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ACNM Policy Update - 11/13/2015

Federal Issues
 
1.  Increasing Membership to Strengthen Advocacy
2.  NAIC Advances Model Law on Provider Network Adequacy
3.  CMS Publishes Final Rule Requiring Medicaid Programs to Assure Access to Covered Services with Adequate Payment
4.  Urban Institute and March of Dimes Issue Report on Coverage for Women of Childbearing Years
5.  HHS Piloting a Provider Lookup Tool in Health Insurance Exchange
6.  HRSA Posts Recording of Webinar on National Health Service Corps
7.  CMS Posts Recording of 10/29 Webinar on Contraceptive Measures
8.  Medicare Physician Fee Schedule to See Small Cut in 2016
9.  AHRQ Publishes Chartbook on Women’s Healthcare
10.  HHS Publishes Updated FAQ, Including Several on Coverage for Lactation Consultation
11.  ACNM Federal Lobbyist, Patrick Cooney, Recognized by Association of Government Relations Professionals


Federal Issues


1.  Increasing Membership to Strengthen Advocacy

Take a look ACNM’s “Member get a Member” campaign.  This is a fantastic way to win a great prize and strengthen ACNM.  But of course, the REAL reason it’s important is because if we have more midwives, then our advocacy efforts are going to be more successful!  So grab your midwifery colleagues and friends and sign ‘em up! Then tell them to use ACNM’s Action Center to write their legislators about issues important to midwives.


2.  NAIC Advances Model Law on Provider Network Adequacy

After a year and a half of debate and discussion, a committee of the National Association of Insurance Commissioners (NAIC) has voted to approve a new model law on health plan provider network adequacy.  This is the first update to existing NAIC requirements since 1996.  The next step is for the model to be voted on by the NAIC’s entire membership on November 22.  If adopted by the full body, then each member will be able to determine whether to push for adoption of any or all of the model law in their state.

It is expected that the federal Department of Health and Human Services will incorporate the requirements of the model law into regulatory requirements applicable to many plans as well. 

Among key provisions in the model law are the following:

  • requirements related to accurate provider directories, allowing consumers to report errors and requiring insurers to audit their directories from time to time
  • continuity-of-care protections for members whose providers leave or are dropped from their network in the middle of treatment, and 
  • protections against balance bills that arrive with surprise fees for services provided at in-network facilities where the care is given by out-of-network providers
  • state insurance commissioners, rather than the insurers, will be required to decide if issuers' provider networks are adequate and nondiscriminatory.  
  • standards for determining network adequacy are included in the model law, although these standards are not so specific as to require coverage for particular provider types.
  • Federal statutory language prohibiting plans from discriminating against providers by refusing to contract with them if they are acting within the scope of their license is incorporated, although with the caveat that the federal language includes that makes clear that plans do not have to contract with all willing providers


3.  CMS Publishes Final Rule Requiring Medicaid Programs to Assure Access to Covered Services with Adequate Payment

The Centers for Medicare and Medicaid Services (CMS) has published a final regulation that requires states to analyze the adequacy of their Medicaid payments to ensure that benefits are available to Medicaid beneficiaries.  The rule includes a requirement that annual reviews be conducted, as well as specific reviews related to any proposed changes to the state’s plan.  There is a mechanism for beneficiaries and providers to give input and a requirement that states compare their fee for service rates to those of managed Medicaid plans and commercial payers.  

This final regulation, based on a proposal that was issued in 2011, gives providers a significant new opportunity to ensure that states are adequately reimbursing services under Medicaid. 


4.  Urban Institute and March of Dimes Issue Report on Coverage for Women of Childbearing Years

The Urban Institute and March of Dimes have issues a report discussing how health insurance coverage for women of childbearing years has changed as a result of the Affordable Care Act (ACA).  

Key findings include that:

  • Between summer 2013 and winter 2014–15, the uninsurance rate among women of childbearing age decreased from 19.6 percent to 13.3 percent as 5.5 million women gained coverage.
  • Low-income women in states that chose not to expand their Medicaid programs to include everyone under 138 percent of the federal poverty level did not experience the same gains as low income women in expansion states.
  • Access to care held steady between summer 2013 and winter 2014–15, with no change in the share of women with a usual source of care or recent routine checkup. 
  • Affordability of care improved, particularly for low-income women in Medicaid expansion states, who reported a 10.4 percentage-point decrease in unmet need for care because of cost.


5.  HHS Piloting a Provider Lookup Tool in Health Insurance Exchange

The Department of Health and Human Services (HHS) is pilot testing a new feature on Healthcare.gov, the website through which most people in the country can access coverage through the health insurance marketplace.  This feature allows users to specify the providers they are interested in using and will then show them whether these providers are in network for the various plan options available to them. 

I recently tested the feature out and it is very easy and clear.  I specifically looked for the CNM that has served my family and I was provided information on which plans she participates with.  The value of the tool depends on accuracy of data provided by plans however, so users should double check with their chosen plan before enrolling to be 100 percent sure that their favored providers are in network.


6.  HRSA Posts Recording of Webinar on National Health Service Corps

The Health Resources and Services Administration (HRSA) has posted on its website a recorded webinar during which agency staff gave a basic overview of the National Health Service Corps (NHSC), a program of the federal government that provides scholarships and loan repayment to providers, including CNMs, who agree to work in a health professionals shortage area for a designated period of time. 

HRSA has also made other information on the NHSC available related to the scholarship and loan repayment programs, as well as the 2016 application process and inspirational member videos.


During ACNM’s last annual conference, HRSA staff explained that loan repayment is based largely on the health professionals shortage area (HPSA) score of the location where the applicant will be working.  Eligible applicants working are ranked according to the score of their location and funding is then allocated starting at the top of that list and working down until funds run out.  The cut-off point in 2014 was a HPSA score of 16.  This cut off will of course vary each year, but individuals wishing to obtain loan repayment should seek employment with an organization with a high HPSA score.  HPSA scores for such organizations can be found in the job listings that HRSA posts for these organizations.


7.  CMS Posts Recording of 10/29 Webinar on Contraceptive Measures

The Centers for Medicare and Medicaid Services (CMS) has made available a recording of an October 29 webinar on contraceptive measures.  During this webinar, CMS staff discuss the agency’s program for increasing the use of effective contraception in Medicaid and CHIP populations. 

In order to access the recording, you will need to register for the webinar through this link.  After registering, you will also have access to a copy of the slides.  If you have questions about the content of the webinar, you can contact CMS at [email protected]


8.  Medicare Physician Fee Schedule to See Small Cut in 2016

The Centers for Medicare and Medicaid Services (CMS) has released a final regulation on Medicare payment to physicians, indicating that the agency will reduce payments by a very small margin (0.3%) in 2016.  

Although CNMs and CMs do not see large numbers of Medicare patients, the fee schedule is important because so many other payers base their rates on those of Medicare.  CNMs and CMs should be aware that where Medicaid and commercial payers have contracted with them to pay a percent of Medicare rates, Medicare’s rates will be declining very slightly in 2016.  CNMs and CMs should, when contracting with plans, be cognizant of how their rates are tied to those of Medicare, as recent legislation has ensured very small increases in payment under Medicare for many years into the future.


9.  AHRQ Publishes Chartbook on Women’s Healthcare

The Agency for Healthcare Research and Quality has published the 2014 National Healthcare Quality and Disparities Report Chartbook on Women’s Health Care.  The publication provides:

  • An overview of women’s health
  • A summary of trends in health care and quality disparities for women
  • Tracking of access and quality measures for rural women, including:
    • Access to health care
    • Patient safety
    • Person and family centered care
    • Communication and care coordination
    • Effective treatment of leading causes of morbidity and mortality
    • Healthy living
    • Affordability 

10.  HHS Publishes Updated FAQ, Including Several on Coverage for Lactation Consultation

The Departments of Health and Human Services, Labor and the Treasury have published a set of updated FAQs to help the public understand requirements related to coverage under the Affordable Care Act and a bill related to mental health benefits.  This set of FAQs contains several items related specifically to lactation consultation and coverage that insurers must provide for such services. 


11.  ACNM Federal Lobbyist, Patrick Cooney, Recognized by Association of Government Relations Professionals

ACNM’s Federal Lobbyist, Patrick Cooney, has been recognized by the Association of Government Relations Professionals for his contribution to the profession and to that organization. 

Patrick established The Federal Group in 1999 to provide high quality, affordable government relations services to a variety of clients.  He has been ACNM’s representative for more than a decade. 

Congratulations Patrick!





 
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