FY14 Contract Training for Public Health Prenatal Program/Maternity Services

1. FY14 Contract Training for Public Health Prenatal Program/Maternity Services Trina Miller Prenatal Program Coordinator Division of Child & Family Health Department for Public Health

2. Public Health Prenatal Program • Prenatal Care is included in the Core Public Health Services. Prenatal care serves as the primary strategy for reducing infant mortality and improving birth outcomes. • The Core Public Health Block Grant Funds should be used to assure routine prenatal services for those women eligible for the Public Health Prenatal Program. • Eligibility Requirements: Pregnant women who have income at or below 185% FPL and have no other payor source (i.e., are not Medicaid eligible). • Funding may also be accessed through local funds, Medicaid and other payors.

3. Public Health Prenatal Program • Contract prices for services for uninsured clients shall be aligned with current Medicaid and DPH approved rates. • DMS Physician fee rates can be found at the following CHFS/DMS link: http://chfs.ky.gov/dms/fee.htm under “Physician Fee Service”. Open PDF version and enter the CPT code in the FIND box to locate the fee easily.

4. Public Health Prenatal Program • LHD should assure the basic and medically necessary prenatal services are provided to patients participating in the Public Health Prenatal Program. • A description of services is listed in the Administrative References and a list of most CPT codes is included in the Public Health Prenatal Program CPT List (Prenatal/Maternity Database) as guidance. • LHD can make local decisions about judiciously covering other services for these income-eligible patients according to their local budget and patient needs. • All local health departments must assure that prenatal care is available for all pregnant women in their jurisdiction, either directly or through referral. Contracts are to fulfill that assurance.

5. Three types of Prenatal Contracts Below are the three types of contracts often utilized for Maternity Services in the Public Health Prenatal Program. The prenatal contract types are: • Personnel contracts for onsite provider for prenatal care clinical services at LHD (Template 1) • Referrals to providers for prenatal care clinical services in their office setting (Template 2) • Prenatal outpatient testing in hospitals if not available in the health department or contracted physician office (optional, depending on local needs – Template 3) *Each type of contract has a template that list the required contract language and examples of other suggested language as applicable.

6. Required Contract Language Health departments may adapt recommended language in the contract templates, but all prenatal contracts must include the following elements (4): • Prenatal care providers must be licensed in Kentucky and Board Certified in Obstetrics, Family Practice, or Midwifery. Any services by a midwife must be provided by a nurse midwife. If prenatal care is not under the direction of an obstetrician, an obstetrician shall be available for consultation. Providers must act within their legal scope of practice and assure they have professional liability insurance for the services they provide. [Include in the Provider Credentials/Qualifications section] • Prenatal care, regardless of which provider is delivering the care, must follow the most current guidelines of the American Congress of Obstetricians and Gynecologists (ACOG), and the CCSG when care is delivered in health department facilities. [Include in the Provider Credentials/Qualifications section]

7. Required Contract Language Health departments may adapt suggested language in the contract templates, but all prenatal contracts must include the following elements: 3. Contracts must specify compensation for services. Include: Compensation for services to any provider shall be at the current Medicaid rate or a lesser agreed upon amount. That payment is to be considered as “payment in full” for the particular service; the patient shall not be billed for these services. [Include in Compensation/Payment section] 4. Billing procedures and required documentation must be specified in the contract. These may vary according to local arrangements. Examples are provided in the Templates. [Include in Billing Procedures section]

8. Contract Templates • The templates are designed to include the REQUIRED LANGUAGE. • Suggestions: • Copy & paste the template into the current CH-53M. • Delete language that does not apply; revise or add language according to local needs and agreements with Contractor.

9. Contract Template 1 – Prenatal Contracted On-Site Services Contract Template 1 – Prenatal Contracted On-Site Services Use when clinical prenatal service are provided at the LHD by the contracted provider. • Indicate the location and anticipated days/times of when the Contractor shall provide prenatal services. • Specify which payment method you will be using and provide detailed information. • There shall not be direct billing by the contractor to the patient. • See Template 1 for additional recommended language

10. Recommended Language - Contract Template 2 Clinical Provider Referral Agreement Contract Template 2 – Clinical Provider Referral Agreement Use for referrals to providers for prenatal care clinical services performed in the provider’s office setting • Indicate the location of where the Contractor shall provide prenatal services. • Specify which payment method you will be using and provide detailed information. • There shall not be direct billing by the contractor to the patient. • The Contractor shall provide the Health Department with the appropriate documentation of services provided utilizing the current CPT codes and ICD-9/ICD-10 nomenclature. Options for documentation may include the CMS-1500, CMS-1450 or the same information provided in an Excel Form. A report of services must be received prior to payment. • See Template 2 for additional recommended language

11. Contract Template 3 – Hospital Outpatient Testing Contract Template 3 – Hospital Outpatient Testing This contract is optional and may not be applicable for all LHD • Contracted provider is Licensed with the state of Kentucky and, preferably accredited by the Joint Commission on Accreditation of Healthcare Organizations. • Contractor agrees to comply with ambulatory obstetrical care standards as specified in the current edition of “Guidelines for Perinatal Care”, a joint document from the American Academy of Pediatrics and the American Congress of Obstetrics and Gynecologists [ACOG]. • Hospital Laboratories performing services shall have a certificate attesting that they meet regulations for Clinical Laboratories Improvement Act [CLIA] • Contractor will provide outpatient services for Authorized Public Health Prenatal Patients only upon written order by the patient’s prenatal care provider. • Test results will be performed according to professional standards, and interpreted by appropriately qualified personnel. Results will be reported in a timely manner to the prenatal care provider. • Contractor may be reimbursed by the Health Department for services to authorized Public Health Prenatal Patients when ordered by the prenatal care provider. Covered services, if not able to be done in other settings, will be paid at a negotiated rate in this contract. • COMPENSATION/PAYMENT: [LHD should insert here table of procedures and negotiated rates.] • See Template 3 for additional recommended language

12. Resources • The Clinical Core Service Guidelines (CCGS) • Program/Maternity Service Matrix is located in the PHPR • The Administrative Reference (AR) • The Prenatal Program website located at http://chfs.ky.gov/dph/mch/cfhi/prenatalprogram.htm • DMS Physician fee rates can be found at the following CHFS/DMS link: http://chfs.ky.gov/dms/fee.htm under “Physician Fee Service”. Open PDF version and enter the CPT code in the FIND box to locate the fee easily.

13. THANK YOU Trina Miller Prenatal Program Coordinator/Perinatal Nurse Consultant 502-564-2154 ext. 4406 TrinaM.Miller@ky.gov