130 CMR, § 433.419

Current through Register 1536, December 6, 2024

Section 433.419 - Certified Nurse Midwife Services

(A)General. 130 CMR 433.419 applies specifically to certified nurse midwives (also known as nurse midwives). In general, however, subject to compliance with state and federal law, the requirements and limitations elsewhere in 130 CMR 433.000 that apply to physicians also apply to certified nurse midwives, such as service and payment limitations, recordkeeping and reporting requirements, and prior-authorization and other conditions of coverage.

(B)Conditions of Payment. The MassHealth agency pays a certified nurse midwife or group practice for certified nurse midwife services when

(1) the services are limited to the scope of practice authorized by state law or regulation (including but not limited to 244 CMR: Board of Registration in Nursing or of the state licensing agency of another state in which the services are provided);

(2) the certified nurse midwife or group practice is not an employee of the hospital or other facility in which the certified nurse midwife services were performed, or is not otherwise paid by the hospital or facility for the service;

(3) the certified nurse midwife participates in MassHealth pursuant to the requirements of 130 CMR 433.419(C)); and

(4) for an out-of-state certified nurse midwife the requirements of 130 CMR 433.403(C) are met.

(C)Certified Nurse Midwife Provider Eligibility. Any certified nurse midwife applying to participate as a provider in MassHealth must submit documentation, satisfactory to the MassHealth agency, that he or she

(1) is licensed to practice as a certified nurse midwife by the Massachusetts Board of Registration in Nursing or by the licensing agency of another state in which the certified nurse midwife services are provided; and

(2) is a member of a group practice or is in a solo private practice;

(D)Consultation Between a Certified Nurse Midwife and Physician. The MassHealth agency does not pay for a consultation between a certified nurse midwife and a physician as a separate service.