Home Birth

Posted: December 31, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Billing

Overview

Minnesota Health Care Programs (MHCP) covers low-risk pregnancy and low-risk delivery services provided at home when MHCP home birth policy requirements are fulfilled.

Eligible Providers

Eligible providers, when home birth is in their scope of practice and experience, include the following:

· Certified professional midwife

· Certified nurse midwife

· Physician

Providers must be enrolled with MHCP and be working within their scope of practice as defined by Minnesota law. Refer to Provider Requirements under Provider Basics in the MHCP Provider Manual for detailed provider policies.

Eligible Members

All members with Medical Assistance or MinnesotaCare fee-for-service coverage are eligible to receive home pregnancy and birth services if they are determined to be at low-risk for pregnancy and delivery complications. Low risk means a routine, uncomplicated prenatal course as determined by documentation of adequate prenatal care and the anticipation of a routine, uncomplicated labor and birth, as defined by reasonable and generally accepted criteria adopted by professional groups for maternal, fetal, and neonatal health care.

Covered Services

MHCP covers prenatal, delivery, postpartum and newborn care for pregnant people that are considered at low-risk for adverse birth outcomes. Covered services include the following which may be conducted in the home as appropriate:

· Prenatal visits

· Laboratory services

· Ultrasound

· Low-risk labor and delivery

· Postpartum visits

· Lactation services

· Newborn care services

· Labor care prior to a hospital transfer

· Telehealth visits where appropriate

Coverage Limitations

MHCP covers home births that are considered to be at low-risk for adverse birth outcomes. Low risk means a routine, uncomplicated prenatal course as determined by documentation of adequate prenatal care and the anticipation of a routine, uncomplicated labor and birth, as defined by reasonable and generally accepted criteria adopted by professional groups for maternal, fetal, and neonatal health care. Providers should consult another provider with more experience when potential concerns of adverse outcomes develop to determine the appropriateness of continued care versus transferring to a higher level of care or hospital for birth.

Diagnoses that would not qualify for a home birth include, but are not limited to, the following:

· Insulin-dependent diabetes

· Essential hypertension

· Active tuberculosis

· Placental abruption

· Insulin-dependent gestational diabetes

· Known fetal anomaly or condition that requires physician management during or immediately after delivery

· Hemoglobin less than 9 at 36 weeks (can return to out of hospital midwifery care if above 9 by onset of labor)

· Deep vein thrombosis or pulmonary embolism

· Placenta previa at term

· Low lying placenta within 2 cm or less of the opening at the cervix at 38 weeks 0 days

· Vasa previa

· Multiple gestation

· Prior cesarean with incision other than low transverse (for example, classical)

· Gestation less than 36 weeks and more than 43 weeks 0 days

· Active substance use disorder, including opioid and alcohol use disorder, but excluding tobacco or marijuana use

· Any other diagnoses or complications that are considered high risk according to reasonable and generally accepted criteria adopted by professional groups for maternal, fetal, and neonatal health care

Plan of Care

Each member’s plan of care should include the following:

· Consent form detailing the risks and benefits of home birth signed by the member

· Recommended test results and sufficient visits to establish the member is low risk

· Consultations that occurred (when needed) to re-affirm the low-risk status of the member

· A plan for immediate safe transfer of care to a hospital in the event a need for a higher level of care develops

Documentation must be retained in accordance with MHCP Health Service Records policy.

Noncovered Services

· Services provided by an unlicensed midwife

· General or regional anesthesia

· Pregnancies that are considered high risk

Billing

· Refer to Billing Policy Overview and Provider Requirements under the Provider Basics section in the MHCP Provider Manual for general billing information.

· Bill electronically using the MN–ITS 837P Professional format

· Obstetrics services can be billed either globally or by individual components

· Bill newborn services using the newborn’s MHCP ID Number (subscriber ID) and the birthing person’s services using the birthing person’s MHCP ID number (subscriber ID)

· Refer to Radiology/Diagnostic Services section of the MHCP Provider Manual for ultrasound policy.

Legal References

Minnesota Rules 9505.0320 (Nurse Midwife Services)
Minnesota Rules 9505.0353 (Prenatal Care Services)
Minnesota Statute 147D (Traditional Midwives)
Minnesota Statute 148.171 – 141.285 (Minnesota Nurse Practice Act)
Minnesota Statute 256B.0625, subdivision 14 (Diagnostic, screening, and preventative services)