Gentle Landing owner outlines licensing, emergency transport and Medicaid limits for birth centers

Catherine Bramhall, owner and midwife at Gentle Landing Birth Center, gave a virtual tour of the Hanover, N.H., facility and described its licensing, emergency equipment and hospital-transport procedures during a virtual meeting on April 2.

Bramhall said the birth center is licensed in New Hampshire under the Department of Health and Human Services rules known as HE-P 8 10 and that her practice meets both facility licensing and individual licensing requirements. "The name of my birth center is Gentle Landing Birth Center," she said while showing exam and birth rooms and emergency equipment.

The center opened in January 2021, Bramhall said, and she estimated the facility handles about 70 births a year. The facility is a roughly 3,100-square-foot office-park site with two private birth rooms, tubs, ADA-accessible bathrooms and a resuscitation station that includes suction and oxygen. Bramhall said she maintains emergency medications and drills transport and emergency protocols regularly and keeps a detailed policies-and-procedures manual to comply with licensing rules: "I have a 750 page policy and procedure manual that covers every single thing," she said.

On hospital transfers, Bramhall said Gentle Landing does not have a standing contract with Dartmouth-Hitchcock or the University of Vermont Medical Center but uses the hospitals' established transport numbers and built-in procedures: "You call the transport number and say, 'This is who I am. This is where I am.' They then call you back with whoever is most appropriate," she said. Bramhall and other participants described the regional perinatal quality networks (referenced in the meeting as NEPQIN) and routine hospital outreach as central to coordinating transfers.

Participants discussed payer coverage. Bramhall said Vermont Medicaid currently pays the midwifery provider fee for midwives but does not cover a separate facility fee for birth centers because Vermont does not license birth centers: "When I get a Vermont Medicaid patient, they have to pay the facility fee out of pocket because you guys don't have anything built into the Vermont Medicaid ... to cover a birth center," she said. A meeting participant identified as Lori Foster, ACNM, said Medicaid will pay the provider fee but not the facility fee. Other participants noted that commercial insurers such as Blue Cross Blue Shield of Vermont may pay both provider and facility fees for birth centers, as discussed in the meeting (specific plan language was not presented in the transcript).

Bramhall described staffing as a mix of one 36-hour-per-week front-desk employee and contracted birth assistants who staff births as needed, with the on-call expectation that a midwife will respond when a laboring person needs care. She said the birth center treats transport planning similarly to an EMS handoff and that hospitals have integrated consultation and transfer workflows that reduce friction compared with past practice.

Speakers asked about the New Hampshire rule Bramhall cited: HE-P 8 10. Bramhall recommended that committee members review those rules as a model, saying they have kept New Hampshire birth centers safe for decades.

No formal votes or decisions were recorded in the transcript excerpt; the session consisted of a presentation, participant questions and clarifications about licensing, payer coverage and transport procedures.