healthy moms healthy babies care coordination (pilot)

Michigan Department of Health and Human Services

Maternal Infant Health Program

MDHHS-5957 (5-21)

Agency:	Month/Year:

Beneficiary	Medicaid ID	Time	Care Coordination Activity	Topic(s) Addressed

Communication with Medical Care Provider Medicaid Health Plan Community Resource Other	Non-billable contact Case conference Research to support plan/care Reflective Supervision	Documented in chart Additional topic(s):
Communication with Medical Care Provider Medicaid Health Plan Community Resource Other	Non-billable contact Case conference Research to support plan/care Reflective Supervision	Documented in chart Additional topic(s):
Communication with Medical Care Provider Medicaid Health Plan Community Resource Other	Non-billable contact Case conference Research to support plan/care Reflective Supervision	Documented in chart Additional topic(s):
Communication with Medical Care Provider Medicaid Health Plan Community Resource Other	Non-billable contact Case conference Research to support plan/care Reflective Supervision	Documented in chart Additional topic(s):
Communication with Medical Care Provider Medicaid Health Plan Community Resource Other	Non-billable contact Case conference Research to support plan/care Reflective Supervision	Documented in chart Additional topic(s):
Communication with Medical Care Provider Medicaid Health Plan Community Resource Other	Non-billable contact Case conference Research to support plan/care Reflective Supervision	Documented in chart Additional topic(s):

The Michigan Department of Health and Human Services will not exclude from participation in, deny benefits of, or discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, gender identification or expression, sexual orientation, partisan considerations, or a disability or genetic information that is unrelated to the person’s eligibility.