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Reducing Non-Medically Necessary Deliveries Before 39 Weeks

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Welcome to the training on Reducing Non-Medically Necessary Deliveries Before 39 Weeks provided by the Texas Department of State Health Services (DSHS) and the Texas Health and Human Services Commission (HHSC).

Goal

The goal of this module is to educate health-care providers and others who care for pregnant women and those who may become pregnant about the new Texas Medicaid reimbursement criteria for delivery of infants at less than 39 weeks of gestation.

This module is designed to educate providers about collaborating with hospitals in developing processes to determine and document the medical necessity of deliveries at less than 39 weeks and create procedures to reduce those deliveries. It will increase provider comprehension of why the new reimbursement criteria were implemented. Providers will be able to recognize the clinical implications of non-medically necessary delivery by induction or cesarean at less than 39 weeks of gestation and be able to educate parents who desire those deliveries.

Target Audience

Texas Health Steps providers and other interested health-care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

  1. Describe the new Texas Medicaid reimbursement criteria for delivery of infants at less than 39 weeks of gestation and the reasons those criteria were implemented.
  2. Recognize three clinical consequences of non-medically necessary delivery by induction or cesarean at less than 39 weeks of gestation.
  3. Outline a process for determining medical necessity for deliveries at less than 39 weeks of gestation.
  4. Evaluate patient and family requests for delivery at less than 39 weeks.
  5. Determine patient and family educational needs and pathways to negotiation.
  6. Indicate two resources to support provider collaboration with hospitals on the process of determining and documenting medical necessity of delivery at less than 39 weeks.

All data presented in the module reflect the most recent year for available data.

Please note this module expires on 7/18/2014.

This module includes a pre-test, post-test, and course evaluation. You must take the ungraded pre-test before beginning the course. After completing the course, you must take a post-test and score at least 75 percent to pass. After passing the post-test and completing the course evaluation, you will be able to print a certificate of completion.


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