WSR 15-16-002
(Washington Apple Health)
[Filed July 23, 2015, 8:36 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 15-12-012.
Title of Rule and Other Identifying Information: WAC 182-533-0600 Planned home births and births in birthing centers.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Conference Room, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at or directions can be obtained by calling (360) 725-1000), on September 8, 2015, at 10:00 a.m.
Date of Intended Adoption: Not sooner than September 9, 2015.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail, fax (360) 586-9727, by September 8, 2015.
Assistance for Persons with Disabilities: Contact Jeff Stender by September 4, 2015, TTY (800) 848-5429 or (360) 725-1307 or e-mail
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule reflects state requirements that hospitals and health care providers attending births inform parents of required newborn screening tests and prophylactic eye ointment. The proposed rule also requires that these providers inform parents of the risks and benefits of vitamin K injection. During the course of this review, the agency has also revised language to improve readability and replace outdated references to "MAA."
Reasons Supporting Proposal: The agency aims to clarify requirements for providers attending births.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160, 70.83.020; SHB 1285, chapter 37, Laws of 2015, 64th Legislature 2015; WAC 246-100-202.
Statute Being Implemented: RCW 70.83.020; SHB 1285, chapter 37, Laws of 2015, 64th Legislature 2015; WAC 246-100-202.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Chantelle Diaz, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1842; Implementation and Enforcement: Nancy Hite, P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-1611.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The joint administrative [rules] review committee has not requested the filing of a small business economic impact statement, and these rules do not impose a disproportionate cost impact on small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
July 23, 2015
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-533-0600 Planned home births and births in birthing centers.
(1) ((MAA)) Client eligibility. The medicaid agency covers planned home births and births in birthing centers for ((its)) clients ((when the client and the maternity care provider)) who choose to ((have a home birth or to)) give birth at home or in an ((MAA)) agency-approved birthing center and ((the client)):
(a) ((Is)) Are eligible for ((CM or MN)) the alternative benefit package under WAC 182-501-0060, categorically needy or medically needy scope of care (((see WAC 388-533-400(2)))) under WAC 182-533-0400(2);
(b) ((Has a MAA-approved)) Have an agency-approved medical provider who has accepted responsibility for the planned home birth or birth in birthing center ((as provided in)) under this section;
(c) ((Is)) Are expected to deliver the child vaginally and without complication (i.e., with a low risk of adverse birth outcome); and
(d) ((Passes MAA's)) Pass the agency's risk screening criteria. ((MAA)) The agency provides these risk-screening criteria to qualified medical services providers.
(2) ((MAA approves)) Qualified providers. Only the following provider types ((to provide MAA-covered)) 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:
(((a))) (i) Be licensed as a childbirth center by the department of health (DOH) under chapter 246-349 WAC;
(((b))) (ii) Be specifically approved by ((MAA)) the agency to provide birthing center services;
(((c))) (iii) Have a valid core provider agreement with ((MAA)) the agency; and
(((d))) (iv) Maintain standards of care required by DOH for licensure.
(((4) MAA)) (b) The agency suspends or terminates the core provider agreement of a birthing center if it fails to maintain DOH standards cited in ((subsection (3))) (a) of this ((section)) subsection.
(((5))) (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 ((MAA's)) the agency's risk screening criteria and consult with ((and/)), 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 ((and/))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 ((the benefits of a)) required prophylactic eye ointment and newborn screening tests ((and offer to)) for heritable or metabolic disorders, and congenital heart defects, and send the newborn's blood sample to the ((department of health)) DOH for testing; ((and))
(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.
(((6))) (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 (((e.g., Joint Underwriting Association (JUA), Midwives Association of Washington State (MAWS), etc.))).
(((7) MAA)) (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 ((and/))or drug addiction or abuse;
(c) Significant hematological disorders((/)) or coagulopathies;
(d) History of deep venous ((thromboses)) 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 ((and/))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 ((site of delivery)) the female reproductive system;
(p) ((Known)) Multiple gestation;
(q) ((Known)) Breech presentation in labor with delivery not imminent; or
(r) Other significant deviations from normal as assessed by the provider.