ACNM Policy Update - 1/16/2015

 

1.  Drum Roll, Please - Announcing ACNM's New Legislative and Regulatory Tracking Sites!

ACNM is pleased to announce the debut of our new state legislative and regulatory tracking sites, which members can access from the drop down Advocacy menu on the home page. There are separate pages for legislative and regulatory actions. Each page will open with a map. States with actions the national office is currently tracking will appear in blue. Click on a state to see the list of actions. By clicking on the links embedded in the search results members can easily and quickly navigate to the full-text of bills and regulations, view session histories, and locate hearing dates and times. Members will also be able to view any comments or summaries of actions drafted by national office staff. The status of bills and regulations are automatically updated by the system on a daily basis.

ACNM strives to track bills and regulations related to issues that members have told us they care about, such as scope of practice, licensure, direct-entry midwives, clinical privileging, ACA implementation, Medicaid and third party payers, reproductive rights, and maternal-child health issues. Tracking does not indicate ACNM support or opposition for any particular action, nor is it an indication of ACNM advocacy efforts at the state level. We continue to respond exclusively to affiliate requests for advocacy assistance.

Members are encouraged to contact their Affiliate Legislative Chair for information on their affiliate's key policy issues and to learn how you can get involved in making a difference for midwifery in your state. Every voice matters!

 

The Utah Department of Health has published a report on trends in out-of-hospital birth in the state from 2010-2012 based on birth certificate data. The report incorporates data from births attended by CNMs, licensed direct-entry midwives, and unlicensed midwives. Some of the report's recommendations include the development of an OOH Birth Transfer Form, voluntary case review process of transfers, and public education "for reproductive age women that describe the types of pregnancies that are not conducive to OOH delivery."

 

Mississippi S.2096 would delete the requirement for a collaborative agreement, but would require APRNs to "practice within the framework of a standing protocol or practice guidelines" that has been approved by the Board. By contrast, Mississippi S.2088 purports to make technical amendments to the Nurse Practice Act by clarifying, among other things, that APRNs shall adhere to the collaborative requirement. 

Missouri H.521 proposes to license certified professional midwives (CPMs). The licensure requirements in the introduced version of the bill do not satisfy the minimal requirements iterated in the US MERA consensus statements.

Oregon S.283 is an APRN title protection bill.

West Virginia H.2046 and its companion S.232 would allow for expedited partner therapy treatment for a sexually transmitted disease by APRNs and other health care providers.

West Virginia S.21 would remove the written collaborative requirement for nurse-midwifery practice.

Because of the tendency of NP regulation to set a precedent for all APRN roles, the national office often tracks NP-only bills. We have decided to include brief updates to members on some of these bills this session as a point of information.

Mississippi S.2101 proposes to allow NPs who have lost their collaborating physician through no fault of their own (such as when a physician moves or retires) and who are unable to identify another collaborating physician to enter into a collaborative relationship with another NP who is certified and been in practice for more than 3,600 hours. 

Mississippi S.2103 would require NPs to practice under the "general supervision" of a physician or dentist. General supervision is defined to require that the physician has examined the patient not more than 9 months prior to the services offered by the NP, that the physician authorize all NP services with a notation in the record, and that all NP services are performed within 100 miles of the physician's usual place of practice, among other things.

Nebraska L.107 proposes to eliminate integrated practice agreements (supervision) for NPs and replace with a 2,000 hour transition to practice agreement. A similar bill last session was vetoed by the Governor.

With input from affiliate leaders, the Government Affairs Committee, Midwives Political Action Committee and ACNM Board of Directors, we have developed both Federal and State policy agendas to help guide our advocacy work during 2015 and 2016.  We look forward to working with our affiliates and individual members to move midwifery forward!

 

As we look forward to exciting events in 2015 like ACNM's 60th anniversary and Lobby Day in Washington, DC, we wanted to take a look back at our federal legislative accomplishments in 2014. What great work you've done!  Here are a few things we accomplished in 2014:

• ACNM was a significant driver behind the introduction of 3 pieces of federal legislation.
• You sent 5,376 messages to your members of Congress urging them to support our bills.  This resulted in 30 cosponsors for one bill, 15 for another and 3 for the last.  Two of these bills garnered significant bipartisan support.  You also sent 982 messages to Congress supportive of the VA's planned changes to its Nursing Handbook to allow APRNs independent practice.  
• Working with others, ACNM helped with the passage of spending language that increased funding for nursing education programs by 3.5%.
• In response to ACNM advocacy efforts, CMS greatly modified its physician certification requirement.

The Centers for Disease Prevention and Control (CDC) has released a final report on birth data for 2013.  Drawn from birth certificates, these data give a detailed demographic picture of the nation's experience with birth in the past year.  Key pieces of information include:

• A total of 3,932,181 births occurred in 2013.
• CNMs/CMs attended 7.8% of hospital births and 8.2% of all births.
• Out-of-hospital deliveries represented 1.4% of births in 2013. Of the more than 56,000 out-of-hospital births in the United States in 2013, 64.4% occurred in a residence (home) and 30.2% in a freestanding birthing center. The number of births occurring at home, 36,080, was the highest since reporting began for this item in 1989.
• The cesarean delivery rate decreased very slightly, from 32.8% in 2012 to 32.7% in 2013.  
• The general fertility rate declined 1% in 2013 to 62.5 births per 1,000 women aged 15-44, reaching another record low for the US.
• The birth rate for women in their 20s declined to record lows, while the rate for women in their 30s and late 40s rose.
• The preterm birth rate declined again in 2013 to 11.39%.  
• The 2013 rate of low birthweight babies was 8.02%, essentially unchanged from 2012.

ACNM has submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to its draft 2016 Letter to Issuers in the Federally-Facilitated Marketplaces.  In this document, CMS lays out policies and parameters expected for the 2016 plan year.  Many of the topics dealt with in the Letter to Issuers were also addressed in a previous proposed regulation issued by CMS upon which ACNM also commented.  ACNM also commented on a draft version of a model act related to insurer network adequacy being written by the National Association of Insurance Commissioners (NAIC).  This model is intended to be adopted by the states to help them in their efforts to oversee the adequacy of insurer plan networks.

In both sets of comments, ACNM provided data from our recent survey of health plans.  We asserted that plans should be required to demonstrate that they include an appropriate range of provider types in their networks and that OB/GYN and midwifery care is not interchangeable.  We argued that both types of care are needed and that therefore both types of providers should be included in a plan's network.  We also cited information from our survey regarding variation in reimbursement based on licensure and noted the need for states to ensure that provider discrimination does not occur.  ACNM will be seeking a meeting with the NAIC to discuss these issues further and has been in contact with CMS staff on this topic as well.  We will report on the content of the final documents when they are available.

The 2015 NURSE Corps Loan Repayment Program application cycle is now open and will close on February 26, 2015 at 7:30 p.m. Eastern Time (ET).  This Program helps address the shortage and distribution imbalance of nurses across the country by offering loan repayment assistance to registered nurses and advance practice nurses working at health care facilities and nurse faculty employed at accredited schools of nursing.

The 2015 application cycle is expected to be very competitive. Applicants are encouraged to apply early. This year the process may improve for applicants, now that some loan information can be automatically populated by the National Student Loan Data System.

Available resources include the Application and Program Guidance and Application Checklist. 

HRSA has provided a recorded webinar that covers eligibility requirements, the online application process, and resources for those considering applying.  In addition, the agency will be holding two webinars, one Thursday January 29 from 2:00 - 4:00 p.m. ET (dial in number: 1-888-957-9878, participant passcode:  5256022), and the other on Thursday, February 12 from 7:30 - 9:30 p.m. ET, (dial in number:  1-888-957-9878, participant passcode:  5256022).

 

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Should you have questions about state issues, please contact Cara Kinzelman, ACNM's Manager of State Government Affairs at [email protected] or 240-485-1841.  

If you have questions regarding federal issues, please contact Jesse Bushman, ACNM's Director of Advocacy and Government Affairs at [email protected] or 240-485-1843.