Healthy Pregnancy
Provider Type
- Physicians
- Participating Physician Groups (PPG)
(does not apply to HSP)
The Decision Power® Healthy Pregnancy program educates women and provides screening to identify high-risk pregnancies. This program has been effective in prolonging pregnancies, improving birth weights and minimizing hospitalizations, by featuring the following:
- Initial assessment and risk screening, conducted at time of enrollment
- Online educational resources
- The book, Your Journey Through Pregnancy, which includes information from early pregnancy through the baby's first weeks, and a resource bookmark
- Access to BabyLine® - a telephone line answered by highly experienced nurses, 24 hours a day, seven days a week, for questions related to pregnancy
- Second assessment at approximately 28 weeks
- Referrals to case management for those at-risk participants identified during assessments
- Final assessment completed post-delivery
- Assessment report for participants and their physicians
Pregnant members identified as high risk and enrolled in the high-risk obstetric case management program have access to the expertise and experience of high-risk obstetric nurse case managers who are available to program participants 24 hours a day, seven days a week. The case manager creates a care plan unique for each participant by helping to set goals and develop strategies to assist the participant. Case managers also coordinate home-care and neonatal intensive care unit (NICU) care as needed. Refer eligible Health Net expectant mothers to this program via fax.
Genetic testing is covered when performed on the fetus using the following recognized tests:
- Alpha-fetoprotein (AFP), maternal serum
- Fetal chromosomal aneuploidy genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, (trisomy 13, 18 and 21)
- Fetal aneuploidy (trisomy 13, 18 and 21), DNA sequence analysis of selected regions using maternal plasma
Testing is covered for the following conditions when there is a family history of one of these conditions:
- Tay-Sachs disease
- Sickle cell anemia
- Fragile X syndrome - covered if there is a history of fragile X syndrome in another child. If there is a history of a child with mental retardation without a diagnosis of fragile X syndrome, the child (not the mother) should be tested
Amniocentesis is covered when the mother is age 35 or older.
Cytogenetic testing is covered if reasonable and necessary in accordance with Medicare guidelines.
Genetic counseling related to covered genetic testing services is considered a specialist consultation and is covered, subject to the applicable specialist consultation copayment.
The screening of newborns includes tandem mass spectrometry screening for fatty acid oxidation, amino acid, organic acid disorders, and congenital adrenal hyperplasia. Women receiving prenatal care or who are admitted to a hospital for delivery must be given information regarding these disorders and the testing resources available to them.
Genetic testing performed on an adult (including parents), genetic counseling related to non-covered genetic testing services, or any genetic testing that is considered investigative, is not covered.