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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]