Sec. 10.09.38.04. Covered Services

Effective July 1, 2006, the Program shall reimburse for the following services:

A. Risk Assessment-Plan of Care.

(1) One unit of service is to be reimbursed for each pregnancy.

(2) A risk assessment is an appraisal of the participant's medical history and current health, nutritional, psychological, and social status, as specified in the Healthy Start Risk Assessment Instrument. It results in the identification of problems having an impact on the outcome of the pregnancy and the subsequent health care status of the child. Based on the assessment, an appropriate plan of care is drafted and appropriate referrals are made. A copy of the completed Healthy Start Risk Assessment Instrument will be sent by the provider to the participant's local health department within 10 working days of the risk assessment.

(3) A plan of care is a description of the services and resources required to meet the participant's needs identified through the risk assessment. An individual participant's plan of care:

(a) Includes a description of the specific action steps necessary to address each identified need;

(b) Matches the risk status of the participant to the appropriate intensity and breadth of care;

(c) Describes the elements of care, provider or providers, and facilities to be utilized by the participant;

(d) Is subject to modification as new information arises during the course of care, including information communicated from the provider of home-visiting services;

(e) Is individualized and is developed in consultation with the participant; and

(f) Encompasses the continuum of care from the prenatal period through postpartum.

B. Enriched Maternity Service. A maximum of one unit of service is to be reimbursed in conjunction with each prenatal and postpartum clinical visit of the participant. The following components comprise enriched maternity service:

(1) Prenatal and postpartum counseling and education. This component shall include, but not be limited to, the following topics:

(a) The benefits and recommended schedule of prenatal visits, including routine laboratory and radiological services;

(b) Danger signs of pre-term labor, including how to differentiate between normal and abnormal signs and symptoms related to pregnancy and what actions the individual should take;

(c) Preparation for labor and delivery, including hospital registration procedures;

(d) The risks of using prescription and over-the-counter medicines during pregnancy;

(e) The risks of alcohol, tobacco, and controlled substance use;

(f) The benefits of proper dental care;

(g) The benefits of seat belt and infant car seat use;

(h) The importance of postpartum care and continuing family planning services; and

(i) Arrangements for pediatric care.

(2) Nutrition education for pregnant and postpartum participants. This component shall include, but not be limited to, the following topics:

(a) The relation of proper nutrition to a healthy pregnancy and to a successful pregnancy outcome;

(b) Kinds and amounts of foods needed to meet nutritional requirements during pregnancy;

(c) Appropriate weight gain during pregnancy, and components of gain;

(d) Early decisions about infant feeding practices;

(e) Benefits of, and preparation for, breastfeeding;

(f) Appropriate use of nutritional supplements, if prescribed;

(g) A postpartum woman's nutritional needs; and

(h) The benefits of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

(3) Case coordination and referral for pregnant participants. This component shall include, but not be limited to, the following activities:

(a) Telephone reminders before prenatal and postpartum appointments and follow-up telephone contact if the participant misses an appointment;

(b) Referral of the participant to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC);

(c) Referral of the participant to specialty services as indicated;

(d) Referral of the participant to high-risk nutrition counseling as indicated;

(e) Referral of the participant to high-risk obstetrician-gynecologist specialists, perinatologists, or other specialists based on the client's medical needs;

(f) Arrangements for hospital delivery, including delivery at a tertiary care maternity center as indicated;

(g) Arrangements for pediatric care; and

(h) Assistance in arranging for transportation to and from clinical services.

C. High-Risk Nutrition Counseling Services. These services are provided to nutritionally high-risk pregnant participants. Nutritionally high-risk pregnant participants are identified to the high-risk nutrition counseling services provider through the Healthy Start High-Risk Nutrition Instrument. The services include, but are not limited to, the following:

(1) Making a nutritional assessment including the recording and interpretation of anthropometric measurements, clinical and laboratory findings, medical conditions, nutrient and drug interactions, diet history, and psychological, social, cultural, religious, and economic factors affecting food intake;

(2) Developing a nutritional care plan based on problems identified through the assessment and integrated into the total plan of care;

(3) Determining appropriate interventions to achieve care plan goals consistent with the participant's culture, family composition, and restrictions imposed by income, transportation availability, and neighborhood food resources, including, but not limited to, counseling for food habit and behavior change, diet modifications for medical conditions, and referral for food assistance; and

(4) Monitoring and recording participant's progress toward goal achievement.