Birthing Centers
Chapter 10
Addendum A
Birthing Center Rate Non-Professional
Component
Revision: C-32, February 8, 2019
Figure 10.A-1 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-2 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
|
2018
RATE YEAR AND BEYOND
For
services provided on or after April 1, 2018, the non-professional
component or facility component of the birthing center all-inclusive
rate is now the one-day Diagnosis Related Group (DRG) Short-Stay Outlier
(SSO) for DRG 775 (uncomplicated vaginal birth) adjusted for geographic
cost variations. Since DRG 775 has been deleted by the Centers for
Medicare and Medicaid Services (CMS) starting in Fiscal Year (FY)
2019, Defense Health Agency (DHA) is replacing DRG 775 with the
one-day SSO for DRG 807 (uncomplicated vaginal birth without sterilization/D&C)
adjusted for geographic cost variations, effective for service dates
on or after October 1, 2018. The DRG zip-to-wage index files shall
be used for adjusting the facility component rate for geographical
labor cost variations. The FY 2018 and FY 2019 DRG rates are available
on the DRG Rates page of the Military Health System (MHS) web site
at https://health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/Diagnosis-Related-Group-Rates. The
birthing center rates information for subsequent future FYs will
no longer be published in this manual (Chapter 10, Addendum A) since
the rates are located on the DRG Rates page of the MHS web site.
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