UPDATE – Prenatal and Postpartum Care (PPC), Prenatal Immunization Status (PRS)-E, Prenatal Depression Screening and Follow-up (PND)-E, Postpartum Depression Screening and Follow-up (PDS)-E
| Date: | October 26, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Contracted Primary Care Providers (PCPs), OB/GYN, and Prenatal Care Providers |
| Type: | Educational/informal |
| Subject: | UPDATE – Prenatal and Postpartum Care (PPC), Prenatal Immunization Status (PRS)-E, Prenatal Depression Screening and Follow-up (PND)-E, Postpartum Depression Screening and Follow-up (PDS)-E |
| Business: | Medi-Cal Managed Care |
Healthcare Effectiveness Data Information Set (HEDIS)
Measurement Year 2023
Prenatal and Postpartum Health Care Measures
The following is an update to Prenatal and Postpartum Health Care Measures.
Timeliness of Prenatal Care and Postpartum Care (PPC)
- Pregnant patients must receive at least 1 prenatal care visit with an OB/GYN, PCP or other qualified prenatal care provider within their first trimester and 1 postpartum care visit no sooner than 7 days and not later than 84 days post delivery. All pregnant patients newly enrolled with HPSJ must be seen within 42 days of enrollment regardless of trimester status.
Prenatal Immunization Status (PRS)
- Pregnant patients should receive at least 1 influenza vaccine and 1 tetanus diphtheria toxoids and acellular pertussis (Tdap) vaccines 28 days prior to their estimated delivery date through the delivery date.
Prenatal Depression Screening (PND) and Follow-up & Postpartum Depression Screening (PDS) and Follow-up
- Pregnant Patients must receive at least 1 depression screening between 28 days prior to their EDD through their delivery date AND at least 1 depression screening post-delivery between the day they deliver up to 60 days post-delivery. All patients with a positive screening result must receive follow-up care within 30 days of the positive finding.
Recommended Best Practices:
- Educate patients on the importance of prenatal and postpartum care for their health and the health of their baby.
- Ensure patients are aware of available resources to overcome barriers to care including any incentives they may be eligible for.
- Offer Immunization during prenatal visits or when admitted for delivery.
- Coordinate care with behavioral health practitioners for patients at risk or screened positive for behavioral health or substance use conditions.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/