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DEPARTMENT OF HEALTH CARE FINANCE
NOTICE OF PROPOSED RULEMAKING
The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in 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 (2006 Repl.; 2012 Supp.)) 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) (2008 Repl.)), hereby gives notice of the intent to adopt a new Section 941 of Chapter 9 (Medicaid Program) of Title 29 (Public Welfare) of the District of Columbia Municipal Regulations (DCMR), to be entitled “Medicaid Birth Center Services and Reimbursement.”
Birth centers provide alternatives to institutionalized childbirth settings for women who have uncomplicated, low risk pregnancies. To be eligible for Medicaid reimbursement, these centers must provide three distinct phases of care: (1) routine ante-partum care in any trimester; (2) delivery services; and (3) postpartum care. The rules also require birth centers to have procedures to access hospital care in the event complications arise during the labor phase of birth in order to be eligible for reimbursement. Lastly, these rules set standards for Medicaid participation and identify health care practitioners eligible for reimbursement of services rendered at freestanding birth centers.
The corresponding amendment to the District of Columbia State Plan for Medical Assistance (State Plan) was approved by the Council of the District of Columbia (Council) on August 10th, 2012 (PR-0820) and submitted to the Centers for Medicare and Medicaid Services (CMS) on August 3, 2012.
The Director of DHCF also gives notice of the intent to take final rulemaking action to adopt these proposed rules in not less than thirty (30) days after the date of publication of this notice in the D.C. Register.
A new Section 941 of Chapter 9 (Medicaid Program) of Title 29 of the DCMR (Public Welfare) is added to read as follows:
941 MEDICAID BIRTH CENTER SERVICES AND REIMBURSEMENT
941.1 These 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.
941.2 A 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 Feb. 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.
941.3 Services 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).
941.4 Services 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.
941.5 Services 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.
941.6 Medicaid 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;
941.7 Medicaid reimbursement for delivery services shall include:
(a) Admission history and physical examination;
(b) Management of uncomplicated labor; and
(c) Vaginal delivery.
941.8 Medicaid 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.
941.9 Medicaid 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 28 weeks gestation;
(b) Thereafter, biweekly visits up to thirty-six (36) weeks gestation;
(c) Thereafter, weekly visits until delivery.
941.10 In order to be eligible for Medicaid reimbursement, additional birth center visits, beyond the requirements set forth in 941.9 must be deemed medically necessary and require prior authorization.
941.11 Reimbursement 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.
Comments on this proposed rule shall be submitted in writing to Linda Elam, Ph.D., M.P.H. Deputy Director/Medicaid Director, Department of Health Care Finance, 899 North Capitol Street, NE, 6th Floor, Washington, DC 20002, via telephone on (202) 442-9115, via e-mail at DHCFPubliccomments@dc.gov, or online at www.dcregs.dc.gov, within thirty (30) days after the date of publication of this notice in the D.C. Register. Additional copies of this proposed rule may be obtained from the above address.
