Summary of Changes to Women's and Children's Health Section Agreement Addenda, FY 18-19
351 – Child Health
FY 17-18 / FY 18-19Negotiable, must be reviewed and approved by the Program Contact / Not negotiable, deliverables will be negotiated prior to distribution of the 351AA in February.
Local Health Department is required to provide or assure child preventive health care services, either by provision of clinical services, contracted services with another agency, or assurance of services by another agency through a MOU or Community Care Plan. / No Change
If the Local Health Department is providing child primary and/or preventive healthcare services, a worksheet must be completed to list services to be delivered. / No Change
If the Local Health Department is providing other services, a local council/board was required to review the data and establish child health priorities. / This requirement to engage a council or board to decide what non-direct activities to include in the 351AA is deleted. If the health department is including non-direct care activities to improve child well-being, community data is still required to justify the activity. Use of the Community Health Assessment is recommended in establishing priorities to address.
If the Local Health Department is providing other services, they must be evidence-based or evidence-informed. / No Change
If the Local Health Department is providing other services, a plan for each service will be completed, including a scope of work and anticipated outcomes worksheet, and a budget worksheet. / No Change
Ensure participation by at least one Child Health Program manager of staff member in C&Y-supported meetings. / No Change
Written policies on cultural competent services and linguistically appropriate materials. / No Change
Maintain a written agreement with Local Education Agency(ies). / No Change
Complete mid-year and end-of-year reports to document progress on meeting deliverables. / No Change
Worksheets and training webinars online. / No Change
715 – Immunization Action Plan
Section I - Background / No ChangeSection II - Purpose / No Change
Section III – Scope of Work and Deliverables /
- Immunization Service Delivery
2. Vaccine Preventable Disease Surveillance: No Change
3. Education and Outreach
b. Changed as follows: CollaboratePartner with local provider organizations such as Women’s Infants and Children (WIC), women’s health care physicians, pediatricians and social service agencies community stakeholdersto provide educational materials on preventing perinatal hepatitis B transmission for distribution to appropriate clients to provide communityand outreach and education activities by incorporating immunization education in prenatal, parenting and other health education curriculum;
c. Added: “*Please contact the NCIP for technical guidance prior to scheduling any off-site vaccine clinics.”
4. North Carolina Immunization Registry: No Change
Section IV – Performance Measures/Reporting Requirements / No change
Section V - Performance Monitoring and Quality Assurance / No Change
Section VI – Funding Guidelines or Restrictions / 3.Removes the requirement to report planned and actual expenditures of passthrough funds
Attachment A – Estimate of total allocation / No Change
Attachment B – Reporting form for planned/actual expenditures / Deleted
Attachment C – Allowable and Non-Allowable Uses of Federal IP Funds / Changed to Attachment B and updated to reflect funding sources for SFY 18/19
Activity 403 – WIC
FY 17-18 / FY 18-19Deliverable#1Provide Access to Program Services for Women / No Change
Deliverable #2 Promote Healthy Weights / No Change
Deliverable #3 Breastfeeding Promotion and Support / No Change
Deliverable #4 Compliance / No Change
Deliverable #5 Required Meetings / No Change
Deliverable #6 Nutrition Education Plan / No Change
Deliverable #7 Evaluation of Prior Year’s Nutrition Education Plan / No Change
Deliverable #8 WIC Program Staffing / Added E. All standing orders or protocols developed for nurses in support of this program must have policies in place that allow for the use of standing orders and procedures that describe the process for development and approval of standing orders within the agency. Additionally, standing orders must be written in the NC Board of Nursing format.
Deliverable #9 Vendor Management / Item A. n. (Revision) - Inclusion of reference for Electronic Benefit Transfer cards and removal of vendor stamp references.
Deliverable #10 National Voter Registration Act (NVRA) / No Change
Deliverable #11 Support of NC eWIC System / Revision - Title and bullet points revised to reflect ‘support’ of eWIC System. Current AA addresses EBT Pilot and Rollout which will be completed by SFY2019.
VI Funding Guidelines or Restrictions / Item #2 – Additional language added to specify the current per month per participant rate. Identification of the rate in the original AA will make any potential future revisions much easier to draft.
Item #6 (New) – Additional language added to encourage the development of processes by local agencies to monitor spending more closely in an effort to avoid lapsed funding.
Activity 415 – Breastfeeding Peer Counselor Program
FY 17-18 / FY 18-19Deliverable#1 Implementation / No Change
Deliverable #2 Staffing / No Change
Deliverable #3 Training / Item C and Item D (New) – Additional language added to include necessary requirements for completion of training for Breastfeeding Peer Counselors and BFPC Managers.
Deliverable #4 Breastfeeding Initiation and Duration / No Change
VI Funding Guidelines or Restrictions / Item #3 (New) – Additional language added to encourage the development of processes by local agencies to monitor spending more closely in an effort to avoid lapsed funding.
Maternal Health (Activity 101)
AA Section – FY17-18 / Current Wording (FY17-18) / Changes Planned (FY18-19) / Change RationaleB4 / Promote excellence in customer friendly services that meet the needs of patients that seek care. / Demonstrate excellence in customer friendly services as evidenced by annual patient satisfaction surveys. / Enhanced this guidance to reflect how LHD will demonstrate excellence in customer friendly services via patient satisfaction surveys. This provides LHDs an opportunity to enhance services based on customer feedback.
B5 / Increase staff awareness of disparities in health status and service delivery, especially disparities related to race/ethnicity, disability, education, and socioeconomic status. (ACOG Committee Opinion, No. 493, May 2011; Guidelines for Perinatal Care, 7th ed., pp.3-4; Healthy People 2020) / All staff, clinical and non-clinical, shall participate in at least one training annually focused on health equity, health disparities, or social determinants of health to support individual competencies and organizational capacity to promote health equity. / Added this guidance to reflect DHHS’ commitment to addressing social determinants of health and health inequities to provide optimal care to local health department patients.
B7 / No previous wording in AA / Provide experienced maternal health nursing professionals who demonstrates competency in fetal heart rate monitoring every two years as evidenced by attending a fetal heart rate monitoring training offered by an approved provider. These healthcare professionals include: RN, Certified Nurse-Midwife (CNM), Certified Midwife(CM), Nurse Practitioners (NP), Clinical Nurse Specialist (CNS). (Journal of Obstetrics, Gynecologic, and Neonatal Nursing -JOGNN, 44, 683-686; 2015) Physicians and PAs are licensed and credentialed in this competency through the American Medical Association and ACOG. / Guidance is supported by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Position Statement who governs the practice of maternal health nurses. Specialty standard is successful completion of bi-annual Fetal Monitoring Competency published by AWHONN, with alternating years being met with a competency review of performance. This guidance applies to those licensed nursing professionals (RNs, NPs, CMs, CNMs & CNSs) that are required to perform and interpret Non-Stress Test (NST) in their work responsibilities or ordered by a provider. Physicians and PAs are licensed and credentialed in this competency through the American Medical Association and ACOG.
C4 / Completion of presumptive eligibility determination and referral for Medicaid eligibility determination for all pregnant patients, not just those who will remain in the Local Health Department for prenatal care services. / Completion of presumptive eligibility determination at the first prenatal appointment and referral for Medicaid eligibility determination for all pregnant patients, not just those who will remain in the Local Health Department for prenatal care services. / To provide clarification and clearer guidance to maternal health staff as to when presumptive eligibility application should be completed.
C5 / Completion of the CCNC Pregnancy Medical Home Risk Screening Form and referral to Pregnancy Care Management program as indicated. Risk Screening Forms should be completed on Medicaid, Medicaid eligible or Presumptively-eligible Medicaid patients only. / Completion of the CCNC Pregnancy Medical Home Risk Screening Form and referral to Pregnancy Care Management program as indicated. Risk Screening Forms should be completed on Medicaid, Medicaid eligible or Presumptively-eligible Medicaid patients only. / To provide clarification as to who is eligible to have a CCNC Risk Screening form completed.
C11 / Complete a validated screening questionnaire such as 5 P’s Modified to identify, refer (if appropriate) and prescribe subsequent follow-up of patients who have a current use or a history of substance use. This includes: alcohol, nicotine, marijuana, cocaine, opioids, herbal remedies, prescriptions or over-the-counter (OTC) medications. / Use of the 5 P’s questionnaire, to identify, refer (if appropriate) or prescribe subsequent follow-up of patients who have a current use or a history of substance use. Substances include: alcohol, nicotine, marijuana, cocaine, opioids, herbal remedies, prescriptions or over-the-counter (OTC) medications. / ACOG recommends that screening for substance use should be done using a validated tool; therefore, to be consistent with all Pregnancy Medical Homes, we are using the 5P’s tool.
C12 / Complete a validated screening questionnaire such as 5 P’s Modified, to identify, refer (if appropriate) and prescribe subsequent follow-up of patients who have a current use or a history of substance use. This includes alcohol, nicotine, marijuana, cocaine, opioids, herbal remedies, prescriptions or over-the-counter (OTC) medications. Process must include assurance of confidentiality and a signed understanding to release medical records to outside authorities if deemed necessary by law. An informed written consent shall be obtained at the initiation of care, and verbal consent(s) given subsequently before performing a drug screen test until the conclusion of care. (Guidelines for Perinatal Care, 7th ed., pp.127-130; / Urine drug screen is not recommended universally. Guidance states that routine screening for substance use disorders should be applied equally to all people, regardless of age, sex, race, ethnicity, and socioeconomic status. Routine screening for substance use disorder can be accomplished by way of validated questionnaires or conversations with patients. Routine laboratory testing of biologic samples is not best practice. If risk indicators are identified, the process must include assurance of confidentiality and informed written consent shall be obtained. (ACOG committee Opinion, No. 633, June 2015) / Added guidance to clarify the current recommendations of ACOG not to perform universal urine drug screening during prenatal care.
C13 / Referral for a positive HIV and/or Hepatitis B result for patient or neonate. (10A NCAC 41A.0203 (d)(1); Guidelines for Perinatal Care, 7th ed., pp. 386-391, 398-403). / Referral of a positive HIV and/or Hepatitis B result for patient or neonate and appropriate follow-up for neonate after birth. (10A NCAC 41A.0203 (d)(1); Guidelines for Perinatal Care, 7th ed., pp. 386-391, 398-403). / Clarify that LHD not testing the baby but follow-up occurs for the baby
C18 / Use of 17 α-Hydroxyprogesterone Caproate (17P) for patients at risk for developing preterm labor, those with a history of a prior birth at less than 37 weeks gestation. / Use of α-Hydroxyprogesterone Caproate (17P) for patients at risk for developing preterm labor as defined by those with a history of a prior spontaneous birth at less than 37 weeks gestation. (Guidelines for Perinatal Care, 7th ed. p. 256-257) / To clarify that induced labors prior to 37 weeks gestation does not qualify for 17P in subsequent pregnancies.
C21 / No previous wording in AA / All standing orders or protocols developed for nurses in support of this program must have policies in place that allow for the use of standing orders and procedures that describe the process for development and approval of standing orders within the agency. Additionally, standing orders must be written in the NC Board of Nursing / Added this section per request of Public Health Nursing Office (Phyllis Rocco). It was shared that this needs to be added to all DPH programs for FY 18-19 AAs.
D4 / No previous wording in AA / Complete the CCNC Pregnancy Medical Home Risk Screening Form if one has not been completed, Complete the 5 P’s questionnaire, to identify, refer (if appropriate) or prescribe subsequent follow-up of patients who have a current use or a history of substance use. Substances include: alcohol, nicotine, marijuana, cocaine, opioids, herbal remedies, prescriptions or OTC medications. / According to ACOG, all patients should be screened for substance use during pregnancy and after birth. This guidance was added to ensure that all patients are screened using the 5 P’s validated screening tool. Currently, the 5P’s questions are on the CCNC Pregnancy Risk Screening form. If a patient has not completed a Risk Screening form, a separate 5P’s screening tool must be completed.
D6 / No previous wording in AA / Complete the Edinburgh or PHQ9 screening tool to facilitate referral (if appropriate) and subsequent follow-up of patients who have a current diagnosis, symptomatic or have history of depression. (ACOG Committee Opinion, No. 630, May 2015; Guidelines for Perinatal Care, 7th ed., pp. 130-131) / ACOG recommends that screening for depression should be completed prenatally as well as postnatally. Guidance was added to this section to ensure maternal health clinic is completing a screening and using one of the validated screening tools listed. This is a current requirement of Pregnancy Medical Homes.
D9 (c) / Depression screening and referral for services as indicated. A validated tool, such as Edinburgh or PHQ9, for depression screening during pregnancy should be used each trimester and at the postpartum visit. (Guidelines for Perinatal Care, 7th ed., pp. 130-131) / Complete the Edinburgh or PHQ9 screening tool to facilitate referral (if appropriate) and subsequent follow-up of patients who have a current diagnosis, symptomatic or have history of depression. (ACOG Committee Opinion, No. 630, May 2015; Guidelines for Perinatal Care, 7th ed., pp. 130-131) / ACOG recommends that screening for depression should be completed prenatally as well as postnatally. Guidance was re-worded in this section to be consistent with other sections of the AA. This is a current requirement of Pregnancy Medical Homes.
D9 (e) / Screening for alcohol, tobacco or electronic nicotine devices and other drug use such as the 5 P’s Modified. (Guidelines for Perinatal Care, 7th ed., pp. 207-208) / Complete the 5 P’s questionnaire, to identify, refer (if appropriate) or prescribe subsequent follow-up of patients who have a current use or a history of substance use. Substances include: alcohol, nicotine, marijuana, cocaine, opioids, herbal remedies, prescriptions or OTC medications. / According to ACOG, all patients should be screened for substance use during pregnancy and after birth. This guidance was added to ensure that all patients are screened using the 5 P’s validated screening tool. Currently, the 5P’s questions are on the CCNC Pregnancy Risk Screening form. If a patient has not completed a Risk Screening form, a separate 5P’s screening must be completed.
F3 / Tetanus, Diphtheria, and Pertussis (Tdap) vaccine should be administered with each pregnancy
and preferably during the 3rd trimester or late 2nd trimester (i.e., after 20 weeks’ gestation).
(CDC MMWR, February 22, 2013, v. 62, #RR-7; ACOG Committee Opinion No. 566, June 2013; Guidelines for Perinatal Care, 7th ed., pp. 422-423) / Tetanus, diphtheria, and pertussis (Tdap) vaccine should be administered with each pregnancy, preferably between 27 and 36 weeks gestation. Document the date the vaccine was given or declined. (ACOG Committee Opinion No. 566, June 2013; Guidelines for Perinatal Care, 7th ed., pp. 422-423) / Language matches as referenced by ACOG
G4 / Offer nutrition consultation to all underweight and obese patients; (pre-pregnancy BMI of < 18.5 or > 30). This may be accomplished by a referral to WIC. (Guidelines for Perinatal Care, 7th ed., pp. 102, 216-217). / Offer nutrition consultation to all underweight and obese patients (pre-pregnancy BMI of < 18.5 or > 30) and/or patients gaining outside of their prescribed weight gain range. This may be accomplished by a referral to WIC. (Guidelines for Perinatal Care, 7th ed., pp. 102, 216-217). / Required nutrition counseling for patients gaining outside of their prescribed gestational weight gain range
H1 / Screen, counsel and/or refer as indicated for pregnant and postpartum patients who are experiencing depression. A validated tool for depression screening during pregnancy should be used each trimester and at the postpartum visit. (ACOG Committee Opinion, Number 343, August 2006; Guidelines for Perinatal Care, 7th ed., pp. 126-130) / Utilize a psychosocial risk screening tool to identify psychosocial risks. Psychosocial risk screen, can be performed by a social worker, nurse, physician, or advanced practice practitioner and is to be completed at the initial visit. This should include screening, counseling and/or referring as indicated for pregnant and postpartum patients who are experiencing depression. A validated tool, such as Edinburgh or PHQ9, for depression screening during pregnancy should be used each trimester, as indicated, and at the postpartum visit. (ACOG Committee Opinion, Number 343, August 2006; Guidelines for Perinatal Care, 7th ed., pp. 126-130) / Clarified to be consistent with Pregnancy Medical Home and specify validated screening tools.
H2 / Complete validated screening questionnaire such as 5 P’s Modified, to identify, refer (if appropriate) and prescribe subsequent follow-up of patients who have a current use or a history of substance use. This includes alcohol, nicotine, marijuana, cocaine, opioids, herbal remedies, prescriptions or OTC medications. Process must include assurance of confidentiality and a signed understanding to release medical records to outside authorities if deemed necessary by law. An informed written consent shall be obtained at the initiation of care, and verbal consent(s) given subsequently before performing a drug screen test until the conclusion of care. (Guidelines for Perinatal Care, 7th ed., pp.127-130; / Complete the 5 P’s questionnaire, to identify, refer (if appropriate) or prescribe subsequent follow-up of patients who have a current use or a history of substance use. Substances include: alcohol, nicotine, marijuana, cocaine, opioids, herbal remedies, prescriptions or OTC medications. / According to ACOG, all patients should be screened for substance use during pregnancy and after birth. This guidance was added to ensure that all patients are screened using the 5 P’s validated screening tool. Clarified the previous guidance.
J5(d) / All social workers hired as Pregnancy Care Managers after September 1, 2011 must have a bachelor’s degree in social work (BSW, BA in SW, or BS in SW) or master’s degree in social work (MSW, MA in SW or MS in SW) from a Council on Social Work Education accredited social work degree program per the Pregnancy Care Management Services Agreement. Nurses that are hired to fill the positions must be a Registered Nurse (RN). [Note: non-degreed social workers cannot provide OBCM care management, even if they qualify as a Social Worker under the Office of State Personnel guidelines.] / Increased clarification for staffing qualifications to align with guidelines of OBCM program.
CPT Code/Modifier
J1725 / Hydroxyprogesterone Caproate, 1mg injection (Makena) / Q9986 / New code
J3490 / 17P/one unit-includes invoice & rebateable NDC number NOT LISTED / Q9985 / New code
96372 / Administration code for 17P cannot bill with 99211 / Administration code for 17P or RhoGam – cannot bill with 99211 / Pertinent to RhoGam as well
Family Planning (Activity 151)