Standards for Providers of MOMS Health Supportive Services
Within 90 days of initiating MOMS health supportive services (HSS), the HSSP shall have a memorandum of understanding or written agreement with the referring MOMS medical provider which clearly describes the formal mechanisms of referral and ongoing communication between the medical provider and the HSSP. The agreement should address: exchange of initial and ongoing risk status findings as identified by both medical and HSSP; mechanisms to followup missed appointments; mutually agreeable documentation to ensure coordination and quality of care.
The HSSP shall initiate services within 10 working days of a referral.
After obtaining an informed consent from the client, the HSSP shall provide all health supportive services as outlined in these standards.
In submitting Medicaid claims for health supportive services, the HSSP shall adhere to the definitions of a threshold or billable visit and billing instructions as contained in Program and Billing Guidelines for MOMS Health Supportive Services.
The MOMS HSS provider shall act as a "qualified provider" as required by the Department of Social Services (see 18 NYCRR 360.3.7 (d)).
Following the determination of a pregnant woman's presumptive eligibility for Medicaid benefits, the MOMS HSS provider shall offer to act as her authorized representative in the Medicaid application process. If the woman wishes the agency to represent her in the Medicaid application process, the agency shall do so.
The MOMS HSS provider shall permit on-site program review by representatives of the Department of Health of at any facilities where HSS care and services are provided.
The MOMS HSS provider shall permit on-site program review by representatives of the Department of Health of any records and reports directly related to MOMS HSS.
Any subcontracts between MOMS HSS providers and other agents or agencies providing care and services shall:
be available for review and inspection by the Department of Health;
include assurances that the Department of Health has access to agent or agency sites and records to conduct on-site program compliance reviews; and
require that the subcontractors provide contracted care and services that meet the minimum standards established by the MOMS program and are provided in accordance with generally accepted standards of practice and patient care services.
Outreach. MOMS HHS providers shall engage in community outreach activities which, as a minimum:
facilitate early entry into maternity services; and
reflect linkages with community-based resources commonly utilized by pregnant women; and
disseminate information concerning available services and initial enrollment procedures.
Nutrition services. The MOMS provider shall establish and implement a program of nutrition screening and counseling which includes:
individual nutrition risk assessment including screening for specific nutritional risk conditions at the initial MOMS HSS visit and continuing reassessment as needed.
professional nutrition counseling, monitoring and follow-up of all pregnant women at nutritional risk by a nutritionist or registered dietitian.
transfer of documentation of nutrition assessment, risk status and nutrition care plan to the MOMS medical provider record;
arrangements for services with funded nutrition programs available in the community including provision for enrollment of all eligible women and infants in the Supplement Food Program for Women, Infants and Children (WIC), at the initial visit; and
provision of basic nutrition education and counseling for each pregnant woman which includes the following topics:
appropriate dietary intake and recommended dietary allowances during normal pregnancy;
appropriate weight gain; and
infant feeding choices including individualized counseling regarding the advantages and disadvantages of breastfeeding.
Psychosocial services. The MOMS HSS provider shall establish and implement a program of psychosocial screening and counseling which includes:
a psychosocial assessment including screening for social, economic, psychological, emotional and domestic violence problems at the initial MOMS HSS visit;
professional counseling, monitoring and followup of women at psychosocial risk; and
referral, as appropriate to the needs of the woman or fetus, to the local Department of Social Services, community mental health resources, support groups or social/psychological specialists.
Development of care plan and coordination of care.
a written care plan which addresses the proper implementation and coordination of all health supportive services required by the pregnant woman shall be developed, routinely updated and implemented jointly by the pregnant woman and her family where mutually agreeable to the woman and all appropriate members of the health care team.
care shall be coordinated to:
ensure that relevant information is exchanged between the MOMS HSS and MOMS medical care provider;
ensure that the pregnant woman and her family, with her consent, have continued access to information resources and are encouraged to participate in decisions involving the scope and nature of care and services being provided;
encourage and assist the pregnant woman in obtaining necessary medical, nutritional, psychosocial, drug and substance abuse services and transportation services appropriate to her identified needs and provide followup to ensure ongoing access to services;
provide the pregnant woman with an opportunity to receive prenatal or postpartum home visitation when the woman may derive medical or psychosocial benefit from such visits; and
encourage continuity of care and client followup including rescheduling of missed visits throughout the prenatal and postpartum period.
Health education: Health and childbirth education services shall be given to each pregnant woman based on an assessment of her individual needs. Appropriate educational materials, including video and written information shall be used, taking into account cultural and language factors including the ability of the pregnant woman to comprehend the information. Such services shall be provided by professional staff, documented in the medical record and shall include but not be limited to the following:
orientation to procedures at MOMS HSS facilities and at the expected site of birth;
rights and responsibilities of the pregnant woman;
signs of complications of pregnancy;
physical activity and exercise during pregnancy;
avoidance of harmful practices and substances including alcohol, drugs, non-prescribed medications, and nicotine;
sexuality during pregnancy;
risks of HIV infection and risk reduction behaviors;
sign of labor;
labor and delivery process;
relaxation techniques in labor;
obstetrical anesthesia and analgesia;
preparation for parenting including information about infant care, growth and development and options for feeding;
the newborn screening program with the distribution of newborn screening educational literature; and
HIV services. The MOMS HSS provider in collaboration with the MOMS medical provider shall:
directly provide all pregnant women with HIV counseling and education;
directly offer all pregnant women confidential HIV testing; and
assist in coordination of necessary medical, social, and addictive services for the HIV positive women.
Records and reports. The MOM HSS provider shall create and maintain records and reports that are complete, legible, retrievable and available for review by representatives of the Commissioner of Health upon request. Such records and reports shall include the following:
a record for each pregnant woman which documents the provision of health supportive services required by this section which is maintained in a manner consistent with medical record confidentiality requirements;
special reports and data summaries necessary for the Commissioner of Health to evaluate the provider's delivery of MOMS HSS services;
records of all internal quality assurance activities; and
all written policies and procedures required by this section.
Internal quality assurance. The MOMS HSS provider shall develop and implement written policies and procedures establishing an internal quality assurance program to identify, evaluate, resolve and monitor actual potential problems in patient care. Components of such program shall include but not be limited to following:
a documented and filed prenatal chart audit performed periodically on a statistically significant number of current MOMS HSS client records;
a system for determining patient satisfaction and for resolving patient complaints;
a system for developing and recommending corrective actions to resolve identified problems;
a followup process to assure that recommendations and plans of correction are implemented and are effective, and
safeguards to prevent the inappropriate breach of patient confidentiality requirements.
Postpartum services. The MOMS HSS provider shall coordinate with the MOMS medical provider and the client to ensure that postpartum and pediatrics services are obtained by the client and her infant in accordance with their medical needs. In addition, the MOMS HSS provider is responsible for:
identifying any health-related, family planning, psychosocial, nutritional, alcohol and drug treatment needs of the mother or infant that are not being met;
referring the mother and other infant caregiver to resources available for meeting such needs and providing assistance in meeting such needs where appropriate; and
advising the mother of the availability of Medicaid for infants.