Date of Adoption: November 30, 2000.

Purpose: MAA will now cover planned home births as part of a pilot project. This rule includes the qualifications for participation, approval process, and requirements for participation, new WAC 388-533-0500.

Statutory Authority for Adoption: RCW 74.08.090.

Adopted under notice filed as WSR 00-21-107 on October 18, 2000.

Changes Other than Editing from Proposed to Adopted Version: Subsection (3)(f) has been rewritten as follows:

     A written plan for consultation, emergency transfer, and transport of both the mother and newborn. The plan must:

     (i) For the mother, specify a physician(s) who has complete obstetrical privileges, including cesarean sections, and who has admitting privileges to the closest appropriate hospital;

     (ii) For the newborn, specify a physician(s) who has an active pediatric practice and admitting privileges to the closest appropriate hospital;

     (iii) Identify the hospital(s) to which the mother and newborn will be transferred in the event of a maternal/neonatal emergency; and

     (iv) Identify emergency transport providers that will be used to transport the mother and/or newborn to the hospital, including private ambulance, municipal aid car, and helicopter service.

     This change was made in response to comments received by the Medical Assistance Administration.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0. Effective Date of Rule: Thirty-one days after filing.

November 30, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

     (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 both the mother and newborn. The plan must:

     (i) For the mother, specify a physician(s) who has complete obstetrical privileges, including cesarean sections, and who has admitting privileges to the closest appropriate hospital;

     (ii) For the newborn, specify a physician(s) who has an active pediatric practice and admitting privileges to the closest appropriate hospital;

     (iii) Identify the hospital(s) to which the mother and newborn will be transferred in the event of a maternal/neonatal emergency; and

     (iv) Identify emergency transport providers that will be used to transport the mother and/or newborn to the hospital, including private ambulance, municipal aid car, and helicopter service.

     (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 breech 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.

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