To examine the number of states with neonatal and maternal transport and reimbursement policies in 2019, compared with 2014.
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.
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.
The number of state neonatal and maternal transport policies increased; these policies may support provision of care at the most risk-appropriate facilities.
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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.
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.
American Academy of Pediatrics. Levels of neonatal care. Pediatrics. 2004;114:1341–7. https://doi.org/10.1542/peds.2004-1697.
Little GA, Merenstein GB. Toward improving the outcome of pregnancy, 1993: perinatal regionalization revisited. Pediatrics. 1993;92:611–2.
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.
AAP Committee on Fetus and Newborn, ACOG Committee on Obstetric Practice. Guidelines for perinatal care. 8th ed. Elk Grove Village, IL: 2017.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70:1–51.
Tufts Health Plan. Ambulance and Transportation Services Payment Policy. 2019. https://tuftshealthplan.com/documents/providers/payment-policies/ambulance-payment-policy.
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.
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.
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.
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.
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.
Jung A, Bose C. Back transport of neonates: improved efficiency of tertiary nursery bed utilization. Pediatrics. 1983;71:918–22.
Lynch T, Jung A, Bose C. Neonatal back transport: clinical outcomes. Pediatrics. 1988;82:845–51.
Bose CL, Lapini TR, Jung AL. Neonatal back transport. Med Care. 1985;23:14–9. https://doi.org/10.1097/00005650-198501000-00002.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
The authors declare no competing interests.
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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
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