INDIANA Medicaid perinatal updates

1. Presumptive Eligibility Notification of Pregnancy Prenatal Care Coordination July 7, 2010 Glenna Asmus Nall, Quality and Outcomes Manager INDIANA Medicaid perinatal updates

2. Programming Updates Implemented July 1, 2009 • Presumptive Eligibility for Pregnant Women • Notification of Pregnancy (risk assessment) Under Development • Prenatal Care Coordination • Processes, including certification • Forms • Coordination with Medicaid health plans

3. Presumptive Eligibility Implemented July 1, 2009 • Provides outpatient prenatal care while Medicaid application is processed As of June 29, 2010: • 10,491 ever enrolled in PE • 1,061 currently enrolled in PE • 80% of PE members are approved for Medicaid • 95% of PE members have Medicaid decision within 45-days of pending application date

4. Presumptive Eligibility • Too early* to review effect of PE on the following measures: • 1st Trimester Prenatal Care • Adequacy of Prenatal Care • Postpartum follow-up care * Need sufficient sample size and time for claims submission * Many women during early PE implementation had been ‘waiting for PE’ and may not be representative of women entering PE now

5. Presumptive Eligibility • PE process relies on Qualified Providers that volunteer to assist women with the PE Application process • Currently 245 QPs are enrolled with Medicaid in 66 counties • Provider Relations will begin recruiting additional providers to become QPs in 2010; 18 contacted for training • Benefits of being a QP: • Payment for services provided during PE period • Pregnant woman is eligible for benefits like pharmacy and transportation during the PE period • Pregnant women is enrolled with a health plan that can assist with finding medical and social supports in the community

6. 1.6% 9.7% 15.2% 9.2% 9.4% 24.1% 10.6% 20.3% Presumptive Eligibility Proportion of PE Enrollment by Region, March 2010 Northwest, North Central and Central Regions are lower than typical pregnancy enrollment. Northwest: 9.7% vs. 11.4% North Central: 1.6% vs. 12.5% Central: 24.1% vs. 30.4% Southwest, Northeast, West Central Southeast, and East Central are higher than typical pregnancy enrollment. Southwest: 20.3% vs. 10.2% Northwest: 15.2% vs. 7.8% West Central: 9.2% vs. 7.8% Southeast: 10.6% vs. 8.8% East Central : 9.4% vs. 8.7% Source: OMPP, MedInsight, Retrieved March 2010

7. Presumptive Eligibility Most PE enrollees are under 24 years of age and appear to be younger than the pregnancy-Medicaid population. Source: Office of Medicaid Policy and Planning, MedInsight, Retrieved March 2010

8. Presumptive Eligibility • Transition to Medicaid • Most PE women transition to one of the pregnancy aid categories after PE coverage ends Source: Office of Medicaid Policy and Planning, MedInsight, Retrieved June 2010

9. Notification of Pregnancy • Notification of Pregnancy (NOP) is a risk assessment completed by medical staff and submitted to OMPP • Implemented July 1, 2009 – over 9,000 submitted • Providers are reimbursed $60 for submission • OMPP transmits the information to the woman’s health plan and ISDH • Health plans utilize the NOP to quantify risk factors that are amenable to interventions Source: Office of Medicaid Policy and Planning, Business Objects, NOP Summary Report, July 1, 2009 – March 31, 2010

10. Notification of Pregnancy • Tobacco Use – 32% • Nearly 70% are ready to quit with some help • Pre-pregnancy BMI >30 – 30% • History of Depression – 14% • Mother <19 years old – 12% • 30% diagnosed as high risk by clinician completing the NOP • Many more women are at high risk due to a combination of several risk factors Source: Office of Medicaid Policy and Planning, Business Objects, NOP Summary Report, July 1, 2009 – March 31, 2010

11. Notification of Pregnancy • Tobacco Use • Referral to Indiana Tobacco Quitline • Quitline provides progress reports back to referring provider • BMI > 30 • Risks to both mother and newborns, can be decreased if pregnancy weight gain is kept to 15lbs • History of Depression • Recognizing and treating depression is important for both mother and newborn • Young Maternal Age • Young women often lack the education/resources necessary to focus on prenatal care The health plans and prenatal care coordinators can be a resource for clinicians treating high risk pregnancies by providing • case management services • assistance locating providers (including transportation) • social and emotional supports during and after pregnancy

12. Notification of Pregnancy • The impact of psycho-social risk factors must not be overlooked • NOP captures psycho-social risk factors, that play a role in the development of a healthy infant • Comprehensive nature of NOP allows for a team approach to linking medical and social needs to support services • Team includes, but is not limited to: • Health plan • Medical Providers • Prenatal Care Coordinators • Family/Community Supports

13. Notification of Pregnancy • NOP analysis shows that PE women have an NOP completed earlier than other pregnant women • This is an early indication that PE is helping women enter care earlier Source: Office of Medicaid Policy and Planning, Business Objects, NOP Summary Report, July 1, 2009 – March 31, 2010

14. Prenatal Care Coordination • OMPP, ISDH, Managed Care Organizations (MCOs), IPN, and Prenatal Care Coordinators (PNCCs) have worked to revise forms and process • New forms to be published the next 4-6 weeks • Submission to MCOs and ISDH will be required for some forms

15. Prenatal Care Coordination Certification Training and Communication Processes will be strengthened in 2011: • OMPP will work with partners to develop a collaborative approach to educating PNCCs of MCO services and requirements • PNCC Certification will have the potential to be offered in more than one location • Collection and reporting of outcomes data will be occurring at the MCO and ISDH • Communication among PNCCs and all prenatal partners will be strengthened

16. Summary • Improving birth outcomes will remain a Quality Strategy for OMPP in 2010-2011 • Pay-for-performance dollars related to prenatal care will continue to be included in MCO contracts • OMPP will review PE outcomes, first focusing on early and adequate prenatal care • PE brochure is available for use by FSSA and partners • Limited print copies are available to county offices and community resource centers • Electronic version is posted on new Medicaid member website: http://member.indianamedicaid.com/media/15239/5096%20pe%20brochure%204web.pdf Or for general information about all Medicaid Programs, go to http://member.indianamedicaid.com/programs--benefits/medicaid-programs.aspx

17. Summary • OMPP will work with partners to develop strategies to address low PE enrollment in North Central, Central, and Northwest areas • MCOs, IPN, CKF, and Medicaid Provider Relations (Hewlett-Packard) • Prenatal Care Coordination improvements will be a focus in 2010-2011 • Data collected from *new* Outcomes Form will be helpful in development of new programs/strategies • Ongoing training and communication will be offered to Medicaid-enrolled PNCCs • NOP data will be published on a semi-regular basis in Medicaid newsletters

18. Questions Contact Information: Glenna Asmus Nall Quality and Outcomes Manager Glenna.Asmus@fssa.in.gov (317) 234-4753