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

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the enrollee’s medical record
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
The health plan required a pregnancy test and a nursing
assessment with referrals to a physician, PA, or ARNP for
comprehensive evaluation
11 The health plan:
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a. Required case management through the gestations period
according to the needs of the enrollee
b. Required any necessary referrals and follow-up
c. Scheduled return prenatal visits at least every four weeks
until week 32, every two weeks until week 36, and every
week thereafter until delivery, unless the enrollee’s condition
required more frequent visits
d. Contacted enrollees who failed to keep prenatal
appointments as soon as possible, and arranged for
continued prenatal care
e. Assisted enrollees in making delivery arrangements, if
necessary
f. Ensured that providers screened all pregnant enrollees for
tobacco use and made available smoking cessation
counseling and appropriate treatment as needed
13 Concerning nutritional assessment/counseling , the health plan:
a. Ensured that providers supplied nutritional
assessment/counseling to all pregnant enrollees
b. Ensured the provision of safe and adequate nutrition for
infants by promoting breast-feeding and the use of breast
milk substitutes
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N Y N Y N Y N Y N
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N Y N Y N Y N Y N
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N Y N Y N Y N Y N
Y N Y N Y N Y N Y N
Y N Y N Y N Y N Y N
c. Offered a mid-level nutrition assessment Y N Y N Y N Y N Y N
d. Provided individualized diet counseling and a nutrition care
plan by a public health nutritionist, a nurse, or physician
following the nutrition assessment
e. Ensured documentation of the nutrition care plan in the
medical record by the person providing counseling
Y N Y N Y N Y N Y N
Y N Y N Y N Y N Y N
Managed Care Organizations Page 3
Pregnancy Related Review Tool F1_07_11
Florida Medicaid