When entry into the system occurs based on factors other than screen score, pregnant women are not re-screened.
Reminder: The purpose of the Prenatal ScreenThe purpose of the screening instrument is to identify pregnant women who are more likely to experience adverse outcomes. For pregnant women the adverse outcome is pre-term labor and/or low birth.For example billing Medicaid for prenatal visits is reimbursed at the following rates:without completion of a Healthy Start Prenatal Risk Screen reimbursement [billing code H1000] patient declines screening, the provider must document the refusal in the medical record Physician PA/ARNP LM(age 21+) $52.00 $41.60 $50.00(<21) $54.08 $43.26 $50.00includes the screen (once per pregnancy) w/screening consent [billing code H1001] Physician PA/ARNP LM(age 21+) $104.00 $83.20 $100.00(<21) $108.16 $86.52 $100.00screening offered during the first trimester (once per pregnancy) w/screening consent [billing code H1001-TG] Physician PA/ARNP LM(age 21+) $156.00 $124.80 $150.00(<21) $162.24 $129.79 $150.00
Florida statute requires that Healthy Start Risk Screening is offered to all pregnant women at their first prenatal visit by their prenatal health care provider. It is the responsibility of the health care provider to administer the screen to the patient, to complete and score the screen correctly, and to send the screen to the Health Department within 5 business days so that the patient receives timely help.
The screening form is a universal tool that services both Healthy Start and Healthy Families Florida for screening purposes. Therefore, there are additional risk factors on the screen that are not scored items for Healthy Start.In this section, questions 1 (high school graduation), 2 (marital status) and 6 (depression) are scored risk factors for Healthy Start.The subscripted number located to the right check box for each Healthy Start risk factor reflects the number of points assigned to the risk factor. We will talk more about this later in the scoring section of the presentation.While question #9 is not a scored Healthy Start item for Healthy Start it is reason for referral based on other factors, therefore if the patient answers “yes", you should make the appropriate referral.
Questions 11-16 all address risk factors for Healthy Start and as such are scored based on the pregnant woman’s responsesBased on research literature, women of black race are found to experience pre-term births, low birth weight births and infant mortality at more than 2 times there white counterparts and therefore are given 3 points.Alcohol use during pregnancy can significantly impact the development of the growing fetus resulting in a myriad of negative outcomes, including low birth weight and preterm births.Tobacco use much like alcohol causes the same effects.Not wanting to be pregnant at all is a risk factor for Healthy Start and is similar to question 5, “Is this a good time for you to be pregnant?”, which is a Healthy Families risk factor addressing pregnancy timing.Women experiencing their first pregnancy were also found to be at increased risk for poor pregnancy outcomes and are therefore given 2 points.Research tells us that if a woman has experienced a previous poor birth outcome that she is at a significantly greater risk for preterm or low birth weight birth and therefore would receive 3 points for each and every item selected in question 16 except “none of the above”.
General Demographic information is requested of the patient for the screening form, which includes:Name: First, Last and Middle InitialSocial Security NumberDate of birthAge, which also is a risk factor for Healthy Start (if less than 18, score is 1)AddressInsurance informationContact Time andPhone numbers
The revised screen has two consent statements rather than three.The general consent statement allows for the exchange of the client’s information between Healthy Start, Healthy Start Providers (contracted), Healthy Start Coalitions, Healthy Families Florida, WIC, Florida Department of Health, and my health care providers for service provision.The specific information release, in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPPA), specifically identifies sensitive health information that may be released based with the client’s consent. This information has been separated from the general release in order to ensure client desiring to participate in Healthy Start may still do, even if she does not want the specific information released.HIPPA establishes standards to protect the privacy of individuals’ medical records and other protected health information by ensuring the security of health care informationThe decline statement, denoted by an asterisk*, may be signed by a client who does not desire to participate in the screening process. See intro paragraph.
If the patient signs the decline statement under the patient information section of the form, ask the patient to fill in demographic information, and sign and date the form below the statement denoted with an asterisk* located just above the provider section. Except for provider identification information and signature, the remainder of the form is not completed. If the patient refuses to sign the form, write “patient refuses to sign” on the form. Assure the patient that she will continue to receive care.Send the screening form (white and yellow copies) to the county health department in the county where the attempted prenatal screening occurred.
The provider section includes additional Healthy Start Risk factors, provider information, Healthy Start Screening Score and referral options.LMP and EDD are required fields and must be completed by the provider.Body Mass Index (BMI) is a new factor added to the screen and is calculated using the patient’s pre-pregnancy weight and height. A BMI chart is provided on the back of the yellow copy for determining the patients BMI score. If the patient’s BMI score is less than 19.8 or greater than 35, check the box of the appropriate response located in the shaded area to the right.
The provider section includes additional Healthy Start Risk factors, provider information, Healthy Start Screening Score and referral options.LMP and EDD are required fields and must be completed by the provider.EDD: is the Estimated Date of Delivery based on clinical judgment.LMP: is the date the patient indicates she began her last menstrual period (enter month and year even if day is unavailable).Body Mass Index (BMI) is a new factor added to the screen and is calculated using the patient’s pre-pregnancy weight and height. A BMI chart is provided on the back of the yellow copy for determining the patients BMI score. If the patient’s BMI score is less than 19.8 or greater than 35, check the box to the right. If the patient answered “no” to Question 15 and provided a date, use this date to calculate the pregnancy interval. If the date is less than 18 months before the current pregnancy, check yes in the shaded area to the right. If the date the patient provided in Question 15 is greater than 18 months or the patient answered “yes” to Question 15, check “no”. If this is the patient’s first pregnancy, check “N/A”.
Enter the trimester at which the patient had her first prenatal visit. If the patient entered prenatal care in the second trimester, check “yes”.Trimester of pregnancyat first prenatal visit: is the trimester based on her LMP when the patient first received prenatal care (even if that care was elsewhere).1st Trimester: 1st day of LMP through 13th week 2nd Trimester: 1st day of 14th week through 26th week3rd Trimester: 1st day of 27th week through 42nd weekIf patient requires ongoing medical care and specify the condition or diagnosis, check “yes” in the shaded area to the right.It is very important that you complete the provider information items, which include:Provider’s Name (Physician, Certified Nurse Midwife, or Advanced Registered Nurse Practitioner providing the prenatal care)Provider’s I.D.: (the number established by the county for each provider)Provider’s Phone NumberProvider’s County of the prenatal healthcare office
As of result of revising the risk factors and scoring criteria, the positive score threshold for the revised screen is now 6. Therefore if the patient’s screening score is below 6 (5 or less), than the patient has not scored positive for Healthy Start and should only be referred if there are other safety concerns or immediate needs.
Calculating the Healthy Start Risk Screen Score:The subscripted number located to the right check box for each Healthy Start risk factor reflects the number of points assigned to the risk factor. Circle the corresponding number of points for any subscripted check box items selected by the patient in response to questions 1, 2, 6, 11-21.
If the patient’s age is less than 18, check the “<18” response box and circle the point. If the patient’s body mass index (BMI) is less than 19.8 or greater than 35.0, check the appropriate (<19.8 or >35.0) response and circle the point(s). If the patient’s last pregnancy was less than 18 months prior to the date of screening, check the “yes” response box and circle the point. If the trimester of pregnancy at 1st prenatal visit is the 2nd trimester, check the “2nd” response and circle the point. If the patient has an illness that requires ongoing medical care, check the “yes” response and circle the points. Add the circled points. This total is the patient’s Healthy Start screening score and is entered in the space indicated in Section 2 of the form. Healthy Families Florida risk scoring and referral will be determined upon risk screen review by Healthy Families staff with the patient’s initialed consent for release of information.
Determine the patient’s Healthy Start screening score. Along side of the check boxes for individual risk factors is a subscripted number, which is the number of Healthy Start points assigned to that risk item. Circle the corresponding check box and point value for risk factors based on responses to specific questions. Add the circled points. This total is the patient’s Healthy Start screening score and is entered in the space indicated. Refer the patient for participation in Healthy Start care coordination if (a) the prenatal screening score is six or more, or (b) the patient is at risk for an adverse outcome based on factors other than score, including maternal illness, homelessness, domestic violence, HIV status, substance abuse, or other factors that Healthy Start care coordination and risk appropriate services might reduce. Check the appropriate box to indicate referral status. Discuss the Healthy Start screening score and status for care coordination with the patient. Sign and date the form.Please note that the form is to be signed by the patient. Please review for completion prior to forwarding all screening forms (white and yellow copies) to the county health department in the county where screening occurred. Keep the pink copy in the patient’s medical record and give the patient the green copy. This documents compliance with s. 383.14, F.S. The demographic data is important to evaluate Healthy Start and must be completed.Complete the name of the Physician, Certified Nurse Midwife, or Advanced Registered Nurse Practitioner providing the prenatal care. Also complete the provider I.D. (the number established by the county for each provider), phone number, and county for the prenatal healthcare office.
Pregnant women and infants are screened only once for Healthy Start.Prenatal Risk Screening and referral for positive score should occur at the first prenatal visit or the earliest time thereafter.
Does this apply to prenatal???
Hs prenatal screening training 2013 8 5-13
Healthy Start Prenatal
• Universal prenatal and infant risk screening
• Healthy Start Care Coordination and
Florida Statute 383.14 - requires the screen
(questionnaire) to be offered to all pregnant
women at their first prenatal visit (and all
infants before leaving the delivering
Training program for the Infant Risk Screening Process is also available from the
Healthy Start Coalition of Sarasota County.
The Healthy Start Coalition
monitors screening rates of the county
and individual providers
and offers technical assistance as needed.
Prenatal Screening Rate for Fiscal Year 2011-12
Sarasota County 96% Florida 81%
Benefits of Screening
Identifies risk factors which could increase a
woman’s risk of having a poor pregnancy
Assures early referral to Healthy Start for
Helps health care providers care for the
Increases Healthy Start funding in the county
• The Prenatal Risk Screen is initiated at the first
• The staff member completing the screen must
“offer” the screen and receive consent to
conduct the screen
• The staff member must review the screen
results with the patient
• Consent must be obtained to send the screen
answers to Healthy Start
The Healthy Start
A statewide, voluntary program available at
no cost to participants
Designed for prenatal women and infants
Tailored to meet each individual’s needs and
circumstances by providing referrals,
information, and supportive services
Healthy Start is NOT
It is Risk-Based
• A Medicaid program
• Based on immigration status
• Department of Children and Families
Three methods of referral to Healthy Start
1. Prenatal risk screen score of 6 or more
2. Referrals based on other factors
Other Risk Factors for
Eligibility and Referral
• Prior fetal or infant loss
• Complicated medical conditions impacting
pregnancy, including HIV+, Hepatitis B+, thyroid or cardiac
diseases, hypertension, diabetes, etc.
• Current substance misuse or abuse – tobacco, drugs, or
• Mother has severe depression or active mental illness
• Current abuse or neglect in the home
• Need breastfeeding classes or education
If the patient does not score a six or more or the
patient does not have any of the other risk
factors for eligibility:
The mother can call Healthy
Start at 861-2905 to discuss
After a Referral
• Assignment to a Care Coordinator
• Initial Contact within 5 working days to
determine risk level and assets
• A more in-depth assessment is scheduled
• Ongoing coordination of care commences
Healthy Start Care
• Make contacts on a regular schedule based
on risk level (P, E, I, II, III)
• Provide education, support, and monitoring
• Make linkages in the community
• Make referrals for wraparound services if
We have 9 Care Coordinators
• Breastfeeding Education and Support
• Psychosocial Counseling
• Tobacco Education and Cessation
• Childbirth Education
• Nutrition Counseling
• Parenting Education and Support
• Interconception Education
We have 8 Wraparound Service Providers
Length of Services
• Prenatal – up to 6-8 weeks post-partum
A client can be closed whenever services are
declined, transitioned elsewhere, or when risks are
A prenatal client remains in care
coordination as long as services are
necessary and the client is actively
Screening benefits your patients!
• Helps identify women who are at risk for
having poor birth outcomes
• Provides access to FREE services
Good for your office!
• A tool to learn about your patient’s history
• Medicaid reimburses at a higher rate when
the prenatal screen has been
completed, especially in the first trimester
Florida Statute 383.14 - requires the screen to be
offered to all pregnant women at their first
prenatal visit by their prenatal care provider.
It is the prenatal care provider’s responsibility to:
• Administer the screen to the patient
• Complete and score the screen correctly
• Send the screen to the Health Department
within 5 business days
It’s the law!
Scoring the Screen cont’d.
Check “referred” if score
≥ 6 or referred based on
reasons other than score
If score 5 or less and
no other risk factors
exist, check not
Enter reason referred
if score <6; must meet
• Consent to the Healthy Start screen - This is done by
signing and dating the first statement
• Consent to release of information - This is done by
stating initialing “yes” to the second statement*
* If the patient states “no” to either of the above statements, she will not be able
to access Healthy Start services.
Recap: How can
a patient begin to
Your Role Is Critical
• Ensure every pregnant women is offered the Prenatal Screen
at her first prenatal visit
• Encourage every pregnant woman to consent to be screened
• Encourage every pregnant woman or new mother to
participate in Healthy Start when:
Her answers indicate that either she or her baby may be high risk
(score of 6 or above)
You, as the professional, think she or her baby would benefit from
Healthy Start services
Reimbursement for the Healthy Start Prenatal Risk
Screen requires that the screening form is
consented and complete.
the patient has not declined the screen
the screening questions are answered
the form is signed, scored and referral status is
indicated by the provider
When the screen is consented and complete, the
recipient’s trimester of care should be referenced
and must correspond with the reimbursement
code filed by the provider.
If reimbursement is filed and received for a prenatal risk
screen that is not consented or the recipient’s trimester of
care and reimbursement code do not agree, then the
provider will be expected to refund overpayment amount to
Medicaid as well as other applicable fees
How can we increase
Explain why the screen is important and how it is used.
• Help identify infants and moms that might need help.
• It is so important that we are required by Florida Law to offer
this screen to all new moms.
• If you need help this allows Healthy Start to contact you.
• Sometimes mom’s needs change, saying “yes” means Healthy
Start can contact you if you need help later.
How can we increase
consent for the third
Explain why consenting to releasing information
• We need permission to share this screening info with
• All information is kept private and confidential.
• Healthy Start only shares information that is needed for
your or your baby’s care.
When she says yes, you can add:
“You are making a good decision to screen your new
baby. Even if you or your baby may not need
services now, if you do in the future this helps
getting you in Healthy Start more quickly.”
If the patient is reluctant
• Reinforce that this information is absolutely
• Healthy Start follows state laws and HIPAA
• The mother’s social security number is entered into
the state data system regardless of consent to share
the Healthy Start Screening Information.
If the patient doesn’t want the screen because she
doesn’t think she is at risk, let her know that our
Healthy Start Program gets additional funding from
the state the greater the number of screens that are
completed and consents to participate in Healthy
Start. Altruism sometimes enhances consent.
If the patient still refuses any aspect of screening, the
demographic information, patient signature declining
screen, and provider’s signature must be entered and
the form is sent to the county health department.
Discussing the results if the
prenatal score is 6 or more:
• Nurse, midwife, or doctor shares the score with the
mother and explains what the risks mean.
• Tell about Healthy Start and the free services offered.
• Let the patient know that a Care Coordinator will be
contacting her soon to learn more about what
services are needed.
• Make sure the patient has authorized consent to
contact and share information!
• Please make sure the patient has brochures about
the Healthy Start and the Infant Screen.
According to Florida State Statute, 383.14 (FAC
64-C), the health care provider shall assure that
the patient is informed of her risk status as
determined by the risk screening instrument.
If at any time during pregnancy someone feels they may
need Healthy Start services, they can call 861-2905 to
talk to a Care Coordinator.
Patients can always call Healthy Start
for more information about any of the
If the patient
For more information…
Contact: Jamee Thumm
941.373.7070 ext. 307
Visit the local Healthy Start Coalition website:
Visit the Florida Dept. of Health info. website: