Notice of Pregnancy and Risk Screening Update
As posted in MHD Provider Bulletin 47-25 on September 26, 2024, providers who provide obstetric care/services, primary care, and emergency care to MO HealthNet participants should begin using the state’s new Notification of Pregnancy (NOP) and Risk Screening Portal for reporting pregnancies no later than January 1, 2025. On this date, the Managed Care Health Plans’ individual portals will sunset and the NOP and Risk Screening Portal will be the unified method for submitting pregnancies for MO HealthNet participants. The portal replaces the Risk Appraisal for Pregnant Women form.
As a reminder, the Family Support Division (FSD) is responsible for eligibility determinations and updates. Therefore, participants should continue to also report pregnancies to FSD utilizing Report a Change.
In addition, MHD will continue to use codes G9919-TH and G9920-TH to bill for the completion and entry of the NOP and Risk Screening in the NOP and Risk Screening Portal. MHD posted that these codes would be changed, however the Centers for Medicare & Medicaid Services (CMS) reversed the decision to retire them. Reimbursement is limited to up to two prenatal and one postpartum screenings per patient, per calendar year with a reimbursement rate of $50.00 each. Providers should bill MHD or the Managed Care Health Plan based on the participant’s eligibility on the Date of Service (DOS).
The NOP and Risk Screening collects information on the patient’s clinical and social risk factors and needs. MHD encourages providers to identify someone on their team to communicate to the patient that they will be contacted by their Managed Care Health Plan, or by MO HealthNet directly, to offer case management which includes various services and supports.
Providers should have received the Healthy Moms Healthy Babies rack card used to quickly communicate helpful resources and to assist providers with making a warm handoff to the participant’s health plan. If you have not received these useful cards, please use the care management contacts found in the NOP and Risk Assessment resource to request them.
Exciting Results: MHD’s data show that the redesigned NOP process is already making a significant impact. The Managed Care Health Plans’ ability to contact the participant increased from 29.3% to 59.8%. Moreover, the rate at which participants engaged in care management services increased to 32.9% compared to 17.0% on average. Many of these members are identified as high or very high risk. Care management services can make a difference for higher risk participants, and improving uptake is a priority for the state.
A live educational webinar has been scheduled for Tuesday, January 7, 2025, from 10:00 a.m. to 11:00 a.m.; please register to learn more and get questions answered.
For questions, contact MHD.NOP@dss.mo.gov.