SECTION 355.8181. Birthing Center Reimbursement

(a) Subject to the specifications, conditions, limitations, and requirements established by the Health and Human Services Commission (HHSC), payment for covered birthing center services provided by a participating birthing center is limited to the lesser of the provider's customary charge or the maximum allowable fee listed on a fee schedule established by HHSC.

(b) The birthing center must bill for the covered services that it provides. The attending physician, certified nurse midwife (CNM), or licensed midwife (LM) will be reimbursed separately. Unless approved by HHSC, the birthing center may not bill for services provided by another type of provider. The birthing center must be enrolled and approved for participation in the Medicaid program at the time the services are provided.

(c) Reimbursement for services provided by a physician is described in §355.8085 of this subchapter (relating to Reimbursement Methodology for Physicians and Other Practitioners). Reimbursement for services provided by a CNM or an LM is described in §355.8161 of this subchapter (relating to Reimbursement Methodology for Midwife Services).

Source Note: The provisions of this §355.8181 adopted to be effective February 1, 2011, 35 TexReg 11847; amended to be effective January 1, 2013, 37 TexReg 8466