Section 29-941. MEDICAID BIRTH CENTER SERVICES AND REIMBURSEMENT

 

941.1These rules establish standards governing Medicaid reimbursement for the delivery of services provided to Medicaid beneficiaries at freestanding birth centers located in the District of Columbia.

 

941.2A freestanding birth center, eligible for Medicaid reimbursement shall be:

 

(a)Licensed in accordance with the Health-Care and Community Residence

Facility, Hospice and Home-Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code, §§ 44-501, et seq. (2005 Repl. &  2012 Supp.)) and implementing rules; and

 

(b)Enrolled by DHCF as a Medicaid provider of birth center/maternity center services.

 

941.3Services eligible for Medicaid reimbursement provided at a freestanding birth center shall be delivered by a:

 

(a)Physician licensed in accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2007 Repl. & 2012 Supp.)); 

 

(b)Pediatric Nurse Practitioner who is licensed as a registered nurse pursuant to the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2007 Repl. & 2012 Supp.)), and certified by the National Board of Pediatric Nurse Practitioners or the Pediatric Nursing Certification Board (PNCB);  

 

(c) Family Nursing Practitioner who is licensed as a registered nurse pursuant to the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2007 Repl. & 2012 Supp.)) and credentialed as a Family Nurse Practitioner- Board Certified (FNP-BC);

 

(d)Nurse Midwife who is licensed as an advanced practice registered nurse pursuant to the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2007 Repl. & 2012 Supp.)), and certified by the American Midwifery Certification Board (AMCB); or

 

(e)Certified Professional Midwife who is certified pursuant to the American Midwifery Certification Board (AMCB).

 

941.4Services eligible for Medicaid reimbursement provided at a freestanding birth center shall be provided:

 

(a)To beneficiaries in an outpatient setting;

 

(b)By a facility that is not a part of a hospital; and

 

(c)By or under the direction of a physician.

 

941.5Services eligible for Medicaid reimbursement provided at a freestanding birth center shall consist of the following:

(a)Routine ante-partum care;

 

(b)Delivery; and

 

(c)Postpartum care.

 

941.6Medicaid reimbursement for routine ante-partum care in any trimester shall include the following:

 

(a)Initial and subsequent medical history;

 

(b)Physical examination;

 

(c)Recording of fetal heart tones;

(d)Recording of weight and blood pressure;

 

(e)Routine chemical urinalysis; and

 

(f)Maternity counseling.

 

941.7Medicaid reimbursement for delivery services shall include:

 

(a)Admission history and physical examination;

 

(b)Management of uncomplicated labor; and

 

(c)Vaginal delivery.

 

941.8Medicaid reimbursement for postpartum care shall include:

 

(a)Mother’s postpartum check within six (6) weeks after birth;

 

(b)Newborn screening test which consists of a screening panel which shall include, but not be limited to:

 

(1)Phenylketonuria (PKU);

 

(2)Congenital Adrenal Hyperplasia (CAH);

 

(3)Congenital hypothyroidism;

 

(4)Hemoglobinopathies;

 

(5)Biotinidase deficiency;

 

(6)Maple Syrup Urine Disease (MSUD);

 

(7)Homocystinuria; and

 

(8)Galactosemia.

 

(c)A well baby check or newborn assessment to include two separate screenings for a newborn on two separate dates of service.

 

941.9Medicaid reimbursement for services for normal, uncomplicated pregnancies shall be limited to fourteen (14) ante-partum visits. These visits shall occur in the following manner:

 

(a)Monthly visits up to twenty-eight (28) weeks gestation;

 

(b)Thereafter, biweekly visits up to thirty-six (36) weeks gestation;

 

(c)Thereafter, weekly visits until delivery.

 

941.10In order to be eligible for Medicaid reimbursement, additional birth center visits, beyond the requirements set forth in § 941.9 shall be deemed medically necessary and require prior authorization.  

 

941.11Reimbursement rates for birth centers and practitioners delivering birth center services shall be published on the DHCF website at www.dhcf.dc.gov.

 

 

941.99 DEFINITIONS

  

For purposes of this chapter, the following terms shall have the meanings ascribed:

Ante-partum care - Care delivered to a pregnant patient during the period before childbirth.

 

Gestation - The period of development in the uterus from conception until birth.

 

Outpatient - A patient who receives medical treatment without being admitted to a hospital.

 

Postpartum care - Care delivered to a patient shortly after childbirth.

 

authority

An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02 (2012 Repl.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).

source

Final Rulemaking published at 50 DCR 2042 (March 7, 2003); as amended by Final Rulemaking published at 50 DCR 6703 (August 15, 2003); as amended by Final Rulemaking published at 50 DCR 7832 (September 19, 2003); as amended by Final Rulemaking published at 55 DCR 2858 (March 21, 2008); as amended by Final Rulemaking published at 60 DCR 15526 (November 8, 2013).