CurrentAlabama MedicaidPolicy N/A

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.

Policy Summary

PayerAlabama Medicaid

PolicyNurse‑Family Partnership (NFP) nurse visiting services — coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 22, 2022

Last ReviewAug 14, 2022

Next Review DateN/A

Key ActionEnsure recipients are referred by their assigned ACHN to an Agency‑enrolled NFP provider and document at least one qualifying visit before submitting a monthly claim.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

through 24 monthsDuration of coverage

monthlyClaim frequency

≥1 visitMinimum visits before claim

monthlyDocumentation cadence

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CurrentAlabama MedicaidPolicy N/A

Nurse‑Family Partnership (NFP) nurse visiting services — coverage criteria

Customize your policy alerts

Sign up for all Alabama Medicaid policy alerts

Know when Alabama Medicaid releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerAlabama Medicaid

PolicyNurse‑Family Partnership (NFP) nurse visiting services — coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 22, 2022

Last ReviewAug 14, 2022

Next Review DateN/A

Key ActionEnsure recipients are referred by their assigned ACHN to an Agency‑enrolled NFP provider and document at least one qualifying visit before submitting a monthly claim.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

through 24 monthsDuration of coverage

monthlyClaim frequency

≥1 visitMinimum visits before claim

monthlyDocumentation cadence

Coverage and Visit Requirements

Covered NFP Services

Covered when ALL of the following are met

Eligibility and Referral: Recipient is Medicaid-eligible and referred to a qualified, Agency-enrolled NFP provider by the recipient's assigned Alabama Coordinated Health Network (ACHN)

Must meet NSO model eligibility requirements as outlined in the Alabama Medicaid Provider Billing Manual

Provider Requirements: Billing provider is an NSO network partner approved for the region with a current Annual Fidelity Support Letter on file

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.

Service Phases and Required Activities: Services are provided during prenatal/postpartum (Maternal Only Phase) and through the infant's second birthday (Maternal/Infant Phase)up to infant age 24 months

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

Qualified Visit: At least one qualifying NFP visit (in-person at home or other recipient-chosen location, or via telehealth when appropriate) must occur prior to submission of a monthly claim>=1 visit before claim

Monthly documentation of active recipient participation and provider engagement is required.

Claim Frequency and Payment: Provider may submit one claim per month for NFP services1 claim/month

Provider agrees to accept Medicaid payment as payment in full for covered NFP services.

Excluded Services: Claims do not include direct care services such as wound care or medication administration

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

Prior Authorization

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.

Step Therapy

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.

Key Definitions

Qualified NFP visit

DefinitionA contact with the recipient in-person at their home or other chosen location or via telehealth when appropriate.

Documentation frequencyMonthly documentation of active recipient participation and provider engagement is required.

Visit settingVisits may occur in the home, via telehealth, or in an alternative community setting as indicated by client need.

Minimum visit for billingAt least one qualifying visit (in-person or via telehealth) must occur prior to monthly claim submission.

PurposeSupports care coordination, assessments, case management, and preventive health education during pregnancy and through the infant's second birthday.

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.