Return to Advocacy > ACNM Policy Updates

ACNM Policy Update - 1/8/2014

This email is to announce the creation of a new communications vehicle for ACNM members, the ACNM Policy Update.

We have been sending very brief notes on policy related items through ACNM's Quick eNews, but felt that some issues required more space to describe.  To keep you informed about policy issues, we are introducing this new service for our members.  We will send these updates when something pertinent happens, so it will arrive somewhat irregularly.  Below are two items exemplifying the type of information we will be sharing with you.

Please contact Jesse Bushman a [email protected] to let us know what you think and send us ideas for the kinds of issues you are interested in.

1.  ACNM Led Coalition Submits Recommendations on Maternity Care to MACPAC

2.  Incident-To Billing and the 2014 Medicare Physician Fee Schedule


1.  ACNM Led Coalition Submits Recommendations on Maternity Care to MACPAC

On Monday, January 6, the Coalition for Quality Maternity Care (CQMC), a group led by ACNM, submitted a letter to the Medicaid and CHIP Payment and Access Commission (MACPAC) providing specific recommendations regarding issues related to maternity care.   MACPAC is a non-partisan, federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, and for making recommendations to the Congress and the Secretary of the U.S. Department of Health and Human Services, and the states on a wide range of issues affecting those programs.  MACPAC responded to the CQMC letter, indicating that the recommendations had been circulated to commissioners and appropriate staff.  The Commission has included a chapter providing general information on Medicaid’s maternity care in one of its previous reports and plans on including recommendations regarding maternity care in a forthcoming report, focused on the complexities around Medicaid coverage for pregnant women.  The goal of the CQMC was to foster continued focus on maternity care by MACPAC as much of its previous work has centered on other aspects of coverage under Medicaid.

2.  Incident-To Billing and the 2014 Medicare Physician Fee Schedule

Each year, the Centers for Medicare and Medicaid Services (CMS) issues revisions to the regulations establishing payment rates and policies used to reimburse physicians under the Medicare program.  Although Medicare is typically a very small part of Midwives’ business, it does set precedence for other payers, and thus bears watching. 

In the
2014 final Medicare Physician Fee Schedule, CMS included revisions to its “incident to” billing policy that explicitly impacts CNMs.   Medicare’s existing incident to billing policies are most clearly explained in the Medicare Benefits Policy Manual, Chapter 15, Section 60

Medicare pays for services and supplies (including drug and biologicals which are not usually self-administered) that are furnished incident to a physician’s or other practitioner’s services, are commonly included in the physician’s or practitioner’s bills, and for which payment is not made under a separate benefit category.  This provision does NOT apply to any service provided in a hospital or skilled nursing facility.  

To be covered incident to the services of a physician or other practitioner, services and supplies must be:

-- An integral, although incidental, part of the physician’s professional service (see §60.1);
-- Commonly rendered without charge or included in the physician’s bill (see §60.1A);
-- Of a type that are commonly furnished in physician’s offices or clinics (see §60.1A);
-- Furnished by the physician or by auxiliary personnel under the physician’s direct supervision (see §60.1B).  

Incident to services are treated as if they were furnished by the billing practitioner for purposes of Medicare billing and payment.  

“Auxiliary personnel” have been defined in the Benefits Policy Manual to mean “any individual who is acting under the supervision of a physician [or other provider], regardless of whether the individual is an employee, leased employee, or independent contractor of the physician, or of the legal entity that employs or contracts with the physician. “ 

In its final rule, CMS modified this definition.  Now, auxiliary personnel means “any individual who is acting under the supervision of a physician (or other practitioner), regardless of whether the individual is an employee, leased employee, or independent contractor of the physician (or other practitioner) or of the same entity that employs or contracts with the physician (or other practitioner) and meets any applicable requirements to provide the services, including licensure, imposed by the State in which the services are being furnished.” 

The revised regulation further specifies that services provided by auxiliary personnel must be provided in accordance with applicable state law.   

In practice, this means individuals who serve as auxiliary personnel and provide services incident to those of a physician or other practitioner (such as a CNM), must do so in accordance with state law.  If state law imposes licensure or training requirements on individuals who provide the incident to service, then those legal requirements must be met by the auxiliary personnel. 

If CNMs are themselves providing services incident to those of a physicain, they must ensure that their licensure allows them to perform the specific services.  Likewise, if CNMs are billing services by auxiliary personnel performed incident to their own services, they must ensure that the auxiliary personnel meet state requirements.   

The specific discussion of this topic begins on page 74410 of the Federal Register published December 10, 2013 (see the link above).  The regulatory text modified pursuant to this discussion is at 42 CFR 410.26.  The GPO will modify its online version of the CFR and CMS will update its manual language to reflect this change in the near future.

If you have questions about either of these items, please contact Jesse Bushman at [email protected]



ACNM's Legislative Tracking Tool

American College of Nurse-Midwives.
8403 Colesville Rd, Suite 1550 | Silver Spring MD 20910
Phone: 240-485-1800 | Fax: 240-485-1818
Follow Us