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From the CEO’s Desk
						
				
				
						
								
										Clarification of the revised Section 88 Maternity 
								
								
										Notice: Due for Implementation 1 July 2007 
						
						
						
				
				Anne Whyte and I were fortunate to be able to recently spend some time with 
				a number of the Ministry of Health team who are actively involved with the 
				implementation of the new Section 88 Maternity Notice. We thank the Ministry 
				representatives for their time. It was very useful as we obtained clarification of 
				a number of areas of concern for members together with information 
				regarding the implementation.
				
						
								Continuity of Care 
						
						It is clear the model of care continues to be one in which all maternity care is 
						delivered through an LMC. It is also clear there is an expectation each LMC 
						shall have adequate back up arrangements.
				
				
						As set out in the Guide to the Notice the new "Notice” (2007) does recognise 
						and codifies current realities of group practice . Where LMCs work in a group 
						the members of the group back each other up. In such a context, it was 
						expected the LMC would make their women aware of the arrangements and 
						ensure, so far as possible, the women met the potential back ups during the 
						antenatal period.
				
				
						There is, however, no change to the expectation that the LMC provides 
						continuity of care through out pregnancy , labour and birth and the postnatal 
						period. LMCs cannot therefore work in “shifts” as such a practice is in conflict 
						with the obligation to provide continuity of care from an individual LMC. The 
						MOH accepted the workforce shortage in some areas may mean an LMC may 
						call for their back up but the back up may not be available (e.g. as they are 
						already committed elsewhere).
				
				
						We specifically asked MOH regarding the use of a medical call centre staffed by 
						nurses to manage and triage calls to LMCs (as many GPs, especially rural GPs, 
						use to manage their after hours calls). The MOH were adamant the use of such
						
								a service would not be acceptable to them. We asked about the situation 
								where an LMC could call for their back up when they felt unsafe due to the 
								hours they had worked (e.g. an extended labour over 12 hours) and the back 
								up was unavailable. The MOH indicated the LMC should, in such cases, 
								negotiate with the facility to hand over care based on the needs of the woman 
								and the individual circumstances.
						
				
		
		
				
						Authorisation 
				
		
		The new notice requires all LMCs to be authorised by MOH before starting in 
		practice as an LMC. We were advised the process for authorisation will 
		essentially be the same process as is currently used by LMCs when they apply 
		for the HealthPAC agreement and PAYE numbers.
		
				
						We were advised all existing LMCs who hold a HealthPAC agreement and PAYE 
						number will automatically be granted an authorisation effective 1 July 2007.
				
		
		
				It was noted authorisations will be tied to DHB regions to assist MOH to 
				manage the interdistrict funding flows. This will not normally affect an LMC so 
				long as the bulk of their practice is in one DHB region. It is accepted by MOH 
				this may be more of an issue in areas like Auckland and Wellington where there 
				are DHBs in close proximity. If an LMC’s practice is such more than 50% of their 
				women are from a DHB region to which their authorisation is not linked, the 
				LMC may need to obtain a second authorisation and separate their claims so 
				they are submitted according to the DHB region (and therefore the 
				authorisation) in which the woman resides. This is expected to be rare.
		
		
				
						National Immunisation Register (NIR) 
				
		
		While the Notice appears to require all LMCs to advise the NIR of all deliveries, 
		MOH advised the requirement for birthing facilities to notify the NIR is still in 
		place. MOH advise the responsibility of the LMC is to ensure the facility does 
		provide the required information to NIR.
		
				
						Where circumstances are such the facility does not notify NIR or for home 
						
								births, the LMC is responsible to ensure NIR receive the information required.
						
				
		
		
				
						First and Second Trimester. 
				
		
		
				As everyone is aware, the service specification and payment rules for the first 
				and second trimester have changed significantly.
		
		
				
						MOH advised if an LMC should see a woman to provide what was previously a 
						single service episode (e.g. threatened miscarriage in first trimester), the fee to 
						be claimed will be the first partial payment for the first and second trimester.
				
		
		
				
						MOH advise the revised rules allow for more than one LMC to see a woman in 
						the first and second trimester and still be paid for services provided.
				
				
						
								For example: 
								In this case:
						
				
		
		
				
						
								<img height="138" alt="table.bmp" src="/images/imagegallery/table.bmp" width="482" border="0" />
						
				
		
		
				
						
								
										LMC 1 would receive the first partial payment of $196.88 (GST incl.)
								
						
						
								
										LMC 2 would receive the first partial payment of $196.88 (GST incl.)
								
						
						
								
										LMC 3 would receive payment for the complete module of $337.50 (GST incl.)
								
						
				
				
						
								In this second case:
						
				
				
						
								<img title="table4" height="86" alt="table4.bmp" src="/images/imagegallery/table4.bmp" width="482" border="0" />
						
				
				
						
								
										LMC 1 would receive the first partial payment of $196.88 (GST incl.)
								
						
						
								
										LMC 2 would receive payment for the complete module of $337.50 (GST incl.)
								
						
						
								
										LMC 3 would receive the second partial payment of $140.62 (GST incl.)
								
						
						
								This is very good news for LMCs as it means the LMC does not lose funding when the woman transfers care at any time during the first and second trimesters. 
						
						
								The examples above assume the LMCs are not employed by or contracted to the same maternity provider (e.g. a PHO). In that case, the maternity provider is entitled to only one payment per service provided, even if that service is provided by more than one LMC. 
						
				
				
						
								Non
						
						‐ LMC Payments 
				
		
		Generally, an LMC will not be able to claim a payment for services as specified in the non LMC section of the new Notice.
		
				The only exception appears to allow LMCs to claim for urgent pregnancy carewhere they see a woman whose residence and LMC are in a different region.
		
		
				
						Deadlines 
				
		
		It is important to note registrations must be submitted within 20 working days of the woman being registered. 
		
				
						Also, the new Notice reiterates the requirement all claims: 
				
		
		Can only be submitted when the module claimed for is completed. 
		
				For example the postnatal module claim can only be submitted when the module is complete including the referrals to well child and primary care services.
		
		
				It must be submitted within six months of the service being completed. Claims submitted after this date will have a penalty of 10% deducted.
		
		
				
						Services being provided at the implementation date 
				
				MOH have clarified the effective date for determining whether a claim is paid at the scale to 30 June or at the scale from 1 July is the date on which the service was completed.
		
		
				That is, if the second trimester ends on 30 June, the fee payable will be the fee at the current scale. If the second trimester ends on 1 July, the fee payable will be the fee due under the new Notice.
		
		
				
						
								Please note claims submitted after 1 July without the new authorisation number will be rejected.
						
				
		
		
				Implementation 
		
		We advise ACIT is working closely with HealthPAC to ensure a smooth transition to the new Notice on 1 July. We will update members on progresscloser to the date.
		
				MOH plan to generate the new agreement number at the end of the second week in May and then send out a covering letter to all agreement holders. Attached to the letter will be: 
		
		• a copy of the Notice • a guide to the Notice • a pad with a single copy of each form to be used when claiming under the new Notice • a user guide for completing the forms • an error code booklet identifying the errors which will cause rejection under the rules of the new Notice
		
				We ask all members to advise us as soon as they receive their new authorisation number so we can update our system ready for the changeover on 1 July. 
		
		
				
						Please note claims submitted after 1 July without the new authorisation number will be rejected. 
				
				
						Other Issues
				
				
						Transfer of Section 88 Maternity Services Notice funding to DHBs 
				
		
		We asked MOH for information regarding the possible transfer of funding to DHBs and the changes which might arise as a result.
		
				We were advised by MOH they could not comment on the subject as the possible transfer of funding to DHBs is still being considered and will need to be submitted to Cabinet before any action is taken.
		
		
				
						
								We were advised it was unlikely the issue would be considered by Cabinet 
								within the next two months.
						
				
				
						
								Transfer of maternity funding to PHOs 
						
				
				There is no intent currently to transfer primary maternity funding to PHOs. 
				Some midwives may currently be employed by PHOs but the PHO will continue 
				to claim from the Notice in the same way.
				
						While we cannot, at this time, see any benefit to LMCs which would make 
						joining a PHO a desirable option. However, we have insufficient information 
						on which to base any informed discussion.
				
				
						We will continue to look at this issue and update members as more information 
						becomes available.
				
				
						
								Maternity Providers 
						
				
				Under the new Notice, a maternity provider is defined as someone who 
				provides maternity care and this may be an individual LMC, a group of LMCs, a 
				PHO or some other organization, providing they meet the criteria in the Notice.
				
						The Board will be considering whether changing the nature and structure of 
						SAMCL from our current status of a claims management and support 
						organisation to the status of maternity provider is desirable.
				
				
						There are a number of factors to be considered and these will be discussed in a 
						future issue of Tall Poppies.
				
				
						No decision on this subject will be made until members have been given the 
						opportunity to discuss the implications and express their preferences.
				
				
						If any member has any specific question they would like to ask, 
						please contact me accordingly.
				
				
						
								Tony Mansfield 
								CEO