Chapter 38. Healthy Start Program

“Department” means the Maryland Department of Health.

“Dietitian or nutritionist” means an individual who:

“Enriched maternity service” means direct counseling, educational, case coordination, and referral services provided to a pregnant or postpartum recipient by or under the supervision of a physician or nurse midwife in conjunction with the clinical services provided by the physician or nurse midwife during the prenatal or postpartum visit.

“Family support center” means a community-based and operated center which provides parenting education, health education, child development assessment services, education and job skill development services, and social support services to families.

“Healthy Start High-Risk Nutrition Instrument” means the form designated by the Department for the purpose of identifying pregnant participants in need of high-risk nutrition counseling services.

“Healthy Start Prenatal Risk Assessment Instrument” means the form furnished by the Department to the provider for the purposes of documenting the results of the prenatal risk assessment and developing the participant's plan of care.

“Healthy Start Program” means a program designed to identify and address medical, nutritional, and psychosocial predictors of poor birth outcomes and poor child health by providing enhanced prenatal and postpartum services to pregnant and postpartum recipients.

“High-risk nutrition counseling services” means educational services provided to nutritionally high-risk pregnant participants by a dietitian or nutritionist.

“Local health department” means the local agency responsible for ensuring the availability of basic public health services in each local jurisdiction, and for administering and enforcing certain State and local health laws and regulations.

“Maternal and Child Health Services Block Grant” means funds allotted by the federal government under Title V of the Social Security Act.

“Medical Assistance Program” means a program of comprehensive medical and other health-related care for indigent and medically indigent persons.

“Nurse” means an individual who is licensed as a registered nurse in the state in which services are provided.

“Nurse midwife” means an individual who:

“Participant” means a pregnant or postpartum recipient who:

“Physician” means a doctor of medicine or osteopathy who:

“Program” means the Maryland Medical Assistance Program.

“Provider” means a qualified provider of services under the Healthy Start Program who meets the conditions of participation in Regulation .03 of this chapter.

“Provider agreement” means a contract between the Department and the provider.

“Recipient” means an individual who is certified for and is receiving Medical Assistance benefits.

“Risk assessment—plan of care” means a package of services provided to a pregnant participant by or under the supervision of a physician or nurse midwife in conjunction with the clinical services provided by the physician or nurse midwife, to include:

“Social worker” means a person who is licensed as a social worker in the state in which services are provided.

“Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)” means the federally funded program authorized under an amendment to the Child Nutrition Act of 1966 (PL 94-105) to provide supplemental foods and nutrition education to pregnant and postpartum women, infants, and young children from families with low incomes who are at risk by reason of inadequate nutrition or health care.

“Tertiary care maternity center” means a facility with all necessary equipment and personnel specifically trained to care for high-risk obstetrical patients and with the capability to perform all necessary tests and obstetrical procedures 24 hours a day.

Licensed as a registered nurse in the state in which services are provided;

Certified as a nurse midwife by the American College of Nurse-Midwives; and

In compliance with requirements to practice nurse midwifery in the state in which services are provided.

Meet the licensure requirements in Regulation .02 of this chapter, and verify the licenses and credentials of all professionals employed by the provider;

Apply for participation in the Program using an application form designated by the Department;

Be approved for participation by the Department;

Have a provider agreement with the Department in effect;

Be identified as a Program provider by issuance of an individual provider number;

Verify the eligibility of recipients;

Accept payment by the Program as payment in full for services rendered and make no additional charge to any person for the covered services specified in Regulation .04 of this chapter;

Provide services without discrimination on the basis of race, color, sex, national origin, marital status, physical or mental handicap;

Maintain adequate records concerning service provision for a minimum of 6 years and make them available, upon request, to the Department or its designee;

Not knowingly employ or contract with any person, partnership, or corporation which has been disqualified from the Program to provide or supply service to Medical Assistance recipients, unless prior written approval has been received from the Department;

Agree that claims rejected for payment due to late billing may not be billed to the participant;

Not place a restriction on the recipient's right to choose the provider;

Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary or has not been preauthorized, the provider may not seek payment for that service from the participant; and

Be selected by the participant from among qualified providers.

Be physicians or nurse midwives;

Provide the covered services as specified in Regulation .04A of this chapter in conjunction with the pregnant participant's initial clinical prenatal visit or, otherwise, as early as possible in the pregnancy;

Maintain the participant's consolidated medical record; and

Agree to on-site visits by Department staff to monitor adherence to Regulation .04A of this chapter.

Be physicians or nurse midwives or be under the supervision of a physician or nurse midwife;

Provide the covered services as specified in Regulation .04B of this chapter in conjunction with each prenatal clinical visit of the pregnant participant and each postpartum clinical visit of the postpartum participant up to 60 days after the delivery; and

Agree to on-site visits by Department staff to monitor adherence to Regulation .04B of this chapter.

Be a dietician or nutritionist as specified in Regulation .02C of this chapter;

Contact the recipient within 10 working days of the receipt of a referral from a local health department or private prenatal care provider, unless client-related extenuating circumstances are documented; and

Agree to on-site visits by Department staff to monitor adherence to Regulation .04C of this chapter.

One unit of service is to be reimbursed for each pregnancy.

A risk assessment is an appraisal of the participant's medical history and current health, nutritional, psychological, and social status, as specified in the Healthy Start Risk Assessment Instrument. It results in the identification of problems having an impact on the outcome of the pregnancy and the subsequent health care status of the child. Based on the assessment, an appropriate plan of care is drafted and appropriate referrals are made. A copy of the completed Healthy Start Risk Assessment Instrument will be sent by the provider to the participant's local health department within 10 working days of the risk assessment.

A plan of care is a description of the services and resources required to meet the participant's needs identified through the risk assessment. An individual participant's plan of care:

Prenatal and postpartum counseling and education. This component shall include, but not be limited to, the following topics:

Nutrition education for pregnant and postpartum participants. This component shall include, but not be limited to, the following topics:

Case coordination and referral for pregnant participants. This component shall include, but not be limited to, the following activities:

Making a nutritional assessment including the recording and interpretation of anthropometric measurements, clinical and laboratory findings, medical conditions, nutrient and drug interactions, diet history, and psychological, social, cultural, religious, and economic factors affecting food intake;

Developing a nutritional care plan based on problems identified through the assessment and integrated into the total plan of care;

Determining appropriate interventions to achieve care plan goals consistent with the participant's culture, family composition, and restrictions imposed by income, transportation availability, and neighborhood food resources, including, but not limited to, counseling for food habit and behavior change, diet modifications for medical conditions, and referral for food assistance; and

Monitoring and recording participant's progress toward goal achievement.

Requests for payment of Healthy Start Program services rendered and completed shall be submitted by an approved provider according to procedures established by the Department. Payment requests which are not properly prepared or submitted may not be processed, but shall be returned unpaid to the provider.

Requests for payment shall be submitted on the invoice form specified by the Department. A separate invoice shall be submitted for each participant. The completed form shall indicate the:

Providers shall bill the Program for the appropriate fee specified in §C of this regulation.

Only to a qualified provider for covered services rendered to a participant, as specified in these regulations;

According to the applicable rate under COMAR 10.09.02 or 10.09.21 for risk assessment—plan of care, and enriched maternity service;

According to methodology described in the memorandum of understanding between the Program and each local health department for risk assessment—plan of care;

For high-risk nutrition counseling as follows: