Nurse‑Family Partnership (NFP) nurse visiting services — coverage criteria
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Defines Alabama Medicaid coverage, provider requirements, recipient eligibility, documentation, visit expectations, and billing rules for Nurse‑Family Partnership nurse visiting services for eligible pregnant recipients and through the infant's second birthday.
No material clinical or coverage changes in this revision.
Coverage and Visit Requirements
Covered NFP Services
Covered when ALL of the following are met
Must meet NSO model eligibility requirements as outlined in the Alabama Medicaid Provider Billing Manual
Billing providers must be NSO network partners approved to implement NFP within specific regions and have a current Annual Fidelity Support Letter on file with the Agency.
Case management activities must include comprehensive assessment, development and periodic revision of an individualized care plan, referrals and related activities, and periodic reassessment as specified in policy.
Visit and Billing Criteria
Billing allowed when ALL of the following are met
Monthly documentation of active recipient participation and provider engagement is required.
Provider agrees to accept Medicaid payment as payment in full for covered NFP services.
Medicaid will not reimburse for direct care services rendered by an NFP provider; such services must not be billed under NFP.
Medicaid will not reimburse for direct care services provided by an NFP provider. Examples of excluded direct care services include, but are not limited to, wound care and medication administration. Claims for NFP services that include these direct care activities will be denied.
Provider Requirements, Enrollment, and Documentation
Referral and recipient eligibility required
NFP services are available only for Medicaid-eligible persons who have been referred to a qualified, Agency-enrolled NFP provider by the recipient's assigned Alabama Coordinated Health Network (ACHN) and who meet the NFP model eligibility requirements established by the NSO and outlined in the Alabama Medicaid Provider Billing Manual.
Provider enrollment and current fidelity letter required
Billing providers must be NSO network partners approved to implement the NFP Program within the specific region(s) and must have a current Annual Fidelity Support Letter on file with the Agency before billing for NFP services.
Maintain complete NFP records and provide access for audits
Providers must maintain complete and accurate NFP records and make them available to Alabama Medicaid for claims audit, program monitoring, and utilization review; records must be retained for the period required by State and Federal law.
- Required record elements: recipient name; recipient Medicaid ID; NFP Client ID; dates of service; provider agency name and person providing services; nature, start and end time, extent or units of services provided; place(s) of service; weeks of gestation or weeks postpartum at time of visit.
- Make all information describing services provided available to the Agency at no charge and permit access to records and facilities for authorized Federal and State representatives.
Direct care services by NFP providers are non-reimbursable
Medicaid will not reimburse for direct care services provided by an NFP provider; claims for services such as wound care or medication administration rendered by an NFP provider will be denied.
- Examples of excluded direct care services: wound care, medication administration.
Key Definitions
Program Background
The Nurse‑Family Partnership (NFP) is an evidence‑based nurse home visiting model delivering tailored care coordination, assessments, case management, and preventive education during pregnancy, the postpartum period, and through the child’s second birthday. Services may be provided in‑home, via telehealth, or in community settings as appropriate and are focused on improving maternal and child health outcomes.
NFP participation under Alabama Medicaid requires that the recipient be Medicaid‑eligible and referred to an Agency‑enrolled NFP provider by the recipient’s assigned Alabama Coordinated Health Network (ACHN). Billing providers must be NSO network partners approved to implement NFP in their region and must maintain a current Annual Fidelity Support Letter on file with the Agency.
NFP services are organized into maternal (prenatal/postpartum) and maternal/infant phases, with coverage through the infant’s second birthday (up to 24 months). Providers may submit one claim per month for NFP services, but at least one qualifying visit (in‑person or via telehealth) must occur before the monthly claim is submitted; monthly documentation of active participant engagement is required.
Providers are expected to accept Medicaid payment as payment in full for covered NFP services and must ensure program fidelity and required documentation to support coverage and billing.
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