CurrentIndependent HealthPolicy M010412090

Home Births by Licensed Midwives

Defines coverage, authorization stages, provider credentialing and member clinical criteria for home births performed by physicians or licensed midwives for Independent Health members across Commercial, Medicare Advantage, MediSource, MediSource Connect, Child Health Plus and Essential Plan lines of business. Also outlines required authorization timing and documentation and malpractice insurance minima for midwives.

Policy Summary

PayerIndependent Health

PolicyHome Births by Licensed Midwives

Policy CodePolicy M010412090

Change TypeReviewed; formatting updates (no material change)

Effective Date4/12/2001

Next Review Date

Key ActionPre-authorization required for home births; submit initial authorization for prenatal services up to 32 weeks, updated information 8 weeks prior to due date, and weekly updates after 40 weeks until delivery or 42 weeks.

SourceLink

POLICY UPDATE CHANGES

2/1/2026 entry: Reviewed.

12/1/2025 entry: Revised - Formatting only.

36Minimum gestational week allowed

42Maximum completed gestational week allowed

$1M/$3MMalpractice limits (per/agg)

Pre-auth

Authorization requirement

Coverage Summary

Defines coverage for home births performed by a physician or a licensed midwife who meets Independent Health credentialing standards across Commercial, Medicare Advantage, MediSource, MediSource Connect, Child Health Plus and Essential Plan lines of business. Coverage is covered with criteria (Policy M010412090; Effective Date 4/12/2001; last reviewed 2/1/2026). The policy also requires pre-authorization and specifies documentation, credentialing and timing requirements.

Thresholds for Home Birth Coverage

Gestational age (minimum)>= 36 completed weeks

Gestational age (maximum)< 42 completed weeks

Malpractice insurance limits$1,000,000 per occurrence / $3,000,000 aggregate

Authorization - first stageAuthorization for prenatal services up to 32 weeks gestation

Authorization - second stageSubmit updated medical info 8 weeks prior to estimated due date for home birth/postpartum/newborn care

Authorization - after 40 weeksSubmit updated medical info weekly after 40 weeks until delivery or completion of 42 weeks gestation

ACOG notes that about 35,000 home births occur annually in the U.S. (about 0.9%) and states that hospitals and accredited birth centers are the safest settings for birth, while recognizing a woman’s right to an informed choice.

The AAP does not recommend planned home birth and cites an association with a two- to three-fold increase in infant mortality in U.S. reports; NICE guidance lists multiple maternal/fetal conditions that increase risk where hospital or birth center care is expected to reduce risk.

Coverage Criteria and Authorization Requirements

General Coverage Statement

Home births are covered when performed by a physician or licensed midwife who meets credentialing standards and when member and provider criteria are met:

ALL of the following

Performed by a physician or licensed midwife who meets credentialing standards as established by the Independent Health Credentialing Committee
Requests for authorization for home birth by a licensed midwife will be evaluated on an individual basis to determine appropriateness
Gestational age at time of planned home birth must be at least 36 but fewer than 42 completed weeks>=36 and <42 completed weeks

Required Provider Actions and Risks

Prior Authorization

Pre-authorization required

Pre-authorization is required. Submit an initial authorization for prenatal services up to 32 weeks gestation, submit updated medical information eight weeks prior to the estimated due date to obtain authorization for home birth, postpartum and newborn care, and submit updated medical information weekly after 40 weeks gestation until delivery or completion of 42 weeks.

First authorization: prenatal services up to 32 weeks gestation
Second authorization: updated information submitted 8 weeks prior to estimated due date for home birth, postpartum and newborn care
After 40 weeks: updated information submitted weekly until delivery or completion of 42 weeks gestation

Documentation Required

Provider credentialing and collaborative documentation

Coding

No procedure or diagnosis codes specified in policymixed

No codes listed

Background and Definitions

Independent Health bases coverage on peer-reviewed literature and guideline recommendations (ACOG, AAP, NICE), emphasizing that hospitals and accredited birth centers are generally considered the safest settings. The policy recognizes member choice and therefore covers home births when strict provider credentialing, malpractice insurance ($1,000,000 per occurrence / $3,000,000 aggregate), member medical criteria (including singleton, cephalic presentation, absence of maternal/fetal disease, and gestational age ≥36 and <42 completed weeks), and pre-authorization stages are met. The policy also notes the risks associated with planned home birth referenced by ACOG and AAP and requires documented collaborative arrangements and transport/emergency plans.

Term	Definition
{"text":"High risk pregnancy","status":""},{"text":"A pregnancy in which the mother, fetus or newborn is or will be at an increased risk for morbidity or mortality before or after delivery.","status":""}
{"text":"Home birth","status":""},{"text":"An attended or an unattended childbirth in a non-clinical setting, typically using natural childbirth methods, which takes place in a residence rather than in a hospital or a birth center and usually attended by a midwife or lay attendant with expertise in managing home births.","status":""}
{"text":"Licensed midwife (LM)","status":""},{"text":"Health care provider who may care for the health needs of pre-adolescent, adolescent and adult women throughout their life span; provides care during pregnancy, childbirth and newborn care. In New York State, licensure and practice are overseen by the Board of Regents and the State Education Department (SED).","status":""}

Revision History

2026-02-01Reviewed (clarified)Latest

Policy reviewed with no clinical policy statement changes noted in header; version control entry indicates 'Reviewed.' Detail: header and version control show review on 2/1/2026 with no material change to clinical criteria.

2025-12-01Revised - Formatting only

Document updated for formatting only as noted in version control entry 'Revised- Formatting only.'

Policy Summary

PayerIndependent Health

PolicyHome Births by Licensed Midwives

Policy CodePolicy M010412090

Change TypeReviewed; formatting updates (no material change)

Effective Date4/12/2001

Next Review Date

SourceLink

On This Page

Pre-authorization is required

Pre-authorization required

Provider Criteria (must meet ALL)

Requests from participating or non-participating licensed midwives require ALL of the following professional criteria:

ALL of the following

The midwife has a current New York State midwife license
ALL of the following
- ONE of
  - A participating physician who is board certified as an obstetrician-gynecologist by a national certifying body
  - A participating physician who practices obstetrics and has obstetric privileges at a participating hospital licensed under article twenty-eight of the public health law
  - A participating hospital, licensed under article twenty-eight of the public health law, that provides obstetrics through a participating physician having obstetrical privileges at such institution
Evidence of malpractice insurance coverage with limits of $1,000,000 per occurrence and $3,000,000 aggregate and evidence that home births are covered by the malpractice carrier$1,000,000 per occurrence; $3,000,000 aggregate
The request includes an evaluation of member's health risk
The request documents the proximity of the back-up physician or hospital

Member Clinical Criteria (must meet ALL)

Requests for both participating and non-participating licensed midwives for home birth must meet ALL of the following medical criteria for the member:

ALL of the following

Absence of maternal or fetal disease previous to or during the pregnancy
Absence of placental abnormalities
No history of prior complicated deliveries
No history of cesarean delivery
Singleton pregnancy
Cephalic presentation
Evidence that the midwife performing the home birth carries the necessary equipment and supplies to initiate emergency treatment and has arranged for backup and transportation to a nearby hospital if needed

Authorization Stages (documentation timeline)

Independent Health requires submission in authorization stages:

ALL of the following

First authorization: for prenatal services up to 32 weeks gestationauthorization up to 32 weeks gestation
Second authorization: updated medical information submitted eight weeks prior to estimated due date to obtain authorization for home birth, postpartum and newborn care confirming criteria are still metsubmit updated info 8 weeks prior to estimated due date
Weekly updates after 40 weeks: After 40 weeks gestation: updated medical information to be submitted weekly until delivery or completion of 42 weeks gestationsubmit updated info weekly after 40 weeks until delivery or 42 weeks
Collaborative relationship note: A documented referral or agreement from listed providers does not by itself establish a collaborative relationship; the relationship must provide consultation, collaborative management and referral including emergency plans

Provide documentation demonstrating a current New York State midwife license; documentation of a collaborative relationship with one or more qualifying entities (board-certified obstetrician-gynecologist participating physician, a participating physician who practices obstetrics with hospital obstetric privileges, or a participating hospital that provides obstetrics through a participating physician); evidence of malpractice insurance with limits of $1,000,000 per occurrence and $3,000,000 aggregate that specifically covers home births; an evaluation of the member's health risk; and documentation of the proximity of the back-up physician or hospital.

Denial Risk

Denial risk if member/provider criteria not met

Requests may be denied when member medical criteria or provider requirements are not met. Denial conditions include member clinical factors such as high-risk pregnancy or presence of maternal/fetal disease, placental abnormalities, history of complicated deliveries or prior cesarean, multiple gestation, or non-cephalic (non-vertex) presentation; and provider deficiencies such as lack of a current New York State midwife license, absence of a documented collaborative relationship with the required physician or hospital, or lack of required malpractice coverage that includes home births.