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ACNM Policy Update - 10/24/14

1.  ACNM Submits Comments in Response to Proposed Rule on Coverage for Contraception

2.  ACNM-Led Coalition Submits Comments on The Joint Commission's Proposed Perinatal Care Certification Standards

3.  ACNM Issue Brief on Supreme Court Case:  North Carolina Board of Dental Examiners vs. FTC

4.  Medscape Publishes Rating of Insurers:  Which Ones are the Best to Work With?

5.  Open Enrollment and the Marketplace:  Significant Issues to Consider

6.  Pregnancy and Options for Coverage:  A Resource for Your Clients

7.  North Carolina Affiliate President Wins Advocacy Award

8.  So, How Do You Get Paid?  ACNM Webinar on Fee Schedule 


 1.  ACNM Submits Comments in Response to Proposed Rule on Coverage for Contraception

 On October 20, ACNM submitted comments  in response to a proposed rule published by the Departments of Health and Human Services (HHS), Labor (DoL), and Treasury which responds to the Supreme Court's recent Hobby Lobby decision.  As a result of the Court's decision, closely held for-profit companies with religious objections are not required to provide insurance coverage for contraceptive items as services.  The Departments proposed to modify their regulations to allow these for-profit entities to refrain from paying for the coverage.  However, the same regulation would require insurers providing coverage to these entities to arrange for contraceptive coverage to the affected women, outside of the plan paid for by the employer.  In effect, women working for employers that take advantage of the exception allowed under the Court's decision would still have access to the full range of FDA approved contraceptive items and services.  ACNM supported this proposal in its comments.  

 2.  ACNM-Led Coalition Submits Comments on The Joint Commission's Proposed Perinatal Care Certification Standards

 The Coalition for Quality Maternity Care (CQMC), led by ACNM has submitted comments to The Joint Commission, responding to a revised version of proposed certification criteria for perinatal programs.  The Joint Commission first released its proposed perinatal care certification program in February of this year.  CQMC submitted comment on that earlier draft and The Joint Commission revised and reissued its proposal for further comments.  In comments submitted on October 17, the CQMC emphasized the need for programs seeking certified status to demonstrate their ability to support normal physiologic birth.  

 3.  ACNM Issue Brief on Supreme Court Case:  North Carolina Board of Dental Examiners vs. FTC

 On October 14, the Supreme Court heard oral arguments in a case which pits the Federal Trade Commission (FTC) against a state licensing board it accuses of anti-competitive actions. Although the case focuses on the relationship between dentists and dental hygienists, its outcome will likely have some implications for the regulation of midwifery practice. ACNM, which signed on to an amicus brief on behalf of the FTC, has created a brief document to help members quickly understand the case.  

4.  Medscape Publishes Rating of Insurers:  Which Ones are the Best to Work With?

Medscape has released the results of an annual survey of thousands of physicians regarding their relationship with a group of key insurers.  The data cover which insurer was seen as the best, both on a national and regional level, which insurers were best to work with in terms of reimbursement and ease of doing business, and which insurers ranked highest with each different specialty group.  The survey also provides a very valuable set of slides covering reimbursement received from the insurers.  


5.  Open Enrollment and the Marketplace:  Significant Issues to Consider

The next open enrollment season for plans offered through the health insurance marketplaces will begin on November 15, 2014 and run through February 15, 2015.  CNMs/CMs should be aware of a number of issues that could potentially impact their patients, including:

  • Coverage will be effective as of January 1, 2015 for applications received by December 15, 2014.  Later applications will result in later effective dates of coverage.

  • Individuals can apply for Medicaid or CHIP at any time and are not restricted to the open enrollment season.
  • Most individuals already enrolled will be automatically re-enrolled in their existing plan.  If the insurer is discontinuing a given plan, enrollees may be automatically enrolled in a similar plan by the insurer.  This may impact the level of premium or cost sharing subsidy they receive.  The insurer will provide them with a notice regarding the status of their enrollment and its impact on subsidies.
  • Individuals should go to www.healthcare.gov or applicable state marketplaces and update their personal information to ensure they receive the correct subsidy amount (or do not end up owing a refund of subsidies received).  
  • Individuals should be aware that subsidies will change each year since they are pegged to premium costs of available plans.  As those costs change, subsidies change.  Plan premiums may change each year as well, so individuals will need to compare premiums to the subsidies for which they qualify to accurately understand any modifications to their net costs in 2015.  
  • Many plans are using high annual deductibles as part of their design.  Individuals should pay attention to this factor and not simply look at monthly premiums. 
  • Individuals should go to www.healthcare.gov or applicable state marketplaces to ensure their preferred providers are still in the plan network.  Many plans are tightening their networks. 
  • It is possible that a pending court case challenging the validity of premium and cost-sharing subsidies offered to individuals enrolling through a federally facilitated marketplace (which includes 34 states) will result in withdrawal of those subsidies, in which case, plans operating in those states have the option of withdrawing from the program.

The best source of information about the upcoming enrollment period is the official government website

6.  Pregnancy and Options for Coverage:  A Resource for Your Clients

ACNM has partnered with the Young Invincibles and ACOG in development of an English and Spanish flyer outlining insurance options for people with a new baby.  The flyer discusses how to ensure that the new baby is covered under an employer plan, Medicaid, CHIP or one of the marketplace plans.  Of particular interest is a wrinkle for individuals under age 26 who are insured under a parent's plan. The Affordable Care Act requires that insurers allow children to remain on a parent's plan up to age 26, even if those children are no longer dependents of the parent and even if those children marry.  In some cases, these children may have babies.  Those babies cannot be insured under what is, effectively, their grandparent's plan.  The parents must seek a different coverage option for their baby.

7.  North Carolina Affiliate President Wins Advocacy Award

Congratulations to Suzanne Wertman for being awarded the 2014 North Carolina Nurse's Association Political/Legislative Nurse of the Year Award! This award is given to a nurse who demonstrates involvement in political activities at the local, state or national level; participates in lobbying on issues that advance health care and/or nursing; promotes the education of nurses in the use of the political process and the value of involvement in governmental affairs; and encourages and/or mentors peers to become involved in the political presence of nursing. Suzanne has been instrumental in the affiliate's efforts to remove physician supervision. ACNM is enormously proud of Suzanne and the countless members like her who dedicate their time and passion to the advancement of midwifery.

8.  So, How Do You Get Paid?  ACNM Webinar on Fee Schedule

Do you have any idea how the payment for a given service is calculated?  And what the heck are these "RVU" thingies that your bonus is based on?  If you're in business for yourself and the contract from the insurer says they'll use the Medicare RVUs from 2008, but a conversion factor that is 110% of Medicare's and national GPCIs instead of the Georgia GPCIs, do you have any idea what that means?  If you don't, you're at a severe disadvantage when it comes to negotiating a salary, proving your worth to your organization, or making sure you keep your business afloat.  

To delve into this topic, as well as a number of others pertinent to midwives, ACNM will be holding a series of webinars through the end of the year.  The first one will be a discussion of the Medicare physician fee schedule, which is the basis of most insurers' reimbursement methodology for midwives.  We'll provide answers to the questions posed above and since I will be the presenter I personally guarantee that it will be sooooo fascinating that you will not even be able to tear yourself away to check Facebook.

It will take place on Thursday, October 30, with two sessions, one at 1:00 p.m. EST and a second at 7:00 p.m. EST.  Pricing is only $19.99 for student members, $29.99 for members and $34.99 for non-members.  You can register for the 1:00 show here, and the 7:00 show here


 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.




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