1. (1) As used in this rule, "provider of perinatal care" means a physician or certified nurse midwife as those terms are defined under OAR 333-077-0010, a physician associate licensed under ORS chapter 677, a nurse practitioner licensed under ORS chapter 678, or a licensed direct entry midwife licensed under ORS chapter 687.
2. (2) A clinical provider at a birthing center shall assess a client's risk status throughout pregnancy, labor, and delivery to determine if care and services including delivery in a birthing center is appropriate based on the criteria for exclusion, risk factor criteria specified in Tables I and II, or any consultation conducted based on the criteria specified in Tables I and II. The list of exclusion and risk factor criteria is not comprehensive, and other physical, behavioral health, obstetric, or fetal conditions may arise that require consultation or transfer to hospital-based care. Having multiple risk conditions requiring consultation may increase the risk sufficiently to indicate the need to transfer care.
3. (3) An initial, in-person risk assessment shall be performed within 21 calendar days of the initial prenatal care visit and updated throughout the pregnancy, labor, and delivery.
4. (4) Appropriate referral or transfer to hospital-based care shall occur promptly if the client, fetus or newborn meet any one criteria for exclusion, or risk factor criteria or complication identified in Tables I through III at any time, including but not limited to during an initial risk assessment, a periodic risk assessment, or if discovered during a consultation conducted in accordance with section (5) of this rule.

5. (5) A clinical provider at the birthing center shall consult with a provider of perinatal care if the client or fetus meet any one of the consultation criteria specified in Tables I through III.

   1. (a) The consulted provider of perinatal care must have direct experience handling complications of the risk(s) present, as well as the ability to confirm the indication for consult which includes, but is not limited to, confirmation of a diagnosis and recommendation(s) regarding management of medical, obstetric, or fetal problems or conditions.
   2. (b) The consulted provider of perinatal care may not be an owner or employee of the birthing center.
   3. (c) A birthing center shall include the client during the consultation, if possible. If the client is unable to participate during the consultation, the birthing center shall notify the client as soon as practicable, but not later than the next appointment, about any findings and recommendations from the consulted provider of perinatal care.

6. (6) The clinical provider at the birthing center shall implement outcomes of the consultation and any decisions made regarding the plan of care and document the following information within seven calendar days of the consultation:

   1. (a) Who participated in the consultation;
   2. (b) Information shared with the consulted provider of perinatal care;
   3. (c) Any findings and recommendations from the consulted provider of perinatal care;
   4. (d) Discussions with the client during or after the consultation about the findings and recommendations;
   5. (e) Decisions made by the clinical provider as to whether the client is no longer suitable for care at the birthing center;
   6. (f) Decisions made by the client for continued care;
   7. (g) Informed consent from the client if the client decides to continue care at the birthing center; and
   8. (h) Plan of care.

7. (7) A client who must be referred or transferred to hospital-based care in accordance with section (4) of this rule, or after consultation under section (5) of this rule is referred or transferred to hospital-based care, may continue to receive prenatal care from the birthing center if:

   1. (a) The client provides informed consent to continue to receive prenatal care after being reasonably informed of:

      1. (A) Known material risk(s);
      2. (B) Possible adverse outcomes; and
      3. (C) Risk of adverse outcomes.
   2. (b) The client acknowledges that the birth will not take place at the birthing center; and
   3. (c) The information contained in section (6) and subsection (7)(a) of this rule is documented in the client's medical record.

8. (8) These rules do not apply to decisions regarding eligibility, prior authorization, coverage determination, or payment from Medicaid, Medicare, or other reimbursement for care provided at a birthing center.

   [ED. NOTE: To view attachments referenced in rule text, click here for PDF copy.]

Statutory/Other Authority

ORS 441.025

Statutes/Other Implemented

ORS 441.025

History

PH 23-2025, adopt filed 11/03/2025, effective 11/03/2025