N.J. Admin. Code § 10:54-6.2

Current through Register Vol. 56, No. 16, August 19, 2024

Section 10:54-6.2 - Scope of services

(a) HealthStart maternity care services shall include all medical services recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse Midwives (ACNM), as well as a program of health support services. HealthStart pediatric care services shall include the nine preventive visits recommended by the American Academy of Pediatrics and all of the necessary immunizations. This subchapter includes provisions for provider participation, standards for service delivery, procedure codes from the CMS Healthcare Common Procedure Coding System (HCPCS) and directions for submitting claims.

(b) HealthStart Comprehensive Maternity Care includes two components; Maternity Medical Care Services and Health Support Services as follows:

1. Maternity Medical Care Services include, but are not limited to:

i. Ambulatory prenatal services;

ii. Admission arrangements for delivery;

iii. Obstetrical delivery services; and

iv. Postpartum medical services.

2. Health Support Services include, but are not limited to:

i. Case coordination services, including the follow-through on Medicaid eligibility determination on the mother and infant, and informing a Medicaid eligible pregnant woman about the availability of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services for the newborn;

ii. Health education assessment and counseling services;

iii. Home visitation;

iv. Nutrition education assessment and counseling services;

v. Outreach, referral and follow-up services;

vi. Social-psychological assessment and counseling services.

(c) HealthStart Comprehensive Pediatric Care includes nine preventive child health visits, all the recommended immunizations, case coordination and continuity of care including, but not limited to, the provision or arrangement for sick care, 24-hour telephone access, and referral and follow-up for complex or extensive medical, social, psychological, and nutritional needs.

N.J. Admin. Code § 10:54-6.2

Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In (a), substituted "CMS Healthcare" for "HCFA", and deleted a comma following "(HCPCS)".