Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Summary of neonatal and maternal transport and reimbursement policies—a 5-year update

Journal of Perinatology volume 42, pages 1306–1311 (2022)Cite this article

Subjects

Abstract

Objective

To examine the number of states with neonatal and maternal transport and reimbursement policies in 2019, compared with 2014.

Study design

We conducted a systematic review of web-based, publicly available information on neonatal and maternal transport policies for each state in 2019. Information was abstracted from rules, codes, licensure regulations, and planning and program documents, then summarized within two categories: transport and reimbursement policies.

Result

In 2019, 42 states had a policy for neonatal transport and 37 states had a policy for maternal transport, increasing by 8 and 7 states respectively. Further, 31 states had a reimbursement policy for neonatal transport and 11 states for maternal transport, increases of 1 state per category. Overall, the number of states with policies increased from 2014 to 2019.

Conclusion

The number of state neonatal and maternal transport policies increased; these policies may support provision of care at the most risk-appropriate facilities.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. March of Dimes Committee on Perinatal Health. Toward improving the outcome of pregnancy: recommendations for the regional development of maternal and perinatal health services. White Plains, NY: March of Dimes National Foundation; 1976.

  2. Kilpatrick SJ, Menard MK, Zahn CM, Callaghan WM, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric Care Consensus #9: Levels of Maternal Care: (Replaces Obstetric Care Consensus Number 2, February 2015). Am J Obs Gynecol. 2019;221:B19–30. https://doi.org/10.1016/j.ajog.2019.05.046.

    Article  Google Scholar 

  3. American Academy of Pediatrics. Levels of neonatal care. Pediatrics. 2004;114:1341–7. https://doi.org/10.1542/peds.2004-1697.

    Article  Google Scholar 

  4. Little GA, Merenstein GB. Toward improving the outcome of pregnancy, 1993: perinatal regionalization revisited. Pediatrics. 1993;92:611–2.

  5. Oh W, Berns SD, Blouin AS, Campbell DE, Fleischman AR, O’Kane ME, et al. Toward improving the outcome of pregnancy III: enhancing perinatal health through quality, safety and performance initiatives. 2011. https://www.marchofdimes.org/materials/toward-improving-the-outcome-of-pregnancy-iii.pdf.

  6. AAP Committee on Fetus and Newborn, ACOG Committee on Obstetric Practice. Guidelines for perinatal care. 8th ed. Elk Grove Village, IL: 2017.

  7. Lasswell SM, Barfield WD, Rochat RW, Blackmon L. Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. JAMA. 2010;304:992–1000. https://doi.org/10.1001/jama.2010.1226.

    Article  PubMed  Google Scholar 

  8. Akula VP, Gould JB, Kan P, Bollman L, Profit J, Lee HC. Characteristics of neonatal transports in California. J Perinatol. 2016;36:1122–7. https://doi.org/10.1038/jp.2016.102.

    Article  CAS  PubMed  Google Scholar 

  9. Bizzarro MJ, Gallagher PG. Why so little progress in regionalization of perinatal care when transport of high-risk neonates remains a substantial risk? J Perinatol. 2020;40:357–8. https://doi.org/10.1038/s41372-020-0600-x.

    Article  PubMed  Google Scholar 

  10. Perinatal Regionalization: October 2009 Meeting Proceedings. Association of Maternal and Child Health Programs Perinatal Regionalization Meeting. 2009. http://www.amchp.org/programsandtopics/womens-health/Perinatal-Health/Perinatal-Regionalization/Pages/default.aspx.

  11. Simpson JB. State certificate-of-need programs: the current status. Am J Public Health. 1985;75:1225–9. https://doi.org/10.2105/AJPH.75.10.1225.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. National Conference of State Legislatures. CON-Certificate of Need State Laws. n.d. https://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx.

  13. Lorch SA, Maheshwari P, Even-Shoshan O. The impact of certificate of need programs on neonatal intensive care units. J Perinatol. 2012;32:39–44. https://doi.org/10.1038/jp.2011.47.

    Article  CAS  PubMed  Google Scholar 

  14. Gagnon D, Allison-Cooke S, Schwartz RM. Perinatal care: the threat of deregionalization. Pediatr Ann. 1988;17:447–52. https://doi.org/10.3928/0090-4481-19880701-06.

    Article  CAS  PubMed  Google Scholar 

  15. Howell EM, Richardson D, Ginsburg P, Foot B. Deregionalization of neonatal intensive care in urban areas. Am J Public Health. 2002;92:119–24. https://doi.org/10.2105/AJPH.92.1.119.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Haberland CA, Phibbs CS, Baker LC. Effect of opening midlevel neonatal intensive care units on the location of low birth weight births in California. Pediatrics. 2006;118:e1667–79. https://doi.org/10.1542/peds.2006-0612.

    Article  PubMed  Google Scholar 

  17. Richardson DK, Reed K, Cutler JC, Boardman RC, Goodman K, Moynihan T, et al. Perinatal regionalization versus hospital competition: the Hartford example. Pediatrics. 1995;96:417–23.

  18. Okoroh EM, Kroelinger CD, Lasswell SM, Goodman DA, Williams AM, Barfield WD. United States and territory policies supporting maternal and neonatal transfer: review of transport and reimbursement. J Perinatol. 2016;36:30–4. https://doi.org/10.1038/jp.2015.109.

    Article  CAS  PubMed  Google Scholar 

  19. Profit J, Wise PH, Lee HC. Consequences of the Affordable Care Act for sick newborns. Pediatrics. 2014;134:e1284–6. https://doi.org/10.1542/peds.2014-0470.

    Article  PubMed  Google Scholar 

  20. Kroelinger CD, Rice ME, Okoroh EM, DeSisto CL, Barfield WD. Seven years later: state neonatal risk-appropriate care policy consistency with the 2012 American Academy of Pediatrics policy. J Perinatol. 2021. https://doi.org/10.1038/s41372-021-01146-y.

  21. Kroelinger CD, Okoroh EM, Goodman DA, Lasswell SM, Barfield WD. Designation of neonatal levels of care: a review of state regulatory and monitoring policies. J Perinatol. 2020;40:369–76. https://doi.org/10.1038/s41372-019-0500-0.

    Article  PubMed  Google Scholar 

  22. Vladutiu CJ, Minnaert JJ, Sosa S, Menard MK. Levels of maternal care in the United States: an assessment of publicly available state guidelines. J Women’s Health. 2020;29:353–61. https://doi.org/10.1089/jwh.2019.7743.

    Article  Google Scholar 

  23. Sinkin RA, Fisher SG, Dozier A, Dye TD. Effect of managed care on perinatal transports for the publicly funded in upstate New York. J Perinatol. 2005;25:79–85. https://doi.org/10.1038/sj.jp.7211213.

    Article  PubMed  Google Scholar 

  24. American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. Levels of Maternal Care: Obstetric Care Consensus. Obs Gynecol. 2019;134:e41–55. https://doi.org/10.1097/AOG.0000000000003383.

  25. Mori R, Fujimura M, Shiraishi J, Evans B, Corkett M, Negishi H, et al. Duration of inter-facility neonatal transport and neonatal mortality: systematic review and cohort study. Pediatr Int. 2007;49:452–8. https://doi.org/10.1111/j.1442-200X.2007.02393.x.

    Article  PubMed  Google Scholar 

  26. Shrestha M, Scarpino SV, Edwards EM, Greenberg LT, Horbar JD. The interhospital transfer network for very low birth weight infants in the United States. EPJ Data Sci. 2018;7:27. https://doi.org/10.1140/epjds/s13688-018-0155-7.

    Article  Google Scholar 

  27. Brantley MD, Davis NL, Goodman DA, Callaghan WM, Barfield WD. Perinatal regionalization: a geospatial view of perinatal critical care, United States, 2010-2013. Am J Obs Gynecol. 2017;216:185 e1–185 e10. https://doi.org/10.1016/j.ajog.2016.10.011.

    Article  Google Scholar 

  28. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70:1–51.

  29. Tufts Health Plan. Ambulance and Transportation Services Payment Policy. 2019. https://tuftshealthplan.com/documents/providers/payment-policies/ambulance-payment-policy.

  30. Paradise J, Garfield R. What is Medicaid’s impact on access to care, health outcomes, and quality of care? Setting the record straight on the evidence—Issue Brief. 2013.

  31. Pittard WB, Geddes KM, Ebeling M, Hulsey TC. Continuing evolution of regionalized perinatal care: community hospital neonatal convalescent care. South Med J. 1993;86:903–7. https://doi.org/10.1097/00007611-199308000-00011.

    Article  PubMed  Google Scholar 

  32. Richardson DK, Zupancic JAF, Escobar GJ, Ogino M, Pursley DWM, Mugford M. A critical review of cost reduction in neonatal intensive care II. Strategies for reduction. J Perinatol. 2001;21:121–7. https://doi.org/10.1038/sj.jp.7200501.

    Article  CAS  PubMed  Google Scholar 

  33. Gates M, Shelton S. Back-transfer in neonatal care. J Perinat Neonatal Nurs. 1989;2:39–50. https://doi.org/10.1097/00005237-198901000-00007.

    Article  CAS  PubMed  Google Scholar 

  34. Zarif MA, Rest J, Vidyasagar D. Early retransfer: a method of optimal bed utilization of NICU beds. Crit Care Med. 1979;7:327–9. https://doi.org/10.1097/00003246-197908000-00001.

    Article  CAS  PubMed  Google Scholar 

  35. Jung A, Bose C. Back transport of neonates: improved efficiency of tertiary nursery bed utilization. Pediatrics. 1983;71:918–22.

    Article  CAS  Google Scholar 

  36. Lynch T, Jung A, Bose C. Neonatal back transport: clinical outcomes. Pediatrics. 1988;82:845–51.

    Article  CAS  Google Scholar 

  37. Bose CL, Lapini TR, Jung AL. Neonatal back transport. Med Care. 1985;23:14–9. https://doi.org/10.1097/00005650-198501000-00002.

    Article  CAS  PubMed  Google Scholar 

  38. Mathews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital Stat Rep. 2015;64:1–30.

  39. Callaghan WM, MacDorman MF, Rasmussen SA, Qin C, Lackritz EM. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics. 2006;118:1566–73. https://doi.org/10.1542/peds.2006-0860.

    Article  PubMed  Google Scholar 

  40. Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, et al. Racial Segregation and Inequality in the neonatal intensive care unit for very low-birth-weight and very preterm infants. JAMA Pediatr. 2019;173. https://doi.org/10.1001/jamapediatrics.2019.0241.

  41. Lake ET, Staiger D, Horbar J, Kenny MJ, Patrick T, Rogowski JA. Disparities in perinatal quality outcomes for very low birth weight infants in neonatal intensive care. Health Serv Res. 2015;50:374–97. https://doi.org/10.1111/1475-6773.12225.

    Article  PubMed  Google Scholar 

  42. Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, Horbar JD. Quality of care in US NICUs by race and ethnicity. Pediatrics. 2021;148:e2020037622. https://doi.org/10.1542/PEDS.2020-037622.

    Article  PubMed  Google Scholar 

  43. Matoba N, Collins JW. Racial disparity in infant mortality. Semin Perinatol. 2017;41:354–9. https://doi.org/10.1053/j.semperi.2017.07.003.

    Article  PubMed  Google Scholar 

  44. Altman MR, McLemore MR, Oseguera T, Lyndon A, Franck LS. Listening to women: recommendations from women of color to improve experiences in pregnancy and birth care. J Midwifery Women’s Heal. 2020;65:466–73. https://doi.org/10.1111/jmwh.13102.

    Article  Google Scholar 

  45. Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, et al. The giving voice to mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health. 2019;16. https://doi.org/10.1186/s12978-019-0729-2.

  46. Bingham D, Jones DK, Howell EA. Quality improvement approach to eliminate disparities in perinatal morbidity and mortality. Obstet Gynecol Clin North Am. 2019;46:227–38. https://doi.org/10.1016/j.ogc.2019.01.006.

    Article  PubMed  Google Scholar 

  47. Afulani PA, Altman MR, Castillo E, Bernal N, Jones L, Camara T, et al. Development of the person-centered prenatal care scale for people of color. Am J Obstet Gynecol. 2021. https://doi.org/10.1016/j.ajog.2021.04.216.

  48. Kroelinger CD, Brantley MD, Fuller TR, Okoroh EM, Monsour MJ, Cox S, et al. Geographic access to critical care obstetrics for women of reproductive age by race and ethnicity. Am J Obs Gynecol. 2021;224:304 e1–304 e11. https://doi.org/10.1016/j.ajog.2020.08.042.

    Article  Google Scholar 

  49. Hung P, Casey MM, Kozhimannil KB, Karaca-Mandic P, Moscovice IS. Rural-urban differences in access to hospital obstetric and neonatal care: How far is the closest one? J Perinatol. 2018;38:645–52. https://doi.org/10.1038/s41372-018-0063-5.

    Article  PubMed  Google Scholar 

  50. James CV, Moonesinghe R, Wilson-Frederick SM, Hall JE, Penman-Aguilar A, Bouye K. Racial/ethnic health disparities among rural adults—United States, 2012–2015. MMWR Surveill Summ. 2019;66:1–9. https://doi.org/10.15585/MMWR.SS6623A1.

    Article  Google Scholar 

  51. Jones DS. The persistence of American Indian health disparities. Am J Public Health. 2006;96:2122–34. https://doi.org/10.2105/AJPH.2004.054262.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kozhimannil KB, Interrante JD, Tofte AN, Admon LK. Severe maternal morbidity and mortality among indigenous women in the United States. Obstet Gynecol. 2020;135:294–300. https://doi.org/10.1097/AOG.0000000000003647.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, et al. Racial/ethnic disparities in pregnancy-related deaths—United States, 2007-2016. Morb Mortal Wkly Rep. 2019;68:762–5. https://doi.org/10.15585/mmwr.mm6835a3.

    Article  Google Scholar 

  54. Floccare DJ, Stuhlmiller DFE, Braithwaite SA, Thomas SH, Madden JF, Hankins DG, et al. Appropriate and safe utilization of helicopter emergency medical services: a joint position statement with resource document. Prehosp Emerg Care. 2013;17:521–5. https://doi.org/10.3109/10903127.2013.804139.

    Article  PubMed  Google Scholar 

  55. Marcin JP, Shaikh U, Steinhorn RH. Addressing health disparities in rural communities using telehealth. Pediatr Res. 2016;79:169–76. https://doi.org/10.1038/pr.2015.192.

    Article  PubMed  Google Scholar 

  56. Kozhimannil KB, Casey MM, Hung P, Han X, Prasad S, Moscovice IS. The rural obstetric workforce in US hospitals: challenges and opportunities. J Rural Heal. 2015;31:365–72. https://doi.org/10.1111/jrh.12112.

    Article  Google Scholar 

  57. Curfman A, Groenendyk J, Markham C, Quayle K, Turmelle M, Tieken B, et al. Implementation of telemedicine in pediatric and neonatal transport. Air Med J. 2020;39:271–5. https://doi.org/10.1016/J.AMJ.2020.04.008.

    Article  PubMed  Google Scholar 

  58. De Vries EF, Scheefhals ZTM, Bruin-Kooistra MDE, Baan CA, Struijs JN. A scoping review of alternative payment models in maternity care: insights in key design elements and effects on health and spending. Int J Integr Care. 2021;21. https://doi.org/10.5334/IJIC.5535.

Download references

Acknowledgements

Keriann Uesugi and students at the University of Illinois at Chicago School of Public Health for conducting the policy review; Nina Nandi for her assistance with reviewing relevant literature

Author information

Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Carla L. DeSisto, Ekwutosi M. Okoroh, Charlan D. Kroelinger & Wanda D. Barfield

Authors
  1. Carla L. DeSisto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ekwutosi M. Okoroh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charlan D. Kroelinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wanda D. Barfield
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

EMO and CDK conceptualized and designed the study, reviewed the data analysis, and critically reviewed and revised the paper. CLD synthesized and analyzed the data, drafted the initial paper, and led the revision process. WDB critically reviewed and revised the paper. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Carla L. DeSisto.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

DeSisto, C.L., Okoroh, E.M., Kroelinger, C.D. et al. Summary of neonatal and maternal transport and reimbursement policies—a 5-year update. J Perinatol 42, 1306–1311 (2022). https://doi.org/10.1038/s41372-022-01389-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-022-01389-3

This article is cited by

Search

Advanced search

Quick links