Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-18 - Freestanding Birth Center
Section 5160-18-01 - Freestanding birth center services
Universal Citation: OH Admin Code 5160-18-01
Current through all regulations passed and filed through September 16, 2024
(A) Definitions.
(1)
"Freestanding birth center (FBC)" is an entity defined
in 42 U.S.C.
1396d(l)(3)(B) (in effect as
of January 1, 2023) that is operated in conformity with rules
3701-83-33 to
3701-83-42 of the Administrative
Code.
(2)
"Independent practitioner" and "non-independent
practitioner" have the same meaning as in rule
5160-4-02 of the Administrative
Code.
(3)
"Low-risk expectant mother" has the same meaning as in
rule 3701-83-33 of the Administrative
Code.
(B) Coverage. Payment may be made for covered services provided to a low-risk expectant mother.
(1)
Facility
services. A single "bundled" payment is made to an FBC for all covered
obstetrical care (antepartum, delivery, postpartum, and newborn care services),
including healthcare services listed in rule
3701-83-36 of the Administrative
Code. If delivery does not occur at the FBC, payment is made for the discrete
covered services.
(2)
Professional services. Additional professional payment
is also made to an independent practitioner, or to an FBC on behalf of either
an independent practitioner or a non independent practitioner, for the
performance of discrete covered services including but limited to the following
examples:
(a)
Antepartum services;
(b)
Intrapartum
services, delivery, postpartum, and newborn care services listed in rule
3701-83-36 of the Administrative
Code;
(c)
A covered medicine, radiology, clinical laboratory, or
evaluation and management (E&M) service;
(d)
The
administration of a pharmaceutical;
(e)
Reproductive
health services (including the provision of contraceptive supplies);
or
(f)
The professional component of a covered service
comprising both professional and technical components.
(C) Claim payment. The maximum payment for a covered item or service in the following list is established in accordance with the indicated rules of the Administrative Code:
(1)
"Bundled" or
discrete covered services payment made to an FBC - appendix DD to rule
5160-1-60;
(2)
Professional
payment:
(a)
Medical or radiological service - Chapter 5160-4, for which
maximum payment amounts are published in appendix DD to rule
5160-1-60;
(b)
Immunization,
injection or infusion (including trigger-point injection), skin substitute, or
provider-administered pharmaceutical - rule
5160-4-12;
(c)
Applicable
durable medical equipment, prostheses, orthoses, and medical supply items -
Chapter 5160-10;
(d)
Laboratory service - rule
5160-11-11; or
(e)
Reproductive
health service - Chapter 5160-21, for which maximum payment amounts are
published in appendix DD to rule
5160-1-60.
Replaces: 5160-18-01
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