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ACNM Policy Update - 2/19/2014

1.    ACNM Advocacy on VHA Yields Results
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 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.     



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