1. CMS Releases
Final 2015 Letter to Issuers and Request for Information Regarding Provider
Non-Discrimination
2. Selected State
Developments from Hawaii, Kentucky, Nebraska, New Mexico, Ohio, Oregon, South
Dakota, Virginia, and West Virginia
Note: Many of the state
developments were slated to be included in an earlier policy update, but did
not go out because I inadvertently scheduled the email to be sent in the year
2104. We assure you that your national office staff aspires to
appropriately inform you of events before you die of old age.
1. CMS Releases
Final 2015 Letter to Issuers and Request for Information Regarding Provider
Non-Discrimination
This past week, the Centers
for Medicare and Medicaid Services (CMS) issued two important documents related
to the new Health Insurance Marketplaces. The first is the final "2015
Letter to Issuers in the Federally-facilitated Marketplaces." This
document outlines policies and operational practices CMS will adopt with regard
to the federally facilitated marketplaces for the 2015 plan year. Among
these are provisions specific to determinations of plan network adequacy.
In its proposed Letter to
Issuers, CMS indicated the agency would no longer allow plans-network adequacy
to be determined via accreditation or by state agencies and would instead make
those determinations itself. ACNM
supported this course, as it allows for a more consistent, centralized
approach. It also make advocacy on this point simpler, as we will not
have to approach each individual state exchange when we note problems with
coverage of midwifery services. In the final Letter, CMS indicates it
will follow this approach.
In the final Letter, as with
the proposal, CMS indicates it is considering appropriate formats for
collection of provider network data, which would allow for the creation of a
search engine function for consumers to find particular providers and provider
types on HealthCare.gov. ACNM supported this approach in its comments on
the proposed Letter.
Related to questions of
network adequacy, CMS has issued a Request
for Information regarding implementation of Section 2706 of the Public
Health Services Act (PHSA). Section 2706 was added to the PHSA by the Affordable
Care Act (ACA) and requires 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."
On April 29, 2013, the
Departments of Labor, Treasury and Health and Human Services issued an FAQ
stating that they had no plans for establishing regulations implementing
Section 2706 in the near future and that plans would be responsible for
implement the requirements of Section 2706 using a good faith, reasonable
interpretation. Unfortunately, the FAQ went on to state that Section 2706
"does not require plans or issuers to accept all types of providers into a
network."
A coalition, of which ACNM is
a member, had lobbied Congress on this issue and in a Senate
Appropriations Committee Report, dated July 11, 2013 (page 126), the
Committee stated that "The goal of this provision is to ensure that patients
have the right to access covered health services from the full range of
providers licensed and certified in their State. The Committee is therefore
concerned that the FAQ document issued by HHS, DOL and the Department of
Treasury on April 29, 2013, advises insurers that this nondiscrimination
provision allows them to exclude from participation whole categories of providers
operating under a State license or certification." The Committee directed
HHS, DOL and Treasury to "correct the FAQ to reflect the law and congressional
intent within 30 days of enactment of this act."
In response, CMS has issued
the Request for Information, asking for input on all aspects of implementing
Section 2706. As you are aware, ACNM is undertaking a survey of health
insurance plans regarding their coverage of midwifery services. The
results of this survey will put us in a good position for providing reliable
information to the federal government regarding whether plans are appropriately
covering the services of midwives. (Hooray for our survey volunteers!)
2. Selected State
Developments
Hawaii - S.2649 requires reimbursement for
services provided through telehealth to be equivalent to reimbursement for the
same services provided via face-to-face contact between a health care provider
and a patient. The bill clarifies that a health care provider of telehealth
includes primary care providers, mental health providers, and oral health
providers such as physicians and osteopathic physicians, advanced practice
registered nurses, psychologists, and dentists. It passed the Senate on March
4.
Kentucky - S.7 removes 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 will
no longer be required to maintain the CAPA-NS. An agreement will still be
needed for controlled substances. The bill was signed into law on February 13.
Nebraska - L.76 establishes the Healthcare Transparency Act. A
committee will be appointed to provide objective analysis of health care costs
and quality, promote transparency for health care consumers, and facilitate the
reporting of health care and health quality data, in the hopes of providing for
the facilitation of value-based, cost-effective purchasing of health care
services by public and private purchasers and consumers. The bill was signed
into law on Feb. 13.
The New Mexico - House
passed a legislative memorial which requests that the Secretary of Health
convene a task force to identify statutory provisions that create obstacles to
the ability of nurse practitioners, nurse-midwives and physician assistants to
function at their full scopes of practice.
Ohio - H.95 clarifies in law that CNMs
may sign birth certificates. Though CNMs have been signing birth certificates
for more than 30 years and the Ohio Department of Health Office of Vital
Statistics has accepted nurse midwife-signed documents, CNMs have never had the
express authority in the law to do so. Recently two Ohio hospitals have gone so
far as to no longer allow their Certified Nurse Midwives to sign birth
certificates. The bill became law on March 4.
Ohio - H.139 states that CNMs and other advanced practice nurses may
admit patients to the hospital if they have a standard care arrangement with a
physician who is a member of the medical staff, the patient will be under the
medical supervision of the collaborating physician, and the hospital has
granted the CNM admitting privileges and appropriate credentials. The bill was
signed into law on February 18.
Oregon - S.1548 amends certain statutes
that reference "physician'" to include references to "physician assistant"' and
"nurse practitioner." (In Oregon, CNMs are licensed as NPs.) The bill is not
meant to expand scope of practice but to correct language to reflect the work
that is already being done lawfully by NPs and PAs. It was signed into law on
March 6.
South Dakota - S.30 implements the Advanced Practice Registered Nurse
(APRN) credential. It was signed into law on February 10.
Virginia - H.580 clarifies that active-duty
military personnel are exempt from state licensure requirements when providing
care at public and private health care facilities. The bill became law on
February 20.
West Virginia - H.4335 relates to a child's
right to nurse. Specifically, the bill states in its entirety that: "The
Legislature finds that breast feeding is an important, basic act of nurturing
that is protected in the interests of maternal and child health. (b) A mother
may breast feed a child in any location, public or private, where the mother
and child are otherwise authorized to be." It is eligible for the
Governor's consideration as of March 8.
West Virginia - S.12 is an expedited partner therapy bill. The bill
proposes to allow a health care professional who makes a clinical diagnosis of
a sexually transmitted disease may provide expedited partner therapy for the
treatment of the sexually transmitted disease if in the judgment of the health
care professional the sexual partner is unlikely or unable to be present for
comprehensive health care, including evaluation, testing and treatment for
sexually transmitted diseases. Expedited partner therapy is limited to a sexual
partner who may have been exposed to a sexually transmitted disease within the
previous sixty days and who is able to be contacted by the patient. It is
eligible for the Governor's consideration as of March 8.
West Virginia - HCR122 requests the Joint Committee on Government and
Finance to study the feasibility of changes to the regulatory requirements of
advanced practice registered nurses. Specifically, the Committee is requested
to study "the feasibility of the following changes to the regulatory
requirements of advanced practice registered nurses (APRN): expanding of scope
of practice; expanding prescriptive authority; permitting annual prescriptions
supplies; permitting that a signature have the same effect as a physician
insofar as patient care documentation in concerned; and removing the
collaborative relationship with physicians." The resolution was introduced
on March 4.
Should you have questions about federal issues, please contact Jesse Bushman,
ACNM's Director of Advocacy and Government Affairs at [email protected] or
240-485-1843.
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.
Don't forget to register
for ACNM 59th Annual Meeting & Exposition. Details are available at the conference website.
Want to
take action or get involved? Contact ACNM's Government Affairs Committee.
Don't have
the time or energy to get involved, but still want to contribute? Support
the Midwives-PAC.
