Preliminary Healthy Start Waiver Evaluation: 2000 and 2001 Prenatal Services and Hospitalization Charges

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1 FINAL Preliminary Healthy Start Waiver Evaluation: 2000 and 2001 Prenatal Services and Hospitalization Charges Presented to Florida Agency for Health Care Administration and Department of Health June 2, 2003

2 FINAL Preliminary Healthy Start Waiver Evaluation: 2000 and 2001 Prenatal Services and Hospitalization Charges Prepared by Maternal Child Health and Education Research and Data Center June 2, 2003

3 TABLE OF CONTENTS Acknowledgments...v Issue Brief...1 Healthy Start Waiver Evaluation...1 Evaluation Design...2 Dictionary of Healthy Start Services Codes...4 Individual Healthy Start Prenatal Services Data Record Dictionary...18 Findings for Healthy Start Prenatal Services: Demographics of Women Who Delivered in Distribution of Healthy Start Prenatal Service Codes for Calendar Year Healthy Start Prenatal Services for Pregnant Women by Non-Medicaid and Medicaid, Healthy Start Prenatal Services for Non-Medicaid Pregnant Women by Healthy Start Prenatal Score, Healthy Start Prenatal Services for Medicaid Pregnant Women by Healthy Start Prenatal Score, Healthy Start Prenatal Services for Medicaid Pregnant Women by SOBRA and Non SOBRA, Healthy Start Prenatal Services by Mother's Payer: Fee for Service (FFS), Health Maintenance Organization (HMO), MediPass, or None, Findings For Healthy Start Prenatal Services: Demographics of Women Who Delivered in Distribution of Healthy Start Prenatal Service Codes for Healthy Start Prenatal Services for Pregnant Women by Non Medicaid and Medicaid, Healthy Start Prenatal Services for Non-Medicaid Pregnant Women by Healthy Start Prenatal Score, Healthy Start Prenatal Services for Medicaid Pregnant Women by Healthy Start Prenatal Score, Healthy Start Prenatal Services by Medicaid Pregnant Women by SOBRA And Non SOBRA, a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. iii

4 Healthy Start Prenatal Services by Mother s Payer: Fee for Service (FFS), Health Maintenance Organization (HMO), MediPass, or None, Comparison of Birth Hospitalization Charges by Medicaid Status, Healthy Start Services, and Infant Birth Weight...55 Comparison of Birth Hospitalization Charges by Medicaid Status, Healthy Start Services, and Infant Birth Weight: Pre Healthy Start Waiver...59 Appendix I: 2000 Maternal Services Distribution by Category...63 Appendix II: 2001 Maternal Services Distribution by Category...85 a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. iv

5 Acknowledgements Project Director Michael B. Resnick, Ed.D. The Maternal Child Health and Education Research and Data Center, a branch of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies would like to acknowledge the following individuals for their diligent work and contributions to this report: University of Florida Faculty and Staff Julie Ackerman, B.A. Ann Jan, B.S. Erin Anderson, M.A.E. Bong Rae Kim, M. S. Mario Ariet, Ph.D. Changxing Ma, Ph.D. Randy L. Carter, Ph.D. Steven Morse, MD Vivian Chang, M. S. Steven Priest, B.S. Wei Cui, Ph.D. Jeffrey Roth, Ph. Rajeeb Das, M.S.P.H Sam Wu, Ph.D. David Figlio, Ph.D. Li Yan, Ph.D. Christina Hayes, M.A.E. Jie Yang, M.S. University of South Florida Faculty and Staff David Darr, M.D. Edward A. Feaver, M.Div., M.S.E. Peter Gorski, M.D. Charles S. Mahan, M.D. We would also like to thank the following individuals for contributing their support and expertise to this report: Florida Department of Health C. Meade Grigg, M.A.. Joann Schulte, D.O., M. P. H. Carol Graham, Ph. D. Dan Thompson, Ph.D. Karen Freeman, B.A. Betsy Wood, R. N. Agency for Health Care Administration Jason Campbell, B.S. Debbie Walters, R. N. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. v

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7 Issue Brief The following report presents descriptive statistics pertaining to Healthy Start Prenatal Services provided in 2000 and The report is organized so that each graph or table is followed by a set of bullets highlighting the important findings. Healthy Start Prenatal Services are reported first by the mothers Medicaid or non-medicaid status, and then mothers Healthy Start Prenatal Scores. The tables present Healthy Start Prenatal Services according to the following categories: Administrative 8 types Care Coordination 3 types Enhanced Services 7 types The Medicaid tables report Healthy Start Services by Medicaid Fee for Service, Health Maintenance Organization, MediPass, SOBRA, and Non-SOBRA.. The last set of tables present infant hospitalization charges associated with Healthy Start Services. The Dictionary of Healthy Start Service Codes section of this report explains in detail what each Healthy Start service code means. The Individual Healthy Start Prenatal Services Data Record Dictionary is a template for the layout of the tables presented in this report. The appendices contain the data that comprise this report. Healthy Start Waiver Evaluation Overview Effective July 1, 2001, the Health Care Finance Administration approved Florida s application for a Medicaid Waiver that allowed the State to receive Medicaid reimbursement for services not previously covered by Medicaid. The Medicaid Waiver allowed Florida's Healthy Start to progress towards fully meeting the identified needs of mothers and infants by increasing the duration and intensity of Healthy Start services. The Medicaid waiver also included a component to provide case management services for women who were eligible for Medicaid through SOBRA (Sixth Omnibus Budget Reconciliation Act). This component involved assisting SOBRA women to be enrolled with a prenatal care provider. The evaluation of the Healthy Start Waiver seeks to determine whether Medicaid clients, who historically are at greater risk of poor perinatal outcomes than other Florida residents, demonstrate improved birth outcomes if they receive more intensive care coordination and a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 1

8 supplemental services than they received prior to the waiver, and if SOBRA women are provided case management services which result in participation in prenatal care early in their pregnancy cycle. Among anticipated post waiver outcomes, the evaluation examines: increases in the screening rates of pregnant women and infants increases in the intensity and duration of care coordination and supplemental prenatal services to Medicaid women potential reductions in the cost of services to special needs children due to a decrease in number of low birth weight babies delivered potential reductions in emergency room use and need for additional services due to chronic medical problems related to complications at birth The Evaluation Design The design of the evaluation calls for contrasting baseline information about service delivery (type, intensity, duration, and cost) during three years pre-waiver, with three years post waiver, In June 2002, the Maternal Child Health and Education Research and Data Center at the University of Florida in collaboration with the Chiles Center at the University of South Florida, issued a first baseline report summarizing the distribution of Healthy Start prenatal services in The report presented findings organized by Medicaid Status (SOBRA, Non-SOBRA, or Non-Medicaid), Medicaid Payor Type (HMO, Medipass or Fee for Service), and Mother s Healthy Start Prenatal Risk Screening Score (High, Low, or Not Screened). In a first effort toward distinguishing intensity and cost, Healthy Start services were categorized into three types: Administrative, Care Coordination, and Enhanced Services [e.g., Nutritional Assessment, Psychosocial Counseling, Parent Education, Childbirth Education, Breast Feeding Education, Smoking Cessation, Planned Educational Sessions]. What We Know So Far MCHERDC s second baseline report summarizes the distribution of Healthy Start prenatal services for two years, one pre-waiver year, 2000, and one post-waiver year, There were no major differences in type, intensity, or duration of the three service types a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 2

9 (Administrative, Care Coordination, and Enhanced Services) across two subgroups, Medicaid Status (SOBRA, Non-SOBRA, or Non-Medicaid), and Medicaid Payer Type (HMO, Medipass or Fee for Service) in the year before the waiver (2000) and the year the waiver began (2001). What We Don t Yet Know It is not yet possible to determine costs associated with services post waiver (2001) because the data source for cost, AHCA s 2001 hospital discharge files, will not be available until August 2003 at the earliest. Similarly, birth outcome data for the first post-waiver cohort, 2001, specifically, the linked 2001 birth-infant death file, will not be available from Birth Vital Statistics until August 2003 at the earliest. How Soon Can We Begin Answering the Evaluation Questions? This year s final version of MCHERDC s second descriptive report will contain some cost information about the 2000 pre-waiver cohort. Outcome data such as infant mortality, low birth weight, and developmental delay may be available during fiscal year In the spring of 2004, it will be possible to report on birth outcomes and associated costs for the first post-waiver cohort, children born in a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 3

10 Program Component (PC) Dictionary of Healthy Start Service Codes Maternal/Prenatal Component Codes = 26 and 27 Infant/Postnatal Component Codes = 30 and Healthy Start Prenatal (Non-County Health Department Providers) 27 Healthy Start Prenatal Non-County Health Departments providers managed through Healthy Start Coalitions who conduct Healthy Start initial contacts, initial assessments, care coordination, and enhanced services to pregnant women to assess potential risks as soon as possible, assure access to services needed and to optimize pregnancy, health, and developmental outcomes. County health departments provide Healthy Start initial contacts, initial assessments, care coordination, and enhanced services to pregnant women to assess potential risks as soon as possible, assure access to services needed and to optimize pregnancy, health, and developmental outcomes. Healthy Start provides supports and services that complement, supplement, and assure continued participation in prenatal and child health care. HEALTHY START INITIAL CARE COORDINATION CONTACT 31XX PC 26, 27, 30, 31 Initial contact after screening is the point-of-entry into Healthy Start Care Coordination. A Healthy Start participant is a pregnant woman or child who has received a positive score of 4 or more on the Healthy Start screen or has been referred for Healthy Start care coordination services based on factors other than score. The initial contact is an evaluation of service needs. Note: See Chapter 14 of the Healthy Start Standards and Guidelines for further explanation of Healthy Start Coding. The initial contact occurs within five working days of the receipt of the Healthy Start screen or subsequent referral and includes: a. Explaining the meaning of a positive Healthy Start ris k screen including, why the referral was made and addressing each risk factor with the participant. b. Determining the participant's ability to access comprehensive prenatal services/child health care services. c. Evaluating the participant's service needs by determining the availability of the participant s or family s assets, strengths, and resources to reduce their risk status using risk appropriate care principles. d. Providing information about how risk factors can be addressed and what types of services are available in the community and through Healthy Start to improve chances of a healthy outcome. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 4

11 e. Providing referrals to community resources. f. Providing a name and phone number of a person at the agency providing Healthy Start care coordination who can be contacted for assistance if the participant or family is unable to access needed services. g. Initiating the participant's Healthy Start Care Coordination record. h. Initiating an Individualized Plan of Care. i. Assigning a level of care based on the Healthy Start State Leveling System Criteria. i. Providing follow-up with the prenatal or child health care provider within 30 days of the receipt of the screen or referral to inform them of the results of the initial contact and the name and phone number of a contact at the agency providing the initial contact. On the completion of the Initial Contact (or attempt) choose one code to describe the outcome of the initial contact: Needs Tracking Only 3101 This initial contact code is used when the participant needs only tracking. Tracking involves only follow-up of referrals and other services to determine that the participant continues to be able to access needed services. Tracking may be face-to-face or non face-to-face. Participant Needs Assessment 3102 This initial contact code is used when the initial contact results in a determination that the participant needs or desires a face-to-face assessment. Attempt to Contact 3103 This initial contact code is used when an attempt to provide an initial contact has been unsuccessful. Minimally, three attempts to contact are made before discontinuing follow-up and coding 3114, unable to locate. The 3103 code may be used more than once. Code one service for every 15 minutes spent in this activity including travel and documentation. Method of contact attempts are summarized in the decision Matrix found in Chapter 4 Start Standards and Guidelines. Attempt to contact may be made by: 1. Telephone call with verbal interaction with the participant or family; 2. Face-to-face; (home visit, WIC appointment, clinic appointment or any other location), or 3. Letter. Exception to closure after 3 attempts: Invitational letter may be used as an initial attempt to contact. The participant who has a score of less than 4, is referred for factors other than score, and does not have safety concerns and immediate needs may be closed after 30 days if participant has not made contact with coordinator. Only one contact is required. Use Unable to Locate, for these cases. Initial Care Coordination Contact Closure Codes Declines Services 3110 This initial contact code is used when the participant verbally declines or refuses services, even if the care coordination provider believes services are warranted. HMC code 3110 indicates you provided the initial contact and met the criteria outlined for providing an initial contact. Follow-up is discontinued. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 5

12 No Further Services Needed 3111 This initial contact code is used when the participant and the care coordination provider collaboratively agree that no further services are needed. Follow-up is discontinued. Receiving or Will Receive Care Coordination from CMS/EIP 3112 This initial contact code is used when the care coordination is (or will be) adequately provided by CMS/EIP. Follow-up is discontinued. Receiving or Will Receive Care Coordination from Another Provider, Not CMS/EIP 3113 This initial contact code is used when the care coordination is (or will be) adequately provided by another provider, not CMS/EIP. Follow-up is discontinued. Unable to Locate 3114 This initial contact code is used when a participant has not received the initial contact. Use this code when: 1. The participant has a score less than 4, is referred for factors other than score, and does not have safety concerns or immediate needs. Close after 30 days if participant has not made contact with coordinator. 2. Three attempts have been made and documented. These attempts may be made by telephone, face-to-face or by letter. 3. The Participant covertly declines services by not responding to attempts to contact. Follow up will be discontinued for clients who cannot be located. Initial Contact Service Units 3115 This code is used to account for time spent providing an initial contact. Code one service for every 15 minutes spent providing an initial contact. Coding Note: Services must be coded to client ID using Healthy Start Encounter Form. Clients should be registered in HCMS. HEALTHY START CARE COORDINATION - INITIAL ASSESSMENT 32XX PC 26, 27, 30, 31 Initial Assessment of service needs is a face-to-face evaluation done in collaboration with the participant and family within 10 working days of the initial contact. A Healthy Start participant is the pregnant woman or child who has received a positive score of 4 or more on the Healthy Start screen or has been referred for factors other than score for Healthy Start care coordination services. The initial assessment activities will be documented and an Individualized Plan of Care may be re-evaluated to include the following provisions: 1. A face-to-face interview with the pregnant participant or child s parents/ caregivers. Assessment risks and of service needs may be made in the clinic, community setting, or home at the time of initial contact if the initial contact is made during a a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 6

13 Face-to-face encounter. If the initial contact is not during a face-to-face encounter, the assessment should be completed or an attempt made to complete within ten working days of the initial contact. 2. Completion of an authorization for release of medical information, as appropriate. 3. Joint determination of participant and family service needs in conjunction with the participant or family and includes evaluation of: a. Participant s, parent/caregiver s and family's concerns, priorities, and resources; b. Participant s physical and emotional well-being, safety, and general appearance; c. The home environment; d. The participant's, parent/caregiver s and family s knowledge and attitudes about pregnancy, childbirth, and parenting; e. Parent/caregiver s child interaction; f. Availability of a social support system; g. Current situation with regard to services, health services and identified Healthy Start risk factors: for example, housing, food (including current eligibility for Women Infant & Children Program), transportation, family planning services, health services (including current eligibility for Medicaid), ability to continue regular participation in ongoing care (including past appointment regularity). h. All unresolved risk factors, corresponding needs and potential for change. 2. An Individualized Care Plan for continuing or discontinuing care coordination services based on the assessment. Re-evaluation of participant s level of care and documentation of leveling changes as Needed. 3. A phone call or written note provided to the prenatal care provider or infant s primary care provider within 30 calendar days of assessment regarding progression of Healthy Start care coordination service delivery. If the Initial contact and the initial assessment are completed separately or together within 30 calendar days of one another, one phone call or note will suffice. On completion of the Initial Care Coordination Assessment of Service Needs (or attempt), choose one code to describe the outcome: Needs Tracking Only 3201 This initial assessment code is used when the participant needs little or no assistance in accessing services but the provider or participant would like to periodically follow-up or track referrals and other services. Plan Ongoing Care Coordination 3202 This initial assessment code is used when the initial assessment results in a determination that the participant needs more follow-up than would be provided by tracking alone. Attempt to Contact 3203 a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 7

14 This initial assessment code is used when an attempt to provide an initial assessment has been unsuccessful. Minimally, three attempts to provide the assessment are made before discontinuing follow-up and coding 3214, unable to locate. The 3203 code may be used more than once. Initial Care Coordination Assessment Closure Codes Declines Services 3210 This initial assessment code is used when the participant verbally declines or refuses services, even if the care coordination provider believes services are warranted. Follow-up is discontinued. No Further Services Needed 3211 This initial assessment code is used when the participant and the care coordination provider collaboratively agree that no further services are needed. Follow-up is discontinued. Receiving or Will Receive Care Coordination from CMS/EIP 3212 This initial assessment code is used when the care coordination is (or will be) adequately provided by CMS/EIP. Follow-up is discontinued. Receiving or Will Receive Care Coordination from Another Provider, Not CMS/EIP 3213 This initial assessment code is used when the care coordination is (or will be) adequately provided by another source, not CMS/EIP. Follow-up is discontinued. Unable to Locate 3214 This initial assessment code is used when a participant has not received the initial assessment outlined in Chapter 4. Use this code when: 1. Three attempts have been made by letter, telephone call, or attempted face-to-face visit. 2. The Participant covertly declines services by not responding to attempts to contact. Follow-up will be discontinued for clients who are unable to be located. Initial Assessment Service Units 3215 This code is used to account for time spent providing an initial assessment. Code one service for every 15 minutes spent providing an initial assessment including travel and documentation. Coding Note: Services must be coded to client ID using Healthy Start Encounter Form. Clients should be registered in HCMS. HEALTHY START ONGOING CARE COORDINATION 33XX PC 26, 27, 30, 31 Provides ongoing care coordination to the pregnant or child Healthy Start participant. Ongoing care coordination is the process of assisting families with locating, coordinating, and monitoring needed services in order to optimize pregnancy, birth, growth and developmental outcomes. A Healthy Start participant is the pregnant woman or child who has received a positive score of 4 or more on the Healthy Start screen or has been referred for factors other than score for Healthy Start care coordination services. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 8

15 Ongoing care coordination may include any of the following activities: 1. Tracking the participant's receipt of services. (Refer to Chapter 4 Healthy Start Standards and Guidelines for tracking activities.) 2. Ongoing systematic assessment of participant, parent/caregiver, or family concerns, priorities, strengths and resources. 3. Planning with the family how to address their concerns, priorities and resources. 4. Developing a Family Support Plan in accordance with state-approved protocols. 5. Providing referrals and follow-up for services. 6. Coordinating services with other providers/agencies/programs. 7. Reinforcing the health care regimen. 8. Providing anticipatory guidance. 9. Advocating on behalf of the participant and family. 10. Monitoring effectiveness of services provided and adjusting the plan for services as appropriate. 11. Care coordination transition to other providers when appropriate. 12. Maintaining ongoing communication with other providers, especially the prenatal or child health care provider. 13. Ongoing systematic assessment of participant, or family assets, risks, concerns, and priorities. 14. Re-evaluation of the Individualized Plan of Care. 15. Re-evaluation of the participant s level of care. Each time Ongoing Care Coordination is provided, choose as many Ongoing Care Coordination service codes as applicable. At the time Ongoing Care Coordination is terminated, choose only one ongoing care coordination closure code. Care Coordination Face-to-Face 3320 This ongoing care coordination code is used when care coordination activity is provided face-to-face with the client. Code one service for every 15 minutes spent in this activity including travel, documentation and other care coordination activities necessary to provide care-coordination face-to-face direct service. Care Coordination Tr acking or Not Face-to-Face 3321 This ongoing care coordination code is used when care coordination is NOT provided face-to-face with the client. This may include: 1. Telephone calls to or on behalf of the Healthy Start participant 2. Referral activ ities (Telephone or face-to-face) 3. Tracking activities (Telephone or face-to-face) Code one service for every 15 minutes spent in this activity. Initial Family Support Plan Meeting 3322 This ongoing care coordination code is used at the time that the Family Support Plan is written. A Family Support Plan for all Level 3 participants is required. Use this code only when a Level 3 participant receives a Family Support Plan. Code one service every 15 minutes spent in this activity including travel and documentation. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 9

16 Update Family Support Plan 3323 This ongoing care coordination code is used when the Family Support Plan is updated. Minimally, this should be done every three months. Use only when updating a Family Support Plan of a Level 3 participant. Code one service for every 15 minutes spent in this activity including travel and documentation. Attempt to Contact 3303 This ongoing care coordination code is used when an attempt to provide a care coordination service has been unsuccessful. A minimum of three attempts to provide ongoing care coordination should be made before discontinuing follow-up. Code one service for every 15 minutes spent in this activity. Ongoing Care Coordination Closure Codes. At the time Ongoing Care Coordination is discontinued, choose only one Ongoing Care Coordination closure code. Declines Services 3310 This ongoing care coordination code is used when the participant verbally declines or refuses services, even if the care coordination provider believes services are warranted. Follow-up is discontinued. No Further Services Needed 3311 This ongoing care coordination code is used when the participant and the care coordination provider collaboratively agree that no further services or follow-up are needed. Receiving Care Coordination from Children Medical Services/EIP 3312 This ongoing care coordination code is used when the ongoing care coordination is (or will be) adequately provided by CMS/EIP. Follow-up is discontinued. Receiving Care Coordination from another provider, not CMS/EIP 3313 This ongoing care coordination code is used when the ongoing care coordination is (or will be) adequately provided by another provider, not CMS/EIP. Follow-up is discontinued. Unable to Locate 3314 This ongoing care coordination code is used when a participant cannot be located after three attempts have been made and documented. These attempts will be according to the following guidelines: 1. Three attempts may be made by letter, telephone call, or attempted face-to-face visit. 2. The Participant covertly declines services by not responding to attempts to contact. Follow-up will be discontinued for clients who are unable to be located. Ineligible for Care Coordination Services 3315 This ongoing care coordination code is used when a participant has completed her postpartum and family planning appointment eight weeks after delivery or when a child reaches three year of age or participant moves out of the state. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 10

17 Coding Note: Services must be coded to client ID using Healthy Start Encounter Form. Clients should be registered in HCMS. HEALTHY START SPECIAL SERVICES: PARTICIPANT IDENTIFICATION 3950 PC 26, 27, 30, 31 Activities which identify specific individuals and groups who are in need of comprehensive prenatal or child care; provide culturally sensitive, family-centered, educationally and demographically appropriate information regarding prenatal and child services available within the community and the importance of accessing services early; and facilitate access to needed services. On the direct level of participant identification, service provision would include sharing family-centered information regarding prenatal or child services available within the community and stressing the importance of accessing services. Direct services include the facilitation of access to needed services. Identification may be done door-to-door or at specific sites such as community health fairs, soup kitchens, or neighborhood centers. This process may include ongoing direct follow-up with individuals that have been identified as potential recipients of Healthy Start services. Special Note: 1. One service should be coded for every 15-minute unit of time spent on this activity. 2. If the service is delivered to an identified Healthy Start participant, the participant's identification number may also be coded. Provider Qualifications: Refer to Chapter on Outreach in the Healthy Start Standards and Guidelines for information on provider qualifications. Coding Note: Services must be coded to client ID using Healthy Start Encounter Form. Clients should be registered in HCMS. PARTICIPANT RELATED ACTIVITIES HEALTHY START CARE COORDINATION ADMINISTRATION 3951 PC 26, 27, 30, 31 Providing administrative activities related to screening and Care Coordination for Healthy Start participants. Participant Related Activities are administrative functions that assure the Healthy Start process and include: 1. Receiving and reviewing screening reports. 2. Reconciling discrepancies in screening data. 3. Transferring of screening forms to the county health department in the county of residence or office of Vital Statistics. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 11

18 4. Performing other Healthy Start Care Coordinator administrative functions that assure the Healthy Start process. Attending conferences or training for Healthy Start programs may also be coded using this code. 5. Other Healthy Start Care Coordinator administrative functions that may be participant specific. 6. Healthy Start Quality Improvement functions. 7. Letters written to participant/family or providers. Special Note: 1. One service should be coded for every 15 minutes spent on this activity. 2. If the service is delivered to an identified Healthy Start participant, code the client ID. 3. If the service is reported on the EAR with time, the time reported should match the units of service reported otherwise the time is left blank and included in the 0000 code. COMMUNITY ACTIVITIES - HEALTHY START CARE COORDINATION ADMINISTRATION 3952 PC 26, 27, 30, 31 Providing information to the community related to Healthy Start and collaboration with other community groups providing services to pregnant women, children and families. Use this code when promoting the Healthy Start Program. Healthy Start Care Coordination Administrative Community Activities include information sharing with community agency representatives or presentations at local places of worship, small business organizations or other community groups or recruitment of public and private providers. The process of information sharing would include the provision of information on the Healthy Start initiative. This process can include facts on the need for linking services and ways to identify participants who may need ongoing support to secure services. It may also assist providers to identify individuals who have the potential to become recipients of Healthy Start services Special Note: One service should be coded for every 15 minutes spent on this activity. NUTRITION ASSESSMENT/COUNSELING - HEALTHY START SERVICES 4501 PC 26, 27, 30, 31 Provides intensive therapeutic nutritional assessment and counseling to the at-risk Healthy Start pregnant/postpartum woman or family/caregiver of the at-risk Health Start child who is threatened by conditions for which medical nutrition therapy is a critical component of management. Nutrition assessment and counseling is a face-to-face contact with the client and/or family/caregiver that includes the process of gathering and assessing anthropometrical; Body Mass Index (BMI) and biochemical data from the medical record; performing a diagnostic nutrition assessment; and evaluating the dietary intake. The plan of care is developed with the client and/or family/caregiver. It is based on the findings of the nutrition assessment and includes goals and methods to monitor or evaluate the client's progress toward goal attainment. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 12

19 Nutrition services provided by Women Infant & Children Program are not considered healthy start services and should not be coded with this code. Individual and family nutritional counseling is based on the nutrition assessment and must be consistent with the nutrition care plan. Counseling will be provided at an appropriate level of understanding for the individual and family members. Therapeutic diet counseling for disease states may be provided upon receipt of a written physician prescription. This process may involve one or a series of sessions that occur to address the specific health outcome nutrition goals identified. Follow-up counseling sessions must monitor the client's progress toward goals, involve the client or family/caregiver in his or her own care and coordinate care with other members of the interdisciplinary treatment team. This service is appropriate for clients who are threatened by conditions for which medical nutrition therapy is a critical component of medical management. Nutrition services must be documented on appropriate forms in the client's medical record. Special Note: Nutrition assessment/counseling services provided on behalf of Healthy Start participants are coded to the Healthy Start participant identification number, even though it is family or household members who receive the services. Code one service for every l5 minutes spent in this activity. Provider Qualifications: professionals may provide Nutritional counseling with one of the following credentials: 1. Registered Dietitian. 2. Licensed Dietitian/Nutritionist as licensed by the Florida Department of Health. 3. Public Health Nutritionist employed by a federal, state or county agency. SOCIAL WORK INTERVENTION (UNIVERSAL) 6030 Coded when social work methods are used to reduce risks to a client's health. See therapeutic Services (definition of Social Work Intervention: 6030 is included under therapeutic services.) PARAPROFESSIONAL ENCOUNTER (UNIVERSAL) 6500 An independent client encounter by a trained paraprofessional to ascertain that clients have taken proper action. UNIVERSAL CODE for direct services. Requires number of services if coded on the Employee Activity Record. COUNSELING (UNIVERSAL) 8000 The provision and documentation of counseling services by professionals other than nutritionists, nurses and social workers. (Counseling is incorporated in codes 4500 for nutritionists, 5000 for nurses and 6030 for social workers.) a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 13

20 UNIVERSAL CODE for direct services. Requires number of services if coded on the Employee Activity Record. PSYCHOSOCIAL COUNSELING - HEALTHY START SERVICES 8002 PC 26, 27, 30, 31 Psychosocial counseling is provided to Healthy Start participants to address emotional, situational and developmental stressors. The goal is to reduce identified risk factors to achieve positive pregnancy outcomes and optimal infant/child health and development. Psychosocial counseling is the process of counseling an individual, family or group during one or more sessions to support the process of overcoming environmental, emotional or social problems that are affecting the health and well being of the Healthy Start participant and/or the child's family members. Psychosocial counseling emphasizes the interaction between the client's and/or family's emotions, behaviors, social relationships and environment. This process helps the family to access resources and modify behaviors, relationships and/or circumstances in order to enhance health and social functioning within the community. The psychosocial assessment process includes the development of a plan of action that addresses the family's identified goals and provides a mechanism by which progress toward goal attainment can be measured. Special Note: Psychosocial counseling services provided on behalf of Healthy Start infants are coded to the Healthy Start infant identification number, even though it is family or household members who receive the services. Code one service for every l5 minutes spent in this activity. Provider Qualifications: Refer to Chapter 9 Healthy Start Standards and Guidelines for provider qualifications. PARENTING EDUCATION & SUPPORT - HEALTHY START SERVICES 8004 PC 26, 27, 30, 31 Provides activities that educate and inform the family and parents/caregivers about care of the newborn, infant, and older child; normal growth and development; anticipatory guidance; encouragement and support; changes in family dynamics; attachment behaviors; nutrition; safety; child injury prevention; and child abuse prevention. Parenting education and support activities are any of those activities described above that are provided by trained and qualified health related professionals and paraprofessionals who use locally approved protocols, procedures, competencies, and curriculum with learning objectives. The curriculum content should have a prevention-based and/or an intervention-based focus to reduce factors that are associated with placing children at health, social, or behavioral risk. Special Note: Parenting education and support services provided on behalf of Healthy Start children are coded to the Healthy Start child identification number, even though it is family or household members who receive the services. Code one service for every 15 minutes spent in this activity. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 14

21 Provider Qualifications: Parenting support and education are provided by trained and qualified health-related professionals and paraprofessionals using locally approved protocols, procedures, competencies, and curriculum with learning objectives. CHILDBIRTH EDUCATION - HEALTHY START SERVICES 8006 PC 26, 27, 30, 31 Provides activities that provide information and education to the pregnant woman and her family, both during early and late pregnancy, which promote healthy outcomes for the woman and her child. Childbirth education includes the following topics: anatomy and physiology of pregnancy and birth; physical and emotional changes related to pregnancy; nutrition and feeding including breastfeeding promotion, barriers, and benefits; prenatal care; self-empowerment; stress management; danger signs of pregnancy; signs and symptoms of pre-term labor; preparation for labor and delivery; parent-infant attachment; breastfeeding initiation and management; normal newborn growth and development; newborn care and safety; postpartum changes; interpersonal support; and family planning. Code one service for every 15 minutes spent in this activity. Provider Qualifications: Refer to Chapter 6 of the Healthy Start Standards and Guidelines for provider qualifications. BREASTFEEDING EDUCATION & SUPPORT - HEALTHY START SERVICES 8008 PC 26, 27, 30, 31 Provides comprehensive information, education, and counseling to prenatal and postpartum participants or to the Healthy Start child s mother including assistance in overcoming barriers to breastfeeding, postpartum hospital and home visits, encouraging the initiation of breastfeeding and providing anticipatory guidance and support in order to prevent breastfeeding problems. Breastfeeding education and support activities are any of those activities described above that are provided by individuals who have received particular, specialized lactation promotion and support training, are able to provide breastfeeding education and support and assist in providing direct services under the supervision of a care coordinator, health care provider, or other health-related professional. Code one service for every 15 minutes spent in this activity. Special Note: Breastfeeding education and support services provided on behalf of Healthy Start participants are coded to the Healthy Start participant identification number, even though it is family or household members who receive the services. Provider Qualifications: Refer to Chapter 6 of the Healthy Start Standards and Guidelines for provider qualifications. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 15

22 EDUCATION: CLASS (UNIVERSAL) 8020 A planned education session using established curriculum and defined learner objectives with one or more persons having common information needs and documentation of attendance noted in client files. A minimum of one participant is needed to hold a "class" or "educational session." A small group discussion or support session may be appropriate within this code if participants are scheduled ahead of time and the group instructor is following a previously approved plan. The focus of this class or series of classes is on risk factors for chronic diseases other than cancer, diabetes or cardiovascular disease. Class curricula should be developed from reputable health resources and course content should be approved by the appropriate County health department health professionals, representative of their discipline (nurse, nutritionist, health educator). School Health: School health staff use code 8020 for a formal, planned education session with an established curriculum to students, parents, school staff, or health professionals having common information needs. Health education (such as human sexuality, etc.) provided to students is subject to parental approval. UNIVERSAL CODE for direct services. Under number of services, enter 1 for the number of educational sessions. Under FTTY, enter the number attending. SMOKING CESSATION COUNSELING - HEALTHY START SERVICES 8026 PC 26, 27, 30, 31 Provides comprehensive information, education, reinforcement and support throughout pregnancy, to postpartum clients, and to parents/caregivers of Healthy Start children, their families, and other household members related to the importance of smoking cessation for both maternal and child health. This includes addressing barriers to smoking cessation, benefits of quitting, counseling when relapse occurs, and methods of behavior modification. Smoking cessation counseling services are any of the above activities that are provided by individuals who have received particular, specialized training to provide smoking cessation information, education, and support. Special Note: Smoking cessation counseling services provided to or on behalf of, Healthy Start pregnant women or children are coded to the Healthy Start participant identification number, even though it is family or household members who receive the services. Code on Healthy Start Encounter form using Client ID. Code one service for every 15 minutes spent in this activity. Provider Qualifications: Smoking cessation counseling and services are provided by individuals who have received particular, specialized training to provide smoking cessation information, education and support. Smoking cessation counseling and services are provided through a contract or under the supervision of a care coordinator, health care provider, or other health-related professional. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 16

23 ORIENTATION/PRE-SERVICE TRAINING (UNIVERSAL) 8050 Time spent in providing or attending these categories of training. UNIVERSAL CODE for support service TIME ONLY. Can only be coded on the Employee Activity Record (EAR) form. CASE MANAGEMENT (UNIVERSAL) 9010 Case Management of an individual, may include review of medical records and discussion of case with other professionals or telephone conversation with or on behalf of client. This does not include Healthy Start Care Coordination Activities. UNIVERSAL CODE for direct services. Time only must be entered on the Employee Activity Record CLERICAL SUPPORT (UNIVERSAL) 9020 During time collection periods clerical personnel report time to the programs in which their time was spent to the closest 15 minutes. UNIVERSAL CODE for support service TIME ONLY. Time is required, can only be coded on the Employee Activity Record (EAR) form. PROFESSIONAL SUPPORT (UNIVERSAL) 9080 Professional time spent in activities that support direct service provisions. UNIVERSAL CODE for support service TIME ONLY. Can only be coded on the Employee Activity Record (EAR) form. INCOMPLETE SERVICE (UNIVERSAL) 9999 A code used when time and mileage are expended and the service cannot be delivered: e.g., "not-at-home". UNIVERSAL CODE for direct services. Requires number of services a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 17

24 Individual Healthy Start Prenatal Services Data Record Dictionary Individual Healthy Start Prenatal Services Data Record Client ID# sid Birth Year b_year Birth Certificate # cid I. Administrative # of Service Units Code 1) Needs Tracking Only TRAKONLY A value of zero or 3101,3201,3301 2) Participant Needs Assessment ASSMNT blank indicates no 3102,3202 3) Attempt to Contact ATT2CONTACT response. 3103,3203,3303 4) Declines Service DECL_SVC 3110,3210,3310 5) Ineligible for Care Coordination INELIG4CC ) Unable to Locate CANTFIND 3114,3214,3314 7) No Further Services Needed NONEED 3111,3211,3311 8) Other Care Coordination OTH_CC a) CMS-EIP OTH_CMS 3112,3212,3312 b) Not CMS-EIP OTH_NOTCMS 3113,3213,3313 c) Coordination Adm OTH_CADM 3950,3951,3952 Number of women who had at least one Administrative Service (1-8) TOT_ADMIN # of Service Units (15 min. per unit) Duration (days)* II. Care Coordination 9) Initial Service Units INIT_SV init_svbeg/init_svend 3115,3218 a) Contact CONTACT contactbeg/contactend 3115 b) Assessment ASSESS assessbeg/assessend ) Care Coordination C_COORD c_coordbeg/c_coordend 3320, ) FSP FSP fspbeg / fspend 3322,3323 Number of women who had at least one Care Coordination Service (9-11) TOT_CC range_cc III. Enhanced Healthy Start Services # of Service Units (15 min. per unit) Duration (days)* 12) Nutritional Assessment/Counseling NUTRI nutribeg / nutriend ) Psychosocial Counseling PSYCHO psychobeg/psychoend ) Parent Education/Support PAR_ED par_edbeg / par_edend ) Childbirth Education CB_ED bc_edbeg / bc_edend ) Breast Feeding Ed/Supp BR_FEED br_feedbeg/br_feedend ) Smoking Cessation/Counseling SMOKE smokebeg/smokeend ) Planned Educational Sessions PLANNED_ED planned_edbeg/...end 8020 Number of women who at least one Enhanced Intervention Service (12-18) TOT_SRV range_srv Number of women who had at least one Care Coordination Service or Enhanced Intervention Service (9 18) TOT_CC_SRV range_cc_srv Data File:.../curr9X/momsrvsummary.sas7bdat generated by /HSSVCS/momsrvsummary.sas * Duration is the number of days, calculated by subtracting begin date from end date. hssrvdictionary.xls a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 18

25 This page intentionally left blank a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 19

26 FINDINGS FOR 2000 a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 20

27 Healthy Start Prenatal Services: Demographics of Women Who Delivered in 2000 Birth Year Mother s Ethnicity Percent 2000Black 35% 2000White 43% 2000Asian 1% 2000Hisp 20% 2000Indian 0% 2000Other 0% 2000Total Birth Education Year Level Percent 2000<High School 36% 2000=High School 39% 2000>High School 25% 2000Total Birth Prenatal Year Screen Score Percent or Greater 43% 2000HS<4 45% 2000none 13% 2000Total Birth Low Birth Year Weight Percent 2000Normal BW 91% 2000Low BW 9% 2000Total Note: Total Number of Mothers = 44,450. Indicators may be less due to missing data or they may exceed a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 21

28 total due to multiple screens. Healthy Start Prenatal Services: Demographics of Women Who Delivered in 2000 Findings White pregnant women received the largest percentage of Healthy Start Prenatal Services, followed by Black pregnant women, followed by Hispanic pregnant women. Pregnant women with an education level equal to high school education received about the same percentage of Healthy Start Prenatal Services as pregnant women with an education level less than high school. Pregnant women with a Healthy Start Screen Score less than 4 received about the same percentage of Healthy Start Prenatal Services as pregnant women with a Healthy Start Screen Score greater than 4. Pregnant women who delivered a normal birth weight child received 91% of Healthy Start Prenatal Services. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 22

29 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Distribution of Healthy Start Prenatal Service Codes for Calendar Year Number of Mothers Service Code a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 23

30 Medicaid Division, Agency for Health Care Administration, and Flo rida Department of Health Distribution of Healthy Start Prenatal Service Codes for Calendar Year 2000 Findings The most frequently recorded Healthy Start Prenatal Service code was 3103 (Attempt to Contact), followed by 3321 and 3320 (Care Coordination), and 3303 (Attempt to Contact). a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 24

31 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services for Pregnant Women By Non-Medicaid and Medicaid, 2000 Non-Medicaid Medicaid Number With Service Percent With Service Average Units of Services* Number With Service Percent With Service Average Units of Services* I. Administrative 1) Needs Tracking Only 2) Participant Needs Assessment 3) Attempt to Contact 4) Declines Service 5) Ineligible for Care Coordination 6) Unable to Locate 7) No Further Services Needed 8) Other Care Coordination a. CMS-EIP b. Not CMS-EIP c. Coordination Adm. 5, , , , , , , , , , , , , , , , , , , , , , Number of women who had at least one Administrative Service (1-8) II. Care Coordination 9) Initial Service Units 16, , a. Contact 14, , b. Assessment 8, , ) Care Coordination 15, , ) FSP 3, , Number of women who had at least one Care Coordination Service (9-11) 22, , III. Enhanced Services 12) Nutritional Assessment/Counseling ) Psychosocial Counseling 1, , ) Parent Education/Support 5, , ) Childbirth Education 3, , ) Breast Feeding Ed/Supp 4, , ) Smoking Cessation/Counseling 2, , ) Planned Educational Sessions Number of women who at least one Enhanced Intervention Service (12-18) 10, , Number of women who had at least one Care Coordination Service or Enhanced Intervention Service (9 18) 23, , * Average unit of service for I is a contact. Average unit of service for II and III is measured in 15-minute units. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 25

32 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services for Pregnant Women by Non-Medicaid and Medicaid, 2000 Findings A three fold greater effort was made to contact Medicaid women (63.2%) than non-medicaid women (21.1%). Healthy Start case workers attempted to contact Medicaid women 1.5 more times than non-medicaid women. The percent of pregnant women declining service was two and half times higher among Medicaid women compared to Non Medicaid women (15.4 vs. 6.2). Not only did 49% of Medicaid women receive Care Coordination services compared to 10% of non-medicaid women, but Medicaid women also averaged one more hour of Care Coordination services (sum of II) than non-medicaid women. Average service units between Medicaid and non-medicaid women for Care Coordination are fairly uniform for 9, 9a, 9b, and 11. However, the proportion of Medicaid women receiving any Care Coordination (sum of II) is four times that of non-medicaid women. 22% of Medicaid women received at least one of the Enhanced services, averaging 13 service units received. For these same services, non- Medicaid women received three more service units. However, only 4% of non-medicaid women received services. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 26

33 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services for Non-Medicaid Pregnant Women by Healthy Start Prenatal Score, 2000 I. Administrative HS = High Non-Medicaid Number With Service % With Service Average Units of Service* HS = HS = HS = HS = HS = HS = HS = Low None High Low None High Low 1) Needs Tracking Only ) Participant Needs Assessment ) Attempt to Contact 2,162 6,415 1, ) Declines Service 538 1, ) Ineligible for Care Coordination ) Unable to Locate 417 1, ) No Further Services Needed 673 1, ) Other Care Coordination 515 1, a. CMS-EIP b. Not CMS-EIP c. Coordination Adm , Number of women who had at least one Administrative Service (1-8) 2,319 6,920 1, HS = None II. Care Coordination 9) Initial Service Units 1,294 2, a. Contact 1,141 1, b. Assessment ) Care Coordination 969 1, ) FSP Number of women who had at least one Care Coordination Service (9-11) 1,593 2, III. Enhanced Services 12) Nutritional Assessment/Counseling 13) Psychosocial Counseling ) Parent Education/Support ) Childbirth Education ) Breast Feeding Ed/Supp ) Smoking Cessation/Counseling 18) Planned Educational Sessions Number of women who at least one Enhanced Service (12-18) Number of women who had at least one Care Coordination Service or Enhanced Service (9 18) 1,658 2, a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 27

34 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health * Average unit of service for administrative is a contact. Average unit of service for care coordination is measured in 15-minute units. Prenatal Healthy Start Score High means the score was greater than or equal to 4. Prenatal Healthy Start Score Low means the score was less than 4. Prenatal Healthy Start Score None means the mother did not receive a score. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 28

35 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services for Non-Medicaid Pregnant Women by Healthy Start Prenatal Score, 2000 Findings For both administrative (sum of I) and care coordination (sum of II) services, the percentage of women receiving any service was greater for women with low Healthy Start scores compared to high Healthy Start scores. However, high scoring women received more administrative and care coordination units of service than low scoring women. Those with low Healthy Start Screening Scores had a slightly higher percentage of women receiving Enhanced Services when compared to women who had high or no Healthy Start Screening Score. However, the average units of service for women with low and high Healthy Start Screening Scores were similar. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 29

36 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services for Medicaid Pregnant Women by Healthy Start Prenatal Score, 2000 I. Administrative HS = High Medicaid Number With Service % With Service Average Units of Service* HS = HS = HS = HS = HS = HS = HS = Low None High Low None High Low 1) Needs Tracking Only 3,116 1, ) Participant Needs Assessment 6,834 3,359 1, ) Attempt to Contact 15,118 10,632 2, ) Declines Service 3,190 2, ) Ineligible for Care Coordination HS = None 1, ) Unable to Locate 3,445 1, ) No Further Services Needed 4,883 3,643 1, ) Other Care Coordination 4,604 3,966 1, a. CMS-EIP b. Not CMS-EIP c. Coordination Adm. 4,080 3,753 1, Number of women who had at least one Administrative Service (1-8) 16,631 12,389 3, II. Care Coordination 9) Initial Service Units 9,579 5,441 1, a. Contact 8,076 4,773 1, b. Assessment 4,832 2, ) Care Coordination 8,880 4,738 1, ) FSP 2, Number of women who had at least one Care Coordination Service (9-11) 12,486 7,306 2, III. Enhanced Services 12) Nutritional Assessment/Counseling ) Psychosocial Counseling 1, ) Parent Education/Support 3,357 1, ) Childbirth Education 1,981 1, ) Breast Feeding Ed/Supp 2,502 1, ) Smoking Cessation/Counseling 18) Planned Educational Sessions 1, Number of women who at least one Enhanced Service (12-18) 5,595 3,235 1, Number of women who had at least one Care Coordination Service or Enhanced Service (9 18) 12,694 7,951 2, a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 30

37 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health * Average unit of service for I is a contact. Average unit of service for II and III is measured in 15-minute units. Prenatal Healthy Start Score High means the score was greater than or equal to 4. Prenatal Healthy Start Score Low means the score was less than 4. Prenatal Healthy Start Score None means the mother did not receive a score. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 31

38 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services for Medicaid Pregnant Women by Healthy Start Prenatal Score, 2000 Findings Care Coordination services for Medicaid pregnant women (with at least one service) ranged between 28% for those with high Healthy Start Prenatal Screening Scores and 16% for those with low scores, and 5% for those with no Healthy Start Prenatal Screening Score. The average amount of time in care coordination ranged between 9 to average units of service. Between 3% to 12% of pregnant Medicaid women received at least one enhanced service for an average 13 to 14 average units of service. Parenting Education had the highest percentage of intervention services provided, ranging between 2% and 7% with an average of between 7 to 9 average units of service. In general, pregnant women with high Healthy Start Prenatal Screen Scores had a greater percentage and amount of services compared to those with low Healthy Start Prenatal Screen Scores. The average amount of time for care coordination and intervention services ranged between 14 average units of service (for those with a low screen score) and 17 average units of service (for those with a high Prenatal Screen Score). a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 32

39 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services for Medicaid Pregnant Women By SOBRA and Non SOBRA, 2000 SOBRA Non-SOBRA I. Administrative Number Percent Average* Number Percent Average* 1) Needs Tracking Only 3, , ) Participant Needs Assessment 6, , ) Attempt to Contact 15, , ) Declines Service 3, , ) Ineligible for Care Coordination 1, , ) Unable to Locate 3, , ) No Further Services Needed 5, , ) Other Care Coordination 5, , a. CMS-EIP b. Not CMS-EIP c. Coordination Adm. 4, , Number of women who had at least one Administrative Service (1-8) 18, , II. Care Coordination 9) Initial Service Units 9, , a. Contact 8, , b. Assessment 4, , ) Care Coordination 8, , ) FSP 1, , Number of women who had at least one Care Coordination Service (9-11) 12, , III. Enhanced Services 12) Nutritional Assessment/Counseling ) Psychosocial Counseling ) Parent Education/Support 3, , ) Childbirth Education 2, , ) Breast Feeding Ed/Supp 2, , ) Smoking Cessation/Counseling 18) Planned Educational Sessions 1, , Number of women who at least one Enhanced Service (12-18) 5, , Number of women who had at least one Care Coordination Service or Enhanced Service (9 18) 13, , * Average unit of service for I is a contact. Average unit of service for II and III is measured in 15-minute units. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 33

40 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services for Medicaid Pregnant Women By SOBRA and Non-SOBRA, 2000 Findings A greater percentage of Medicaid SOBRA pregnant women received Administrative, Care Coordination, or Enhanced Services when compared to Medicaid Non-SOBRA pregnant women. The average amount of time of services provided to these sub-groups of the Medicaid population was essentially the same. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 34

41 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services by Mother s Payer: Fee for Service (FFS), Health Maintenance Organization (HMO), MediPass, or None, 2000 I. Administrative FFS HMO MediPass None Number Percent Average* Number Percent Average* Number Percent Average* Number Percent Average* 1) Needs Tracking Only 3, , , ) Participant Needs Assessment 7, , , , ) Attempt to Contact 18, , , , ) Declines Service 4, , , , ) Ineligible for Care Coordination 1, ) Unable to Locate 3, , , ) No Further Services Needed 6, , , , ) Other Care Coordination 6, , , , a. CMS-EIP b. Not CMS-EIP c. Coordination Adm. 5, , , , Number of women who had at least one Administrative Service (1-8) II. Care Coordination 21, , , , ) Initial Service Units 10, , , , a. Contact 9, , , , b. Assessment 5, , , , ) Care Coordination 9, , , , ) FSP 2, Number of women who had at least one Care Coordination Service (9-11) III. Enhanced Services 12) Nutritional Assessment/Counseling 13) Psychosocial 14, , , , Counseling ) Parent Education/Support 3, , , ) Childbirth Education 2, ) Breast Feeding Ed/Supp 2, ) Smoking Cessation/Counseling 18) Planned Educational Sessions 1, Number of women who at least one Enhanced Service (12-18) Number of women who had at least one Care Coordination Service or Enhanced Service (9 18) 6, , , , , , , , * Average unit of service for I is a contact. Average unit of service for II and III is measured in 15-minute units. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 35

42 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services by Mother s Payer, 2000: Fee for Service (FFS), Health Maintenance Organization (HMO), MediPass, or None, 2000 Findings Over 90% of Medicaid pregnant women, regardless of whether they received prenatal care in the FFS, HMO, or Medipass system, had at least one administrative service. This was not appreciably different from the non-medicaid comparison group. Attempt to Contact was the dominant administrative service in all categories of mother s payer. Medicaid women with a FFS payer had the greatest percentage (41%) receiving Attempt to Contact services. Over 60% of the Medicaid pregnant women received at least one care coordination service. There were no appreciable differences in the amount of time of services received in the various payer groups. About 30% of Medicaid pregnant women received at least one Enhanced Service. The amount of time in these Enhanced services ranged from 2 to 22 average units of service. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 36

43 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health THIS PAGE INTENTIONALLY LEFT BLANK a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 37

44 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health FINDINGS FOR 2001 a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 38

45 Medicaid Division, Agency for Health Care Administration, and Florida Department of Health Healthy Start Prenatal Services: De mographics of Women Who Delivered in 2001 Birth Mother s Year Ethnicity Percent 2001Black 36% 2001White 39% 2001Asian 1% 2001Hisp 23% 2001Indian 0% 2001Other 0% 2001Total Birth Education Year Level Percent 2001<High School 39% 2001=High School 38% 2001>High School 23% 2001Total Birth Prenatal Year Screen Score Percent or Greater 42% 2001HS<4 46% 2001none 12% 2001Total Birth Low Birth Year Weight Percent 2001Normal BW 90% 2001Low BW 10% 2001Total Note: Total Number of Mothers = 39,862. Indicators may be less due to missing data or they may exceed total due to multiple screens. a branch of the Chiles Center for Healthy Mothers and Babies, University of South Florida. 39