Title V Maternal Health Program

Updates and Resources

Welcome!

General Updates

● Change to the 2 tier system○ Tier 2 social worker requirement

● Some standardization to educational elements and outreach activities ○ **we’ll get into this soon!

● New direct care orientation available late spring, will include documentation guidance● Site visits will occur virtually and will be more comprehensive, including information

generally collected on the mid-year report. More guidance on that will be out soon. ○ Information on policy and procedure requirements (section 302.1) in the MCAH

administrative manual ■ As part of the 1 on 1 meetings this fall we’ll be talking about where you’re

at with these. ○ More to come on standing order needs for MH services

● Collecting info as community events in Signifycommunity● MCAH Portal - will house all of the handouts and information talked about today

2019 Needs Assessment Though involved with OB/GYN clinic and

having a Primary Care Physician, no one ever mentioned family support to this pregnant mom with a toddler.People are often treated

differently based on who they are and what they have. How has this affected your health care?

Day to day struggle. Getting to appointments. Getting providers to understand need help and getting the right help.

What can the community do to help with the concerns you have about the health of mothers and pregnant women?

● Shifting to a place where not afraid to ask for help.

● Building what it means to be a community.

“...if you can find somebody that understands our diversity, our culture a little bit differently, um, I think, I think you ended up having better experiences and even if they don't necessarily look like you, but if they understand the struggle." - Black Hawk Maternal African American Participant

Public Health Services and Systems

Enabling Services

Direct Services

SPM 1: Maternal Mortality Rate

Infrastructure Building

Health Equity● Health Equity Trainings: Implicit Bias training if not already completed.

IDPH will send out opportunities as they arise. ● Health Equity Activities: Assess gaps in staff training- where do they need

education based on the populations you serve. How will you address these gaps?

Maternal Mortality Review● All direct care staff should review Iowa’s Maternal

Mortality report○ https://idph.iowa.gov/Portals/1/userfiles/38/Final%202020%20M

MRC%20report.pdf● Policies, procedures and education should align with

this guidance

Enabling Services

● Presumptive Eligibility Determination

● Connect with Medical and Dental home

● For tier 1 not providing direct care- opportunity to link pregnant people to other services in your area

Ensure early entry to prenatal care by connecting all pregnant people with needed health care services:

Direct Care Services Health Education:

● Seat Belt Education (brochures available, document in Signify)*

● POST-BIRTH Warning Signs Education (handouts available, document in Signify)*

● Gestational Diabetes Education*● 5-2-1-0 Healthy Choices Count! Healthy Pregnancy Education

(webinar on portal, resources were mailed to all agencies)*

Postpartum Follow-Up:● Offer a home visit for all clients

○ If they refuse, offer a clinic visit or a phone call○ Document follow-up type in Signify (home or clinic

visit, phone call, phone attempt, client lost)

*These items will be further addressed on Oct. 26, 2020

Direct Care Services - Screenings

Screen and refer for depression● At least once during pregnancy and

once postpartum

Screen and refer for domestic violence● Use Abuse Assessment Screening or 4

P’s Plus

Screen and refer for substance abuse● SBIRT or 4 P’s Plus

Alcohol/Substance Abuse Training: SBIRT

Training for MCAH agencies: Tuesday, December 15th 11:00 AM - 4:00 PM

SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons

with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency

rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before

more severe consequences occur.

● Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.

● Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral

change.

● Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.

Screening tools:

● CRAFFT (adolescents up to 18 years of age)

● AUDIT and/or DAST

Training for MCAH agencies: Thursday, December 3rd 9:00 AM - 10:00 AM

The 4Ps Plus -- which was developed by Dr. Ira Chasnoff, is the only validated screening tool for pregnant

women that screens for: illegal substance use, misuse of prescription medications, tobacco use, domestic

violence, and depression.

In addition to providing the training on implementing the tool and the screening tool itself, our staff from

Iowa Children's Justice would also provide a brief intervention tool ("I am Concerned..."), which provides the

clinicians with the information to inform the pregnant mother of the benefits of stopping substance use

during the remainder of the pregnancy.

We also provide additional information of where mothers can be referred to in the event that further

assessment and evaluation may be in the best interests of their patients.

Alcohol/Substance Abuse Training: 4 Ps Plus

Listening Visits

Training for MCAH agencies: Friday December 11, 2020 8:30-3:30

This innovative approach has the potential to fill the gap in mental health treatment services for low

income women who are at high risk for depression. It is a maternal depression intervention that can be

provided by public health nurses, case managers or social workers with little or no prior counseling

experience, increasing access to care. Listening Visits are especially critical in rural Iowa where there

is limited access to mental health professionals.

NPM 14.1: Percent of women who smoke during pregnancy

Infrastructure Building and Enabling Activities

Partner with Tobacco Control Community Partnerships

● Educate them on what you do (get the word out, new referral source!)● Learn about what they do● Work together to provide education (distribute materials)● Division of Tobacco Use Prevention and Control

Connect pregnant women, mothers and women of reproductive age to Quitline Iowa

● Provide referrals (as appropriate) to Quitline for all MCAH clients who express interest in quitting tobacco.

● Quitline Iowa

Direct Care Services

Ensure direct care staff are adequately trained

● Motivational interviewing training (offered by IDPH Spring 2021)● Ask, Advise, Refer (available on demand on IDPH Tobacco Division Website)● Additional tobacco training (The New Nicotine Addiction presented by

Tabetha Gerdner on Oct. 19, 2020 will count if direct care staff attend)

Direct Care Provision:

● Link back to health equity and culturally competent care● Health Education- Including SIDS information● Tobacco Screening and Referral (AAR and Quitline)

NPM 4b: Percent of infants breastfed exclusively through six months

Infrastructure Building

Collaborate with community partners to improve community breastfeeding support:

● Collaborate with hospital lactation consultants in your service area○ Mutual referrals and community building - Signify Community Event○ Lactation support was a theme in the needs assessment

● Breastfeeding coalitions● Workplace support

○ Work with a local employer to educate on breastfeeding laws and best practices

○ These connections can also be referral sources!○ Signify Community Event

Enabling Services

Link clients to breastfeeding resources

● WIC peer counselors and breast pump policies● Breastfeeding resource list/directory and materials● Refer to lactation counselor

Direct Care Services

Provide direct, individualized education to clients

● Opportunity to provide culturally competent care, what do you need to be aware of?

● Document as Health Education in Signify● Breastfeeding classes - if needed in your service area

NPM 5: a) Percent of infants placed to sleep on their backsb) Percent of infants placed to sleep on a seperate,

approved sleep surfacec) Percent of infants placed to sleep without soft

objects or loose bedding

Infrastructure Building and Enabling Services

Safe Sleep Community Education● Who is selling infant items in your service area?● How are you going to reach out to them?● Community Education

Crib/Safe Sleep Resource Directory● Where can families go to find safe sleep environment help

in your community?

Crib referral, if available in your area

October is National SIDS Awareness Month!

NICHQ Safe Sleep Website

Safe Sleep Assessment Video

Direct Care Services

Health Education

● Provide safe sleep education based on the mother’s needs

● Safe sleep educational materials○ Safe Sleep Brochures and Crib Cards from

the Iowa SIDS Foundation: https://www.iowasids.org/files/2020resourceorderform.pdf

○ Flyers included with every birth certificate

NPM 13.1 Percentage of Women who had a dental visit in the last year

Oral health

Direct oral health services required for Tier 2 and optional for Tier 1

Oral Health Only can be provided to any pregnant woman

All MH clients must receive dental care coordination

Incentive for dental care coordination

IDPH- State Level Title V Work

● IME/DHS billing concerns● Collaborations with WIC on planning and health equity work● Participation in Statewide Breastfeeding Coalition● Children’s Healthy Weight COIIN● Maternal Health Smoking Task force

○ Department wide task force to develop best practice○ Plans to implement more statewide

● State-level alignment (DHS/DPH)on Safe Sleep● Iowa SIDS Foundation● Hospital Safe Sleep Audit

IDPH- State Level Work

● State-level data surveillance○ Barriers to Prenatal Care○ PRAMS○ Obstetrical Care in Iowa Report

● IDPH Representation on state committees○ Neonatal Quality Collaborative○ Iowa Medicaid Maternal Health Task Force○ Medicaid Learning Series: Leveraging Midwifery-Led

Care to Address Disparities and Equity in Medicaid

IDPH- State Level Work

● HRSA- Maternal Health Innovation Grant○ Iowa’s Maternal Quality Care Collaborative - IMQCC

■ Alliance for Innovation in Maternal Health (AIM)

● Maternal Mortality Review● Regionalized System of Perinatal Care

○ Hospital Level System○ LOCATe

● Statewide Perinatal Care Team

Maternal Health Contract Performance Measures

1. Dental Care Coordination

2. Tier 2 - provide services to 10% of medicaid covered births - disincentive.

Tools and Resources

These are all available as PDF’s on the MCAH Portal

● Training log● Direct Service Protocol● Community events notes worksheet● Printed materials at ISU Extension● NPM/SPM resources- Comprehensive educational materials

and the infographics for each MH NPM/SPM

Direct Services

Maternal Health Billing - Reminders

There is a new process for addressing ongoing billing concerns - if unable to resolve through your MCO provider representative or IME Provider Services, follow the new procedure, available on the MCAH Portal.

● Iowa Total Care IME contacts are (include both contacts in email):Maria James mjames@dhs.state.ia.us Mary Tavegia mtavegi@dhs.state.ia.us

● Amerigroup IME contacts are (include both contacts in email): Maria James mjames@dhs.state.ia.us Becky Blum bblum@dhs.state.ia.us

Third Party Liability - Updates and Reminders● Do not submit claims until we have confirmation of the policy clarification● Continue to share any third party insurers your clients have via the MCAH Google Group in case

other agencies have had success credentialing with that company, have a good contact, or have received a letter [ia-mcah-contractors@googlegroups.com]

Signify

● Reminders○ Demographic data○ QA reports

● Bundles - minor changes coming soon● Data Entry Guides - single page guides coming soon● Care Plans (optional to be included in Signify)

○ Goals○ Needs/Referrals

Signify Spotlight! Maternal Mortality

Requirement Where to Document

Health Education Education Type: POST-BIRTH Warning Signs; Seat Belt Use; Nutrition and Physical Activity; Gestational Diabetes

Postpartum Follow-Up Select one of the following options in the MH Episode Status:● Closed - Postpartum Home Visit● Closed - Postpartum Clinic Visit● Closed - Postpartum Phone Call Complete● Closed - Postpartum Phone Call Attempt● Closed - Client Moved Out of Area● Closed - Miscarriage/Fetal Death● Closed - Unable to Locate

Depression Screening Screening Type within a Health Services Activity; Survey attached to activityYou do not need to create a separate health services activity for a depression screen unless you are billing separately for it (and not providing health education or psychosocial)

Domestic Violence Screening Type of Service: 96160-XU Administration & Interpretation of health risk-Domestic Violence Screen-Distinct Non-Overlapping Service; ORScreening Type: 4Ps Plus

Alcohol/Substance Abuse Screening Type: 4Ps Plus; CRAFFT, AUDIT, or DAST; SBIRT Type of Service: 99408/99409 Alcohol/Substance Abuse Screen with Brief Intervention - (15-30min)/(over 30 min)

Signify Spotlight! Percentage of Women Who Smoke During Pregnancy

Requirement Where to Document

Health Education Education Type: SIDS and Tobacco Use; Tobacco Cessation

Ask, Advise, Refer Screening Type (within health education activity): Ask, Advise Refer

Coming soon! Maternal Health and Risk Assessment Survey: Q3 - Client advised and referred per Ask Advise Refer protocol? Yes, No, N/A (will default to N/A if Q1 is “no”)

Tobacco Community Partnership Collaboration & Education

Community Event

Signify Spotlight! Percent of infants breastfed exclusively through six months

Requirement Where to Document

Health Education Education Type: Breastfeeding

Lactation Class (optional) Type of Service: S9443 Lactation Class - per person

Employer Outreach Community Event

Signify Spotlight! Safe Sleep

Requirement Where to Document

Health Education Education Type: Safe Sleep

Safe Sleep Community Education Community Event

Signify Spotlight!

Requirement Where to Document

Oral Health Direct Services (Tier 2) In the Maternal Health Episode (not Oral Health, as this is only for child health)

Dental Care Coordination In the Maternal Health Episode (not Oral Health, as this is only for child health)

Direct Service Protocols