Subject: New State Mandates Effective January 1, 2021
Date: January 5, 2021
Medicaid Coverage of Doula Services
We are please to share updates on New Jersey’s implementation of doula benefits. Attached is the Medicaid Newsletter on the program and also the next steps for providers interested in offering Doula Services. Once a doula is enrolled in NJ Medicaid and has their Medicaid FFS identification number, please email Joseph Manger, Chief Operating Officer ([email protected]) so he can arrange for a contracting representative reach out to you to walk you through our simplified enrollment process. (See: Volume 30 Number 23 Doula Services.pdf (PDF) and 2020-12-01 NJFC Doula Steps.pdf (PDF))
Non-payment for early non-medically indicated early elective deliveries (EEDs)
Public Law 2019, Chapter 87 prohibits NJFC Medicaid reimbursement for professional and hospital, as well as clinic claims, for non-medically indicated early elective deliveries. Obstetricians and midwives are encouraged to share educational materials with their patients to ensure their understanding of the risks associated with early elective deliveries. Effective January 1, 2021, neither NJ Medicaid nor Aetna Better Health of New Jersey will reimburse providers for non-medically indicated early elective deliveries (EEDs). Please refer to the attached newsletter for details on the requirements. (See: Newsletter 30-21 Non reimbursement for EED.pdf (PDF))
Perinatal Risk Assessment (PRA) Required for Reimbursement of Prenatal Care
Effective for claims with service dates on or after January 1, 2021, a provider shall not receive reimbursement for prenatal services provided to a pregnant NJFC Medicaid beneficiary until the First Visit PRA Plus form is submitted to FHI for that beneficiary. Please note that PRAs must be transmitted to FHI and FHI will record them and share them with Aetna Better Health of NJ so we can make sure claims will pay if a PRA is present. (See: Newsletter 30-24 Perinatal Risk Assessment (PRA) Required for Reimbursement.pdf (PDF))
