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