TRICARE Reimbursement Manual 6010.61-M, April 1, 2015 Birthing Centers Chapter 10 Addendum A Birthing Center Rate Non-Professional Component Revision: C-15, February 21, 2018 Figure 10.A-1 2015 Rate YearThese state specific non-professional component amounts are to be used in creating the maximum allowable all-inclusive TRICARE-authorized birthing center prices during the 2012 rate year (i.e., April 1, 2015 - March 31, 2016). The all-inclusive prices are to be updated on April 1st each year to coincide with the Outpatient Prospective Payment System (OPPS) quarterly update. (See Section 1, for instruction for the use of these amounts.) 2015 Rate Year TRICARE-Authorized Birthing Center Provider Non-Professional Component For All-Inclusive Pricing Formula Alabama $4,174.51 Montana $2,808.87 Alaska $5,763.04 Nebraska $3,698.43 Arizona $3,134.13 Nevada $6,947.53 Arkansas $6,787.90 New Hampshire $4,142.02 California $5,265.59 New Jersey $5,746.23 Colorado $4,313.85 New Mexico $3,794.83 Connecticut $5,978.47 New York $2,295.37 Delaware $4,504.27 North Carolina $4,016.23 District of Columbia $7,138.74 North Dakota $2,325.70 Florida $5,117.97 Ohio $4,946.59 Georgia $4,661.69 Oklahoma $4,502.55 Hawaii $3,598.03 Oregon $2,594.82 Idaho $3,697.99 Pennsylvania $4,339.23 Illinois $4,090.83 Puerto Rico $941.01 Indiana $4,496.27 Rhode Island $3,966.18 Iowa $3,598.49 South Carolina $4,453.79 Kansas $5,231.14 South Dakota $2,309.43 Kentucky $2,892.84 Tennessee $3,302.13 Louisiana $3,286.34 Texas $4,150.62 Maine $3,958.73 Utah $2,178.34 Maryland $2,976.79 Vermont $3,724.89 Massachusetts $4,381.90 Virginia $3,243.43 Michigan $3,569.90 Washington $3,524.92 Minnesota $3,875.64 West Virginia $2,836.54 Mississippi $4,916.55 Wisconsin $3,039.69 Missouri $3,843.29 Wyoming $4,398.81 Figure 10.A-2 2016 Rate YearThese state specific non-professional component amounts are to be used in creating the maximum allowable all-inclusive TRICARE-authorized birthing center prices during the 2012 rate year (i.e., April 1, 2016 - March 31, 2017). The all-inclusive prices are to be updated on April 1st each year to coincide with the Outpatient Prospective Payment System (OPPS) quarterly update. (See Section 1, for instruction for the use of these amounts.) 2016 Rate Year TRICARE-Authorized Birthing Center Provider Non-Professional Component For All-Inclusive Pricing Formula Alabama $4,324.06 Montana $2,989.28 Alaska $5,199.64 Nebraska $3,208.72 Arizona $3,314.39 Nevada $6,377.82 Arkansas $7,088.18 New Hampshire $4,397.25 California $5,545.26 New Jersey $5,553.59 Colorado $4,250.03 New Mexico $4,193.49 Connecticut $6,313.36 New York $2,323.34 Delaware $4,720.91 North Carolina $4,026.43 District of Columbia $7,059.48 North Dakota $2,654.37 Florida $5,282.39 Ohio $5,180.16 Georgia $4,884.28 Oklahoma $4,422.62 Hawaii $3,658.48 Oregon $2,954.86 Idaho $3,983.03 Pennsylvania $4,770.33 Illinois $4,268.78 Puerto Rico $868.89 Indiana $4,892.74 Rhode Island $5,139.17 Iowa $3,923.07 South Carolina $4,676.38 Kansas $5,179.01 South Dakota $2,556.59 Kentucky $3,287.92 Tennessee $3,631.33 Louisiana $3,414.76 Texas $4,425.49 Maine $4,175.41 Utah $2,377.76 Maryland $3,254.58 Vermont $3,493.23 Massachusetts $4,532.72 Virginia $3,433.93 Michigan $3,554.68 Washington $3,672.69 Minnesota $4,026.35 West Virginia $2,913.36 Mississippi $5,322.57 Wisconsin $3,126.70 Missouri $4,170.78 Wyoming $4,937.25 Figure 10.A-3 2017 Rate YearThese state specific non-professional component amounts are to be used in creating the maximum allowable all-inclusive TRICARE-authorized birthing center prices during the 2017 rate year (i.e., April 1, 2017 - March 31, 2018). The all-inclusive prices are to be updated on April 1st each year to coincide with the Outpatient Prospective Payment System (OPPS) quarterly update. (See Section 1, for instruction for the use of these amounts.) 2017 Rate Year TRICARE-Authorized Birthing Center Provider Non-Professional Component For All-Inclusive Pricing Formula Alabama $4,498.83 Montana $3,156.29 Alaska $4,823.88 Nebraska $3,072.27 Arizona $3,393.89 Nevada $6,760.56 Arkansas $7,072.78 New Hampshire $4,369.86 California $5,762.19 New Jersey $5,336.08 Colorado $4,524.52 New Mexico $4,239.63 Connecticut $6,751.59 New York $2,612.86 Delaware $5,133.16 North Carolina $4,405.72 District of Columbia $7,274.87 North Dakota $3,100.27 Florida $5,595.41 Ohio $5,428.50 Georgia $5,249.76 Oklahoma $4,631.94 Hawaii $3,744.24 Oregon $2,893.58 Idaho $4,015.52 Pennsylvania $5,086.33 Illinois $4,392.88 Puerto Rico $658.00 Indiana $5,253.38 Rhode Island $4,725.58 Iowa $4,368.57 South Carolina $5,020.77 Kansas $5,362.90 South Dakota $2,747.16 Kentucky $3,413.35 Tennessee $3,728.32 Louisiana $3,741.41 Texas $4,699.01 Maine $3,586.18 Utah $2,572.90 Maryland $3,466.07 Vermont $3,768.11 Massachusetts $4,443.08 Virginia $3,554.41 Michigan $3,895.53 Washington $4,036.80 Minnesota $4,277.05 West Virginia $2,694.33 Mississippi $5,737.93 Wisconsin $3,091.87 Missouri $4,324.98 Wyoming $4,915.51 - END -