Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Agency For Health Care Administration
Managed Care Organizations
Pregnancy Related Requirements
CONTRACT SECTION V.H.15
REQUIREMENTS FOR PREGNANCY-RELATED REVIEWS
Required Components File #1 File #2 File #3 File #4 File #5
4. The health plan ensures that practitioners provided:
a. A completed Florida WIC program medical referral form with
the current height or length and weight
Y N Y N Y N Y N Y N
b. Hemoglobin or hematocrit Y N Y N Y N Y N Y N
c. Any identified medical/nutritional problems Y N Y N Y N Y N Y N
5. The health plan:
6.
7.
8.
9.
a. Ensures that providers offered all pregnant women
counseling and HIV testing at the initial prenatal care visit
Y N Y N Y N Y N Y N
b. Ensures that providers offered all pregnant women
counseling and HIV testing at 28 weeks
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
c. Ensures that providers offered all pregnant women
counseling and HIV testing at 32 weeks
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
d. Ensures that providers attempted to obtain a signed objection
if a pregnant woman declined an HIV test (s. 384.31, F.S.
and 64-D-3.019, F.A.C.)
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
e. Ensures that all pregnant women who were infected with HIV
were counseled about and offered the latest antiretroviral
regime recommended by the USDHHS (Public Health
Service Task Force Report: 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)
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
The health plan ensures that providers screened all pregnant
enrollees receiving prenatal care for the Hepatitis B surface antigen
(HBsAg) during the first prenatal visit
The health plan ensures that providers performed a second HBsAg
test between 28 and 32 weeks of pregnancy for all pregnant
Y N Y N Y N Y N Y N
enrollees who tested negative at the first prenatal visit and were
considered high-risk for Hepatitis B infection. This test was
performed at the same time as other routine prenatal screenings.
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
All HBsAg-positive women were reported to the local CHD and to
Healthy Start, regardless of the Healthy Start screening score
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
The health plan ensures that the PCP maintained all documentation
of Healthy Start screenings, assessments, findings, and referrals in
Y N Y N Y N Y N Y N
Managed Care Organizations Page 2
Pregnancy Related Review Tool F1_07_11
Florida Medicaid