WSR 00-21-107



(Medical Assistance Administration)

[ Filed October 18, 2000, 10:36 a.m. ]

Supplemental Notice to WSR 00-14-064.

Preproposal statement of inquiry was filed as WSR 99-06-043.

Title of Rule: WAC 388-533-0500 Planned home births -- Pilot project.

Purpose: WAC 388-533-0500 was previously proposed with other maternity-related rules in chapter 388-533 WAC under WSR 00-14-064. Since the rules were proposed, MAA decided to cover planned home births only as part of a pilot project. This draft includes the approval process and minimum requirements for providers and clients to participate in the pilot project.

Statutory Authority for Adoption: RCW 74.08.090.

Statute Being Implemented: RCW 74.09.760 through 74.09.800.

Summary: This rule provides another option for birthing locations for clients and their providers participating in the planned home births pilot project.

Reasons Supporting Proposal: MAA expanded the birthing options offered to eligible clients, and decided that a pilot project was the best way to monitor the program, its effectiveness, and the results.

Name of Agency Personnel Responsible for Drafting: Leslie Saeger, MAA/RIP, P.O. Box 45533, Olympia, WA 98504, (360) 725-1347; Implementation and Enforcement: Bev Atteridge, MAA/DHSQS, P.O. Box 45506, Olympia, WA 98504, (360) 725-1575.

Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The proposed rule establishes a pilot project to cover planned home births. The rule establishes minimum requirements for providers who want to participate in the project, establishes risk screening criteria for clients who want to participate in the project, and requires providers to send an outcome report to an MAA-designated quality assurance/quality improvement organization for each client for whom a home birth is planned.

Proposal does not change existing rules.

No small business economic impact statement has been prepared under chapter 19.85 RCW. MAA reviewed the proposed rules and concluded that the impact of the proposed rules will not place "a more than minor impact on businesses." MAA program managers surveyed the service providers who will bear most of the impact of the addition of the home birth option and they have agreed with MAA's assessment.

RCW 34.05.328 applies to this rule adoption. MAA has determined that the proposed rules qualify as "significant legislative rules." Therefore, MAA has analyzed the probable costs and the probable benefits of the proposed rules, taking into account both the qualitative and quantitative benefits and costs. MAA's analysis revealed that no new costs will be imposed, existing costs will not be increased, and benefits to businesses will not be decreased.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on November 21, 2000, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Kelly Cooper, Rules Coordinator, by November 14, 2000, phone (360) 664-6094, TTY (360) 664-6178, e-mail

Submit Written Comments to: Identify WAC Numbers, Kelly Cooper, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by November 21, 2000.

Date of Intended Adoption: Not sooner than November 22, 2000.

October 13, 2000

Edith M. Rice

for Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

WAC 388-533-0500
Planned home births -- Pilot project.

(1) MAA covers planned home births only as part of a pilot project.

(2) Prior to participating in the planned home birth pilot project providers must be approved by MAA.

(3) To meet minimum requirements for participation, a provider must have all of the following:

(a) A core provider agreement with MAA;

(b) A current license, in good standing, as a:

(i) Physician under chapter 18.57 or 18.71 RCW;

(ii) Nurse midwife under chapter 18.79 RCW; or

(iii) Midwife under chapter 18.50 RCW.

(c) A diploma of graduation from an accredited midwifery, nurse midwifery or medical school, or copy of current national certified professional midwife (CPM) certification, and additional documentation, if necessary, to show a minimum attendance of:

(i) Five births in a home setting as an observer; and

(ii) Ten births in a home setting as the primary attendant or primary under the supervision of a practitioner who meets or exceeds the requirements in this subsection. Three or more of these births must have been with a client for whom the applicant provided care during at least four prenatal visits, attended all stages (one-four) of labor and birth, performed a newborn exam, and conducted one postpartum home visit within seventy-two hours after birth.

(d) Current CPR certification for:

(i) Adult CPR; and

(ii) Neonatal resuscitation, including the use of positive pressure ventilation and chest compressions.

(e) Liability insurance coverage and documentation of liability insurance claims history;

(f) A written plan for consultation, emergency transfer, and transport of clients and newborns to a hospital;

(g) Arrangements for twenty-four hour per day coverage by an MAA-approved home birth provider;

(h) Documentation of contact with local area emergency medical services to determine the level of response capability in the area, and to facilitate communication; and

(i) An informed consent form to be signed by each client to indicate agreement to participate in a planned home birth.

(4) A provider may apply to participate in the project by submitting to MAA:

(a) A letter of interest;

(b) Verification of meeting the minimum requirements in subsection (3); and

(c) A signed statement of intent to comply with project requirements.

(5) The participating provider must do all of the following:

(a) Verify each client is eligible for the categorically needy program or medically needy program scope of care;

(b) Assure each client passes the risk screening criteria published in MAA's planned home birth pilot project billing instructions, and follow indications for consultation and referral;

(c) Plan for a home birth only if the client is expected to deliver vaginally and without complication;

(d) Prior to planning a home birth, obtain a signed consent form from the client agreeing to participate in a planned home birth, and keep the signed form in the client's file;

(e) Provide medically necessary equipment, supplies, and medications for each client;

(f) Make appropriate referral of the newborn for screening and medically necessary follow-up care;

(g) Inform parents of the benefits of a newborn blood screening test, and offer to send the newborn's blood sample to the department of health for testing;

(h) Refer the client or newborn to a physician or hospital when medically appropriate;

(i) Submit to the MAA-designated quality assurance/quality improvement (QA/QI) organization a completed planned home birth outcome report (on an MAA approved form) for each client for program evaluation. MAA requires the completed report before payment is made, even if the client is transferred to another provider or delivery setting and the provider is billing for only a portion of the maternity care.

(j) Notify MAA immediately of changes in licensure and/or provider status;

(k) Renew participation status every two years by submitting documentation to verify continued compliance with the minimum requirements in subsection (3); and

(l) Comply with the requirements in this chapter.

(6) MAA does not cover planned home births 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/coagulopathies;

(d) History of deep venous thromboses or pulmonary embolism;

(e) Cardiovascular disease causing functional impairment;

(f) Chronic hypertension;

(g) Significant endocrine disorders including pre-existing 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/platelet sensitization;

(j) Neurologic disorders or active seizure disorders;

(k) Pulmonary disease or active tuberculosis or severe asthma uncontrolled by medication;

(l) Renal disease;

(m) Collagen-vascular diseases;

(n) Current severe psychiatric illness;

(o) Cancer affecting site of delivery;

(p) Known multiple gestation;

(q) Known breach presentation in labor with delivery not imminent; or

(r) Other significant deviations from normal as assessed by the home birth provider.

(7) The planned home birth pilot project will run for five years from the effective date of this rule, however:

(a) MAA may terminate the project at an earlier date with written notice to participating providers if data reports indicate poor outcomes;

(b) A provider may terminate participation in the pilot project at any time with written notice to MAA. The provider must offer to make a good faith effort to transfer ongoing cases to other participating providers.

(c) MAA may terminate a provider's participation immediately if:

(i) The provider fails to comply with project requirements;

(ii) The provider's enrollment as a MAA provider is suspended or terminated (see WAC 388-502-0030); or

(iii) The MAA medical director determines the quality of care provided endangers the health and safety of one or more clients.


Washington State Code Reviser's Office