Current through Register Vol. 24-18, September 15, 2024
(1)
Client eligibility. The
medicaid agency covers planned home births and births in birthing centers for
clients who choose to give birth at home or in an agency-approved birthing
center and:
(a) Are eligible for the
alternative benefit package under WAC
182-501-0060,
categorically needy or medically needy scope of care under WAC
182-533-0400(2);
(b) Have an agency-approved medical provider
who has accepted responsibility for the planned home birth or birth in birthing
center under this section;
(c) Are
expected to deliver the child vaginally and without complication (i.e., with a
low risk of adverse birth outcome); and
(d) Pass the agency's risk screening
criteria. The agency provides these risk-screening criteria to qualified
medical services providers.
(2)
Qualified providers. Only
the following provider types may be reimbursed for planned home births and
births in birthing centers:
(a) Physicians
licensed under chapters 18.57 or 18.71 RCW;
(b) Nurse midwives licensed under chapter
18.79 RCW; and
(c) Midwives
licensed under chapter 18.50 RCW.
(3)
Birthing center
requirements.
(a) Each participating
birthing center must:
(i) Be licensed as a
childbirth center by the department of health (DOH) under chapter 246-329
WAC;
(ii) Be specifically approved
by the agency to provide birthing center services;
(iii) Have a valid core provider agreement
with the agency; and
(iv) Maintain
standards of care required by DOH for licensure.
(b) The agency suspends or terminates the
core provider agreement of a birthing center if it fails to maintain DOH
standards cited in (a) of this subsection.
(4)
Home birth or birthing center
providers. Home birth or birthing center providers must:
(a) Obtain from the client a signed consent
form in advance of the birth;
(b)
Follow the agency's risk screening criteria and consult with, or refer the
client or newborn to, a physician or hospital when medically
appropriate;
(c) Have current,
written, and appropriate plans for consultation, emergency transfer and
transport of a client or newborn to a hospital;
(d) Make appropriate referral of the newborn
for pediatric care and medically necessary follow-up care;
(e) Inform parents of required prophylactic
eye ointment and newborn screening tests for heritable or metabolic disorders,
and congenital heart defects, and send the newborn's blood sample to the DOH
for testing. Parents may refuse these services for religious reasons under
RCW
70.83.020. The provider must obtain the
signature from the parent(s) on:
(i) The
reverse side of the screening card to document refusal of screenings for
heritable or metabolic disorders; and
(ii) A waiver form to document refusal of
prophylactic eye ointment or a screening for congenital heart
defects;
(f) Inform
parents of the benefits and risks of Vitamin K injections for newborns;
and
(g) Have evidence of current
cardiopulmonary resuscitation (CPR) training for:
(i) Adult CPR; and
(ii) Neonatal
resuscitation.
(5)
Planned home birth
providers. Planned home birth providers must:
(a) Provide medically necessary equipment,
supplies, and medications for each client;
(b) Have arrangements for twenty-four hour
per day coverage;
(c) Have
documentation of contact with local area emergency medical services to
determine the level of response capability in the area; and
(d) Participate in a formal,
state-sanctioned, quality assurance improvement program or professional
liability review process.
(6)
Limitations. The agency does
not cover planned home births or births in birthing centers for women
identified with any of the following conditions:
(a) Previous cesarean section;
(b) Current alcohol or drug addiction or
abuse;
(c) Significant
hematological disorders or coagulopathies;
(d) History of deep venous thrombosis or
pulmonary embolism;
(e)
Cardiovascular disease causing functional impairment;
(f) Chronic hypertension;
(g) Significant endocrine disorders including
preexisting diabetes (type I or type II);
(h) Hepatic disorders including uncontrolled
intrahepatic cholestasis of pregnancy or abnormal liver function
tests;
(i) Isoimmunization,
including evidence of Rh sensitization or platelet sensitization;
(j) Neurologic disorders or active seizure
disorders;
(k) Pulmonary
disease;
(l) Renal
disease;
(m) Collagen-vascular
diseases;
(n) Current severe
psychiatric illness;
(o) Cancer
affecting the female reproductive system;
(p) Multiple gestation;
(q) Breech presentation in labor with
delivery not imminent; or
(r) Other
significant deviations from normal as assessed by the provider.
11-14-075, recodified as §182-533-0600, filed
6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.09.760, and
74.09.770. 05-01-065, §
388-533-0600, filed 12/8/04, effective 1/8/05. Statutory Authority:
RCW
74.08.090,
74.09.760 through
74.09.800. 00-23-052, §
388-533-0600, filed 11/13/00, effective
12/14/00.
