Case management services are available for MO HealthNet eligible pregnant women who are “at risk” of poor pregnancy outcomes and are intended to reduce infant mortality and low birth weight by encouraging adequate prenatal care and adherence to the recommendations of the prenatal caregiver.
A risk appraisal is a set of criteria to be used in identifying pregnant women who are at risk of poor pregnancy outcomes, and children who have or are at risk of developing physical, psychosocial and/or developmental problems. All appropriate MO HealthNet participating providers are urged to perform risk appraisals on pregnant women during the initial visit and as changes in the patient's medical condition indicate. Completion of the Risk Appraisal for Pregnant Women is mandatory in order to establish the “at risk” status of the patient and to bill the global prenatal or global delivery procedure code. No additional payment is made for performing the risk appraisal as it is included in the global reimbursement for prenatal care or delivery.
The Risk Appraisal for Pregnant Women form must be sent directly to the enrolled MO HealthNet Case Management Provider of the patient's choice and a copy filed in the patient's medical record. Any eligible pregnant woman who meets any one of the identified risk factors, as determined by the administration of the Risk Appraisal for Pregnant Women, is eligible for prenatal case management services and a referral should be made to a MO HealthNet participating prenatal case management provider.
Providers who are interested in becoming case managers should contact the Provider Enrollment Unit for more information at MMAC.ProviderEnrollment@dss.mo.gov.