FY13 Contract Language for Public Health Prenatal Program/Maternity Services Trina Miller Prenatal Program Coordinator Division of Child & Family Health Department for Public Health 1

Public Health Prenatal Program Prenatal Care is a core public health service that serves as the primary strategy for reducing infant mortality and improving birth outcomes. Prenatal Care is included in the Core Public Health Services and core public health block grant funds should be used to provide routine prenatal services. There will no longer be a Federal allocation to 803 for prenatal services, so LHDs will have to plan and monitor closely the expenses to 803 from their core public health funding. In the PSRS system, program-eligible patients will be assigned to Payor code 7. 2

Public Health Prenatal Program Maternity funding may be accessed through local funds, Medicaid and other payors, or the core public health block grant. However, Core public health funding should be used for the Prenatal Program eligible women who have income at or below 185% FPL and have no other payor source (i.e., are not Medicaid eligible). Minimum required prenatal covered services will continue to be listed in the Prenatal/Maternity Database, but LHDs can make local decisions about judiciously covering other services for these income-eligible patients according to their local budget and patient needs. 3

Public Health Prenatal Program All local health departments must assure that prenatal care is available for all pregnant women in their jurisdiction, either directly or through referral. Contracts are to fulfill that assurance. 4

Three types of Prenatal Contracts Below are the three types of contracts often utilized for Maternity Services in the Public Health Prenatal Program. The prenatal contract types are: 1.Personnel contracts for onsite provider for prenatal care clinical services at LHD (Template 1) 2.Referrals to providers for prenatal care clinical services in their office setting (Template 2) 3.Prenatal outpatient testing in hospitals if not available in the health department or contracted physician office (optional, depending on local needs – Template 3) *Each type of contract has a template with examples of complete contract language. 5

Required Contract Language Health departments may adapt recommended language in the contract templates, but all prenatal contracts must include the following elements (4): 1.Prenatal care providers must be licensed in Kentucky and Board Certified in Obstetrics, Family Practice, or Midwifery. Any services by a midwife must be provided by a nurse midwife. If prenatal care is not under the direction of an obstetrician, an obstetrician shall be available for consultation. Providers must act within their legal scope of practice and assure they have professional liability insurance for the services they provide. 2.Prenatal care, regardless of which provider is delivering the care, must follow the most current guidelines of the American Congress of Obstetricians and Gynecologists (ACOG), and the PHPR when care is delivered in health department facilities. 6

Required Contract Language Health departments may adapt suggested language in the contract templates, but all prenatal contracts must include the following elements: 3. Contracts must specify compensation for services; compensation for services to any provider shall be at the current Medicaid rate or a lesser agreed upon amount. That payment is to be considered as payment in full for the particular service; the patient shall not be billed for these services. 4. Billing procedures and required documentation must be specified in the contract. These may vary according to local arrangements. Examples are provided in the Templates 7

Contract Template 1 – Prenatal Contracted On-Site Services Provider Credentials/Qualifications Include Required Contract Language Scope of Work Specify the location of where the prenatal services will be provided and the dates and times (for each County if a District) See Template 1 for recommended language Compensation/Payment Specify which payment method you will be using and provide detailed information. 8

Recommended Language - Contract Template 2 Clinical Provider Referral Agreement Contract Template 2 – Clinical Provider Referral Agreement Provider Credentials/Qualifications Include Required Contract Language Scope of Work Indicate the location of where the Contractor shall provide prenatal services. See Template 2 for recommended language Compensation/Payment Specify which payment method you will be using and provide detailed information. 9

Contract Template 3 – Hospital Outpatient Testing This contract is optional and may not be applicable for all LHD Provider Credentials/Qualifications Include Required Contract Language Scope of Work See Template 3 for recommended language Compensation/Payment Specify which payment method you will be using and provide detailed information. 10

Resources The Public Health Prenatal Program/Maternity Service Matrix is located in the PHPR and can be referenced in the contract and used as guidance for services to be provided. The Prenatal Program has a website located at This will include the Public Health Prenatal Program list of routine prenatal services and CPT codes. 11

Resources DMS Physician fee rates can be found at the following CHFS/DMS link: under Physician Fee Service. Open PDF version and enter the CPT code in the FIND box to locate the fee easily. 12

THANK YOU Trina Miller Prenatal Program Coordinator/Perinatal Nurse Consultant ext