Sec. 10.67.06.21. Benefits — Pregnancy-Related Services

A. An MCO shall provide to its pregnant and postpartum enrollees medically necessary pregnancy-related services, including:

(1) Comprehensive prenatal, perinatal, and postpartum care, including high-risk specialty care when appropriate;

(2) Prenatal risk assessment and development of an individualized plan of care that specifies the actions required to address each identified need and is appropriately modified during the course of care;

(3) Enriched maternity services, including:

(a) Prenatal and postpartum counseling and education;

(b) Basic nutritional education;

(c) Substance abuse treatment, as provided in Regulation .10 of this chapter;

(d) Appropriate referrals to services that may improve the pregnancy outcome, including:

(i) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and

(ii) Healthy Start services;

(e) High-risk nutrition counseling services for nutritionally high-risk pregnant women;

(f) Appropriate levels of inpatient care, including emergency transfer of pregnant women and newborns to tertiary care centers; and

(g) Smoking cessation education and treatment.

B. When an enrollee recovering from childbirth elects to be discharged before 48 hours following a normal vaginal delivery or 96 hours following an uncomplicated cesarean section, the MCO is responsible for providing:

(1) One home visit scheduled to occur within 24 hours after discharge; and

(2) An additional home visit as may be prescribed by the attending provider.

C. When an enrollee recovering from childbirth and her newborn enrollee remain in the hospital for at least as long as the period of time provided under §B of this regulation, the MCO shall provide a home visit as prescribed by the attending provider.

D. An MCO shall provide for home visits required by §§B and C of this regulation to be performed by a registered nurse and in accordance with generally accepted standards of nursing practice for home care of a mother and newborn child, including:

(1) An evaluation of the presence of immediate problems of dehydration, sepsis, infection, jaundice, respiratory distress, cardiac distress, or other adverse physical symptoms of the infant;

(2) An evaluation of the presence of immediate problems of dehydration, sepsis, infection, bleeding, pain, or other adverse symptoms of the mother;

(3) Collection of a blood specimen for newborn screening if not previously completed;

(4) Referrals for any medically necessary continuing health care services; and

(5) Any other nursing services ordered by the referring provider.