<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".21" citation="COMAR 10.67.06.21" title_num="10" subtitle_num="67" chapter_num="06" heading="Benefits — Pregnancy-Related Services.">
  <paragraph num="A.">
    <text>An MCO shall provide to its pregnant and postpartum enrollees medically necessary pregnancy-related services, including:</text>
    <paragraph num="(1)">
      <text>Comprehensive prenatal, perinatal, and postpartum care, including high-risk specialty care when appropriate;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Prenatal risk assessment and development of an individualized plan of care that specifies the actions required to address each identified need and is appropriately modified during the course of care;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Enriched maternity services, including:</text>
      <paragraph num="(a)">
        <text>Prenatal and postpartum counseling and education;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Basic nutritional education;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Substance abuse treatment, as provided in Regulation .10 of this chapter;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Appropriate referrals to services that may improve the pregnancy outcome, including:</text>
        <paragraph num="(i)">
          <text>Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Healthy Start services;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>High-risk nutrition counseling services for nutritionally high-risk pregnant women;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Appropriate levels of inpatient care, including emergency transfer of pregnant women and newborns to tertiary care centers;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Smoking cessation education and treatment;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Doula services; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Home visiting services.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>When an enrollee recovering from childbirth elects to be discharged before 48 hours following a normal vaginal delivery or 96 hours following an uncomplicated cesarean section, the MCO is responsible for providing:</text>
    <paragraph num="(1)">
      <text>One home visit scheduled to occur within 24 hours after discharge; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An additional home visit as may be prescribed by the attending provider.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>When an enrollee recovering from childbirth and her newborn enrollee remain in the hospital for at least as long as the period of time provided under §B of this regulation, the MCO shall provide a home visit as prescribed by the attending provider.</text>
  </paragraph>
  <paragraph num="D.">
    <text>An MCO shall provide for home visits required by §§B and C of this regulation to be performed by a registered nurse and in accordance with generally accepted standards of nursing practice for home care of a mother and newborn child, including:</text>
    <paragraph num="(1)">
      <text>An evaluation of the presence of immediate problems of dehydration, sepsis, infection, jaundice, respiratory distress, cardiac distress, or other adverse physical symptoms of the infant;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An evaluation of the presence of immediate problems of dehydration, sepsis, infection, bleeding, pain, or other adverse symptoms of the mother;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Collection of a blood specimen for newborn screening if not previously completed;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Referrals for any medically necessary continuing health care services; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Any other nursing services ordered by the referring provider.</text>
    </paragraph>
  </paragraph>
</regulation>