HCA Incorporates WSHA Comments into Final Rule for Early Obstetrical Deliveries

December 2, 2015

The final rule for payment of early obstetrical deliveries adopted by the Washington State Health Care Authority (HCA) includes protections requested by WSHA for patients and providers. The rule is intended to deny Medicaid payment for early elective deliveries. The final rule allows payment for deliveries prior to 39 weeks if the early delivery is medically necessary. HCA will consider the early delivery to be necessary if the patient has a specific condition listed by The Joint Commission. HCA also agreed that other cases where the doctor provides substantiation of the medical necessity would also be covered. WSHA testified at the rulemaking hearing and commented that there needs to be this type of  additional mechanism to protect patients and providers in early delivery cases that do not meet the specific Joint Commission criteria, but where the doctor believes it is necessary for the safety of the mother and baby. We are pleased this has been addressed in the final rule. HCA provided a concise explanatory statement for the rule change and will provide more specific instructions in the provider billing guide for January 2016.


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