For the purposes of CHAMPUS, a medical assistant must meet government requirements for the qualification of medical assistants and at least one of the following conditions: non-connected providers have not signed agreements with Health Net Federal Services, LLC (HNFS) and are therefore considered “off-grid”. Suppliers may choose to participate on a case-by-case basis. The center has a written protocol of understanding (MOU) with at least one backup hospital that certifies that the hospital accepts and treats any woman or newborn who is transferred from the center and who needs emergency obstetric or neonatal care. Instead of this letter of intent with a hospital, a birthing home may have a declaration of intent with a physician who otherwise meets the requirements as an individual professional provider of CHAMPUS and who has privileges for a relief hospital capable of caring for critical maternal and neonatal patients, as shown in a letter from that hospital in which the extent and likely duration of care provided by the hospital to the Physician Accreditation privileges are certified. The Memorandum of Understanding is to be reviewed annually.