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check the file 

Talk about Maternity Care as global Health Policy. look at the Systems Model on the policy process,

Figure 1.3 (Problem Identification, Policy Formulation, Policy Implementation, Policy Evaluation) on page 36 in your textbook.

Write a paper with the purpose of overcoming the problems described by the four Rs (Reaction, Repetition, Results, and Raising Funds) on page 57.

Overcoming the Four Rs: Recommendations Overcoming problems of reaction, repetition, results, and raising funds requires the following. The first is strong leadership to articulate a short-and medium-term vision, galvanizing support for such a vision both inside and outside an institution, and diversifying the funding base of that organization. Such diversification of funding cannot, however, contradict the strategic vision of the institution or the leadership. Strong leadership requires the building of coalitions within the broad and expansive global health community and relying less on donors to outline policy objectives. Hence those articulating global health policy must be separate to those who fund health policy. This is not easily achieved, as donor soften want to know where their money is going, and private philanthropists seek to invest in those causes they deem to be the most worthwhile. Actors should play to their strengths and assert their experience, expertise, and legitimacy. Global policy-making needs to be less driven by global finance for health. Money is intrinsic for the delivery of drugs, education campaigns, medical supplies, construction of health centers, health worker training, and a whole host of issues. However, the need to generate, maintain, and increase funds should exist separately to policy-making, otherwise policy-making is more reactionary and less visionary and strategic. Second, key principles of public health – the right to health, distributive justice, questions of equality in access to healthcare, and how different people experience good or bad health–must be re-engaged with as a matter of policy practice (seeChapters4,10,12,25, and 28). Results-based frameworks and the need for a return on investment should not exclude such commitments and principles. One way of reintroducing these themes is to bring the public back into discussions on global health and making the private – including philanthropic organizations – subject to the same accountability and transparency structures as public bodies, whether governmental or intergovernmental. Whilst private actors may not be spending taxpayers’ money, they have considerable influence on the health of the world’s population. The plurality of actors and ideas is a unique and positive component of global health, yet such plurality needs to translate to decision- and policy-making and be held to account.

Third, global health policy must be designed in-country, by the government, as the elected government through public engagement and discussion sees fit. Global institutions such as the World Bank and the Global Fund should provide support through finance and as such can make recommendations, but such recommendations should not form the basis of conditional lending. Country-based agendas will make health strategies more context specific, will reduce the burden on state-based health agencies that often have to juggle competing donor demands, and will avoid repetition in the formation of health policy. Focusing on country-based strategies will invert current structures of policy-making so that implementers of policy at the local level become the policy formulators and those who currently make policy at the global level concentrate on working with countries on effective implementation.

Assume the role of the leader who will be building a coalition by creating a policy vision for the internal and external stakeholders of your geographical area or country. First, begin by identifying the deficiencies in a global policy that you have researched so that you can establish a policy vision by determining the needed funding for the services you feel must be provided and including that in the policy. Explain how your policy would benefit your target population. Include the following headings/sections in your submission:

· Introduction—Describe the population affected by the policy

· Deficiencies of—Name of Global Policy

· Vision of Changes—Needed what needs to change to make the policy better

· Gaining Support for the Vision—Internal and external

· Needed Funding—Where will funding come from for services discussed in the policy

· Conclusions

· References

Your paper should meet the following requirements:

· Be 4 pages in length, not including the cover or reference pages.

· Provide support for your statements with in-text citations from a minimum of 8 scholarly articles.

· Be formatted according to APA writing guidelines.

· Remember to utilize headings to organize the content in your work

Use the following references:

Bruen, C., & Brugha, R. (2014). A ghost in the machine? Politics in global health policy.

International journal of health policy and management, 3(1), 1.

Ishola, F., Owolabi, O., & Filippi, V. (2017). Disrespect and abuse of women during childbirth in Nigeria: A systematic review. PloS one, 12(3), e0174084.

Freedman, L. P., & Kruk, M. E. (2014). Disrespect and abuse of women in childbirth:

challenging the global quality and accountability agendas. The Lancet, 384(9948), e42-e44.

Pyone, T., Smith, H., & van den Broek, N. (2017). Implementation of the free maternity services policy and its implications for health system governance in Kenya. BMJ global health, 2(4), e000249.

Miltenburg, A. S., Lambermon, F., Hamelink, C., & Meguid, T. (2016). Maternity care and Human Rights: what do women think?. BMC international health and human rights, 16(1), 17.

Koblinsky, M., Moyer, C. A., Calvert, C., Campbell, J., Campbell, O. M., Feigl, A. B., … & McDougall, L. (2016). Quality maternity care for every woman, everywhere: a call to action. The Lancet, 388(10057), 2307-2320.

Benoit, C., Declercq, E., Murray, S. F., Sandall, J., Van Teijlingen, E., & Wrede, S. (2015).

Maternity care as a global health policy issue. In The Palgrave International Handbook of Healthcare Policy and Governance (pp. 85-100). Palgrave Macmillan UK.

Bruen, C., & Brugha, R. (2014). A ghost in the machine? Politics in global health policy.

International journal of health policy and management, 3(1), 1.

Freedman, L. P., & Kruk, M. E. (2014). Disrespect and abuse of women in childbirth:
challenging the global quality and accountability agendas. The Lancet, 384(9948), e42-e44.

Vermeiden, T., & Stekelenburg, J. (2017). Maternity waiting homes as part of an integrated

program for maternal and neonatal health improvements: Women’s lives are worth saving. Journal of Midwifery & Women’s Health, 62(2), 151-154.

Global Maternity Payment Policy
Policy number M.OBG.04.120301, effective 01/01/2017

Page 1

Global Maternity

Maternity care services rendered by licensed providers are covered. This includes prenatal care, false
labor, delivery, and postnatal care.

Global Maternity Care is reported when a physician from an individual or group practice provides the global
routine obstetric care, which includes the antepartum care, delivery, and postpartum care. Providers are
reimbursed a global payment for the total physician services related to the pregnancy from the initial
diagnosis of the pregnancy until the end of the postpartum period. The provider is reimbursed at the global
fee for all physician services regardless of the number of office visits or possible complications with the
pregnancy.

Note:
Other visits or services within the antepartum care, such as diagnostic tests, laboratory services (excluding
urinalysis), and radiology services are covered separately or as defined in the Medical Benefits Guide.

A. The following services are included in the global obstetrical package related to both vaginal and
Cesarean delivery and will not be reimbursed separately when performed by the OB provider.

1. All prenatal visits, including history and physical examinations

2. Urinalysis, initial and subsequent (CPT codes 81000, 81001, 81002, 81003, 81005)

3. Labor and delivery (vaginal and Cesarean section) services including, but not limited to
induction and any internal or external fetal monitoring performed and any obstetrical
administered anesthesia except those services otherwise listed (CPT codes 59400, 59510,
59610, 59618)

4. Initial evaluation and resuscitation of the newborn by the obstetrician

5. Episiotomy (CPT code 59300)

6. All postpartum care through 6 weeks, including suture removal, Pap smears and discussions
on birth control (CPT codes: Q0091 Pap and 99401 birth control counseling)

7. Supervision of labor

8. Delivery of placenta (CPT 59414)

B. The following services are not included in the global obstetrical package and are reimbursed
separately:

1. Professional component of ultrasounds when deemed medically necessary (CPT codes
76801, 76802, 76805, 76810, 76811, 76812, 76815, 76816 76817, 76825, 76826, 76827,
76828, 76945, 76946)

2. Technical component of ultrasounds (CPT code 76801, 76802, 76805, 76810, 76811, 76812,
76815, 76816 76817, 76825, 76826, 76827, 76828, 76945, 76946)

I. Policy

II. Definitions

III. Reimbursement Guidelines

Global Maternity Payment Policy
Policy number M.OBG.04.120301, effective 01/01/2017

Page 2

3. Fetal biophysical profile (CPT code 76818, 76819)

4. Fetal nuchal translucency (CPT code 76813, 76814)

5. External cephalic version (CPT code 59412)

6. Chorionic villus sampling, any method (CPT 59015)

7. Circumcision (CPT code 54150, 54160)

8. RhoGAM injection (CPT code 90384, 90385, 90386)

9. Cervical cerclage (CPT code 59320, 59325)

10. Postpartum D&C (CPT code 59160)

11. Antenatal inpatient medical care for medical complications of pregnancy. Bill the inpatient
codes CPT codes 99221-99233 as appropriate

12. Other laboratory tests not including urinalysis

13. Observation or inpatient hospital care (CPT code 99217, 99218, 99219, 99220, 99234, 99235,
99236, G0378) not resulting in delivery during the same admission

14. Payment for non-obstetrical services provided by an obstetrician during the pregnancy

15. Tubal ligation performed alone (CPT codes 58600, 58605, 58611, 58615, 58617), or in
conjunction with Cesarean or normal vaginal delivery in accordance with standard payment
practice

16. Transabdominal amnioinfusion, including ultrasound guidance

17. Antepartum services:

a) Amniocentesis; diagnostic

b) Amniocentesis; therapeutic amniotic fluid reduction, includes ultrasound guidance
(CPT code 59001)

c) Fetal contraction stress test (CPT 59020, 59025)

d) Fetal non-stress test (CPT 59025)

18. Cordocentesis (intrauterine), any method (CPT 59012)

19. Fetal monitoring during labor by consulting physician

A. Documentation must be clear, legible and maintained in the patient’s medical record and must be made
available to UHA upon request. UHA reserves the right to perform retrospective review using the
criteria specified in this policy to validate if services rendered met medical necessity and/or if claims
submitted follow the specified reimbursement guidelines.

A. Claims for global obstetric care should be submitted with one global obstetric code (59400, 59510,
59610, or 59618). When separate claims are submitted irrespective of the number of providers for
prenatal delivery or postnatal services UHA will pay the individual claims separately up to the amount
that would have been paid for the global fees.

B. UHA understands that as a result of an occasional patient changing providers or eligibility issues, care
might be provided on an episodic basis by more than one provider.

I. Administrative Guidelines

II. Billing/Coding Guidelines

Global Maternity Payment Policy
Policy number M.OBG.04.120301, effective 01/01/2017

Page 3

1. If a provider renders all or part of the antepartum/prenatal and/or postpartum patient care but
does not perform the delivery, submit claims using the following guidelines:

a) For the provision of one to three antepartum visits, bill the appropriate evaluation and
management code (new patient 99201-99205, established patient 99211– 99215)
and the appropriate diagnosis, also append with the modifier TH.

b) For the provision of four to six antepartum visits, bill CPT code 59425 (Antepartum
care only; 4 to 6 visits). One unit of service is billed with code 59425 and is inclusive
of all four to six visits. Bill one line of service indicating the applicable start and
through dates.

c) For the provision of seven or more antepartum visits are performed, bill CPT code
59426 (Antepartum care only; 7 or more visits). One unit of service is billed with code
59426 and is inclusive of seven or more visits. Bill one line of service indicating the
applicable start and through dates.

d) For postpartum care, bill CPT code 59430 (Postpartum care only).

2. If a provider renders delivery services only, submit claims using one the following guidelines:

a) CPT code 59409 for vaginal delivery

b) CPT code 59514 for Cesarean section delivery

c) CPT code 59612 for vaginal delivery after previous Cesarean section

d) CPT 59620 for Cesarean section delivery following attempted vaginal delivery after
previous Cesarean section

3. Billing for Multiple Gestation Deliveries

a) When billing the global maternity fee for multiple gestation deliveries, the provider
should use the appropriate CPT code (59400 or 59610 for vaginal delivery or 59510
or 59618 for cesarean delivery) and add a modifier 22. The diagnosis indicated in
block 21 of the CMS 1500 claim form should reflect the multiple birth (e.g., 651.01 to
represent twins) and a comment should appear in block 19 (e.g., twins or triplets).

C. UHA understands that as a result of a change in circumstances of the member, maternity care might be
covered by more than one insurance carrier. Global obstetric care coding would not apply in these
instances.

1. If a provider renders only a portion of the antepartum/prenatal and/or postpartum patient care
for a member while covered by UHA, submit claims using the following guidelines:

a) For the provision of one to three antepartum visits while patient is a UHA member, bill
the appropriate evaluation and management code (new patient 99201-99205,
established patient 99211– 99215) and the appropriate diagnosis, also append with
the modifier TH.

b) For the provision of four to six antepartum visits while patient is a UHA member , bill
CPT code 59425 (Antepartum care only; 4 to 6 visits). One unit of service is billed
with code 59425 and is inclusive of all four to six visits. Bill one line of service
indicating the applicable start and through dates.c) For the provision of seven or
more antepartum visits while patient is a UHA member, bill CPT code 59426
(Antepartum care only; 7 or more visits). One unit of service is billed with code 59426
and is inclusive of seven or more visits. Bill one line of service indicating the
applicable start and through dates.

c) For postpartum care, bill CPT code 59430 (Postpartum care only).

Global Maternity Payment Policy
Policy number M.OBG.04.120301, effective 01/01/2017

Page 4

III. Policy History

Policy Number: M.OBG.04.120301

Current Effective Date: 01/01/2017

Original Document Effective Date: 03/01/2012

Previous Revision Dates: 12/01/2013, 01/01/2017

PAP Approved: 03/01/2012

HCR_MPP-0208-010117