Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 405.000 - Community Health Center Services › Section 405.423 - Obstetric Services: Global Fee Method of Payment

Current through Register 1525, July 5, 2024
(A)
Definition of Global
			 Fee
. The global fee is a single inclusive fee for all prenatal
			 visits, the delivery, and one postpartum visit. The global fee is available
			 only when the conditions in
			 130 CMR
			 405.423 are met.
(B)
Conditions for Global
			 Fee
.
(1)
General
			 Requirements
. Only the CHC may claim payment of the global fee. To
			 qualify to receive a global fee payment, the CHC must coordinate a minimum of
			 six prenatal visits, the delivery, and postpartum care, provided by a
			 physician, a nurse, a certified nurse practitioner, a certified nurse midwife,
			 or a physician assistant who is qualified to perform such services and is a
			 contractor or employee of the CHC. Such an employee or contractor must not be
			 receiving a salary from a hospital or institution to perform the same service.
			 For example, if a staff physician from a hospital performs a delivery while on
			 hospital salary for that service, the CHC must not bill for the global fee for
			 that delivery, but may bill fee for service for the medical visits. However,
			 those visits are not covered if provided by someone receiving a hospital or
			 institutional salary to perform the same service.
(2)
Standards of
			 Practice
. All the components of a global fee must be provided at a
			 level of quality consistent with the standards of practice of the American
			 College of Obstetrics and Gynecology.
(3)
Coordinated Medical
			 Management
. The CHC must provide referral to and coordination of
			 the medical and support services necessary for a healthy pregnancy and
			 delivery. This includes the following:
(a)
			 tracking and follow-up of the patient's activity to ensure completion of the
			 patient care plan, with the appropriate number of visits;
(b) coordination of medical management with
			 necessary referral to other medical specialties and dental services;
			 and
(c) referral to WIC (the
			 Special Supplemental Food Program for Women, Infants, and Children),
			 counseling, and social work as needed.
(4)
Health-care
			 Counseling
. In conjunction with providing prenatal care, the CHC
			 must provide health-care counseling to the woman over the course of the
			 pregnancy. Topics covered must include, but are not limited to, the following:
(a) EPSDT screening for teenage pregnant
			 women;
(b) smoking and substance
			 abuse;
(c) hygiene and nutrition
			 during pregnancy;
(d) care of
			 breasts and plans for infant feeding;
(e) obstetrical anesthesia and
			 analgesia;
(f) the physiology of
			 labor and the delivery process, including detection of signs of early
			 labor;
(g) plans for transportation
			 to the hospital;
(h) plans for
			 assistance in the home during the postpartum period;
(i) plans for pediatric care for the infant;
			 and
(j) family planning.
(5)
Obstetrical-risk
			 Assessment and Monitoring
. The CHC must manage the member's
			 obstetrical-risk assessment and monitoring. Medical management requires
			 monitoring the woman's care and coordinating diagnostic evaluations and
			 services as appropriate. The professional and technical components of these
			 services will be reimbursed separately and should be billed for on a
			 fee-for-service basis. Such services may include, but are not limited to, the
			 following:
(a) counseling specific to
			 high-risk patients (for example, antepartum genetic counseling);
(b) evaluation and testing (for example,
			 amniocentesis); and
(c) specialized
			 care (for example, treatment of premature labor).