State Issues
1. Kansas Introduces CNM-Only Bill for Full Practice Authority
2. Rhode Island Bill Would Grant Prescriptive Authority to Certified Midwives
3. Tennessee Full Practice Authority Bill and Countermeasure Introduced
4. South Carolina Full Practice Authority Bill Receives Subcommittee Hearing
5. Multiple Provider Non-Discrimination Bills under Consideration
6. Other Selected State Updates
Federal Issues
1. ACNM Submits Comments to FTC on Plan Network Adequacy
2. ACNM Leads Joint Letter to GAO Regarding Failure to Appoint Representative of Pregnant Women to MACPAC
Don't Forget to Forward this Note to CNMs/CMs who are not ACNM Members
State Issues
Note: Current status of state legislation of interest to ACNM members can be obtained through ACNM's Legislative Tracking Tool.
1. Kansas Introduces CNM-Only Bill for Full Practice Authority
The Kansas affiliate has drafted and introduced a CNM-only bill, H.2280. The bill will define the role of certified nurse-midwife, define the scope of nurse-midwifery practice, and remove the requirement for a signed collaborative practice agreement after the completion of a transition to practice period.
Kansas Medical Society Publicly Responds to CNM Bill
Their response stated, in part, that, "The nurse midwives hope to differentiate their proposal from the broader APRN proposal, contending that their bill is more limited and less controversial. They state that their goal is to limit their practice to low-risk, well-woman maternity care, arguing that pregnancy and childbirth are not a disease process and therefore their practice is not medical in nature. However, as with the other proposals for independent practice, their bill reaches far beyond their stated intent"
Simply put, their proposal lacks any legal distinction between the scope of practice of a nurse midwife and that of an obstetrician or family physician or any other medical doctor. Their proposal isn't any different than the other APRN bills which allow nurse practitioners to practice medicine without a requirement for physician collaboration or participation at any level.
Throughout all this the KMS policy has been clear: the independent practice of medicine should be limited to those with a medical education and training, to best ensure patient safety. APRN education and training lacks the clinical depth and breadth to prepare an APRN to practice medicine independent of any physician collaboration or involvement.
This argument will be familiar to many CNMs in other states working toward full practice authority. ACNM's position remains that the practice of midwifery is not synonymous with the practice of medicine. The excellent outcomes achieved by nurse-midwives are the result of the midwifery model of care, not state-mandated relationships with physicians.
2. Rhode Island Bill Would Grant Prescriptive Authority to Certified Midwives
Rhode Island S.319 would authorize all AMCB-certified midwives "to prescribe medications that might be reasonably required by his or her patients." This bill would grant CMs prescriptive authority that is equivalent to the CNM authorization.
3. Tennessee Full Practice Authority Bill and Countermeasure Introduced
Tennessee H.456/S.680 proposes to implement the APRN credential, update the definition of nurse-midwifery practice, and create a pathway to autonomous practice. Tennessee H.861/S.521, titled the "Tennessee Health Care Improvement Act of 2015," is a countermeasure that would implement a supervisory relationship with physicians. The bill includes physician-led patient care team language. It also requires the Board of Nursing, in consultation with the Boards of Medical Examiners and Osteopathic Examination, to develop rules that establish minimum requirements for physician involvement and referral for both complex and non-complex medical conditions when services are provided by an APRN. If a decision related to what constitutes a complex medical condition contradicts a decision made by the Board of Nursing concerning a similar condition, the decision of the medical and osteopathic boards would supersede the Board of Nursing's ruling. Complex medical condition is defined to mean "a diagnosis, treatment, or procedure that has a high degree of outcome variation and requires specialized skills possessed by a physician or a patient care team to provide care for the patient in order to prevent a serious adverse outcome." Pregnancy is included in the list of complex medical conditions.
4. South Carolina Full Practice Authority Bill Receives Subcommittee Hearing
Hundreds of APRNs turned out in support of a subcommittee hearing on H.3078. APRN testimony focused on the practice barriers associated with existing physician supervision requirements and highlighted how the proposed regulatory change will result in better access to care for South Carolina patients. The opposition testimony argued in favor of physician-led medical teams and urged consideration of the medical association's countermeasure, H.3508, which was discussed in a previous policy update. The subcommittee voted to adjourn debate on the APRN bill, although there is still a possibility that the bill will be heard again at a later date. The physician-supported countermeasure is expected to receive a subcommittee hearing shortly.
5. Multiple Provider Non-Discrimination Bills under Consideration
Section 2706 of the Affordable Care Act, commonly known as the provider nondiscrimination clause, states that, "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law." Multiple state bills currently under consideration closely mirror this language, including Hawaii S.1217, Rhode Island S.5046, New Mexico S.190, and California A.41. ACNM has been actively involved in assisting our affiliate organizations to meet with their local insurance commissioner to discuss issues related to network adequacy. We have also submitted comments on that topic to the Centers for Medicare and Medicaid Services, the National Association of Insurance Commissioners and the Federal Trade Commission.
6. Other Selected State Updates
Arkansas H.1136 proposes to authorize APRNs to prescribe hydrocodone combination products reclassified from Schedule III to Schedule II if expressly authorized by their collaborative practice agreement. The bill has passed the House.
South Dakota S.77 would authorize a mother to breastfeed her child in any location, public or private, where the mother and child are otherwise authorized to be present as long as the mother is in compliance with all other state and municipal laws. The bill has passed both the Senate and House.
Federal Issues
1. ACNM Submits Comments to FTC on Plan Network Adequacy
In response to a request for comment from the Federal Trade Commission in preparation for an upcoming meeting on competition in health care, ACNM submitted comments summarizing the results of our survey of health insurance plans operating through the marketplaces. The FTC has been strongly supportive of APRN freedom to practice and we believe that our survey will provide them concrete data to assist in their examination of anti-competitive practices in the healthcare arena that limit what APRNs are able to do.
2. ACNM Leads Joint Letter to GAO Regarding Failure to Appoint Representative of Pregnant Women to MACPAC
The Medicaid and CHIP Payment and Access Commission (MACPAC) is a congressionally chartered body tasked with giving policy recommendations to the Congress related to those two public programs. The statute creating the Commission requires the General Accountability Office (GAO) to select commissioners from among nominations put forth by the public. The GAO is specifically required to include a representative of pregnant women among the commissioners.
ACNM member Denise Henning, CNM recently finished her term as a commissioner. Unfortunately, the GAO did not appoint any new commissioner with specific expertise in treating pregnant women or advocating on their behalf despite the fact that both ACNM and ACOG had put forth qualified applicants.
ACNM coordinated an effort to express concern to the GAO regarding this failure, leading to a joint letter from ACNM, ACOG, AWHONN, AABC, CHI, ICTC, Lamaze, MANA, NACPM, NWHN, and SMFM. Appropriate members of Congress were cc'd on the communication and we have information that at least one Senator is looking into the matter further with the GAO.
Don't Forget to Forward this Note to CNMs/CMs who are not ACNM Members
As usual, if you know any CNMs/CMs who are not currently ACNM members, please forward this Policy Update to them. We want to be sure they know what the association is doing on their behalf and the kinds of activities that their membership would support.
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.
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Want to take action or get involved? Contact ACNM's Government Affairs Committee.
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