Pregnancy Care Management Program offered

The Sampson County Health Department offers a Prenatal Program, Pregnancy Care Management Services –CMHRP. The Program has recently undergone a name transformation and is now referred to as Care Management for High-Risk Pregnancies – CMHRP. The Program was developed by the North Carolina Division of Public Health and the North Carolina Division of Medical Assistance and is designed to assist pregnant women with Medicaid eligible and non-Medicaid eligible who have priority risk factors to achieve a healthier pregnancy. Pregnancy Care Management serves Pregnant Women with Medicaid eligibility or non-Medicaid eligibility who have a priority Maternal Infant Impact Score (MIIS) associated with preterm birth, low birth weight or other risk factors.

Medicaid Transformation to Managed Care become effective as of July 1st, 2021. Key objectives for Medicaid Managed Care are to show improvement in health plan performance, health care quality, and outcomes. Members are identified for the CMHRP Program through referrals made by Health Plans for prenatal women that are deemed priority patients. Care Management for High-Risk Pregnancies is provided as a benefit for health care services covered by Health Plans. Members are encouraged to become familiar with the standard and value-added benefits made available through the Health Plan they are enrolled with. Medicaid Recipients were enrolled in either one of the six Health Plans:

• Healthy Blue

• Carolina Complete Health

• WellCare

• United Healthcare

• AmeriHealth Caritas

• NC Medicaid Direct

Tailored Plans, originally scheduled to launch December 1st, 2022, has been delayed until April 1st, 2023. Tailored Plans will provide the same services as Standard Plans in NC Medicaid Managed Care and will also provide additional specialized services for individuals with significant behavioral health conditions, Intellectual/Developmental Disabilities, and traumatic brain injury.

The criteria for providing services to both Medicaid eligible and non-Medicaid eligible clients are the same; therefore, Pregnancy Care Management staff will ensure both populations receive the same high level of care management services and care.

Pregnancy Care Management services are provided by nurses and social workers with a focus on patient need and risk status. The type and frequency of patient contacts are determined by the patient’s individual needs and plan of care in order of effectively meeting desired outcomes.

Prenatal care providers may refer patients for CMHRP services by completing the Pregnancy Risk Screening Form at the initial prenatal visit, in order for early identification of risk factors. If the pregnancy risk screening form is not utilized when making the referral, the Pregnancy Care Manager will contact the patient to assess for the presence of priority risk factors. Some priority risk factors include but are not limited to:

• Hypertension

• A history of spontaneous preterm labor

• A history of low birth weight

• Unsafe living environment (homelessness, inadequate housing, domestic violence, or abuse)

• Substance Use

• Tobacco Use

• Antenatal hospital utilization

Services are available to any woman with Medicaid who lives in Sampson County, regardless of where she goes for prenatal care. Pregnancy Care Management staff receives a referral and contacts the person for follow-up care. Any medical provider or agency that works with pregnant women can refer clients. Clients that have any of the above risk factors and are interested in the program can also contact the Pregnancy Care Management staff.

The Pregnancy Care Management staff provides the following services:

• Follow-ups on prenatal care issues and other clinical needs.

• Work with OB Providers and others who provide services to the pregnant woman to make sure everyone is aware of her concerns and needs.

• Provide education regarding: the need to keep all prenatal-related appointments; understanding and following the OB provider’s instructions; and the importance of getting postpartum care.

• Arrange/assist with the transition from the OB Provider to a primary care medical home as needed for the woman after delivery if she remains or becomes eligible for Medicaid after the postpartum period.

The Pregnancy Care Management staff assist with 17P treatment program. 17P is a series of weekly injections offered to women who have had previous preterm labor and/or deliveries. The purpose of the injections is to help prevent preterm labor with the current pregnancy. Services provided are:

• Educating the client/family on 17P and its purpose

• Assisting the patient in arranging to receive 17P injections and follow up when an injection is missed

Effective and ongoing communication and collaboration between the Pregnancy Care Manager and the 17P patient’s prenatal care provider is a key component of the program. The over

Pregnancy Care Management Program offered