441—78.25 (249A) Maternal health centers. Payment will be made for prenatal and postpartum medical care, 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, and one postpartum home visit. Maternal health centers shall provide trimester and postpartum reports to the referring physician. Risk assessment using Form 470-2942, Medicaid Prenatal Risk Assessment, shall be completed at the initial visit during a Medicaid member's pregnancy. If the risk assessment reflects a low-risk pregnancy, the assessment shall be completed again at approximately the twenty-eighth week of pregnancy. If the risk assessment reflects a high-risk pregnancy, referral shall be made for enhanced services. (See description of enhanced services at subrule 78.25(3).)
Vaccines available through the Vaccines for Children program under Section 1928 of the Social Security Act are not covered as maternal health center services. Maternal health centers that wish to administer those vaccines to Medicaid members shall enroll in the Vaccines for Children program and obtain the vaccines from the department of public health. Maternal health centers shall receive reimbursement for the administration of vaccines to Medicaid members.
	 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	  b.   	 Rescinded IAB 12/3/08, effective 2/1/09.
	  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.   	 Home visit.
	  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.   	 Rescinded IAB 12/3/08, effective 2/1/09.
	  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.