The policy explicitly identifies several services provided by home health vendors that are considered not medically necessary when billed as part of obstetrical home care. These include multiple repeat courses or intermittent injections of betamethasone, management of multiple gestations (refer to individual program risk factors), continuous heparin infusion therapy, member-administered nonstress tests or fetal heart rate monitoring, management of preterm prelabor rupture of membranes (PPROM), preterm labor management, and 17-hydroxyprogesterone caproate (Makena) injections.

Preeclampsia with severe features is explicitly excluded from home management and requires inpatient care. The policy notes that home visits and remote monitoring apply to selected cases such as preeclampsia without severe features, but members with preeclampsia with severe features are not eligible for home management and should be managed in an inpatient setting.

This clinical policy is a guidance document to assist in coverage decision-making and benefit administration; it does not constitute medical advice, medical treatment, or medical care and is not intended to dictate how providers practice. Providers must exercise professional medical judgment in caring for members/enrollees and are solely responsible for medical advice and treatment decisions.

Services listed in the policy under exclusions are treated as not medically necessary when provided by a home health vendor. These specifically include: repeated betamethasone courses or intermittent antenatal corticosteroid injections, home management for multiple gestations, continuous heparin infusion, patient-administered NST or fetal monitoring, PPROM management, preterm labor management, and 17-hydroxyprogesterone caproate (Makena) injections.

Administration of 17-hydroxyprogesterone caproate (17-OHPC, Makena) nursing visits was removed from the policy criteria. The background and revision notes record ACOG’s statement and the FDA action proposing withdrawal of 17-OHPC for prevention of recurrent preterm birth; following these developments the policy removed Makena administration visits from covered home health services.

Obstetrical homecare programs provide risk assessment, education, case management and in‑home clinical services for pregnant members at increased risk. Typical program components include an obstetrical nurse assessment performed in the home when delivered with specified services (e.g., infusion therapy, hydration, diabetes or hypertensive disorder management, dietary analysis); condition‑specific monitoring such as remote blood pressure measurement for hypertensive disorders; targeted interventions including IV hydration (commonly 1–4 liters per visit) and home infusion of antiemetics or insulin when indicated; and coordination of care with the ordering provider and obstetric team.

Clinical guidance and evidence considered in developing this policy include ACOG practice guidance and committee opinions along with peer‑reviewed literature. Representative sources cited in the reference list include ACOG Practice Bulletin No. 189 on Nausea and Vomiting of Pregnancy and ACOG Committee Opinion documents (for example, outpatient antenatal fetal surveillance guidance). The policy’s reference list and background review reflect these and other clinical publications used to inform criteria and program design.

This policy is owned by the Health Plan and was developed by clinicians and reviewers. It is consistent with generally accepted standards of medical practice at the time of approval but does not supersede contract terms. For Medicaid members, state Medicaid coverage provisions take precedence where they conflict with this policy; for Medicare members, applicable NCDs, LCDs and Medicare Coverage Articles should be reviewed prior to applying these criteria. The Health Plan retains the right to change or withdraw this policy and plan‑level administrative procedures may require prior authorization as determined by the Health Plan.