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ACNM Policy Update - 3/25/2015

State Issues

1.  Midwifery Bills in the News – A Round Up of Selected Articles
2.  Selected State Developments – Introduction and Progress - AR, FL, IL, ME, MD, NV, NH, NY, OH, RI, SC, UT, WV
3.  Selected State Developments – New Laws - KY, SD, VA
Federal Issues

1.  Legislation Introduced to Increase Primary Care Payments Under Medicaid
2.  National Health Service Corps to Hold Conference Call on Scholarship Application Program
3. HRSA Releases Maternal, Infant and Early Childhood Home Visiting Program Fact Sheet and State-by-State Data
4.  HRSA Opens 2014 NURSE Corps Scholarship Program

State Issues

Note:  Current status of state legislation of interest to ACNM members can be obtained through ACNM's Legislative Tracking Tool.  We strongly encourage affiliate legislative chairs to regularly check this site to see the status of legislation in their states .

1.  Midwifery Bills in the News – A Round Up of Selected Articles

Oregon H.2930, which would require hospitals to grant admitting privileges to CNMs, received coverage in The Lund Report. Oregon Affiliate Legislative Chair Laura Jenson explained that, ‘Limitations on admitting privileges prevents us from doing what we’re trained to do.’ The article goes on to note that “hospital admitting privileges might be more important to nurse midwives than other nurse practitioners, since their work is geared toward helping mothers give birth in hospitals, while other practitioners may seldom work outside a clinic. ‘We’ll see them in outpatient clinics but eventually our patients are going to end up at the hospital to have their babies.’  The bill is currently under consideration by the House Committee on Health Care. At a hearing earlier in the month, supportive testimony was offered by the Board of Nursing and Oregon ACOG, among others.

Media coverage of the previously mentioned Duke study on the economic benefits of less restrictive regulation of APRNs in North Carolina is increasing. A Forbes blog by study author Christopher J. Conover emphasizes that increased utilization of APRNs is a “faster, better, cheaper path” to addressing physician shortages than focusing efforts on increasing the physician workforce. Additional coverage has appeared in the North Carolina news show “Capital Tonight,” North Carolina Health News, and the John Locke Foundation. The North Carolina Medical Society has declined to comment on the study, while the North Carolina Hospital Association said that hospitals support the current state law that “allows nurses to practice at the top of their license with physician supervision.”  

2.  Selected State Developments – Introduction and Progress - AR, FL, IL, ME, MD, NV, NH, NY, OH, RI, SC, UT, WV

Arkansas H.1609 makes minor modifications to collaborating physician requirements by striking the phrase that physicians must have a "practice comparable in scope" and replacing with "has training in scope" equivalent to the APRN. The bill has passed the House.

Florida S.614 proposes to grant prescriptive authority to advanced practice nurses for controlled substances. The bill passed the Health Policy Committee by a 4-3 vote and is now referred to the Regulated Industries Committee.

Illinois H.1407 would require hospitals to provide information and instructional materials regarding sudden infant death syndrome, including information developed by the National Institutes of Health concerning safe sleep environments. The bill passed the House unanimously.

Maine LD.970 revises statutory language regarding advanced practice registered nursing, including providing for prescriptive authority for all 4 roles of advanced practice (CNMs currently have prescriptive authority), incorporating a grandfather provision, and granting global signature authority for CNMs and NPs.

Maryland H.739 proposes to establish the Task Force to Study Maternal Mental Health to explore and make recommendations regarding maternal mental health disorders that occur during pregnancy and the first postpartum year. The bill has passed the House.

Nevada A.269 provides, among other things, that a person has a right to engage in a lawful occupation free from any substantial burden contained within an occupational regulation unless the governmental entity or regulatory body seeking to enforce the regulation demonstrates that it has an important interest in protecting against a present and recognizable harm to public health or safety and the regulation represents the least restrictive means of furthering that important interest. This bill is likely being proposed in response to the recent Supreme Court ruling on regulatory board compositions.

New Hampshire S.200 requires newborns to be screened for Krabbe Leukodystrophy. The bill has passed the Senate.

New Hampshire S.219 requires employers to provide reasonable accommodations to women who are breastfeeding. The bill also exempts a nursing mother from jury duty. The bill has passed the Senate.

New York A.446, which directs the Commissioner of Health to make regulations relating to the establishment and operation of midwifery birth centers, has passed the Assembly with a 112-32 vote. The bill is currently referred to the Senate Health Committee for consideration.

Ohio H.124 would allow CNMs to issue a prescription to treat chlamydia, gonorrhea, or trichomoniasis without examining the individual if he or she is the sexual partner of the CNM’s patient and the patient reports to the nurse that the individual is unable or unlikely to be evaluated or treated by a health professional.

Rhode Island S.419 requests the Director of the Department of Health to oversee the creation of educational materials about postpartum depression, including its symptoms, methods of coping with the illness, and treatment resources available to them, in order to ensure that all birthing facilities in the state provide this information to departing new mothers and fathers and other family members, as appropriate.  The resolution has passed the Senate.

South Carolina H.3851 would require birth centers to be accredited, inserts new language related to risk evaluation and transfer procedures, and would require birth centers to collect and report data.

Utah HJR.26 suggests several topics for possible legislative interim studies, including the question of whether to require informed consent forms from unlicensed and licensed midwives. This suggestion is almost certainly in response to H.202, which proposes to require unlicensed direct-entry midwives to obtain an informed consent from potential clients. The consent form would require disclosures that the midwife is not licensed, that his or her education has not been evaluated by the state, and acknowledgment that “the risk of harm or death to a mother or newborn may be greater because the    individual is not licensed.” HJR.26 has advanced to the Governor for consideration.

West Virginia H.2776 authorizes APRNs to write prescriptions for hydrocodone combination drugs to a patient for a duration of no more than three days per thirty day period pursuant to the collaborative agreement. The bill has passed both chambers.

3.  Selected State Developments – New Laws - KY, SD, VA

Arkansas H.1136 allows an APRN to prescribe hydrocodone combination products reclassified from a Schedule III to a Schedule II if expressly allowed by the collaborative agreement. The bill was signed into law on March 18.

Kentucky S.75 includes Krabbe Disease testing as part of the newborn screening program. The bill became law on March 19.

Kentucky S.159 requires health care providers, including CNMs, to provide expectant or new parents with up-to-date, evidence-based, written information about spina bifida and contact information for support programs when a positive test result is received. The bill was signed into law on March 20.

South Dakota S.60 requires each infant to be screened for metabolic, inherited, and genetic disorders. The bill became law on March 13.

Virginia H.1499 provides that a mother may breastfeed in any place where the mother is lawfully present. The bill was signed into law on March 10.

Virginia H.1515 adds information about safe sleep environments for infants that is consistent with current information available from the American Academy of Pediatrics to the list of information that licensed nurse midwives, licensed midwives, and hospitals must provide to maternity care patients. The bill became law on March 17.

Virginia H.1657 adds a section to the suggested form of written advance directives that allows a declarant to add specific instructions for life-prolonging procedures in case the declarant is pregnant when her attending physician determines that she has a terminal condition. The bill became law on March 16.

Federal Issues

1.  Legislation Introduced to Increase Primary Care Payments Under Medicaid

Senators Patty Murray (D-WA) and Sherrod Brown (D-OH) have re-introduced legislation to increase Medicaid payments for specified primary care services to the level of payment received through Medicare.  The "Access to Primary Care for Women & Children Act" (S. 737) was introduced with 11 additional original cosponsors (all Democrats).

The bill provides for such increased Medicaid payments for a period of two years after its passage.  A provision of the ACA had allowed for these payments only to certain primary care physicians during 2013 and 2014.  S. 737 expands the availability of these increased payments to CNMs, NPs, PAs and OB/GYNs.  In another positive change, the current legislation does not include a provision in the original statute that required that providers receiving these increased payments attest that at least 60 percent of their Medicaid reimbursement came from provision of primary care.  This expands the number of providers that could potentially benefit from the increased payments.

ACNM supports this legislation.  At an appropriate time, we will be sending out an Action Alert to allow members to contact their Senators in support of this important bill.

2. National Health Service Corps to Hold Conference Call on Scholarship Application Program

On Thursday, March 26, from 7:00 - 9:00 p.m. ET the National Health Service Corps (NHSC) will host a conference call to answer questions about applying for the NHSC Scholarship Program. NHSC staff will be available to answer questions from prospective applicants.

You are encouraged to view the 2015 NHSC Scholarship Application and Program Guidance Overview Webinar, which reviews the eligibility requirements, letters of recommendation, essays, application process and more.  Keep in mind that the application process closes on May 7, 2015 at 7:30 p.m. ET. 

To participate in the call, dial 1-888-391-6801.  The passcode is 8081979.

3. HRSA Releases Maternal, Infant and Early Childhood Home Visiting Program Fact Sheet and State-by-State Data

The Health Resources and Services Administration (HRSA) has released a Fact Sheet and state-by-state data on the Maternal, Infant and Early Childhood Home Visiting Program.  Congress created the Home Visiting Program to support voluntary, evidence-based home visiting services for at-risk pregnant women and parents with young children up to kindergarten entry.  The Home Visiting Program builds upon decades of scientific research showing that home visits by a nurse, social worker, early childhood educator, or other trained professional during pregnancy and in the first years of life improve the lives of children and families by preventing child abuse and neglect, supporting positive parenting, improving maternal and child health, and promoting child development and school readiness.

4.  HRSA Opens 2014 NURSE Corps Scholarship Program

The Health Resources and Services Administration (HRSA) has opened up the 2015 NURSE Corps Scholarship Program application cycle.  It will be open through May 21, 2015 at 7:30 p.m. ET.  An Application and Program Guidance have been made available.  

This program assists students completing their nursing education by paying tuition, fees and other education costs, while providing a monthly living stipend.  The program is open to all full-time or part-time nursing students accepted or enrolled in diploma, associate, baccalaureate or graduate nursing programs at accredited schools located in the U.S.  Upon graduation, scholarship program members fulfill a service commitment at an eligible NURSE Corps site.

The program is competitive and applications take approximately 3 weeks to complete.  Applicants are encouraged to participate in two technical assistance calls with program staff and to view the NURSE Corps Scholarship Technical Assistance Webinar.
The technical assistance conference calls will occur:

April 7, 2015, 8:00 - 10:00 p.m. ET

Dial in Number:  1-800-779-8389

Passcode:  8645774

May 16, 2015, 1:00 - 3:00 p.m. ET

Dial in Number:  1-800-779-8389

Passcode:  8645774

Please share this Policy Update with any CNMs/CMs you know who are not ACNM members.  We want them to know what the association is doing to help them out and encourage them to become a part of the association.

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. 

Not an ACNM member?  You can access all of the member benefits, including receipt of every ACNM Policy Update, by joining today.  

Want to take action or get involved?  Contact ACNM's Government Affairs Committee.

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American College of Nurse-Midwives.
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Phone: 240-485-1800 | Fax: 240-485-1818
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