indiana medicaid perinatal updates
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INDIANA MEDICAID PERINATAL UPDATES
Presumptive EligibilityNotification of Pregnancy
Prenatal Care Coordination
July 7, 2010Glenna Asmus Nall, Quality and Outcomes Manager
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Programming Updates
Implemented July 1, 2009– Presumptive Eligibility for Pregnant Women– Notification of Pregnancy (risk assessment)
Under Development–Prenatal Care Coordination
• Processes, including certification• Forms• Coordination with Medicaid health plans
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Presumptive Eligibility
Implemented July 1, 2009– Provides outpatient prenatal care while
Medicaid application is processed
As of June 29, 2010:– 10,491 ever enrolled in PE– 1,061 currently enrolled in PE– 80% of PE members are approved for Medicaid– 95% of PE members have Medicaid decision
within 45-days of pending application date
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Presumptive Eligibility
• Too early* to review effect of PE on the following measures:– 1st Trimester Prenatal Care– Adequacy of Prenatal Care– Postpartum follow-up care
* Need sufficient sample size and time for claims submission
* Many women during early PE implementation had been ‘waiting for PE’ and may not be representative of women entering PE now
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Presumptive Eligibility
• PE process relies on Qualified Providers that volunteer to assist women with the PE Application process
• Currently 245 QPs are enrolled with Medicaid in 66 counties– Provider Relations will begin recruiting additional providers
to become QPs in 2010; 18 contacted for training
• Benefits of being a QP:– Payment for services provided during PE period– Pregnant woman is eligible for benefits like pharmacy and
transportation during the PE period – Pregnant women is enrolled with a health plan that can
assist with finding medical and social supports in the community
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Presumptive Eligibility
Northwest, North Central and Central Regions are lower than typical pregnancy enrollment.
Northwest: 9.7% vs. 11.4% North Central: 1.6% vs. 12.5%Central: 24.1% vs. 30.4%
Southwest, Northeast, West Central Southeast, and East Central are higher than typical pregnancy enrollment.
Southwest: 20.3% vs. 10.2%Northwest: 15.2% vs. 7.8%West Central: 9.2% vs. 7.8%Southeast: 10.6% vs. 8.8%East Central : 9.4% vs. 8.7%
Source: OMPP, MedInsight, Retrieved March 2010
9.7%1.6%
15.2%
9.2%
24.1%9.4%
20.3%
10.6%
Proportion of PE Enrollment by Region, March 2010
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Presumptive Eligibility
0.3%
21.5%
44.2%
21.3%
8.4%
3.5% 0.7% 0.1%PE Enrollees by Age Group
8-14 years 15-19 yrs 20-24 yrs 25-29 yrs
30-34 yrs 35-39 yrs 40-44 yrs 45-49 yrs
Source: Office of Medicaid Policy and Planning, MedInsight, Retrieved March 2010
Most PE enrollees are under 24 years of age and appear to be younger than the pregnancy-Medicaid population.
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• Transition to Medicaid– Most PE women
transition to one of the pregnancy aid categories after PE coverage ends
74.4%
20.2%
3.2% 2.1%Pregancy Aid Categories
Low Income Families
Children, including CHIP
Other, including ward/fosters, disabled
Presumptive Eligibility
Source: Office of Medicaid Policy and Planning, MedInsight, Retrieved June 2010
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Notification of Pregnancy
• Notification of Pregnancy (NOP) is a risk assessment completed by medical staff and submitted to OMPP– Implemented July 1, 2009 – over 9,000
submitted– Providers are reimbursed $60 for submission
• OMPP transmits the information to the woman’s health plan and ISDH
• Health plans utilize the NOP to quantify risk factors that are amenable to interventionsSource: Office of Medicaid Policy and Planning, Business
Objects, NOP Summary Report, July 1, 2009 – March 31, 2010
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Notification of Pregnancy
• Tobacco Use – 32% – Nearly 70% are ready to quit with some help
• Pre-pregnancy BMI >30 – 30%• History of Depression – 14%• Mother <19 years old – 12%• 30% diagnosed as high risk by clinician
completing the NOP– Many more women are at high risk due to a
combination of several risk factors
Source: Office of Medicaid Policy and Planning, Business Objects, NOP Summary Report, July 1, 2009 – March 31, 2010
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Notification of Pregnancy
• Tobacco Use– Referral to Indiana Tobacco Quitline– Quitline provides progress reports back to referring provider
• BMI > 30 – Risks to both mother and newborns, can be decreased if pregnancy weight gain is
kept to 15lbs
• History of Depression– Recognizing and treating depression is important for both mother and newborn
• Young Maternal Age– Young women often lack the education/resources necessary to focus on prenatal care
The health plans and prenatal care coordinators can be a resource for clinicians treating high risk pregnancies by providing – case management services– assistance locating providers (including transportation)– social and emotional supports during and after pregnancy
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Notification of Pregnancy
• The impact of psycho-social risk factors must not be overlooked – NOP captures psycho-social risk factors, that play a role in the
development of a healthy infant
• Comprehensive nature of NOP allows for a team approach to linking medical and social needs to support services– Team includes, but is not limited to:
• Health plan• Medical Providers• Prenatal Care Coordinators• Family/Community Supports
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• NOP analysis shows that PE women have an NOP completed earlier than other pregnant women
• This is an early indication that PE is helping women enter care earlier
Weeks of Pregnancy PE NOPs (N= 2,382)
Other NOPs (N= 5,019)
1-12 Weeks 62% 36%13-27 Weeks 36% 55%28+ Weeks 2% 9%
Notification of Pregnancy
Source: Office of Medicaid Policy and Planning, Business Objects, NOP Summary Report, July 1, 2009 – March 31, 2010
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Prenatal Care Coordination
• OMPP, ISDH, Managed Care Organizations (MCOs), IPN, and Prenatal Care Coordinators (PNCCs) have worked to revise forms and process
• New forms to be published the next 4-6 weeks
• Submission to MCOs and ISDH will be required for some forms
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Prenatal Care Coordination
Certification Training and Communication Processes will be strengthened in 2011:
– OMPP will work with partners to develop a collaborative approach to educating PNCCs of MCO services and requirements
– PNCC Certification will have the potential to be offered in more than one location
– Collection and reporting of outcomes data will be occurring at the MCO and ISDH
– Communication among PNCCs and all prenatal partners will be strengthened
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Summary
• Improving birth outcomes will remain a Quality Strategy for OMPP in 2010-2011– Pay-for-performance dollars related to prenatal care will continue to
be included in MCO contracts
• OMPP will review PE outcomes, first focusing on early and adequate prenatal care
• PE brochure is available for use by FSSA and partners– Limited print copies are available to county offices and community
resource centers– Electronic version is posted on new Medicaid member website:http://member.indianamedicaid.com/media/15239/5096%20pe%20brochure
%204web.pdf Or for general information about all Medicaid Programs, go tohttp://member.indianamedicaid.com/programs--benefits/medicaid-programs.aspx
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Summary
• OMPP will work with partners to develop strategies to address low PE enrollment in North Central, Central, and Northwest areas– MCOs, IPN, CKF, and Medicaid Provider Relations (Hewlett-Packard)
• Prenatal Care Coordination improvements will be a focus in 2010-2011– Data collected from *new* Outcomes Form will be helpful in
development of new programs/strategies– Ongoing training and communication will be offered to Medicaid-
enrolled PNCCs
• NOP data will be published on a semi-regular basis in Medicaid newsletters
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Questions
Contact Information:Glenna Asmus Nall Quality and Outcomes ManagerGlenna.Asmus@fssa.in.gov(317) 234-4753
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