No posts received thumbs up, next time you see a good one, give some respect and thumb it up.
Attached is the file from which the posts were generated. The concerns and recommendations have been posted on this site for your review and comment. Please post comments within each topic for all members of the committee to view.
All women presenting for prenatal services should be asked for the insurance information. If she does not have commercially available insurance, the NJ FamilyCare/Medicaid Member Verification System (MVS – on line [EMVS] ) should be checked. If the woman does not have any evidence of any type of coverage, she should be sent, while on site, to the presumptive eligibility (PE) worker on site (at a hospital or an FQHC).The Presumptive Eligibility Worker would then complete a PE application and provide the woman with the “Important Information Letter” and a copy of documents which most likely would be requested later by the County Board of Social Services in order to establish full Medicaid eligibility.If there is no presumptive eligibility worker on site, any provider may distribute a copy of the NJ Medicaid/Family Care Application (or the web site address; http://www.njfamilycare.com).In the meantime, there is a program, being piloted in Salem County, that allows outstation worker to access the County file, in real time, process the information, and verify that she examined whatever paperwork is required; this relieves the woman from going to the County Board of Social Services, the application is filled out, on the spot, and an HMO selection is made at the time of application.
Recommendation
The NJDHSS should as the Board of Medical Examiners and the Board of Nursing to request verification of the continued provision of OB services at the time of biennial license renewal. In addition, hospitals should be requested to give a listing on annual basis identifying OB providers who have privileges at their facilities.
Identify incentives to encourage private providers to serve the underinsured and Medicaid population.
Increase reimbursement to providers
Need additional trained professionals in New Jersey
Note Re Formatting: Concern not noted on original document. Concern text can be posted for review below.
Recommendation
Increase access to free pregnancy testing at non-traditional sites including, but not limited to WIC sites, School Based Youth Services Programs, Child Health Conference locations and Family Success Centers.
State funded grant projects should be allowed to offer free pregnancy testing within the scope of their project with specific funds dedicated to this expense.
Community based health promotion, utilizing Health Promoters to encourage access to care. Based on existing evidenced based on models, including, Healthy Mothers/Healthy Babies, NFP, Healthy Families, TIP
Additional changes need to be made regarding the Transition Plan for
Hospital Closings. Ilise Zimmerman agreed to update this section and will send later. Update will be in format of other posts.
Concern:
Recommendation:
Recommendation
The State of New Jersey should provide funding to Federally Qualified Health Centers and community-based clinics that care for vulnerable, high-risk obstetric patients based on analogous increases in capacity and impending strain on their infrastructure and operating margins. In light of recent hospital closures within several medically under served areas Statewide, there is a need to support the existing community based health centers that provide prenatal services to high-risk patients. For those who will be required to seek specialty care based on high-risk obstetric conditions, every effort should be made to ensure that high quality specialty care is either available within the same facility or accessible at a regional perinatal center that has an affiliation agreement with the respective FQHC. According to the New Jersey Primary Care Association, the cost of increasing capacity is projected at $20.8M
Encourage partnership between high risk specialist and FQHC’s through federal tort claims protection for medical malpractice
Concern
The current FQHC infrastructure is reaching capacity.
Recommendation
The State should reform and expand the PE system to expedite the enrollment of women into managed care system (in accordance with the current federal law, which allows delegation of the PE function to hospitals, FQHC’s, HMO’s and other entities.)
Medicaid should describe the accountability process that ensures County outreach station productivity to ensure that there is uniformity throughout the State.
Provide funding for additional “my pc.com” licenses and encourage others counties, hospitals and FQHCs to comply with the requirement that an outstation worker be on site with office space and connectivity.
Concern
The current enrollment process for PE is slow, inconsistent, and fragmented creating a barrier to early entry into prenatal care.
Recommendation 2
Tort Reform
It is recommended that the overall issue of medical malpractice be examined particularly to the relationship with OB providers. There is a need to examine the medical malpractice subsidy to ensure a meaningful and sufficient impact on OB malpractice premiums. According to the Task Force on Medical Care Availability, the current subsidy does not significantly contribute to providers decision to practice in the State.
Currently, malpractice premium subsidies are only available to physicians. Nurse-Midwives who are not practicing in FQHC's (covered by tort reform) should be able to access this benefit.
Recommendation 1
Loan Redemption
The State should increase funding and visibility of the State loan redemption program aimed at providing relief to clinicians graduating from OB/Gyn residencies and Nurse-Midwifery programs who plan on practicing in New Jersey.
Provide loan redemption opportunity to providers (OB, APN, CNM) who agree to practice in underserved communities.
Concern
The distribution of OB providers in this State adversely impacts access to prenatal care for the uninsured and under-insured.
Submitted by Kaye Marrow:
All women presenting for prenatal services should be asked for their insurance information. If she does not have commercially available insurance, the NJ FamilyCare/Medicaid Member Verification System (MVS – on line [EMVS] ) should be checked. If the woman does not have any evidence of any type of coverage, she should be sent, while on site, to the presumptive eligibility (PE) worker on site (at a hospital or an FQHC).
The Presumptive Eligibility Worker would then complete a PE application and provide the woman with the “Important Information Letter” and a copy of documents which most likely would be requested later by the County Board of Social Services in order to establish full Medicaid eligibility.
If there is no presumptive eligibility worker on site, any provider may distribute a copy of the NJ Medicaid/Family Care Application (or the web site address; http://www.njfamilycare.com).
In the meantime, there is a program, being piloted in Salem County, that allows outstation worker to access the County file, in real time, process the information, and verify that she examined whatever paperwork is required;
this relieves the woman from going to the County Board of Social Services, the application is filled out, on the spot, and an HMO selection is made at the time of application.
Recommendation: provide funding for additional “my pc.com” licenses and encourage others counties, hospitals and FQHCs to comply with the requirement that an outstation worker be on site with office space and connectivity. It is also recommended that a provision be built into the $4.8M grant to Medicaid for Emergency Room diversion to utilize the staff placed in the emergency room
When you are adding comments about the recommendations to the message board please add them as comments to the topics already on the board.
Do not add a new topic if the comment relates in any way to one of the recommendations as it may be missed by other committee members.
We will add a general/miscellaneous topic where you can put comments unrelated to any of the existing recommendations
You can also communicate privately with members by going to the member section and clicking the member user name and then on the envelope at the top of the next page
Please post any additional recommendations or general miscellaneous comments to this thread.
In order to streamline your feedback on the recommendations for the Prenatal Care Task Force a Message Forum has been established at http://access2pncnj.lefora.com/.
Please click on the link above and select "Join Now". The site will ask you to create a user profile with your email account and a unique user ID and password. You will receive an email confirming your membership within a few hours (no more than 24 hours...usually much less) and you will be able to respond to the posts of your fellow committee members.
The recommendations of the committees will be posted by the site administrator (contact information below) and members should use the site to comment on recommendations.
We have added the comments that were already circulated via email. You will now be able to see all comments and suggested edits in one place for each recommendation. If you have submitted other comments directly to the assigned subcommittee members please add them to the applicable thread.
Comments fall into two categories on the message board, "reply" or "quote". When you reply to a post your note will appear in a box below the posting without the text of the post. This option is best for discussion points related to the post.
Selecting quote will place the entire text of the post in the box with your comment, you can cut the quoted text once it is in the comment box. This option is best for suggested edits.
While the forum is visible on the internet and can be viewed like any website, comments are limited to approved members of the Commissioner's Task Force on Prenatal Care Access.
Please do not hesitate to contact the forum administrator
Helen Hannigan
Director of MIS and Administration, SNJPC
P: 856-665-6000
F: 856-665-7711
if you have any questions or concerns. I am also available at 609-922-5336 if you want to discuss anything related to this
Submitted by Shirley White-Walker, CNM, FACNM on 5/15/08
The state should provide funding for loan redemption programs aimed at providing relief to clinicians graduating from OB/Gyn residencies and Nurse-Midwifery programs who plan on practicing in New Jersey
Currently, malpractice premium subsidies are only available to physicians. Nurse-Midwives who are not practicing in FQHC's (covered by tort reform) should be able to access this benefit.
Submitted by Katherine Grant Davis on 5/12/08
Keep in mind that the analysis done by the NJPCA was based on responses from
FQHCs only. I have no idea what the needs are of community based free
clinics. We need to make that clear. Also, any money that is forthcoming
should have strings attached such as providers must serve all, have sliding
fee scales, etc. same stuff that was in the old funding bills. Lastly,
speciality care should also be done by private physicians and not just
regional centers. We are working on agreements now with the Medical Society
to increase the role of private speciality physicians. Their presence is
very much needed to expand access.
Submitted by Ilese Zimmerman on 5/9/08:
The State of New Jersey should provide funding to Federally
Qualified Health Centers and community-based clinics that care for
vulnerable, high-risk obstetric patients based on analogous increases
in capacity and impending strain on their infrastructure and operating
margins.
In light of recent hospital closures within several medically
under served areas statewide, there is a need to support the existing
community based health centers that provide prenatal services to
high-risk patients. For those who will be required to seek specialty
care based on high-risk obstetric conditions, every effort should be
made to ensure that high quality specialty care is either available
within the same facility or accessible at a regional perinatal center
that has an affiliation agreement with the respective FQHC. According
to the New Jersey Primary Care Association, the cost of providing a
true medical home for its patients is projected at $20.8M.
Submitted by Katherine Grant Davis on 5/12/08:
question - how would the hospital prenatal clinic get paid if they are no longer getting charity care for the uninsured? Funding may not be assured for these program if the hospital closes all operations.
Submitted by Marijane Lundt on 5/12/08:
The Department of Health and Senior Services should require hospital systems that close hospitals and/or maternity services to operate a prenatal clinic in the affected community for a minimum of three years. Three years would enable a smoother transition of services in that community and provide the planning time required to make appropriate modifications to the existing prenatal clinics and systems of care. It is essential that these clinics be based in the community to provide the continuum of care to which these mothers and babies have come to trust.
The recommendations circulated by Maggie are now available on the message board for review and comment.
Explore models of care such as centering pregnancy and pregnancy test at non traditional sites.
No Committee Member Responsible
