Rate Structure. (a) Reimbursement for maternity care furnished by an authorized birthing center shall be limited to the lower of the TRICARE established all-inclusive rate or the center’s most-favored all- inclusive rate. (b) The all-inclusive rate shall include the following to the extent that they are usually associated with a normal pregnancy and childbirth: laboratory studies, prenatal management, labor management, delivery, post-partum management, newborn care, birth assistant, certified nurse-midwife professional services, physician professional services, and the use of the facility. (c) The TRICARE established all-inclusive rate is equal to the sum of the TRICARE area prevailing professional charge for total obstetrical care for a normal pregnancy and delivery and the sum of the average TRICARE allowable institutional charges for supplies, laboratory, and delivery room for a hospital inpatient normal delivery. (d) Extraordinary maternity care services, when otherwise authorized, may be reimbursed at the lesser of the billed charge or the TRICARE allowable charge. (e) Reimbursement for an incomplete course of care will be limited to claims for professional services and tests where the beneficiary has been screened but rejected for admission into the birthing center program, or where the beneficiary has been admitted but is discharged from the birthing center program prior to delivery. These charges will be adjudicated by CHAMPUS as individual professional services and items.
Appears in 6 contracts
Samples: Participation Agreement, Participation Agreement, Participation Agreement
