441—78.25 (249A) Maternal health centers. Payment will be made for prenatal and postpartum medical care, care coordination, health education, and transportation to receive prenatal and postpartum services. Payment will be made for enhanced perinatal services for persons determined high risk. These services include additional health education services, nutrition counseling, social services, additional care coordination services, and one postpartum home visit. Maternal health centers shall provide trimester and postpartum reports to the referring physician. Risk assessments using Form 470-2942, Medicaid Prenatal Risk Assessment, shall be completed twice during a Medicaid recipient’s pregnancy.
Maternal health centers which wish to administer vaccines which are available through the vaccines for children program to Medicaid recipients shall enroll in the vaccines for children program. In lieu of payment, vaccines available through the vaccines for children program shall be accessed from the department of public health for Medicaid recipients. Maternal health centers shall receive reimbursement for the administration of vaccines to Medicaid recipients.
	 78.25(1) Provider qualifications.
	  a.   	 Prenatal and postpartum medical services shall be provided by a physician, a physician assistant, or a nurse practitioner employed by or on contract with the center. Medical services performed by maternal health centers shall be performed under the supervision of a physician. Nurse practitioners and physician assistants performing under the supervision of a physician must do so within the scope of practice of that profession, as defined by Iowa Code chapters 152 and 148C, respectively.
	  b.   	 Care coordination services shall be provided by a registered nurse; a person with at least a bachelor’s degree in social work, counseling, sociology, family and community services, health or human development, health education, individual and family studies, or psychology; a person with a degree in dental hygiene; a licensed practical nurse; or a paraprofessional working under the direct supervision of a health professional.
	  c.   	 Education services and postpartum home visits shall be provided by a registered nurse.
	  d.   	 Nutrition services shall be provided by a licensed dietitian.
	  e.   	 Psychosocial services shall be provided by a person with at least a bachelor’s degree in social work, counseling, sociology, psychology, family and community services, health or human development, health education, or individual and family studies.
	 78.25(2) Services covered for all pregnant women. Services provided may include:
	  a.   	 Prenatal and postpartum medical care.
	  b.   	 Health education, which shall include:
	 (1) 	 Importance of continued prenatal care.
	 (2) 	 Normal changes of pregnancy including both maternal changes and fetal changes.
	 (3) 	 Self-care during pregnancy.
	 (4) 	 Comfort measures during pregnancy.
	 (5) 	 Danger signs during pregnancy.
	 (6) 	 Labor and delivery including the normal process of labor, signs of labor, coping skills, danger signs, and management of labor.
	 (7) 	 Preparation for baby including feeding, equipment, and clothing.
	 (8) 	 Education on the use of over-the-counter drugs.
	 (9) 	 Education about HIV protection.
	  c.   	 Care coordination services, which shall include:
	 (1) 	 Presumptive eligibility.
	 (2) 	 Referral to WIC.
	 (3) 	 Referral for dental services.
	 (4) 	 Referral to physician or midlevel practitioners.
	 (5) 	 Risk assessment.
	 (6) 	 Arrangements for delivery, as appropriate.
	 (7) 	 Arrangements for prenatal classes.
	 (8) 	 Departmental multiprogram application.
	 (9) 	 Hepatitis screen.
	 (10) 	 Referral for eligible services.
	  d.   	 Transportation to receive prenatal and postpartum services that is not payable under rule 441—78.11(249A) or 441—78.13(249A).
	  e.   	 Dental hygiene services within the scope of practice as defined by the dental board at 650—paragraph 10.5(3)“b.”
	 78.25(3) Enhanced services covered for women with high-risk pregnancies. Enhanced perinatal services may be provided to a patient who has been determined to have a high-risk pregnancy as documented by Form 470-2942, Medicaid Prenatal Risk Assessment. An appropriately trained physician or advanced registered nurse practitioner must be involved in staffing the patients receiving enhanced services.
Enhanced services are as follows:
	  a.   	 Care coordination, the coordination of comprehensive prenatal services, which shall include:
	 (1) 	 Developing an individual plan of care based on the client’s needs, including pregnancy and personal and interpersonal issues. This package includes counseling (such as coaching, supporting, educating, listening, encouraging, and feedback), referral, and assistance for other specified services such as mental health.
	 (2) 	 Ensuring that the client receives all components as appropriate (medical, education, nutrition, psychosocial, and postpartum home visit).
	 (3) 	 Risk tracking.
	  b.   	 Education, which shall include as appropriate education about the following:
	 (1) 	 High-risk medical conditions.
	 (2) 	 High-risk sexual behavior.
	 (3) 	 Smoking cessation.
	 (4) 	 Alcohol usage education.
	 (5) 	 Drug usage education.
	 (6) 	 Environmental and occupational hazards.
	  c.   	 Nutrition assessment and counseling, which shall include:
	 (1) 	 Initial assessment of nutritional risk based on height, current and prepregnancy weight status, laboratory data, clinical data, and self-reported dietary information.
	 (2) 	 Ongoing nutritional assessment.
	 (3) 	 Development of an individualized nutritional care plan.
	 (4) 	 Referral to food assistance programs if indicated.
	 (5) 	 Nutritional intervention.
	  d.   	 Psychosocial assessment and counseling, which shall include:
	 (1) 	 A psychosocial assessment including: needs assessment, profile of client demographic factors, mental and physical health history and concerns, adjustment to pregnancy and future parenting, and environmental needs.
	 (2) 	 A profile of the client’s family composition, patterns of functioning and support systems.
	 (3) 	 An assessment-based plan of care, risk tracking, counseling and anticipatory guidance as appropriate, and referral and follow-up services.
	  e.   	 A postpartum home visit within two weeks of the child’s discharge from the hospital, which shall include:
	 (1) 	 Assessment of mother’s health status.
	 (2) 	 Physical and emotional changes postpartum.
	 (3) 	 Family planning.
	 (4) 	 Parenting skills.
	 (5) 	 Assessment of infant health.
	 (6) 	 Infant care.
	 (7) 	 Grief support for unhealthy outcome.
	 (8) 	 Parenting of a preterm infant.
	 (9) 	 Identification of and referral to community resources as needed.
This rule is intended to implement Iowa Code section 249A.4.