Federal Issues
1. ACNM Submits Comments to CMS on Network Adequacy Requirements
2. ACNM Affiliates Contacting State Insurance Commissioners Re: Provider Network Adequacy
3. Percent of Births Attended by Midwives in Each State: 1990-2013. What Do You Think is Going On?
State Issues
1. It's the Most Wonderful Time of the Year - Convening of State Legislatures!
2. South Carolina Pre-Files Bill to Remove Physician Supervision!
3. Other Selected Pre-Files and Introductions: California, Kentucky, Missouri, New York
4. New Laws in Ohio
Don't Forget to Forward this Note to CNMs/CMs who are not ACNM Members
Federal Issues
1. ACNM Submits Comments to CMS on Network Adequacy Requirements
On December 17, 2014, ACNM submitted comments to the Centers for Medicare and Medicaid Services, in response to the proposed "Payment and Benefit Parameters" regulation for health insurers operating in the Health Insurance Marketplaces during CY 2016.
ACNM's comments focused on the need to include CNMs in plan networks and to adequately represent them in provider directories.
2. ACNM Affiliates Contacting State Insurance Commissioners Re: Provider Network Adequacy
In an effort to ensure appropriate inclusion of CNMs/CMs in insurers' provider networks, ACNM's national office has provided affiliates with materials to use in a discussion of that topic with their respective insurance commissioners.
Specifically, we have developed a joint national office/affiliate letter, informing the commissioner of the results of our recent survey of health plans and asking for an opportunity to meet. We have also developed a set of slides to guide the discussion as well as a talking points document.
Some 30 of the affiliates have indicated an interest in pursuing these discussions and letters have been sent to their insurance commissioners. A number of commissioners have already indicated a willingness to meet. If you would like to assist in this discussion, please contact your affiliate president to inquire as to what you might be able to do. Affiliate officers can be identified here.
3. Percent of Births Attended by Midwives in Each State: 1990-2013. What Do You Think is Going On?
ACNM has made available a set of slides that show, for every state, the percent of births attended by CNMs/CMs, "Other" midwives and also the total births attended by both groups of midwives from 1990-2013. The charts are based on birth certificate data made available by the CDC. I hypothesized that in states where midwives attend a high percent of births, there was an inflection point at which the percent really took off. In a few states (AK, ME, NH, NM, VT and WV) that is certainly the case. They have seen consistent and impressive growth over the last two decades.
My question for those of you who live in those states, particularly if you've been there a long time, is, "What happened?" I know the regulatory environment has something to do with it, as CNMs/CMs in all of those states have full practice authority (although in WV they must have a prescriptive collaborative agreement). Is that the determining factor, or were there other things driving the growth?
There are some other oddities as well. Several states (DE, DC, KY, MT, ND, and WY) seem to be on something of a roller coaster. Three states (AK, CO, and MT) have what appear to be one-year data anomalies, although there could be legitimate reasons for these very odd charts.
I also put together several slides that show the number of CNM/CM attended births, divided by the number of AMCB certified midwives - a sort of rough approximation of how many births are attended per midwife and how well this provider resource is being utilized. There's quite a lot of variation in that figure among the states and it does not seem to be strongly dependent on whether midwives have full practice authority.
I would be interested in any thoughts you have on these data. So let me know.
State Issues
1. It's the Most Wonderful Time of the Year - Convening of State Legislatures!
States that are convening this week include CA, MT, OH, WI, IN, KY, MN, MS, ND, PA, RI, CO, CT, MA, MO, NE, NH, NY, and VT. Stay tuned for frequent updates from the states as the sessions get underway.
2. South Carolina Pre-files Bill to Remove Supervision!
South Carolina H.3078 proposes to remove physician supervision and expand prescriptive authority to include Schedule IIs, among other things. Members can learn more about the bill and grassroots efforts to help it succeed at the South Carolina Coalition for Access to Health Care's website.
3. Other Selected Pre-Files and Introductions: California, Kentucky, Missouri, New York
California A.41 would prohibit a health care service plan or health insurer from discriminating against any health care provider who is acting within the scope of that provider's license or certification, beginning January 2016.
Kentucky S.35 enacts fines for interfering with breastfeeding or expressing milk if mothers are doing so in public or private areas where they are otherwise authorized to be; Kentucky S.36 states that for three years after the birth of a child, a working mother should be allowed reasonable time for pumping at work and employers should strive to provide a private place that is not a bathroom stall. Employers would be excluded from these requirements if compliance would "substantially disrupt the employer's operations."
Missouri H. 252 specifies that early elective deliveries without a medical necessity shall not be reimbursed by MO HealthNet, the state Medicaid program.
New York A.115 provides for a premium reduction for physicians and licensed midwives who complete a risk management strategies course in obstetrics or midwifery.
4. New Laws in Ohio
Ohio H.552 requires CNMs and other providers who diagnose Down syndrome in the prenatal or postnatal period to supply parents with a Department of Health handout that includes a description of the condition, options for treatment and therapy, contact information for organizations that offer support services. The bill was signed into law on December 19.
Ohio S.276 requires the Department of Health to establish the Safe Sleep Education Program that presents easily understood information on safe sleep practices and SIDS. The bill also requires hospitals and birth centers to implement a safe sleep screening procedure. The bill became law on December 19.
Don't Forget to Forward this Note to CNMs/CMs who are not ACNM Members
As usual, if you know any CNMs/CMs who are not currently ACNM members, please forward this Policy Update to them. We want to be sure they know what the association is doing on their behalf and the kinds of activities that their membership would support.
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.
Not an ACNM member? You can access all of the member benefits, including receipt of every ACNM Policy Update, by joining today.
Want to take action or get involved? Contact ACNM's Government Affairs Committee.
Don't have the time or energy to get involved, but still want to contribute? Support the Midwives-PAC.
