Medicaid Perinatal Care Standards

New York State (NYS) issued updated policies on Medicaid Perinatal Care Standards. The below updates, effective Oct. 1, 2022, apply to EmblemHealth-contracted perinatal care providers who offer prenatal/antepartum care, intrapartum care, and/or postpartum care to Medicaid and HARP members:
 

Principal Maternal Care Provider

• Every pregnant/postpartum person must have a principal maternal care provider. 
• The principal maternal care provider functions as the pregnant/postpartum person’s main maternal care provider and is responsible for leading and coordinating the pregnant/postpartum person’s obstetric care throughout the course of the pregnancy and postpartum period (the 12 weeks immediately following delivery). 
• Maternal care providers must work with EmblemHealth Care Management to ensure coordination of care for the pregnant/postpartum person’s health needs.
• NYS-licensed providers may serve as the principal maternal care provider according to NYS law. This includes: 
  • Licensed physicians 
  • Licensed midwives
  • Licensed nurse practitioners
    

Comprehensive Prenatal Care Risk Assessment

• Principal maternal care providers must conduct a comprehensive prenatal care risk assessment at the first prenatal care visit. 
• The purpose of the comprehensive prenatal care risk assessment is to identify all relevant past and current maternal-fetal biopsychosocial risk factors as early in the pregnancy as possible, so that the identified risk factors can be promptly addressed before they cause any harm to the pregnancy. 
• When a risk factor is identified, care providers must address the concern(s) as soon as possible by providing treatment, counseling, education, and/or a referral to a specialist or community resource. 

Home Visits – Prenatal, Postpartum, Initial Postpartum, and Additional Postpartum

• A skilled nursing home visit is provided by either a Certified Home Health Agency (CHHA) or a Licensed Home Care Services Agency (LHCSA) under Public Health Law Article 36. Other home visit providers may include, but are not limited to the following, which may or may not be covered as a Medicaid benefit: 
  
  • Nurse-family partnership programs
  • Local health departments
  • Community health worker programs 
• Prenatal home visits must be provided to pregnant persons if ordered by the principal maternal care provider and if they are medically necessary for managing the pregnant person’s prenatal course or prenatal issue at hand.
• All postpartum persons are eligible for one initial postpartum home visit after they give birth. Additional postpartum home visits could be covered depending on the postpartum person’s unique medical, obstetrical, and/or psychosocial profile, and if their situation meets medical necessity criteria.
• The initial postpartum home visit addresses acute postpartum issues as per the American College of Obstetricians and Gynecologists (ACOG)/American Academy of Pediatrics (AAAP) postpartum recommendation.
  • All principal maternal care providers and/or birthing hospitals must offer and arrange for the initial postpartum home visit with all postpartum persons. All birthing hospitals must have a system in place to arrange and schedule the postpartum person’s first/initial postpartum home visit prior to discharge.
    
  • If a postpartum person agrees to receive the initial postpartum home visit, then the birthing hospital is responsible for arranging and scheduling the initial postpartum home visit for the postpartum person, and the postpartum home visit should take place 36 to 72 hours after the postpartum person’s discharge.
    
• The home visit findings must be sent to the principal maternal care provider for management of any identified issues. 

JP #56547 10/22