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ACNM Policy Update - 2/25/2014

1.  ACNM Submits Comments on Marketplace "Letter to Issuers"
2.  Help Needed to Survey Health Plans Regarding Coverage of Midwifery Services

1.  ACNM Submits Comments on Marketplace "Letter to Issuers"

Earlier today, ACNM submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to a draft "Letter to Issuers" that the agency released for comment earlier this month.  The Letter, which is released on an annual basis, contains policies that CMS intends to put into place for the following year affecting the operation of health insurance plans offered through the Federally Facilitated Marketplaces. 

At this point in time, the majority of states (36) allow the federal government to operate a Marketplace on their behalf or in partnership with them.  The remaining states operate their own Marketplaces.  As a result, the content of this Letter will affect the majority of Marketplaces and may have spillover effect to the extent that states adopt its policies.  For information on which course your state took, click here.

In the Letter, CMS proposes to make changes in the way the adequacy of plans' provider networks are evaluated.  For 2014, plan networks were evaluated by existing mechanisms used by states, or by an accrediting agency.

For 2015, CMS has proposed that the agency would be solely responsible for evaluating plan network adequacy and all plans operating through the Federally Facilitated Marketplace would be required to submit information on their provider networks to CMS for evaluation.

ACNM supports the centralization of this review, as we believe it will result in a more consistent approach and will certainly make it simpler to advocate on this topic, given the need to interact with only a single entity.

CMS further proposed the creation of a search engine function for consumers to search for particular providers and provider types.  ACNM supported this proposal as well.

Finally ACNM informed CMS that we intend to conduct a survey of plans' coverage of midwifery services that will allow us to provide them with concrete information about this important coverage. 

2.  Help Needed to Survey Health Plans Regarding Coverage of Midwifery Services

Related to the previous topic, ACNM is conducting a survey of health plans operating in the Health Insurance Marketplaces to gather data on their coverage of midwifery services, birth centers and home birth.  We will also be asking about their reimbursement rates vs. physicians and how they list midwives in their plan network directories.

This information will be critical to our ability to advocate on this issue, both with the regulators and also to convince plans that are outliers to ensure adequate coverage of midwifery services. 

There are 277 plans that must be contacted.  There is only one ACNM Director of Advocacy and Government Affairs.  So, I need some help.

If you would be willing to make some calls to plans on ACNM's behalf, please contact me to let me know.    

I can be contacted at [email protected] or 240-485-1843.



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American College of Nurse-Midwives.
8403 Colesville Rd, Suite 1550 | Silver Spring MD 20910
Phone: 240-485-1800 | Fax: 240-485-1818
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