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CMS Issues Guidance to Birth Centers

AABC Policy Update

June 16, 2016

Remember that AABC met with the Centers for Medicaid and Medicare Services (CMS) in January, along with NACPM and ACNM?

Well, this happened…

 CMS issued guidance affecting birth centers called “FQHC, RHC and FBC network sufficiency under Medicaid managed care”. It explains that these benefits are mandatory (in any states that license or recognize birth centers), and must be included in the managed care plan.

 The guidance states that in the past Medicaid MCOs were “encouraged” to include birth centers in their networks. Now CMS wants to ensure better access to these services, so they have strengthened requirements for inclusion. The new guidance states that as of July 1, 2017, each managed care plan must include at least one birth center in their provider network. The guidance further says that states may require managed care plans to contract with more than one birth center, but that one will be the minimum acceptable to CMS.

 CMS then states that this new position balances meeting the mandatory requirement with allowing Medicaid MCOs to establish their provider networks. The conclusion is that this guidance will promote access to needed care for Medicaid MCO enrollees.

 So what does this mean for you and your birth center?

  1.  There will be easier access to birth centers for those enrolled in Medicaid MCOs.
  2. You will be in a better position to negotiate with your Medicaid MCOs.
  3. CMS is more focused on access to birth centers than they previously were.

We are continuously working at the federal level to: 

  • Revise the Tricare Payment Manual to add more codes for birth center care.
  • Develop birth center legislation that will improve access to birth center care and increase the sustainability of freestanding birth centers.
  • Advocate for equitable, fair and sustainable reimbursement levels for all birth centers.


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