Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Acute Inpatient Hospital Bulletin 114
March 1999

TO:      Acute Inpatient Hospitals Participating in MassHealth

FROM:      Bruce M. Bullen, Commissioner

RE:      CHANGES TO THE NOTIFICATION OF BIRTH (NOB-1) FORM

Background                     The Health Care Financing Administration (HCFA) requires that the Division report, on an annual basis, the incidence of low birthweight of infants born to mothers enrolled in MassHealth.  HCFA also requires that low birthweight be reported by race.  Previously, the reporting of race was optional.

The Division will use the Notification of Birth (NOB-1) form to gather this information.  This form is used by hospitals and managed-care organizations (MCOs) participating in MassHealth to notify the Division when a MassHealth member has given birth to a child who may be eligible for MassHealth.

Revisions to the               To comply with HCFA requirements, the Division has revised the NOB-1
NOB-1 and                       form and its instructions.
Instructions
·   A block has been added to report the weight of the newborn at the time of the delivery.  You may report the birthweight in either pounds and ounces or grams.

·   Reporting a newborn’s race is no longer optional.  The code options for race have been expanded and are listed in the instructions on the back of the NOB-1.  Enter Code 9 if the child’s race is unknown or not reported.

Supplies                            A copy of the revised NOB-1 is attached for your reference.  Supplies of the revised NOB-1form, which is printed in two-page, NCR format, will be available after May 1, 1999, and may be obtained by sending or faxing a written request for form # AIH-001 (Rev. 03/99) to:

MassHealth
Acute Inpatient Hospital Bulletin 114
March 1999
Page 2

Supplies                                     Unisys
(cont.)                                       ATTN:  Forms Distribution
P.O. Box 9101
Somerville, MA  02145
Fax:  (617) 576-4087

Obsolete NOB-1s will not be accepted after May 31, 1999.

Questions                         If you have any questions about the revised NOB-1, please call the NOB Unit at (413) 785-4100 or 1-800-332-5545, or fax your questions to (413) 785-4180.