Cal. Code Regs. Tit. 22, § 51348 - Comprehensive Perinatal Services
(a) Comprehensive perinatal services, as
defined in Section
51179, are covered to the extent
specified in this section. Prior authorization is required for nutrition,
psychosocial and health education services which exceed the Maximum Frequency
amounts as set forth in Section
51504.
(b) Except where a capitated health system
contract entered into by the Department provides otherwise, obstetrical
services in addition to all necessary medical care shall include, but are not
limited to:
(1) A written assessment of each
patient's obstetrical status.
(2)
Preparation of the individualized care plan obstetrical
component.
(c) Except
where a capitated health system contract entered into by the Department
provides otherwise, nutrition services shall include but are not limited to:
(1) Written assessments of each patient's
nutritional status.
(A) A complete initial
nutrition assessment shall be performed at the initial visit or within four
weeks thereafter and shall include: anthropometric data, biochemical data,
clinical data, and dietary data.
(B) A nutrition reassessment using updated
information shall be offered to each client at least once every trimester and
the individualized care plan revised accordingly.
(2) Preparation of the individualized care
plan nutritional component that addresses:
(A)
The prevention and/or resolution of nutrition problems.
(B) The support and maintenance of strengths
and habits oriented toward optimal nutritional status, and;
(C) The goals to be achieved via nutrition
interventions.
(3)
Dispensing, as medically necessary, prenatal vitamin/mineral supplement to each
client.
(4) Treatment and
intervention directed toward helping the patient understand the importance of,
and maintain good nutrition during pregnancy and lactation, with referrals as
appropriate.
(5) Postpartum
reassessment, development of a care plan, and
interventions.
(d) Except
where a capitated health system contract entered into by the Department
provides otherwise, health education services shall include, but are not
limited to:
(1) Client orientation including,
but not limited to provision of detailed information regarding the services to
be provided, what to do in case of an emergency, and;
(2) Written assessments of each patient's
health education status.
(A) A complete
initial education assessment shall be performed at the initial visit or within
four weeks thereafter and shall include an evaluation of: current health
practices; past experience with health care delivery systems; prior experience
with and knowledge about pregnancy, prenatal care, delivery, postpartum
self-care, infant care, and safety; client's expressed learning needs; formal
education and reading level; learning methods most effective for the client;
educational needs related to diagnostic impressions, problems, and/or risk
factors identified by staff; languages spoken and written; mental, emotional,
or physical disabilities that affect learning; mobility/residency;
religious/cultural influences that impact upon perinatal health; and client and
family or support person's motivation to participate in the educational
plan.
(B) An education reassessment
using updated information shall be offered to each client every trimester and
the individualized care plan revised accordingly.
(3) Preparation of the individualized care
plan health education component that addresses:
(A) Health education strengths.
(B) The prevention and/or resolution of
health education problems and/or needs and medical conditions and health
promotion/risk reduction behaviors which can be ameliorated and/or resolved
through education.
(C) The goals to
be achieved via health education interventions.
(D) Health education interventions based on
the patient's identified needs, interests, and capabilities, and particularly
directed toward assisting the patient to make appropriate, well-informed
decisions about her pregnancy, delivery, and parenting, with referrals, as
appropriate.
(4)
Postpartum assessment, development of care plan, and
interventions.
(e) Except
where a capitated health system contract entered into by the Department
provides otherwise, psychosocial services shall include, but are not limited
to:
(1) Written assessments of each patient's
psychosocial status.
(A) A complete initial
assessment of psychosocial functioning shall be performed at the initial visit
or within four weeks thereafter and shall include review of: current status
including social support system; personal adjustment to pregnancy; history of
previous pregnancies; patient's goals for herself in this pregnancy; general
emotional status and history; wanted or unwanted pregnancy, acceptance of the
pregnancy; substance use and abuse; housing/household; education/employment;
and financial/material resources.
(B) A psychosocial reassessment using updated
information shall be offered to each client every trimester, and the
individualized care plan revised accordingly.
(2) Preparation of the individualized care
plan psychosocial component that addresses:
(A) The prevention and/or resolution of
psychosocial problems.
(B) The
support and maintenance of strengths in psychosocial functioning,
and;
(C) The goals to be achieved
via psychosocial interventions.
(3) Treatment and intervention directed
toward helping the patient understand and deal effectively with the biological,
emotional, and social stresses of pregnancy with referrals, as
appropriate.
(4) Postpartum
reassessment, development of a care plan, and
interventions.
(f) Review
and revisions of the care plan shall occur during the antenatal, intrapartum,
and postpartum periods on a regular basis and will be based on repeated and
ongoing assessments and evaluation of the client's status.
(g) Nutrition, psychosocial, and health
education services as defined in Sections
51179.2,
51179.3, and
51179.4 shall be provided by a
comprehensive perinatal practitioner as defined under Section
51179.7.
(h) Each Comprehensive Perinatal Provider
shall perform the duties of, or shall have on staff or employ or contract with
one or more comprehensive perinatal practitioners as defined in Section
51179.7, to provide
interdisciplinary services.
(i)
Each Comprehensive Perinatal Provider shall inform the beneficiary what
services will be provided, who will provide these services, where to obtain the
services, when the services will be delivered, and procedures to follow in case
of emergency.
(j) The Comprehensive
Perinatal Provider shall refer patients, as appropriate, to services not
specifically made part of comprehensive perinatal services, as defined in
Section 51179. These services shall
include, but are not limited to, those provided by the following programs:
Women, Infants, and Children Supplemental Foods, Child Health and Disability
Prevention, Family Planning, Genetic Disease, and Dental.
(k) The Comprehensive Perinatal Provider
shall complete and forward to the Department, upon request, a Perinatal Data
Form in a format prescribed by the Department for each patient
served.
Notes
2. New section refiled 6-5-87 as an emergency; operative 6-17-87 (Register 87, No. 25). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-15-87.
3. Certificate of Compliance including amendment filed 9-17-87 (Register 87, No. 38).
4. Editorial correction of subsection (i) (Register 95, No. 45).
Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14053, 14132 and 14134.5, Welfare and Institutions Code.
2. New section refiled 6-5-87 as an emergency; operative 6-17-87 (Register 87, No. 25). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-15-87.
3. Certificate of Compliance including amendment filed 9-17-87 (Register 87, No. 38).
4. Editorial correction of subsection (i) (Register 95, No. 45).
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