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.
