The Medicaid Birth Center Reimbursement (H.R. 2358 / S. 1423) guarantees Medicaid birth center facility fee payments.
Birth centers have been recognized by CMS (and earlier, by HCFA) as a Medicaid provider type in State Medicaid Plans since 1987. Recently, however, CMS has disallowed such payment by several state Medicaid Agencies, including Alaska, South Carolina, Texas, and Washington State, claiming that it lacks clear statutory authority and direction to allow these payments. CMS has also directed its regional offices to stop paying the federal share of any state Medicaid plan’s payments for birth center services, even though these payments have in many cases been part of the reimbursement structure for years.
In an appeal filed by the State of Texas, a recent decision by a federal administrative judge ruled in favor of CMS, stating that CMS is not required to pay the federal match to any state for birth center facility fees. Without Medicaid payment of the birth center facility fees, birth centers in all states could be pushed to the brink of closure.
Sponsor: Susan Davis (CA)
Co-Sponsors: Gus Bilirakis (FL), Lois Capps (CA), Robert Wittman (VA), Tammy Baldwin (WI), Sander Levin (MI), Diana DeGette (CO), Eric Massa (NY), Janice Schakowsky (IL), Kathy Castor (FL), Sheila Jackson-Lee (TX), Joseph Pitts (PA), and Gabrielle Giffords (AZ)
Sponsor: Barbara Boxer (CA)
Co-Sponsors: Mark Begich (AK), Bob Corker (TN), Patty Murray (WA), Daniel Inouye (HI)
Birth centers are included in the H.R. 3200 "America's Affordable Health Choices Act of 2009" under optional coverage. This provision does not guarantee that all states will cover the facility fee. The Medicaid Birth Center Reimbursement will guarantee payment for birth centers.
AABC, of course, supports birth center accreditation, but accreditation is not mandated in the bill because to do so would be contrary to the present structure of the Social Security Act. The section of that Act which we seek to amend (section 1905(a)) does not limit payment to accredited facilities of any type. Rather, that section simply lists various types of provider facilities that are eligible for payment. It does not use terms like "accredited" or "licensed" to describe any of these other facilities, such as hospitals, clinics, FQHCs, or nursing homes. Rather, whether or not a particular facility is accredited is dealt with in the CMS rules, not the statute. The conditions for participation in Medicaid (“CoPs”) by any individual birth center will depend upon rules to be later developed by CMS. CMS rules for hospitals, clinics, nursing homes and other types of facilities rely on CMS-developed conditions of participation (CoPs), but CMS is willing to deem accredited facilities as meeting those conditions. Non-accredited facilities may qualify for payment if they meet the CoPs.
Read AABC's letter to ACOG on this subject.
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