Selected State Initiatives on Medicaid Financing of Perinatal Regionalization

twitterToday, nearly 40 states have a system of risk appropriate perinatal care. As the payer for nearly half of all births nationwide, Medicaid is a key partner in the financing of perinatal regionalization. Medicaid covers specific services that can maximize access to risk-appropriate care for mothers and infants, including the coverage of pre- and post-natal care, delivery, and other services such as transportation. Medicaid coverage of neonatal transportation is a critical component of timely provision of care and overall patient health, specifically for high-risk mothers and infants, and a core element of a comprehensive perinatal regionalization system.  This chart includes selected state initiatives and highlights Medicaid as a key partner in financing perinatal regionalization systems.

For more information on Medicaid funding opportunities in support of perinatal regionalization systems, read the blog post and issue brief that further explore Medicaid’s role as an important partner in developing perinatal regionalization policies and strategies given its significant investments in a disproportionate share of high-risk births and flexibility in the range and scope of services covered. Case studies of California and Georgia demonstrate how state Medicaid agencies have developed various approaches to support risk appropriate perinatal care.

This resource was developed by NASHP in partnership with the National Institute for Children’s Health Quality (NICHQ) as part of the Health Resources and Services Administration’s Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN).

Current System
California The Regional Perinatal Programs of California (RPPC) were established in 1979 due to the need for a more comprehensive network of healthcare providers within specific geographic areas to promote access to high quality levels of maternal and infant care.[ii] Today, the RPPC has divided California into 9 separate regions, each of which include between 18-38 hospitals each.[iii]The California Perinatal Transport Systems (CPeTS) act of 1976 appropriated funds for the development of a dispatch service to facilitate transportation of mother and infants to NICUs.[iv] It also provides collection and analysis of perinatal and neonatal transportation data.
Florida Developed in the 1970’s, Florida’s eleven Regional Perinatal Intensive Care Centers (RPICCs) provide access to high-risk perinatal care and are managed by FL’s Department of Health. Each facility provides community outreach education, and consultative support to other obstetricians and Level II and III NICUs in their areas, in addition to inpatient and outpatient services.[x]
Georgia The Georgia Regional Perinatal Care Network Project (GRPCN) is a statewide initiative funded by the state Medicaid agency and state general funds appropriated to the Georgia Department of Public Health. Georgia’s six regional care centers are designated based on regional need and available funding.[xiii]
Illinois[xv] First adopted in 1976, Title 77 created a perinatal regionalization system through Illinois Administrative code. [xvi] The Illinois Department of Public Health oversees the system and works with a Perinatal Advisory Committee (PAC) that offers recommendations relating to perinatal care. Today, Illinois’ perinatal regionalization system includes 10 administration Perinatal Centers that supervise 122 obstetric hospitals. In additional to a supervisory role, each Regional Perinatal Center has both clinical and administrative responsibilities.[xvii]
South Carolina Established in the 1970’s, South Carolina’s regionalized perinatal system of care, is now made up of five perinatal centers in four regions that contract with the SC Department of Health. Key elements of the system include early risk assessment and referral to appropriate care; coordination and communication between hospitals and community providers; monitoring systems through data; and ensuring access to services from preconception through the first year of life.[xx]
Role of Medicaid
California Medi-Cal works with a variety of different partner programs to ensure coverage and access to services for pregnant women and neonates. These programs include the California Children’s Services Program (CCS),[v] The California Medi-cal Access Program (CMAP),[vi] and the Comprehensive Perinatal Services Program (CPSP).[vii] Through these programs, Medi-cal provides a variety of benefits, but the most notable is reimbursement for transportation services.[viii]
Florida All RPICC Program patients are potential Medicaid Recipients. RPICC Medicaid reimbursement is inclusive for all services provided by the neonatology or obstetrical groups. [xi] The Agency for HealthCare Administration pays claims for inpatient-only services provided to Medicaid recipients by neonatologists and obstetricians enrolled in RPICC with Medicaid funds.
Georgia Georgia Department of Public Health services for Medicaid members include: Perinatal Health Partners (PHP), Perinatal Case management, and Presumptive Eligibility Determination. [xiv]
Illinois[xv] Two main programs offering coverage are available for pregnant women: Medicaid Presumptive Eligibility (MPE) which offers immediate temporary coverage for pregnant women who meet income requirements (outpatient care) and Moms & Babies, which covers healthcare during pregnancy and 60 days post-partum (inpatient, outpatient, and transportation).[xviii] Illinois’ Medicaid managed care plans are required to pay for and ensure the same level of care for pregnant women as in the fee-for-service benefit package.
South Carolina Overall, the ability to link and contract with Medicaid providers has been difficult due to variations in policies and services of the Medicaid managed care plans. [xxi]
Financing
California Funding for the RPPC and CPeTS is provided via Federal Title V Maternal and Child Health (MCH) Block Grant Funds.[ix]
Florida The RPICC program is funded through a combination of Federal Title V MCH Block Grant Funds and Medicaid dollars. [xii]
Georgia GRPCN is jointly funded by Georgia Medicaid and the Georgia Department of Public Health.
Illinois[xv] IDPH allocates state funds to target preventative services, and provide grants to designated APCs responsible for the administration and implementation of the perinatal program.[xix]
South Carolina Majority of the funding is through SC Department of Health and Hospitals. Additional funds are provided by the Title V MCH Block Grant.[xxii]
Neonatal Transportation Policy[i]
California There is a neonatal transportation policy and it includes maternal transportation. Medicaid reimbursement policy exists for neonatal transportation.
Florida There is a neonatal transportation policy and it includes maternal transportation and inter-hospital transportation. Medicaid reimbursement policy exists for neonatal transportation.
Georgia There is a neonatal transportation policy and it includes maternal transportation, back transportation for infants, and inter-hospital transportation. Medicaid reimbursement policy exists for neonatal transportation.
Illinois[xv] There is a neonatal transportation policy and it includes maternal transportation, back transportation for infants and mothers, and inter-hospital transportation.
South Carolina There is a neonatal transportation policy and it includes maternal transportation, back-transportation for infants, and inter-hospital transportation.

 


[i] E. M. Okoroh, C.D. Kroelinger, S.M. Lasswell, D.A. Goodman, A.M. Williams, and W.D. Barfield, “United States and Territorial Policies Supporting Maternal and Neonatal Transfer: Review of Transport and Reimbursement,” Journal of Perinatology 36 (2016):30, doi:10.1038/jp2015.109

[ii] “Regional Perinatal Programs of California Fact Sheet,” California Department of Public Health, Accessed August 24, 2016, http://www.cdph.ca.gov/healthinfo/healthyliving/childfamily/Pages/RPPC.aspx[i] E. M. Okoroh, C.D. Kroelinger, S.M. Lasswell, D.A. Goodman, A.M. Williams, and W.D. Barfield, “United States and Territorial Policies Supporting Maternal and Neonatal Transfer: Review of Transport and Reimbursement,” Journal of Perinatology 36 (2016):30, doi:10.1038/jp2015.109

[iii] California Department of Public Health- Maternal, Child, and Adolescent Health Program – Epidemiology, Assessment, and Program Development Branch, “Regional Perinatal Programs of California (RPPC),” October 2015, http://www.cdph.ca.gov/programs/rppc/Documents/RPPC_Regions_Oct2015.pdf

[iv] California Perinatal Transport System, “California Perinatal Transport System,” Accessed August 24, 2016, http://www.perinatal.org/

[v] California Department of Health Care Services, “Program Overview – California Children’s Services,” Accessed August, 29, 2016, http://www.dhcs.ca.gov/services/ccs/Pages/ProgramOverview.aspx

[vi] California Department of Health Care Services, Medi-Cal Access Program, “What Services are Covered in MCAP?,” Accessed August 24, 2016, http://mcap.dhcs.ca.gov/Services/?lang=en

[vii] County of Los Angeles Public Health, “Comprehensive Perinatal Services Program,” Accessed August 24, 2016, http://publichealth.lacounty.gov/mch/cpsp/CPSPwebpages/cpsp_rev.htm

[viii] “Medical Transportation – Ground,” in: California Code of Regulations, 2015, https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwi7_PmV7trOAhXDHx4KHScUBtkQFggeMAA&url=https%3A%2F%2Ffiles.medi-cal.ca.gov%2Fpubsdoco%2Fpublications%2Fmasters-mtp%2Fpart2%2Fmctrangndcd_a05.doc&usg=AFQjCNFzBYxIjWfYOw5gAKxm32BkzRkHug&sig2=QFlVSnGrnpIL6_Y7Sjbd2Q

[ix] California Department of Public Health, “Maternal and Child Health Services Title V Block Grant – California,” 2015, https://www.cdph.ca.gov/programs/mcah/Documents/Title%20V%202016%20Application%202014%20Report%20final.pdf

[x] Children’s Medical Services (CMS), “Regional Perinatal Intensive Care Centers,” Accessed August 29, 2016, http://www.floridahealth.gov/AlternateSites/CMS-Kids/providers/rpicc.html

[xi]Florida Department of Health, Regional Perinatal Intensive Care Centers Handbook, August 2010, http://www.floridahealth.gov/AlternateSites/CMS-Kids/providers/documents/rpicc_handbook.pdf

[xii] Ibid.

[xiii] National Perinatal Information Center, “Medicaid Funding – The Georgia Regional Perinatal Care Network, Accessed August 24, 2016, http://www.npic.org/projects/MedicaidFunding.php

[xiv] Georgia Department of Community Health, “Georgia Public Health Services Available for Medicaid Members,” Accessed August 29, 2016, http://dch.georgia.gov/sites/dch.georgia.gov/files/Georgia_Public_Health_Services_for_Medicaid_Members.pdf

[xv] Bruce Rauner, Felicia F. Noorwood, and Teresa Hursey, Report to the General Assembly, January 2016 – Public Act 93-0536, (2016), http://www.illinois.gov/hfs/SiteCollectionDocuments/perinatalreport2016.pdf

[xvi] Joint Committee on Administrative Rules, Title 77, Chapter 1, Subchapter 1, Part 640: Regionalized Perinatal Health Care Code, Accessed August 29, 2016, http://www.ilga.gov/commission/jcar/admincode/077/07700640sections.html

[xvii] Illinois Department of Public Health, “Perinatal Regionalization,” Accessed August 29, 2016, http://www.dph.illinois.gov/topics-services/life-stages-populations/infant-mortality/perinatal-regionalization

[xviii] Illinois Department of Healthcare and Family Services, “Moms and Babies,” Accessed August 29, 2016, http://www.illinois.gov/hfs/MedicalPrograms/AllKids/Pages/MomsAndBabies.aspx#momsbabies

[xix]Joint Committee on Administrative Rules, Title 77, Chapter 1, Subchapter 1, Part 640, Section 640.80: Regional Perinatal Networks – Composition and Funding, Accessed August 29, 2016, http://www.ilga.gov/commission/jcar/admincode/077/077006400000800R.html

[xx] Association of State and Territorial Health Officials, “South Carolina’s Perinatal Regionalized System of Care: Reducing Premature Births and Infant Mortality,” (2013), http://www.astho.org/Presidents-Challenge-2013/SouthCarolina/

[xxi] South Carolina Department of health and Environmental Control, Healthy Mothers, Healthy Babies: South Carolina’s Plan to Reduce Infant Mortality & Premature Births, (October 2013), https://www.scdhec.gov/library/cr-010842.pdf

[xxii] The Title V Maternal and Child Health Block Grant funded components include: obstetric and neonatal outreach education, transport coordination, and physician consult and follow-up.
Association of Maternal and Child Health Programs, “South Carolina – Maternal and Child Health Block Grant 2016 State Profile,” Accessed August 29, 2016, http://www.amchp.org/Policy-Advocacy/MCHAdvocacy/Documents/South%20Carolina%202016.pdf