General Provisions

(1) Scope and Purpose. 101 CMR 355.00 governs the rates of payment to eligible freestanding birth centers to be used by all governmental units for services provided to publicly aided individuals. (2) Applicable Dates of Service. Rates contained in 101 CMR 355.00 apply for dates of service provided on and after February 13, 2026, unless otherwise indicated. (3) Coverage. 101 CMR 355.00 and the rates of payment contained in 101 CMR 355.00 are full compensation for the facility component of services furnished in connection with prenatal, labor, delivery, newborn nursery, and postpartum care for low-risk births that can be performed safely in a freestanding birth center under the scope of covered services and that meet the conditions for payment for such services by the governmental purchaser. Payment from any other sources is used to offset the amount of the purchasing governmental unit’s obligation for services rendered to the publicly aided individuals. 101 CMR 355.00 does not cover professional services billed separately from the birth center facility component fee by either the facility or the clinical staff. (4) Disclaimer of Authorization of Services. 101 CMR 355.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 355.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided individuals. (5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association’s Current Procedural Terminology® (CPT). The publication of such updates and corrections will list (a) codes for which the code numbers change, with the corresponding cross-references between new codes and the codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced; (b) codes for which the code number remains the same but the description has changed; (c) deleted codes for which there are no corresponding new codes; and (d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (IC) payment for these codes until appropriate rates can be developed. (6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers; to clarify its policy on and understanding of substantive provisions of 101 CMR 355.00; and as otherwise specified in 101 CMR 355.00.