samples: Health Care Services Contract (Wellcare Health Plans, Inc.), Health Care Services Contract (Wellcare Health Plans, Inc.)
Pregnancy Related Requirements. a. The Health Plan shall must provide the most appropriate and highest level of quality care for pregnant enrolleesEnrollees. Required care includes the following:
a. (1) Florida's Healthy Start Prenatal Risk Screening – The Health Plan shall ensure that the provider Provider offers Florida's Healthy Start prenatal risk screening to each pregnant enrollee Enrollee as part of her first prenatal visit. As required by s. Section 383.14, F.S., s. 381.004, F.S., and Rule 64C-7.009, F.A.C.
(1a) The Health Plan shall ensure that the provider Provider uses the DOH prenatal risk form (DH Form 3134), which can be obtained from the local CHD.
(2b) The Health Plan shall ensure that the provider keeps Provider retains a copy of the completed screening instrument in the enrolleeEnrollee's medical record Medical Record and provides a copy to the enrolleeEnrollee.
(3c) The Health Plan shall ensure that the provider Provider submits the completed DH Form 3134 to the CHD in the county where in which the prenatal screen was completed within ten (10) business days Business Days of completion of the screening. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contractcompletion.
(4d) The Health Plan shall collaborate with the Healthy Start care coordinator within the enrolleeEnrollee's county of residence to assure delivery of risk-risk appropriate carecare is delivered.
b. (2) Florida's Healthy Start Infant (Postnatal) Risk Screening Instrument – The Health Plan shall ensure that Florida hospitals contracting with the Health Plan electronically file Provider completes the Florida Healthy Start Infant (Postnatal) Risk Screening Instrument (DH Form 3135) and with the Certificate of Live Birth with and transmits the documents to the CHD in the county where in which the infant was born within five ten (510) business days Business Days of the birthcompletion. The Health Plans that contract with birthing facilities not participating in the Department of Health electronic birth registration system Plan shall ensure that the provider files required birth information with the CHD within five (5) business days of the birth, keeps Provider retains a copy of the completed DH Form 3135 in the enrolleeEnrollee's medical record Medical Record and mails provides a copy to the enrolleeEnrollee.
c. (3) Pregnant enrollees Enrollees or infants who do not score high enough to be eligible for Healthy Start care coordination may be referred for services, regardless of their score on the Healthy Start risk screen, in the following ways:
(1a) If the referral is to be made at the same time the Healthy Start risk screen is administered, the provider Provider may indicate on the risk screening form that the enrollee Enrollee or infant is invited to participate based on factors other than score; or
(2b) If the determination is made subsequent to risk screening, the provider Provider may refer the enrollee Enrollee or infant directly to the Healthy Start care coordinator based on assessment of actual or potential factors associated with high risk, such as HIV, Hepatitis hepatitis B, substance abuse or domestic violence.
d. (4) The Health Plan shall refer all infantspregnant women, children breast-feeding and postpartum women, infants and Children/Adolescents up to age five (5), and pregnant, breast-feeding and postpartum women ) to the local WIC office.
(1a) The Health Plan shall ensure providers provide:
(ai) A completed Florida WIC program medical referral form Medical Referral Form with the current height or length and weight (taken within sixty (60) calendar days Calendar Days of the WIC appointment);
(bii) Hemoglobin or hematocrit; and
(ciii) Any identified medical/nutritional problems.
(2b) For subsequent WIC certifications, the Health Plan shall ensure that providers Providers coordinate with the local WIC office to provide the above referral data from the most recent CHCUP.
(3c) Each time the provider Health Plan completes a WIC referral formReferral Form, the Health Plan shall ensure that the provider Provider gives a copy of the form WIC Referral Form to the enrollee Enrollee and keeps retains a copy in the enrolleeEnrollee's medical recordMedical Record.
e. (5) The Health Plan shall ensure that providers give the Providers provide all women of childbearing age HIV counseling and offer them HIV testing. See Chapter 381, F.S. WellCare of Florida, Inc., Medicaid HMO Non-Reform ContractF.S.
(1a) The Health Plan shall ensure that its providers Providers, in accordance with Florida law, offer all pregnant women counseling and HIV testing at the initial prenatal care visit and again at twenty-eight (28) and thirty-two (32) weeks.
(2) The Health Plan shall ensure that its providers attempt to obtain a signed objection if a pregnant woman declines an HIV test. See s. 384.31, F.S.
(3) The Health Plan shall ensure that all pregnant women who are infected with HIV are counseled about and offered the latest antiretroviral regimen recommended by the U.S. Department of Health & Human Services (Public Health Service Task Force Report entitled Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States).
f. The Health Plan shall ensure that its providers screen all pregnant enrollees receiving prenatal care for the Hepatitis B surface antigen (HBsAg) during the first prenatal visit.
(1) The Health Plan shall ensure that its providers perform a second HBsAg test between twenty-eight (28) and thirty-two (32) weeks of pregnancy for all pregnant enrollees who tested negative at the first prenatal visit and are considered high-risk for Hepatitis B infection. This test shall be performed at the same time that other routine prenatal screening is ordered.
(2) All HBsAg-positive women shall be reported to the local CHD and to Healthy Start, regardless of their Healthy Start screening score.
g. The Health Plan shall ensure that infants born to HBsAg-positive enrollees receive Hepatitis B Immune Globulin (HBIG) and the Hepatitis B vaccine once they are physiologically stable, preferably within twelve (12) hours of birth, and shall complete the Hepatitis B vaccine series according to the vaccine schedule established by the Recommended Childhood Immunization Schedule for the United States.
(1) The Health Plan shall ensure that its providers test infants born to HBsAg-positive enrollees for HBsAg and Hepatitis B surface antibodies (anti-HBs) six (6) months after the completion of the vaccine series to monitor the success or failure of the therapy.
(2) The Health Plan shall ensure that providers report to the local CHD a positive HBsAg result in any child age 24 months or less within twenty-four (24) hours of receipt of the positive test results.
(3) The Health Plan shall ensure that infants born to enrollees who are HBsAg-positive are referred to Healthy Start regardless of their Healthy Start screening score.
h. The Health Plan shall report to the Perinatal Hepatitis B Prevention Coordinator at the local CHD all prenatal or postpartum enrollees who test HBsAg-positive. The Health Plan also shall report said enrollees’ infants and contacts to the Perinatal Hepatitis B Prevention Coordinator. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract
(1) The Health Plan shall report the following information – name, date of birth, race, ethnicity, address, infants, contacts, laboratory test performed, date the sample was collected, the due date or estimated date of confinement, whether the enrollee received prenatal care, and immunization dates for infants and contacts.
(2) The Health Plan shall use the Practitioner Disease Report Form (DH Form 2136) for reporting purposes.
i. The Health Plan shall ensure that the PCP maintains all documentation of Healthy Start screenings, assessments, findings and referrals in the enrollees’ medical records.eight
Appears in 1 contract
Samples: Health Care Services Agreement
Pregnancy Related Requirements. The Health Plan shall provide the most appropriate and highest level of quality care for pregnant enrollees. Required care includes the following:
a. Florida's ’s Healthy Start Prenatal Risk Screening – — The Health Plan shall ensure that the provider offers Florida's ’s Healthy Start prenatal risk screening to each pregnant enrollee as part of her first prenatal visit. As required by s. 383.14, F.S., s. 381.004, F.S., and Rule 64C-7.009, F.A.C.
(1) The Health Plan shall ensure that the provider uses the DOH prenatal risk form (DH Form 3134), which can be obtained from the local CHD.
(2) The Health Plan shall ensure that the provider keeps a copy of the completed screening instrument in the enrollee's ’s medical record and provides a copy to the enrollee.
(3) The Health Plan shall ensure that the provider submits the completed DH Form 3134 to the CHD in the county where the prenatal screen was completed within ten (10) business days of completion of the screening. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract.
(4) The Health Plan shall collaborate with the Healthy Start care coordinator within the enrollee's ’s county of residence to assure delivery of risk-appropriate care.
b. Florida's ’s Healthy Start Infant (Postnatal) Risk Screening Instrument – — The Health Plan shall ensure that Florida hospitals contracting with the Health Plan electronically file provider completes the Florida Healthy Start Infant (Postnatal) Risk Screening Instrument (DH Form 3135) and with the Certificate of Live Birth with and transmits the documents to the CHD in the county where the infant was born within five ten (510) business days of the birth. The Health Plans that contract with birthing facilities not participating in the Department of Health electronic birth registration system Plan shall ensure that the provider files required birth information with the CHD within five (5) business days of the birth, keeps a copy of the completed DH Form 3135 in the enrollee's ’s medical record and mails provides a copy to the enrollee.
c. Pregnant enrollees or infants who do not score high enough to be eligible for Healthy Start care coordination may be referred for services, regardless of their score on the Healthy Start risk screen, in the following ways:
(1) If the referral is to be made at the same time the Healthy Start risk screen is administered, the provider may indicate on the risk screening form that the enrollee or infant is invited to participate based on factors other than score; oror AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract
(2) If the determination is made subsequent to risk screening, the provider may refer the enrollee or infant directly to the Healthy Start care coordinator based on assessment of actual or potential factors associated with high risk, such as HIV, Hepatitis B, substance abuse or domestic violence.
d. The Health Plan shall refer all infants, children up to age five (5), and pregnant, breast-feeding and postpartum women to the local WIC office.
(1) The Health Plan shall ensure providers provide:
(a) A completed Florida WIC program medical referral form with the current height or length and weight (taken within sixty (60) calendar days of the WIC appointment);
(b) Hemoglobin or hematocrit; and
(c) Any identified medical/nutritional problems.
(2) For subsequent WIC certifications, the Health Plan shall ensure that providers coordinate with the local WIC office to provide the above referral data from the most recent CHCUP.
(3) Each time the provider completes a WIC referral form, the Health Plan shall ensure that the provider gives a copy of the form to the enrollee and keeps a copy in the enrollee's ’s medical record.
e. The Health Plan shall ensure that providers give all women of childbearing age HIV counseling and offer them HIV testing. See Chapter 381, F.S. WellCare of Florida, Inc., Medicaid HMO Non-Reform ContractF.S.
(1) The Health Plan shall ensure that its providers offer all pregnant women counseling and HIV testing at the initial prenatal care visit and again at twenty-twenty- eight (28) and thirty-two (32) weeks.
(2) The The. Health Plan shall ensure that its providers attempt to obtain a signed objection if a pregnant woman declines an HIV test. See s. 384.31, F.S.F.S. and 64D-3.019, F.A.C.
(3) The Health Plan shall ensure that all pregnant women who are infected with HIV are counseled about and offered the latest antiretroviral regimen recommended by the U.S. Department of Health & Human Services (Public Health Service Task Force Report entitled Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States).
f. The Health Plan shall ensure that its providers screen all pregnant enrollees receiving prenatal care for the Hepatitis B surface antigen (HBsAg) during the first prenatal visit.
(1) The Health Plan shall ensure that its the providers perform a second HBsAg test between twenty-eight (28) and thirty-two (32) weeks of pregnancy for all pregnant AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract enrollees who tested negative at the first prenatal visit and are considered high-high- risk for Hepatitis B infection. This test shall be performed at the same time that other routine prenatal screening is ordered.
(2) All HBsAg-positive women shall be reported to the local CHD and to Healthy Start, regardless of their Healthy Start screening score.
g. The Health Plan shall ensure that infants born to HBsAg-positive enrollees receive Hepatitis B Immune Globulin (HBIG) and the Hepatitis B vaccine once they are physiologically stable, preferably within twelve (12) hours of birth, and shall complete the Hepatitis B vaccine series according to the vaccine schedule established by the Recommended Childhood Immunization Schedule for the United States.
(1) The Health Plan shall ensure that its providers test infants born to HBsAg-positive HBsAgpositive enrollees for HBsAg and Hepatitis B surface antibodies (anti-HBs) six (6) months after the completion of the vaccine series to monitor the success or failure of the therapy.
(2) The Health Plan shall ensure that providers report to the local CHD a positive HBsAg result in any child age 24 months or less within twenty-four (24) hours of receipt of the positive test results.
(3) The Health Plan shall ensure that infants born to enrollees who are HBsAg-positive HBsAgpositive are referred to Healthy Start regardless of their Healthy Start screening score.
h. The Health Plan shall report to the Perinatal Hepatitis B Prevention Coordinator at the local CHD all prenatal or postpartum enrollees who test HBsAg-positive. The Health Plan also shall report said enrollees’ infants and contacts to the Perinatal Hepatitis B Prevention Coordinator. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract.
(1) The Health Plan shall report the following information – — name, date of birth, race, ethnicity, address, infants, contacts, laboratory test performed, date the sample was collected, the due date or estimated date of confinement, whether the enrollee received prenatal care, and immunization dates for infants and contacts.
(2) The Health Plan shall use the Practitioner Disease Perinatal Hepatitis B Case and Contact Report Form (DH Form 21361876) for reporting purposes.
i. The Health Plan shall ensure that the PCP maintains all documentation of Healthy Start screenings, assessments, findings and referrals in the enrollees’ medical records.
Appears in 1 contract
Samples: Standard Contract (Amerigroup Corp)
Pregnancy Related Requirements. a. The Health Plan shall must provide the most appropriate and highest level of quality care for pregnant enrolleesEnrollees. Required care includes the following:
a. (1) Florida's ’s Healthy Start Prenatal Risk Screening – The Health Plan shall ensure that the provider Provider offers Florida's ’s Healthy Start prenatal risk screening to each pregnant enrollee Enrollee as part of her first prenatal visit. As required by s. Section 383.14, F.S., s. 381.004, F.S., and Rule 64C-7.009, F.A.C.
(1a) The Health Plan shall ensure that the provider Provider uses the DOH prenatal risk form (DH Form 3134), which can be obtained from the local CHD.
(2b) The Health Plan shall ensure that the provider keeps Provider retains a copy of the completed screening instrument in the enrollee's medical record Enrollee’s Medical Record and provides a copy to the enrolleeEnrollee.
(3c) The Health Plan shall ensure that the provider Provider submits the completed DH Form 3134 to the CHD in the county where in which the prenatal screen was completed within ten (10) business days Business Days of completion of the screening. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contractcompletion.
(4d) The Health Plan shall collaborate with the Healthy Start care coordinator within the enrollee's Enrollee’s county of residence to assure delivery of risk-risk appropriate carecare is delivered.
b. (2) Florida's ’s Healthy Start Infant (Postnatal) Risk Screening Instrument – The Health Plan shall ensure that Florida hospitals contracting with the Health Plan electronically file Provider completes the Florida Healthy Start Infant (Postnatal) Risk Screening Instrument (DH Form 3135) and with the Certificate of Live Birth with and transmits the documents to the CHD in the county where in which the infant was born within five ten (510) business days Business Days of the birthcompletion. The Health Plans that contract with birthing facilities not participating in the Department of Health electronic birth registration system Plan shall ensure that the provider files required birth information with the CHD within five (5) business days of the birth, keeps Provider retains a copy of the completed DH Form 3135 in the enrollee's medical record Enrollee’s Medical Record and mails provides a copy to the enrolleeEnrollee.
c. (3) Pregnant enrollees Enrollees or infants who do not score high enough to be eligible for Healthy Start care coordination may be referred for services, regardless of their score on the Healthy Start risk screen, in the following ways:
(1a) If the referral is to be made at the same time the Healthy Start risk screen is administered, the provider Provider may indicate on the risk screening form that the enrollee Enrollee or infant is invited to participate based on factors other than score; or
(2b) If the determination is made subsequent to risk screening, the provider Provider may refer the enrollee Enrollee or infant directly to the Healthy Start care coordinator based on assessment of actual or potential factors associated with high risk, such as HIV, Hepatitis hepatitis B, substance abuse or domestic violence.
d. (4) The Health Plan shall refer all infantspregnant women, children breast-feeding and postpartum women, infants and Children/Adolescents up to age five (5), and pregnant, breast-feeding and postpartum women ) to the local WIC office.
(1a) The Health Plan shall ensure providers provide:
(ai) A completed Florida WIC program medical referral form Medical Referral Form with the current height or length and weight (taken within sixty (60) calendar days Calendar Days of the WIC appointment);
(bii) Hemoglobin or hematocrit; and
(ciii) Any identified medical/nutritional problems.
(2b) For subsequent WIC certifications, the Health Plan shall ensure that providers Providers coordinate with the local WIC office to provide the above referral data from the most recent CHCUP.
(3c) Each time the provider Health Plan completes a WIC referral formReferral Form, the Health Plan shall ensure that the provider Provider gives a copy of the form WIC Referral Form to the enrollee Enrollee and keeps retains a copy in the enrollee's medical recordEnrollee’s Medical Record.
e. (5) The Health Plan shall ensure that providers give the Providers provide all women of childbearing age HIV counseling and offer them HIV testing. See Chapter 381, F.S. WellCare of Florida, Inc., Medicaid HMO Non-Reform ContractF.S.
(1a) The Health Plan shall ensure that its providers Providers, in accordance with Florida law, offer all pregnant women counseling and HIV testing at the initial prenatal care visit and again at twenty-eight (28) and to thirty-two (32) weeks.
(2b) The Health Plan shall ensure that its providers Providers attempt to obtain a signed objection if a pregnant woman declines an HIV test. See s. Section 384.31, F.S.F.S. and 64D-3.019, F.A.C.
(3c) The Health Plan shall ensure that all pregnant women who are infected with HIV are counseled about and offered the latest antiretroviral regimen recommended by the U.S. Department of Health & Human Services (U.S. Department of Health & Human Services, Public Health Service Task Force Report entitled Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States. To receive a copy of the guidelines, contact the DOH, Bureau of HIV/AIDS at (000) 000-0000, or go to xxxx://xxxxxxxx.xxx.xxx/guidelines/).
f. (6) The Health Plan shall ensure that its providers Providers screen all pregnant enrollees Enrollees receiving prenatal care for the Hepatitis B surface antigen (HBsAg) during the first (1st) prenatal visit.
(1a) The Health Plan shall ensure that its providers the Providers perform a second (2nd) HBsAg test between twenty-eight (28) and thirty-two (32) weeks of pregnancy for all pregnant enrollees Enrollees who tested negative at the first (1st) prenatal visit and are considered high-risk for Hepatitis B infection. This test shall be performed at the same time that other routine prenatal screening is ordered.
(2b) All HBsAg-positive women shall be reported to the local CHD and to Healthy Start, regardless of their Healthy Start screening score.
g. (7) The Health Plan shall ensure that infants born to HBsAg-positive enrollees Enrollees shall receive Hepatitis B Immune Globulin (HBIG) and the Hepatitis B vaccine once they are physiologically stable, preferably within twelve (12) hours of birth, birth and shall complete the Hepatitis B vaccine Xxxxxx series according to the recommended vaccine schedule established by the Recommended Childhood Immunization Schedule for the United States.
(1a) The Health Plan shall ensure that its providers Providers test infants born to HBsAg-positive enrollees Enrollees for HBsAg and Hepatitis B surface antibodies (anti-HBs) six (6) months after the completion of the vaccine series to monitor the success or failure of the therapy.
(2b) The Health Plan shall ensure that providers Providers report to the local CHD a positive HBsAg result in any child age 24 aged twenty-four (24) months or less within twenty-four (24) hours of receipt of the positive test results.
(3c) The Health Plan shall ensure that infants born to enrollees Enrollees who are HBsAg-positive are referred to Healthy Start regardless of their Healthy Start screening score.
h. (8) The Health Plan shall report to the Perinatal Hepatitis B Prevention Coordinator at the local CHD all prenatal or postpartum enrollees Enrollees who test HBsAg-positive. The Health Plan also shall report said enrolleesEnrollees’ infants and contacts to the Perinatal Hepatitis B Prevention Coordinator. WellCare of Florida, Inc., Medicaid HMO Non-Reform ContractCoordinator at the local CHD.
(1a) The Health Plan shall report the following information – name, date of birth, race, ethnicity, address, infants, contacts, laboratory test performed, date the sample was collected, the due date or estimated date of confinementEDC, whether or not the enrollee Enrollee received prenatal care, and immunization dates for infants and contacts.
(2b) The Health Plan shall use the Practitioner Disease Perinatal Hepatitis B Case and Contact Report Form (DH Form 21361876) for reporting purposes.
i. (9) The Health Plan shall ensure that the PCP maintains all documentation of Healthy Start screenings, assessments, findings and referrals in the enrolleesEnrollees’ medical recordsMedical Records. The Health Plan shall ensure quick access to Enrollees’ Medical Records in the Provider Contract.
(10) The Health Plan shall provide the most appropriate and highest level of quality care for pregnant Enrollees, including, but not limited to, the following:
(a) Prenatal Care – The Health Plan shall:
(i) Require a pregnancy test and a nursing assessment with referrals to a physician, PA or ARNP for comprehensive evaluation;
(ii) Require Case Management through the gestational period according to the needs of the Enrollee;
(iii) Require any necessary referrals and follow-up;
(iv) Schedule return prenatal visits at least every four (4) weeks until the thirty-second (32nd) week, every two (2) weeks until the thirty-sixth (36th) week, and every week thereafter until delivery, unless the Enrollee’s condition requires more frequent visits;
(v) Contact those Enrollees who fail to keep their prenatal appointments as soon as possible, and arrange for their continued prenatal care;
(vi) Assist Enrollees in making delivery arrangements, if necessary; and
(vii) Ensure that all Providers screen all pregnant Enrollees for tobacco use and make certain that the Providers make available to the pregnant Enrollees smoking cessation counseling and appropriate treatment as needed.
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