Alternative birth centers: licensing and Medi-Cal reimbursement.

Assembly Member Bonta, joined by Senator McGuire, advances a measure that replaces the older reliance on a Medi-Cal definition of comprehensive perinatal services with a structured set of licensing and reimbursement requirements for alternative birth centers, and introduces a formal hospital transfer framework alongside staffing and patient-information standards. The bill also links Medi-Cal reimbursement for facility-related delivery costs to defined rate schemes and certification criteria, tying these provisions to federal approvals where necessary.

At the core of the licensing changes, the measure requires each licensed alternative birth center or primary care clinic delivering as an alternative birth center to provide perinatal services that are comprehensive in nature, including psychosocial assessments, referrals to counseling when appropriate, nutritional assessments, education on health, childbirth, and parenting, and related elements. It obligates facilities to maintain a quality assurance program and to meet certification standards established by the American Association of Birth Centers or an equivalent standard determined by the state. A new provision replaces a proximity-based criterion with a written hospital-transfer policy approved by the facility’s governing body. The policy must cover arrangements for referral of complications, transfer of care across prenatal, intrapartum, and postpartum periods, access to emergency services, requirements to share medical records at transfer, anticipated transfer times, and a clear explanation of the overall emergency transfer plan, including risk-mitigation measures related to distance from the receiving hospital. The bill also requires dissemination of information to patients about child passenger restraints and related programs, and it adds a requirement that two attendants be present at all times during birth, one of whom must be a physician and surgeon, licensed midwife, or certified nurse-midwife. A related provision authorizes a permit for a primary care clinic to provide services as an alternative birth center, without necessitating a separate license for that purpose. The measure also makes explicit that establishments must meet the revised criteria to be represented as alternative birth centers and clarifies scope of practice for practitioners.

On Medi-Cal reimbursement, the bill establishes two parallel pricing schemes for facility-related delivery costs. Initially, reimbursements would be issued at a statewide all-inclusive rate per delivery not to exceed 80 percent of the average Medi-Cal reimbursement received by general acute care hospitals with Medi-Cal contracts, anchored to an average 1.7-day hospital length of stay, and updated annually based on the California Medical Assistance Commission’s published data. This rate must not exceed the alternative birth center’s charges to non-Medi-Cal patients for similar services and is contingent on federal approvals. A secondary approach, effective no earlier than July 1, 2017, would reimburse at a statewide all-inclusive rate per delivery not to exceed 80 percent of the average DRG Level 1 rates for general acute care hospitals with Medi-Cal contracts, subject to applicable Medi-Cal State Plan provisions and federal authorization. The bill specifies that the department shall seek necessary federal approvals and that the new reimbursement arrangements are not in effect until those approvals are obtained. Additional provisions tie eligibility for reimbursement to meeting the Section 1204.3 criteria and to standards governing the involvement of hospitals and medical staff. The section further notes that implementation may be affected by federal approvals and does not alter the scope of practice or permissible delivery settings. Finally, it establishes that no reimbursement is required for local agencies to implement these changes, consistent with state constitutional requirements and the bill’s characterization of the new obligations as crime-related violations if not complied with.

Together, the provisions place new, codified expectations on alternative birth centers and affiliated clinics, aligning licensure with defined comprehensive-service elements and a formalized transfer framework, while restructuring Medi-Cal reimbursement to a rate-based framework that depends on federal approvals and certified standards. The measure foregrounds a reliance on transfer planning, documentation, and staffing configurations as mechanisms for coordinating perinatal care across settings, and it situates these changes within a broader policy effort to standardize care pathways for birth-related services and their financing.