Current through Register Vol. 54, No. 45, November 9, 2024
Section 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.The provisions of this §1127.51 adopted January 16, 1987, effective retroactively to July 1, 1986, 17 Pa.B. 267; amended September 30, 1988, effective 10/1/1988, 18 Pa.B. 4418. This section cited in 55 Pa. Code § 1127.53 (relating to limitations on payment); and 55 Pa. Code § 1127.54 (relating to noncompensable services).