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
Rule on Coverage for Contraception
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.
Commission's Proposed Perinatal Care Certification Standards
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.
Carolina Board of Dental Examiners vs. FTC
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.
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.
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.
