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Maternal and Child Health Frequently Asked Questions and Answers

1. If a screening is performed on the mother, and the infant is the Medicaid patient, where do I file the results of the screening?

Document in the infant's medical record that a "risk assessment" has been performed. Maintain the perinatal depression screening tool and results in a separate file. The Illinois Chapter of the American Academy of Pediatrics' Web site provides record keeping suggestions.

2. Who can perform and bill for the perinatal depression screening?

Medicaid enrolled providers who provide primary care services may bill for perinatal depression screening, using an approved screening instrument. (The Edinburgh Postnatal Depression Scale is one such instrument that has been approved.) Primary providers include: Physicians, Nurse Practitioners, General Hospitals, Federally Qualified Health Centers, Encounter Rate Clinics, Rural Health Clinics, Certified Health Departments and School Based/Linked Centers.

However, Encounter Rate Clinics (ERCs), Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will not receive separate reimbursement for perinatal depression screenings because ERCs, FQHCs and RHCs are paid an encounter rate that encompasses all services provided during an encounter. ERCs, FQHCs and RHCs should include the appropriate "risk assessment" procedure code on the encounter claim. The screening can be performed during a medical or a behavioral health encounter (for those enrolled FQHCs and RHCs that provide behavioral health services).

At certified local health departments, licensed clinical staff who work under the Medical Director's Standing Orders may perform a screening, with the claim form showing the local health department’s provider number.

3. Will you be providing copies of the Edinburgh Postnatal Depression Screening tool?

A copy of the Edinburgh Postnatal Depression Screening tool is being sent with the Provider Notice. It can also be downloaded from the HFS Web site and printed. As long as credit is given to the authors, that screening tool can be reproduced.

4. Can the perinatal depression screening be billed more than one time during the woman's pregnancy or post partum period?

Yes. Providers are encouraged to administer the Edinburgh Postnatal Depression Screening even in the absence of overt risk factors. In that perinatal depression may occur at any time during the pregnancy, post partum period or even up to a year after delivery, it may be necessary to repeat the screening.

5. Who will be available to give me help with billing questions?

HFS Bureau of Comprehensive Health Services at 877-782-5565 will be able to assist providers with billing questions.

6. How long after delivery can this screening be administered for HFS reimbursement?

Up to a year after delivery.

7. Will HFS or any of the other agencies rolling out this program have additional training available for my staff?

This satellite training is the training for local health departments. A copy of the video presentation is available.

There will be additional training, known as Healthy Beginnings, for physicians, as part of an initiative to promote the social-emotional development of young children. That training will be provided by the Illinois Chapter of the American Academy of Pediatricians and the Illinois Academy of Family Physicians and will include training on screening for the social-emotional development of young children as well as training on the Edinburgh Postnatal Depression Screening.

8. Please explain why HFS will pay, under the infant's RIN, for a screening for his or her mother?

Unidentified or untreated maternal depression can have long-lasting and sometimes, devastating consequences. Typically, the overall well being of the infant and of any other children is affected by the mother's depression. HFS views screening for postpartum depression as a risk assessment.

9. Will HFS reimburse for antidepressants for someone who is ultimately diagnosed as depressed?

HFS reimburses for antidepressants and other pharmacological treatment, if the mother is enrolled in one of HFS Medical Programs, with the exception of Illinois Healthy Women. Illinois Healthy Women is a limited coverage benefit -for family planning for women who would otherwise lose benefits.

If the woman is not enrolled in HFS medical program, referrals to mental health resources can be made, such as to FQHC that provide behavioral health services and community mental health centers. As HFS continues to develop the Maternal and Child Health Web site, mental health and other relevant resources will be added to the site.

Providers are encouraged to refer women needing resources to the DHS Help Line at 1-800-843-6154 for medical and behavioral health resources within their community.

A state-by-state resource directory for mental health services is through SAMHSA (Substance Abuse and Mental Health Services Administration). This information is available on the Substance Abuse and Mental Health Publications Web site.