Doctor's and Health Care Professional's Corner


Family Planning Medicaid Waiver Training Conference Call Thursday, August 27 at 2 pm

Click below to access the documents for this call:

Training Agenda
Florida's Medicaid Family Planning Waiver Update
Citizenship and Identity for Medicaid

Revised FP Waiver Elegibility Span Rules
Sample Documents FPW 082409

Prenatal Summit Executive Summary "Expediting Access to Care for Pregnant Women"

Click here for a copy of the Prenatal Summit Executive Summary of the study on Expediting Access to Care for Pregnant Women.

Click these links below for information on:

Amniotic Fluid Infection May be Linked to Risk of Premature Birth
Antiretroviral  Pregnancy Registry
Breast Feeding - USPSTF Recommends Primary Care Interventions to Promote Breast-Feeding
Chantrix and pregnant or nursing women
Chapter 64D-3 Florida Administrative Code (Notifiable Disease Reporting) Rewrite
Disaster Fact Sheet on Infant Nutrition
Fetal Alcohol Syndrome
Florida Tobacco Quit-For-Life Free Cessation Service
Folic Acid Research
Food Safety for Moms-to-Be Educational Materials from the U.S. FDA
New-Health Information in Multiple Languages
Health Literacy Measurement Tools from AHRQ
Healthy Start Prenatal and Postnatal Screening Process
Healthy Start Standards and Guidelines
HIV/AIDS Magazine for Health Care Professionals - The Source
HIV/AIDS National Clinicians' Consultation Center
New-HIV/AIDS Perinatal Prevention Guidelines/Recommendations/Reports/Resources
HIV/AIDS Perinatal Surveillance Procedures
HIV/AIDS Testing Paid for During Pregnancy and Delivery
HIPPA Act Information
Immunization Guidelines for Florida Schools, Child Care Facilities and Family Daycare Homes
Immunization Schedule for Children 0-18 for 2008
Influenza – 2008 CDC Prevention and Control Recommendations of the ACIP
Influenza – CDC Vaccine Information Statements
Influenza – CDC Web Site
Influenza-H1N1 MMWR - Novel H1N1 Virus Infections in Pregnant Women
Medical Information and Professional Development - Medscape
Medical Provider Survey
Medipass - Summary of Changes Coming in 2009
New-Marchman Act - Florida Statute 397
Nutrition
Oral Health - Prenatal - A Summary of Practice Guidelines
Oral Health - Prenatal and Early Childhood - Practice Guidelines
PAMR Report (Pregnancy Associated Mortality Review)
Perinatal Depression Booklet Published by HRSA
Practitioner's List of Reportable Diseases
Prenatal Medicaid Application
Prenatal Medicaid - Tips for Navigating the Prenatal Medicaid System

Prenatal Medicaid - How to Help Women Apply
Prenatal Vitamins May Protect Against Childhood Cancer
Pre-teen Vaccination Campaign - CDC
Safe Haven for Newborns Smoke Free Homes and Cars Program from the EPA (brochures)
New-Sexual Behavior in Children - Study Shows Most Sexual Behavior is Not Abnormal - Kellogg's Report
New-SIDS Research 2009 Kinney and Thach
Surgeon General's Report on the Health Consequences of Involuntary Exposure to Tobacco Smoke
Upcoming Trainings, Seminars, and Web casts for Doctors and Health Care Professionals
New-Weight Gain During Pregnancy: Reexamining the Guidelines, by the National Academies Press
Women's Health Issues Journal from the Jacob's Institute of Women's Health

Healthy Start Prenatal and Postnatal Screening Process

We thank our providers for their increased efforts to encourage every pregnant woman they see to take the Healthy Start Prenatal Screen. This collaboration and teamwork certainly shows in the 30% increase we have experienced in our Service Area Prenatal Screening Rate from FY06-07 to FY07-08!

Healthy Start prenatal screens assist in efforts to reduce the infant mortality rate. New screen revisions that offer a place for input about a woman’s pre-pregnancy weight and intervals between pregnancies make it easier than before to more accurately access a woman’s pregnancy risk. It is wonderful that a two-minute screen can change a birth outcome because someone took the time to answer a few risk questions.

Women who participate in the screen are also helping to provide health experts with a snapshot of community social, economic and health issues. In addition, those who consent to participate in the Healthy Start program as a result of the screen can receive prenatal and childbirth education and services via a voluntary home visitation program

Healthy Start of Flagler and Volusia thanks all the provider offices who are committed to this worthy program.

We also thank Cher Philio, Healthy Start’s Marketing and Education Director, for her diligent efforts to increase our screening rates by helping our providers understand the importance of screening every prenatal client.

Please have your office manager contact Cher at 386.323.0000 or cher.philio@halifax.org and receive effective ideas for presenting screens within your practice. Show your support for this program by encouraging screening by your employees, and provide the opportunity and tools for them to do so. Become familiar with the literature available to inform your staff and patients. And, please encourage your patients to also fill out the infant screening that is offered at delivering hospitals.

 

Breast Feeding - USPSTF Recommends Primary Care Interventions to Promote Breast-Feeding

USPSTF recommendation statement in Annals of Internal Medicine (Free)
USPSTF evidence review in Annals of Internal Medicine (Free)
USPSTF's 2003 recommendations (Free)

The U.S. Preventive Services Task Force now recommends primary care interventions during pregnancy and after childbirth to encourage and support breast-feeding (grade B recommendation). In Annals of Internal Medicine, the task force cites evidence that breast-feeding is associated with lower risks for:

  • breast and ovarian cancers in mothers;
  • ear, respiratory, and gastrointestinal infections in infants;
  • asthma, type 2 diabetes, and obesity in young children.

Strategies that may increase breast-feeding initiation, duration, and exclusivity include:

  • formal breast-feeding education of mothers, partners, family members, and friends;
  • direct support of women during breast-feeding, such as consultation with lactation specialists and peer counseling;
  • training of primary care staff in techniques to offer support.

Florida Tobacco Quit-For-Life Counseling Program Quit For Life

The Florida Tobacco Quit-For-Life Line is a free cessation service offering individualized counseling and support to any Florida resident who is ready to quit. The Quit-For-Life Line can provide the counseling component of tobacco dependence treatment without added time or costs to health care providers or insurers.

Folic Acid Research

Folic Acid Fortification and Supplementation—Good for Some but Not So Good for Others, Young-In Kim, MD, FRCP(C) 2007

Evidence has established the protective effect of folic acid (FA) fortification and periconceptional supplementation on neural tube defects (NTDs). Folic acid fortification and periconceptional supplementation of women may reduce the risk of certain childhood cancers in their offspring. However, recent human studies have suggested that FA supplementation and fortification may promote the progression of already existing, undiagnosed, preneoplastic and neoplastic lesions, thereby corroborating earlier observations from animal and in vitro studies. Following the success of mandatory FA fortification on the reduction of NTD rates in the United States and Canada, several countries are currently considering whether or not, and at what dose, to institute FA fortification. More

Body Mass Index and Serum Folate in Childbearing Age Women, Ramin Mojtabai, Department of Psychiatry, Beth Israel Medical Center, New York, NY, USA Accepted in revised form 12 August 2004

Higher pre-pregnancy body mass index (BMI) is associated with increased risk of neural tube defects (NTDs) and possibly other negative birth outcomes in the offspring. More

Reassessing folic acid consumption patterns in the United States (1999–2004): potential effect on neural tube defects and overexposure to folate1–3, Eoin P Quinlivan and Jesse F Gregory III

In the United States, folic acid fortification of cereal grain foods has significantly increased folate status. However, blood folate concentrations have decreased from their post fortification high as a result, in part, of decreasing food fortification concentrations and the popularity of low-carbohydrate weight-loss diets.

The objectives of the study were to quantify changes in folate intake after folic acid fortification and to estimate the effect on neural tube defect (NTD) occurrence. More

Greater Maternal Weight and the Ongoing Risk of Neural Tube Defects After Folic Acid Flour Fortification, Joel G. Ray, MD, MSc, Philip R. Wyatt, MD, PhD, Marian J. Vermeulen, BScN, MHSc, Chris Meier, BSc, and David E. C. Cole, MD

Maternal obesity is likely a risk factor for neural tube defects (NTDs). By late 1997, it became mandatory in Canada that all refined wheat flour be fortified with folic acid. Because overweight women may consume greater quantities of refined wheat flour, we questioned whether their risk of NTD changed after flour fortification. The risk of open NTD was evaluated across maternal weight quartiles and deciles, and an interaction between greater maternal weight and the presence of flour fortification was tested using multiple logistic regression analysis. More

Food Fortification with Folic Acid: Has the Other Shoe Dropped? Noel W. Solomons, M.D.

Folic acid (FA) supplementation effectively reduces the rates of children born with neural tube defects (NTDs). Currently, 42 nations practice mandatory FA fortification to combat NTD. In addition to NTD, FA fortification may also have salutary effects on the incidence of orofacial cleft birth defects and have secondary benefits in reducing serum homocysteine concentrations and stroke mortality. However, a recent note of caution has been raised concerning a possible negative effect of mandatory FA fortification on the incidence of colorectal cancer. More

Health Information in Multiple Languages

Click here to view the MedlinePlus multilingual feature, providing access to high quality health information in languages other than English and Spanish. This new service benefits people who prefer to read consumer health information in their native language. It also helps supply information to professionals and health care providers who serve them. The new collection contains 2,500+ links to information in more than 40 languages and covers nearly 250 Health Topics.

Medical Information and Professional Development - Medscape

  • Physician optimized MEDLINE
  • Free Online CME
  • 25+ medical specialty sites
  • 100+ online medical journals
  • Conference Coverage
  • Daily Medical News

Medical Provider Survey

The goal of Healthy Start is to reduce infant mortality, increase access to maternal and child health care and support services and improve the health and developmental outcomes of children in our community. This initiative includes ongoing collection and assessment of information regarding the services available to the maternal and child populations. We are asking maternal and child health care providers in Flagler and Volusia counties to please take a few minutes to complete the survey below so that we can better assess what medical services are currently available to our target population. Thank you in advance for helping us gather this data.

Medical Provider Survey (pdf file) click here to download free pdf reader

 

HIPPA Act Information

HIPPA Act allows release of protected health information, without specific client consent, for public health investigations. Click the letters below for HIPPA Act information from the Florida Department of Health.

HIPPA Letter regarding FIMR (Fetal Infant Mortality Review)
HIPPA Letter regarding PAMR (Pregnancy Associated Mortality Review)
HIPPA Letter regarding MomCare - Prenatal choice counseling and care management women who are eligible for Medicaid through the Sixth Omnibus Budget Reconciliation Act (SOBRA)


Surgeon General's Report on the Health Consequences of Involuntary Exposure to Tobacco Smoke

Those of you interested in reading The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General (including the full report, the executive summary, or the consumer-oriented publication}. click here.

A Safe Haven for Newborns

Safe Haven provides an alternative to a frightened girl/woman, who, in a moment of desperation, may do something drastic, destroying two lives, hers and her babies.

There is now a Florida Law which allows a mother/ father an alternative to infant abandonment with their confidentiality protected. Parents may call the Safe Haven 24-hour, multi-lingual, confidential hotline at 1-877-767-2229. The result will be:

- A child’s life is saved.
- A mother/father is saved from a lifetime of guilt and criminal prosecution.
- The hopes and dreams of parents waiting to adopt are fulfilled.

Many Hospitals and all staffed 24/7 Fire and Emergency Medical Service stations have signs with the Safe Haven logo and help line # posted outside of their facility. For more information, visit the Safe Haven web site. For a brochures in English, Spanish and Creole, click here. To contact Save Haven for Newborns, call 305-882-1304 Ext. 103, or email safehaven@asafehavenfornewborns.com

Nutrition

Click here to find: vegetable consumption surveillance data; information on various 5 A Day pilot programs; internet and legislative resources; more about the 5 A Day program; and help encouraging others to eat a colorful variety of fruits and vegetables.

National HIV/AIDS Clinicians' Consultation Center

The National HIV/AIDS Clinicians' Consultation Center (NCCC) is a component of the AIDS Education and Training Centers (AETC) program funded by the Ryan White CARE Act, administered by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, in partnership with the Centers for Disease Control and Prevention (CDC). Click here to visit the web site. See services offered below:

Warmline - National HIV telephone consultation service offers healthcare providers expert clinical consultation on antiretroviral treatment options, drug interactions and toxicity, resistance testing, prophylaxis and management of opportunistic infections, and primary care of persons with HIV/AIDS. 1-800-933-3413, Monday-Friday, 8 am to 8 pm EST, Voicemail 24 hours a day - 7 days a week.

Perinatal Hotline - National perinatal HIV consultation and referral service provides 24-hour advice from HIV experts on indications and interpretations of HIV testing as well as consultation on treating HIV-infected pregnant women and their infants. 1-888-448-8765, 24 hours a day - 7 days a week.

PEPline - National clinicians' post-exposure prophylaxis hotline offers healthcare providers around-the-clock advice on managing occupational exposures to HIV, and hepatitis B and C. 1-888-448-4911, 24 hours a day - 7 days a week.

HIV/AIDS Testing Paid for During Pregnancy and Delivery

From:   Harrelle, Nita 
Sent:   Monday, June 15, 2009 3:13 PM
Subject: Payment for HIV testing during labor and delivery

Hello all.  We had some feedback that even though Florida Administrative Rule 64D-3.042 states that pregnant women are to be tested for HIV at:

Their initial prenatal care visit,
Again at 28 - 32 weeks, or
At L&D if no test after 27 weeks,

some hospitals are not testing during L&D because they believe Medicaid will not pay for the test.  We have researched this, and Medicaid will pay for an HIV test at L&D, if it is ordered by the physician.  Attached you will find a link to a list of tests covered by Medicaid.  The CPT codes for rapid HIV tests can be found on page 28 of this document. http://www.cms.hhs.gov/CLIA/downloads/waivetbl.pdf  We also polled the larger private insurers and they all told us the same thing.  They will pay for the test if it is ordered by the physician.

The majority of hospitals are following the current recommendations and testing at L&D if there is no documentation of HIV status when the patient presents at L&D.  At this juncture, I would like for you to be our eyes and ears in the community.  If you are aware of a facility that does not routinely do an opt-out HIV test for a woman with undocumented HIV status at L&D, please call me at the number below or send an email, and we can provide one-on-one technical assistance to that facility.  There are only a handful of birthing hospitals that are not complying with 64D-3.042, and this is probably just an education issue.

Thank you so much for all you do on behalf of mothers and babies in Florida.   

Nita Harrelle
Florida Department of Health
Linkage Team Leader
Perinatal Prevention Coordinator
phone:  850-245-4444 ext. 2565