MHCP covers low-risk pregnancy and delivery services provided in a licensed, free-standing birth center if the service is covered when provided in a hospital by a licensed health professional. Free-standing birth centers are licensed health care facilities that perform low-risk deliveries following a low-risk pregnancy by a licensed health professional. A low-risk pregnancy is a normal, uncomplicated pregnancy. A free-standing birth center is not a hospital or licensed as part of a hospital. All free-standing birth centers must be accredited by the Commission for the Accreditation of Birth Centers (CABC).The Minnesota Department of Health (MDH) issues licenses for free-standing birth centers.
Refer to Provider Requirements for detailed provider policies. MHCP reimburses free-standing birth center services performed by the following licensed providers:
A licensed, free-standing birth center may only render care or services permitted within the scope of the issued license or accreditation.
All MA and MinnesotaCare recipients are eligible to receive free-standing birth center services.
Covered professional services include the following (all care must be documented):
MHCP will cover ultrasounds for the Zika virus if a positive diagnosis is determined from a blood test.
Covered facility services include:
Refer to the Inpatient Hospital Services section for birth weight requirements.
The following limitations apply to the services performed at a free-standing birth center:
The following are not covered for free-standing birth centers:
For professional services, submit separate claims for a mother and her newborn. When a mother is enrolled in a health plan at the time of birth, the newborn will be retroactively enrolled in the same health plan for the birth month, unless the newborn meets an exclusion (refer to Managed Care Organizations (MCOs) and Prepaid Health Plans (PPHPs), Excluded Recipients section).
For questions about a claim, contact the MHCP Provider Call Center at 651-431-2700 or 800-366-5411.
Professional services provided in a free-standing birth center are paid at the lower of billed charges or 100% of the rate paid to a physician performing the same services.
Facility services provided by a free-standing birth center are paid at the lower of billed charges or 70% of the statewide average hospital payment for an uncomplicated vaginal birth.
If the recipient is transferred to a hospital before the delivery, facility services are paid at the lower of billed charges or 15% of the statewide average hospital payment for an uncomplicated vaginal birth.
Minnesota Statutes 256B.0625, subd 54 (Services provided in Birth Centers)
Minnesota Statutes 147D (Traditional Midwives)
Minnesota Statutes 144.615 (Birth Centers)