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ACNM Policy Update - 2/7/2014

State Developments
1.  Recent State Legislative Developments
2.  Maryland Proposed Rule Eliminates Requirement for Collaborative Plan
3.  State Legislative and Regulatory Tracking System 

Federal Developments
1.  Lab Regulations to Require Direct Patient Access to Test Results 


State Developments 

1.  Recent State Legislative Developments
The highlights selected below represent a sampling of bills that passed a significant legislative hurdle in recent weeks.

-- Delaware H.214
requires that hospitals, physicians and other health professionals provide information about Down Syndrome and Down Syndrome resources and support groups to parents who have received a prenatal or postnatal diagnosis of Down Syndrome. The bill passed the House on January 30.
-- Kentucky S.7 would remove the requirement for a written collaborative agreement to prescribe non-scheduled legend drugs (CAPA-NS). After four years of prescribing in collaboration with a physician, APRNs would no longer be required to maintain the CAPA-NS. The bill has passed both chambers as of February 4.
-- Mississippi H.813 provides that APRNs may, but shall not be required to, practice in a collaborative relationship with a physician. The bill died in committee on February 4, but a companion bill, S.2748, is still slated for consideration by the Senate Committee on Public Health and Welfare.
-- New Jersey S.2843 requires the Department of Health to establish protocols for stillbirths, establishes a stillbirth research database, and directs the Commissioner of Health to develop policies to ensure that families experiencing a stillbirth receive psychological and emotional support. The bill was signed into law on January 17.
-- New York A.414 provides for a premium reduction for physicians and licensed midwives who complete a risk management strategies course in obstetrics or midwifery, among other things. The bill passed the Assembly on January 23.
-- Ohio H.139 permits certain advanced practice registered nurses and physician assistants to admit patients to hospitals, including a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner who has a standard care arrangement with a collaborating doctor or podiatrist who is a member of the medical staff and all parties have admitting privileges. The bill became eligible for the Governor's consideration on January 30.
-- Ohio H.315 requires hospital reporting to the Department of Health regarding newborns diagnosed as opioid dependent. The bill passed the House on January 22.
-- Pennsylvania S.29 provides for mandatory reporting of infants and newborn prenatal exposure to illegal substances. The bill was signed into law on January 22.
-- South Dakota S.30 proposes to implement the Advanced Practice Registered Nurse (APRN) credential. The bill was introduced on January 14 and has passed both chambers as of January 31.  

2.  Maryland Proposed Rule Eliminates Requirement for Collaborative Plan
CNMs in Maryland are currently required to have a collaborative plan with a physician. The plan must provide for consultation, collaboration with, and referral to a physician to address complications during a pregnancy that are beyond the educational preparation or scope of practice of the CNM. The plan must also include an assurance that a client can be transferred, whenever required, to the care of a physician with admitting privileges to a facility with an OB/GYN unit located in the client's geographic area. The state has issued a proposed rule that would eliminate the collaborative plan. CNMs providing clinical services would nonetheless be required to have written practice guidelines that include, but are not limited to, emergency consultation, transfer of care, and admission of the client or newborn to a nearby hospital, if needed. ACNM understands that there may be commenters on the proposed rule who will recommend an attestation as an alternative to eliminating the collaborative plan. ACNM has submitted a letter to the state opposing any potential requirement for an attestation because the certification process already ensures the competency of nurse-midwives.

3.  State Legislative and Regulatory Tracking System
The Department of Advocacy and Government Affairs regularly updates the state tracking system with the status of legislative and regulatory developments of possible interest to members.  Visit the tracking system to see what is happening in your state.  While not an exhaustive list of all measures, ACNM strives to report on developments related to licensure and regulation, full practice authority, insurance and reimbursement, health reform, liability, and women’s health issues.

ACNM recognizes that members have differing opinions on policy issues, such as the implementation of the Affordable Care Act or access to reproductive health services. Because these issues are under consideration by numerous state legislatures and because of their potential to impact either the practice of midwifery or women’s health care options, we do report on proposed measures related to potentially controversial topics. We do not, however, selectively choose legislative or regulatory measures that are reflective of any particular partisan position. Moreover, the inclusion of these issues in the tracking system does not indicate ACNM support or opposition for any issue, and ACNM does not advocate on these topics at the state level unless there is a request from affiliate leadership. The tracking system is solely designed to relay information to interested members and should not be misunderstood to be a reporting of ACNM’s advocacy efforts.  

Federal Developments 

1.  Lab Regulations to Require Direct Patient Access to Test Results
Under current federal regulation of clinical laboratories, a laboratory may only disclose laboratory test results to three categories of individuals or entities:
-- the ‘‘authorized person,’’
-- the person responsible for using the test results in the treatment context, and
-- the laboratory that initially requested the test.
‘‘Authorized person’’ is defined as the individual authorized under state law to order or receive test results, or both.  A number of states have laws in place that prohibit a laboratory from releasing a test report directly to the individual patient or that prohibit the release without the ordering provider’s consent.   
To ensure that patients have access to their own health related information and are most able to take an active part in their care, the Centers for Medicare and Medicaid Services (CMS) has revised its laboratory regulations.  The revised final regulations require that upon request by a patient (or the patient’s personal representative), the laboratory may provide patients, their personal representatives, and those persons designated in writing by the patient, as applicable, with access to completed test reports that, using the laboratory’s authentication process, can be identified as belonging to that patient. 
The agency noted that several states do not allow patients access to their test results, instead requiring them to receive these results from their provider.  The agency cited data indicating that in up to seven percent of cases, providers do not convey the results of laboratory tests.  Because federal privacy rules supersede state laws, the revised final regulation will allow laboratories in states with such restrictive laws to begin providing laboratory test results directly to patients.     The provisions of this revised final rule are effective as of April 7, 2014.  The regulation can be accessed here.   



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