Pregnancy Medical Home

Pregnancy Medical Home (PMH) improves the quality of perinatal care given to Medicaid beneficiaries. This is done by modeling the PMH after the enhanced primary care case management (PCCM) program developed by Community Care of North Carolina (CCNC).

NC Medicaid partners with CCNC and other community stakeholders, including providers, local health departments and the Division of Public Health (DPH).

PMH Case Management

• PMH is NOT only for customers of Medicaid for Pregnant Women (MPW)
• If a pregnant Medicaid beneficiary’s aid program category covers pregnancy services, she is eligible to participate in this program
• Pregnant Medicaid customers receive care management (population management)
• High-risk pregnant women in a PMH receive case management services
• Case managers closely monitor the pregnancy through regular contact with the physician and patient to promote a healthy birth outcome.

PMH Participation

To qualify for PMH, the provider must agree to:

• Ensure that no elective deliveries are performed before 39 weeks of gestation by agreement with all professional providers
• Decrease the cesarean section rate among nulliparous women
• Complete a high-risk screening on each pregnant Medicaid beneficiary in the program and integrating the plan of care with local care/case management
• Open chart audits

In exchange for meeting the program expectations described above, the PMH will receive:

• Exemption from prior approval on ultrasounds
• $50 for completing a high-risk screening tool at initial visit
• $150 incentive for the postpartum visit per Medicaid beneficiary
• Increased rate for a vaginal delivery

Providers who bill global, package or individual pregnancy procedures are eligible to participate in PMH if the provider agrees to program requirements. PMH is not only for obstetric providers.

Clinical Coverage Policy 1E-6, Pregnancy Medical Home

PMH Forms

Pregnancy Risk Screening Form - English

Pregnancy Risk Screening Form - Spanish

More Information

Pregnancy Medical Home Seminar Presentation

Pregnancy Medical Home Overview Presentation

Pregnancy Care Management Overview Presentation

Presentation to the Social Services Institute

Contact

Contact Information for CCNC Networks

NC Medicaid Clinical Section
Phone: 888-245-0179
Fax: 919-715-0051