Obstetric Services: Introduction

(A) The MassHealth agency offers two methods of payment for obstetric services: the fee-for- service method and the global-fee method. Fee for service requires submission of claims for services as they are performed and is available for covered obstetric services. The global-fee method is available only when the conditions in 130 CMR 405.423 are met. (B) The MassHealth agency will pay for a delivery performed in a hospital by a physician or, in the case of a pelvic delivery, by a certified nurse midwife who meets the requirements in 130 CMR 405.427 when the physician or certified nurse midwife is a contractor or employee of the CHC. Such a delivery is covered provided that such a contractor or employee is not receiving a salary from a hospital or other institution to perform the same service. For each such delivery, the CHC may claim payment for the services of only one practitioner (that is, a CHC may not submit two claims for one delivery—one for a physician and one for a certified nurse midwife).