The following services shall be covered, rendered singularly or in any combination during a calendar month, and in accordance with the recipient’s plan of care:

1. (a) Social services including:

   1. (1) An initial assessment;
   2. (2) Assisting the recipient in identifying her ongoing needs and referring her to appropriate services; and
   3. (3) Home visits;

2. (b) Care coordination between a recipient and any other individuals or agencies involved in the recipient’s care, including:

   1. (1) Communicating outcomes or status to appropriate providers;
   2. (2) Providing liaison assistance during the transition process to ongoing health, mental health, or social services;
   3. (3) Assisting with arrangements for transportation, childcare, or community services;
   4. (4) Making referrals to other agencies, programs, and community services, including the federal special supplemental food program for women, infants and children;
   5. (5) Follow-up to ensure the delivery of necessary services, including tracking missed appointments, rescheduling, and the identification and resolution of care barriers; and
   6. (6) Intra-agency consultations concerning the recipient’s care needs;

3. (c) Individual or group education including:

   1. (1) Education about the health implications of risk behavior, such as smoking, and use of alcohol and other drugs;
   2. (2) Education about infant health, mental health, and development, including positive parenting and its role in infant and child development; and
   3. (3) Individual instruction about the course of pregnancy, delivery and child care; and
4. (d) Nutritional services including:
5. (a) An initial assessment of the recipient’s current nutritional status;
6. (b) Nutritional counseling; and
7. (c) Assisting the recipient in identifying her ongoing needs and appropriate services.

Source. (See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99 New. #7036, eff 6-25-99; ss by #8904, eff 6-25-07; ss by #10914, eff 8-26-15