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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Pregnancy Medical Home

DMA Managed Care
Phone Number 919-855-4780
Fax  919-715-0844 or 919-715-523

DMA is working in partnership with Community Care of North Carolina (CCNC) External link and other community stakeholders including providers, local health departments, and the Division of Public Health, to create a program that provides pregnant Medicaid recipients with a pregnancy medical home (PMH).  The goal is to improve the quality of perinatal care given to Medicaid recipients, thereby improving birth outcomes and reducing Medicaid spending.  This will be done by modeling the PMH after the enhanced primary care case management (PCCM) program developed by CCNC.

 

Case Management

If a pregnant Medicaid recipient’s aid program category covers pregnancy services, she is eligible to participate in this program.  This program is NOT just for recipients of Medicaid for Pregnant Women (MPW).  Pregnant Medicaid patients will receive care management (population management).  High-risk pregnant women in a PMH will receive case management services.  The level of service provided will be in proportion to the individual’s identified needs.  Case managers are expected to closely monitor the pregnancy through regular contact with the physician and patient to promote a healthy birth outcome. 

 

Program Participation

The PMH project will be modeled after the enhanced primary care case management program developed by CCNC. To qualify for participation as a PMH, the provider must agree to the following:

  • Ensuring that no elective deliveries are performed before 39 weeks of gestation by agreement with all professional providers
  • Engaging fully in the 17P project in each pregnancy medical home
  • Decreasing the cesarean section rate among nulliparous women
  • Completing a high-risk screening on each pregnant Medicaid recipient in the program and integrating the plan of care with local care/case management
  • Open chart audits

In exchange for meeting the program expectations described above, the PMH will receive the following incentives:

  • Exemption from prior approval on ultrasounds
  • $50 for completing a high risk screening tool at initial visit
  • $150 incentive for the postpartum visit per Medicaid recipient
  • Increased rate for a vaginal delivery

Any provider who bills global, package or individual pregnancy procedures is eligible to participate in this program as long as he/she agrees to the program requirements.  It is NOT just for obstetric providers.

To become a PMH provider, contact your local network. Contact information for CCNC networks

 

Additional Information

For service requirements, coverage criteria and limitations, refer to Clinical Coverage Policy 1E-6, Pregnancy Medical Home.

Additional information on the PMH project is available in the following presentations

 

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

 

Forms

 

PMH Steering Committee Meetings

 

CCNC OB Workgroup Meetings