Medicaid Benefits: Freestanding Birth Center Services

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2018

Location	Benefit Covered	Coverage Code	Copayment Required?	Limits on Services	Prior Approval Required	Reimbursement Methodology
United States	Yes - 33 No - 11 NR - 7	2018 data limited to CN	Yes - 0	Yes - 6	Included in "Limits on Services" for 2018	Not included in 2018 survey
Alabama	No				-	-
Alaska	Yes	CN	No	No	-	-
Arizona	Yes	CN	No	No	-	-
Arkansas	NR	NR	NR	NR	-	-
California	Yes	CN	No	Prenatal, labor and delivery and postpartum care covered when rendered by appropriately licensed health care professionals within their scope of practice.	-	-
Colorado	Yes	CN	No	No	-	-
Connecticut	Yes	CN	No	No	-	-
Delaware	Yes	CN	No	NR	-	-
District of Columbia	Yes	CN	No	No	-	-
Florida	Yes	CN	No	No	-	-
Georgia	Yes	CN	No	No	-	-
Hawaii	No				-	-
Idaho	No				-	-
Illinois	NR	NR	NR	NR	-	-
Indiana	Yes	CN	No	Limited to admitting and retaining only low risk expectant mothers anticipating a normal full- term spontaneous birth. Delivery must be performed by a certified nurse midwife or physician. Birth attendants not covered.	-	-
Iowa	NR	NR	NR	NR	-	-
Kansas	Yes	CN	No	No	-	-
Kentucky	Yes	CN	No	No	-	-
Louisiana	Yes	CN	No	NR	-	-
Maine	No				-	-
Maryland	Yes	CN	No	No	-	-
Massachusetts	Yes	CN	No	No	-	-
Michigan	No				-	-
Minnesota	Yes	CN	No	No	-	-
Mississippi	No				-	-
Missouri	Yes	CN	NR	NR	-	-
Montana	Yes	CN	No	NR	-	-
Nebraska	Yes	CN	No	No	-	-
Nevada	NR	NR	NR	NR	-	-
New Hampshire	NR	NR	NR	NR	-	-
New Jersey	Yes	CN	No	No	-	-
New Mexico	Yes	CN	No	No	-	-
New York	NR	NR	NR	NR	-	-
North Carolina	Yes	CN	No	NR	-	-
North Dakota	No				-	-
Ohio	Yes	CN	No	Payment may be made to a freestanding birth center (FBC) either for covered global obstetrical care (i.e., a bundled combination of antepartum, delivery, and postpartum services) or for covered discrete antepartum, delivery, and postpartum services, but not for both. Separate payment may be made to an independent practitioner, or to a FBC on behalf of either an independent practitioner or a non-independent practitioner, for the performance covered global obstetrical care or covered discrete antepartum, delivery, and postpartum services, but not both.	-	-
Oklahoma	Yes	CN	No	Services are limited to one each nine months	-	-
Oregon	Yes	CN	No	No	-	-
Pennsylvania	Yes	CN	No	No	-	-
Rhode Island	No				-	-
South Carolina	NR	NR	NR	NR	-	-
South Dakota	Yes	CN	No	Limited to labor and delivery	-	-
Tennessee	Yes	CN	No	No	-	-
Texas	Yes	CN	No	No	-	-
Utah	Yes	CN	No	No	-	-
Vermont	No				-	-
Virginia	No				-	-
Washington	Yes	CN	No	No	-	-
West Virginia	Yes	CN	No	The birthing center must be licensed by the appropriate state regulatory agency. Conditions of that licensure include the requirement for transfer agreement between the birthing center and an acute care general hospital for patients who might experience complications in the delivery.Must have medical director on call and in the facility at the time of birth	-	-
Wisconsin	Yes	CN	No	NR	-	-
Wyoming	No				-	-

2012

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Reimbursement Methodology
United States	Yes - 32 No - 19 Did not Respond - 0		Yes - 7 No - 30
Alabama	No
Alaska	Yes	CN			Fee for service at 85% of physician fee plus 50% of statewide average rate for normal vaginal hospital birth for previous year
Arizona	Yes	CN & MN		Prenatal, labor and delivery and postpartum care covered without limitations when rendered by appropriately licensed health care professionals	Percentage of charge, one revenue code used for billing
Arkansas	No. Also, there are no such facilities in the state.
California	Yes	CN & MN		Prenatal, labor and delivery and postpartum care covered when rendered by appropriately licensed health care professionals within their scope of practice	Fee for service using global rate for labor and delivery, fee for service for other professional services
Colorado	No. Policy is still under development.
Connecticut	Yes	CN & MN		Prenatal, labor and delivery and postpartum care covered when rendered by appropriately licensed health care professionals within their scope of practice	Fee for service, with global fee for labor and delivery facility costs
Delaware	Yes	CN		Coverage limited to labor and delivery as well as postpartum care	Single revenue code established to pay facility costs, practitioner services paid fee for service
District of Columbia	Yes	CN & MN		Routine prenatal care, labor and delivery, and postpartum care covered	Fee for service
Florida	Yes	CN & MN	$2/day for gynecological services	10 prenatal visits, labor and delivery, and 2 postpartum visits within 90 days of delivery	Fee for service
Georgia	Yes	CN & MN	$3/visit	Prenatal care, labor and delivery, and postpartum care covered, birth attendants are not covered	Fee for service
Hawaii	No
Idaho	No. Also, such facilities are not licensed or certified in the state.
Illinois	No. The policy and rule development process has not been finalized.
Indiana	Yes	CN		Limited to admitting and retaining only low-risk expectant mothers anticipating a normal full-term spontaneous birth. Delivery must be performed by a certified nurse midwife or physician. Birth attendants not covered.	Flat rate paid to center, fee for service payment for professional services
Iowa	Yes	CN & MN		Routine prenatal care, labor and delivery, and postpartum care covered; No. additional payment for birth attendants or lay midwives	Fee for service
Kansas	Yes	CN & MN		Coverage is limited to labor and delivery only, birth attendants are not covered	Fee for service
Kentucky	Yes	A, B & C - See state-specific FN		Routine prenatal care, labor and delivery, and postpartum care covered; No. additional payment for birth attendants or lay midwives	Flat rate paid to center, fee for service payment for professional services at 75% of upper limit for physicians in outpatient setting
Louisiana	No
Maine	No. Such centers are not currently recognized in state law.
Maryland	Yes	CN & MN		Coverage limited to labor and delivery as well as postpartum care	Fee for service
Massachusetts	Yes	CN & MN		Routine prenatal care, labor and delivery of uncomplicated vaginal births, and postpartum care; professional services limited to physicians, nurse practitioners and certified nurse midwives	Fee for service, with separate payments for facility and professional services
Michigan	No. Centers are not licensed in the state.
Minnesota	Yes	A & B - See state-specific FN		Routine prenatal care, labor and delivery of uncomplicated vaginal births, nursery care, and the first postpartum visit covered; professional services limited to physicians, certified traditional midwives and certified nurse midwives	Fee for service, center may bill for global service or components of care as appropriate
Mississippi	No. There are no freestanding birth centers in the state.
Missouri	No. Policy is still under development
Montana	Yes	A & B - See state-specific FN		Limited to labor and delivery; coverage for birth attendants awaiting CMS approval	Center is paid fee for service using Medicare APC methodology
Nebraska	Yes	CN & MN		Limited to labor and delivery services	Fee for service
Nevada	Yes	CN		Coverage limited to labor and delivery as well as postpartum and immediate newborn care, birth attendants not covered	Center is paid a single encounter rate, professional care paid fee for service
New Hampshire	Yes	CN & MN		Routine prenatal care, labor and delivery of uncomplicated vaginal births, and postpartum care; professional services limited to physicians, and certified midwives and certified nurse midwives	Global facility fee to center
New Jersey	No. Policy is still under development
New Mexico	No. Such facilities are not licensed in the state. See also the Nurse Midwife Services benefit.
New York	Yes	CN & MN			Prospective payment using APGs
North Carolina	Yes	CN & MN		Limited to labor and delivery	Center is reimbursed an all-inclusive fee established at 80% of hospital reimbursement rate for vaginal delivery without complications under applicable DRG and 45th percentile DRG base rate, with rates adjusted annually for inflation; practitioners reimbursed fee for service
North Dakota	No. There are no freestanding birth centers in this state.
Ohio	Yes	CN		Routine prenatal care, labor and delivery for low-risk pregnancies	Fee for service
Oklahoma	Yes	CN		Limited to labor and delivery, birth attendants include certified midwives and physicians	Center is reimbursed an all-inclusive fee
Oregon	Yes	A & B - See state-specific FN			Centers are reimbursed a flat/global rate that covers all costs for use of the facility, equipment and supplies as well as employed nursing and other personnel
Pennsylvania	Yes	CN & MN		Prenatal, labor and delivery and postpartum care covered when rendered by appropriately licensed health care professionals	Fee for service using a global payment
Rhode Island	No. There are no such centers in the state.
South Carolina	Yes	CN		Prenatal, labor and delivery and postpartum care covered when rendered by appropriately licensed health care professionals	Center is reimbursed an all-inclusive fee established at 50% of hospital reimbursement rate for vaginal delivery without complications, practitioners reimbursed fee for service with licensed midwives paid at 65% of nurse midwife rate
South Dakota	Yes, but no providers yet enrolled.	CN		Limited to labor and delivery services	Fee for service
Tennessee	Yes	A, B & C - See state-specific FN		Prenatal, labor and delivery and postpartum care covered when rendered by appropriately licensed health care professionals	Reimbursement rates established and paid by managed care contractors
Texas	Yes	CN & MN		Birth attendant must be a physician, certified nurse midwife or state-licensed midwife; licensed midwives limited to prenatal care, labor and delivery and postpartum care only until discharge or transfer from the center	Fee for service: certified nurse midwives paid 92% of physician rate and licensed midwives paid 70% of physician rate
Utah	No. There are no freestanding birth centers in the state that meet program qualifications.
Vermont	No. There are no such centers in the state.
Virginia	No. Such facilities are not recognized or licensed in the state.
Washington	Yes	CN & MN		Physicians, nurse practitioners and licensed midwives provide prenatal, labor and delivery, and postpartum care	Fee for service
West Virginia	Yes	A, B & C		Prenatal, labor and delivery and postpartum care covered when rendered by appropriately licensed health care professionals, birth attendants are not covered	Fee for service using a facility-based rate
Wisconsin	Yes	CN & MN		This service is covered but only professional services are reimbursed, facility costs are not separately reimbursed	Fee for service
Wyoming	No. There are no freestanding birth centers in this state.
American Samoa	Did not Respond. See About the Benefit below.
Guam	Yes	CN			Negotiated rate for the service
Northern Mariana Islands	Did not Respond. See About the Benefit below.
Puerto Rico	Did not Respond. See About the Benefit below.
U.S. Virgin Islands	Did not Respond. See About the Benefit below.

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Medicaid Benefits: Freestanding Birth Center Services

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Medicaid Benefits: Freestanding Birth Center Services

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