1124

NEW ZEALAND GAZETTE
No. 40

3.4 Services Following Birth

3.4.1 The Module identified as ‘Inpatient Postnatal Care’ may be claimed where the woman receives Inpatient Postnatal Care. The Module identified as ‘No Inpatient Postnatal Care’ may be claimed where the woman does not receive Inpatient Postnatal Care.

3.4.2 Where a Lead Maternity Carer utilises Hospital Midwifery Services, Health Benefits will pay the Hospital Midwifery Services directly and the Lead Maternity Carer will claim the fee payable for where a General Practitioner or Obstetrician has used Hospital Midwifery Services.

3.4.3 Where a woman changes her Lead Maternity Carer during the first five days following the Birth, the new Lead Maternity Carer is deemed to be the Lead Maternity Carer for Services Following Birth and the previous Lead Maternity Carer cannot claim payment for Services Following Birth. Where a woman changes her Lead Maternity Carer on or after the sixth day after the Birth, the first Lead Maternity Carer will receive 50% of the Services Following Birth fee while the new Lead Maternity Carer will receive 50% of the fee.

3.4.4 The payment for Rural Travel may be claimed by the Lead Maternity Carer (or the Hospital Midwifery Service if the Lead Maternity Carer uses Hospital Midwifery Services) where the woman’s Usual Place of Residence is in a domicile identified as semi rural, rural or remote rural as listed in Appendix VI. The semi rural, rural and remote rural fees are separate fees and not cumulative.

3.4.5 The payment for Additional Home Visits may be claimed once where the Lead Maternity Carer (or the Hospital Midwifery Service if the Lead Maternity Carer uses Hospital Midwifery Services) has provided twelve or more Home Visits.

3.4.6 Only one payment for Services Following Birth and one payment for Rural Travel will be paid per woman, except where the mother and baby have different residential addresses. Where two fees for Services Following Birth and Rural Travel are sought, details of the circumstances must be provided with the Claim. The birth mother’s NHI is to be provided with the baby’s Claim (or, if the birth mother’s NHI is unknown, the adopting or foster mother’s NHI).

See clause C4.5 for the service specification applying to these payment rules.

4.0 PAYMENT RULES FOR SINGLE SERVICE EPISODES

4.1 Assessment Prior to Termination of Pregnancy

This payment may only be claimed once per woman per pregnancy and may only be claimed by an Authorised Practitioner who is not the Lead Maternity Carer.

See clause C5.1 for the service specification to which these payment rules apply.

4.2 Pregnancy Care and Urgent Out of Hours Pregnancy Care

4.2.1 These payments may be claimed during the First Trimester.

4.2.2 These payments may only be claimed in the Second and Third Trimester by an Authorised Practitioner other than the Lead Maternity Carer where the Authorised Practitioner documents that:

(a) the woman is Away From Her Usual Place of Residence and the Lead Maternity Carer cannot reasonably have been expected to provide the service; or

(b) the woman is registered with a Lead Maternity Carer and the following circumstances exist:

• the woman requires Maternity Services in emergency circumstances; and