PCAP

New York State Department of Health Bureau of Women's Health Prenatal Care Assistance Program (PCAP)

Guidance for Submission of an Application for Designation as a Provider under the Prenatal Care Assistance Program (PCAP)

Background

To meet the health needs of low income and high risk women, New York State developed a comprehensive prenatal care program that ensures access to the full range of health and related services necessary to enable women to have the best possible pregnancy outcome. This program was developed in 1985 as a grant program for low income women not eligible for Medicaid. In 1990, it was transitioned to reimbursement through Medicaid for all women with incomes less than 185% of the poverty level. Legislation was passed amending the Public Health and Social Services Laws to extend Medicaid eligibility to pregnant women and infants up to one year of age who families have household incomes up to 185% of the federal poverty guidelines. The current eligibility guidelines effective November 1, 2000 include pregnant women who have household incomes up to 200% of the federal poverty level.

In addition, this legislation provided all eligible pregnant women with comprehensive prenatal care services and authorized the Commissioner of Health to set standards (10NYCRR. 85.40) for these services and to increase their availability. Any enrolled provider under the medical assistance (Medicaid) program may qualify as a comprehensive prenatal care service provider. (Original guidance related to provider approval was disseminated in Department of Health Memorandum 89-91 Application for Designation as a Comprehensive Prenatal Care Service Provider under the Prenatal Care Assistance Program.)

Applicant Requirements

Applications are accepted from qualified Article 28 providers of prenatal services to become eligible for Medicaid reimbursement as Comprehensive Prenatal Care Service Providers. Such providers will be responsible for the provision of comprehensive prenatal services including: outreach, presumptive eligibility screening, risk assessment, nutrition services, health education, psychosocial assessment, primary medical services, postpartum services, care coordination and quality assurance in accordance with the Part 85.40 standards set by the Department of Health for participation in this program. Abortion and abortion-related services are not available under the extended Medicaid program.

Eligible providers must agree to serve eligible service recipients and meet one of the following criteria:

  1. A medical care facility certified through Article 28 of the Public Health Law to provide ambulatory prenatal care services. Examples include neighborhood health centers, hospital outpatient departments, and local public health departments.
  2. A medical care facility certified through Article 28 which, prior to the time of application, has sought and is awaiting permission to deliver prenatal care services.
  3. An agency or facility whose application for establishment/construction (including the provision of prenatal services) under Article 28 is under review at the time of application.
    Under this criterion, an application may be submitted, but it will not be reviewed until site where prenatal care will be rendered has received final Article 28 approval.

Program Standards

All Article 28 facility-based providers of prenatal care must comply with minimum standards for ambulatory and prenatal care as found in Parts 405 and 750 of the State Hospital Code. All other providers enrolled in the New York State Medical Assistance program must comply with its standards. In addition, for the purposes of this program, providers must comply with Part 85.40 of 10 NYCRR and apply to become a designated comprehensive prenatal service provider.

Reimbursement

All Article 28 providers who have been designated as comprehensive prenatal service providers will be reimbursed for prenatal ambulatory services through a Medicaid visit rate schedule. Calculated rates can be found by clicking here.

Application Process

The Application for Comprehensive Prenatal Care Service Provider Participation in New York State's Prenatal Care Assistance Program must be completed by eligible providers and submitted with all required attachments.

Following the receipt and evaluation of applications from new providers, Department of Health regional staff will schedule a site visit to verify the representations of the applicant and the preparedness of the applicant to function in accordance with Section 85.40 requirements.

All applicants should forward three copies of their application to:

Perinatal Health Unit
Bureau of Women's Health
NYS Department of Health
ESP, Corning Tower Bldg. - Rm. 1805
Albany, New York 12237- 0621

Upon application approval, providers will be required to sign a written agreement with the Department of Health. Execution of the agreement will qualify the applicant for payment under the PCAP/Medicaid rates.

For additional information or assistance, contact Denise Hernas, Perinatal Health Unit, Bureau of Women's Health, of the Department of Health, (518) 474-1911.