2. CMS Provides Guidance on Enrollment Policies Allowing
Changes of Coverage
3. Joint Commission Releases Proposed Perinatal Care
Certification Program
4. Kaiser Family Foundation Webinar on Women's Health Under
the ACA
1. ACNM Advocacy on VHA Yields Results
On February 7, ACNM sent out an Action Alert requesting that members contact
their U.S. Representative to object to a draft "Dear Colleague" letter being
circulated on Capitol Hill. This letter requested that other
Representatives join the authors in objecting to changes that the Veterans
Health Administration (VHA) is reportedly planning for its Nursing
Handbook. According to an early
unofficial draft of the revised Nursing Handbook, the VHA plans to allow
APRNs to practice independently.
I am happy to report that in response to our ACNM Action Alert, a total of 982
email messages were sent to 321 Representatives, encouraging them to oppose the
Dear Colleague letter. Many other provider groups conducted similar
grassroots campaigns. This work on your part had a result.
The Dear Colleague letter was revised to emphasize a concern about supervision
of anesthesia nurses and does not say anything objecting to the independence of
other advance practice nurses. In fact, the final version of the letter
states that "We firmly believe that Advanced Practice Registered Nurses (APRNs)
play a significant and important role in the delivery of care within
VA."
Related to this issue, ACNM has sent a letter
to the Secretary of the VA, Eric Shinseki, endorsing the independence of APRNs,
offering some suggestions for clarification of the wording around CNMs within
the draft Handbook and pointing out that CMs should be included as appropriate
providers in the VHA system. The draft Handbook makes no mention of CMs
at this point. We also request clarity on the possibility of employment
of CNMs and CMs within the VHA.
2. CMS Provides Guidance on Enrollment Policies Allowing Changes of Coverage
In guidance
released on February 6, 2014, the Centers for Medicare and Medicaid Services
(CMS) provided insurers offering coverage through the Health Insurance
Marketplace instruction regarding when to allow individuals to make changes in
their coverage. Opportunities to make changes in coverage are generally
limited to the annual open enrollment period (which ends March 31 this year)
and other special enrollment periods that are typically tied to a qualifying
event (such as a change in residence). Keep in mind that this applies to
the states for which the Federal government is operating the Marketplace, or
which are partnering with the Federal government in that work. States
operating their exchanges independently may have different functionalities.
Of notable interest to ACNM members, in the new guidance, CMS has specified
that:
-- When a birth, adoption or placement for adoption or foster care occurs, a
special election period is allowed to an individual with an existing enrollment
to add the new child to their coverage. If the individual opts to use
this special enrollment period, he or she may terminate existing coverage, effective
the day before the date the child was born, adopted, or placed for adoption or
foster care. The individual can choose to replace the existing coverage
with any plan available in his/her area. The significant change in the
guidance is that this change can now be executed by the affected individual
directly through www.healthcare.gov
and no longer requires a separate call to the plan of original
enrollment.
-- For individuals who have already enrolled in a plan through the
Marketplace, have passed the effective date of their enrollment and have paid
their first month's premium, CMS will now allow them to switch plans during the
initial open enrollment (through March 31) if the new plan they select is
offered by the same insurance company and is at the same metal level (e.g.
switching from one silver plan to another silver plan offered by the same
insurer). Of note to ACNM members, another criteria that must be met for
such a change to occur is that the purpose of the change must be to move to a
plan with a more inclusive provider network. This might potentially help
some individuals who wish to switch coverage during a pregnancy to a plan with
a broader provider network.
3. Joint Commission Releases Proposed Perinatal Care Certification
Program
The Joint Commission, an independent body that accredits approximately 82
percent of the hospitals in the country, has issued proposed
standards for a Perinatal Care Certification Program. This
certification will provide an independent evaluation of organization's
prenatal, intrapartum, and postpartum care services, while more fully
addressing all stages of this specialty service. The certification program will
focus on the requirements for mothers and newborns who have been assessed as
clinically uncomplicated.
Presumably the certification would be used by hospitals to demonstrate their
capabilities to policy makers, payers and the public. The Joint
Commission is accepting comment on the proposal through March 26. ACNM
will be developing comments, likely in conjunction with the Coalition for
Quality Maternity Care. Should you have comments or concerns with
regard to these proposed standards, please forward them to Jesse Bushman at [email protected] and Tina Johnson at [email protected].
4. Kaiser Family Foundation Hosts Webinar on Women's Health Under the
ACA
The Kaiser Family Foundation has been conducting a series of webinars for
journalists regarding the Affordable Care Act (ACA). They provide basic,
plain language discussion of various aspects of the law and are a reliable
resource. The latest KFF webinar may be of particular interest to ACNM
members as it focuses on women's health issues. It details new coverage
available under the ACA, including such things as preventive and screening
services and contraception. It also covers Medicaid's expansion and its
impact on women, as well as the treatment of abortion under the ACA. The
webinar slides also include a long list of helpful resources related to the
topic. The slides are available here,
and a recording of the webinar here.
