55 Pa. Code § 1127.51 - General payment policy
(a)
Payment is made for services provided for participating birth centers subject
to the conditions and limitations established in this chapter, Chapters 1101
and 1150 (relating to general provisions; and MA Program payment policies) and
the MA Program fee schedule.
(b) A
total fee determined by the Department is paid to each birth center for
services, including professional services, provided by the facility throughout
the course of a routine pregnancy, delivery and post-partum period.
(c) Birth center services shall be
comprehensive beginning with the initial prenatal visit and concluding with the
final post-partum visit. The services include but are not limited to:
(1) Orientation to birth center
care.
(2) Twenty-four hour
availability of the nurse-midwife/physician team.
(3) Routine laboratory and other diagnostic
services. For the purpose of this chapter, routine laboratory tests include
only hematocrit, hemoglobin and urinalysis.
(4) Patient education regarding nutrition
with respect to both mother and child, substances hazardous to the health of
mother and child, anatomy and physiology pertaining to the mother and child
throughout all phases of the pregnancy, preparation for birth center delivery
and early discharge, infant care, parenting and options for family planning and
contraception.
(5) Prenatal care
including, but not limited to, a written social and medical history, initial
physical examination, examination by obstetrician, identification of risk
status with referral for appropriate care when indicated and visits with
midwife or physician.
(6) Labor,
delivery and newborn services including a minimum of 6 hours of post delivery
care.
(7) Routine medically
necessary medications administered in the birth center.
(8) Post-partum care that includes a minimum
of three visits during which the mother and baby are examined by the midwife or
a registered nurse. The first visit shall take place within 24 to 72 hours
after delivery, with subsequent visits within 6 weeks after delivery.
(9) Mileage for midwife/physician trips to
and from the patient's home for the purpose of visits.
(10) Facilities available to
patients.
(11) The maintenance of
medical records as required by the Department of Health and under §
1101.51 (relating to ongoing
responsibilities of providers.)
(d) Claims shall be submitted to the
Department under the provider handbook.
(e) The Department's payment for birth center
services shall be considered payment in full as specified under §
1101.63 (relating to payment in
full).
(f) If a birth center
voluntarily terminates the provider agreement, payment for birth center
services is made for those MA patients receiving services prior to the
effective date of the termination of the provider agreement. Payment shall be
made under §
1127.52 (relating to payment
criteria).
(g) The Department will
pay the lesser of the birth center's charge to the general public or the rate
established by the Department.
Notes
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