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ACNM Policy Update - 4/11/2014

1.  ACNM Clarifies Position on Licensure and Regulation of Midwives
2.  Support Legislation Designating Maternity Shortage Areas!
3. Open Enrollment is Over – But Special Enrollment Periods Still Apply to Many
4.  Update on Kansas APRN Independent Practice Bill
5.  Selected State Legislative Developments from South Carolina, Washington, West Virginia


1.  ACNM Clarifies Position on Licensure and Regulation of Midwives

Earlier today, ACNM posted on its website an updated position statement, approved by the Board of Directors, entitled “Principles for Licensing and Regulating Midwives in the United States in Accordance with the Global Standards of the International Confederation of Midwives.” 

In publishing this updated statement, ACNM continues to clarify its longstanding positions on licensing and regulating midwives that were last updated in 2009.   As the next ICM Triennial Congress approaches in June 2014, ACNM leadership felt that it was important to re-examine the organization’s principles and professional standards in light of the ICM standards, confirm our endorsement of the ICM standards, and provide guidance to Affiliates and ACNM members about how to apply ICM standards in the US context when considering midwifery licensure and regulation in individual states.   

ACNM gratefully acknowledges the collaboration and support of the Accreditation Commission for Midwifery Education (ACME) and the American Midwifery Certification Board (AMCB) in writing this update.  The resulting statement represents the most comprehensive examination of the ICM standards in the US context currently available.  ACNM, ACME, and AMCB also worked together to conduct a gap analysis of the education and regulation of CNMs and CMs against the ICM standards.  This gap analysis—developed by ICM and recommended for all midwifery organizations worldwide—represents a key step in understanding our profession in the global context and is available here

Key concepts of ACNM’s position include:

•  In the interest of public health and safety, any individual seeking to practice as a midwife in the United States should meet the ICM standards at a minimum.

•  States with existing statutes or regulations for midwifery licensure that are not consistent with ICM standards should revise their laws and regulations to bring them into accord with these standards. 

•  As policymakers adopt laws and regulations that meet ICM standards, they should work with midwifery organizations to help currently practicing midwives meet these standards within reasonable timeframes, while protecting public health and safety. 

CNMs/CMs and CPMs frequently work and collaborate with each other and share many core beliefs.  ACNM’s desire is also to see a shared vision for midwifery in the United States.  ACNM continues to be actively engaged in ongoing dialogue with CPM community leaders through the US Midwifery Education, Regulation, and Association (US MERA) workgroup.  US MERA is holding the second in-person meeting April 10-13, 2014 in the Washington, DC area.  ACNM will be utilizing that meeting as an opportunity for face-to-face discussion with CPM community leaders about the importance of coming together to embrace minimum standards for midwifery education such as have been embraced throughout the world, and to commit to working together to support midwives to attain these standards and legal recognition.  ACNM understands that achieving this vision will take time but it is a key step in advancing midwifery in the US and ensuring that every woman has access to a fully qualified midwife wherever she lives, and whatever her choice of birth setting.

In addition to the document noted above, ACNM has prepared a more succinct version more suitable for use with policymakers and others engaged in this dialogue.  ACNM always welcomes member input on our work.  Please send your comments to [email protected].

2.  Support Legislation Designating Maternity Shortage Areas!

On April 3, 2014, Rep. Michael Burgess (R-TX) and Rep. Lois Capps (D-CA) introduced bipartisan legislation (H.R. 4385, the Improving Access to Maternity Care Act of 2014) that would require the Health Resources and Services Administration (HRSA) to identify geographic areas and populations that are experiencing a shortage of providers and facilities that supply “full scope maternity care.”  Full scope maternity care is defined to include prenatal, labor and birth, and postpartum care.  The language of the bill is written very broadly so that HRSA should take into account physicians, CNMs, CMs and CPMs in its consideration of provider types and it specifically requires that HRSA consider birth centers in evaluating access to facilities providing maternity care. 

The National Health Service Corps, operated by HRSA, currently administers a scholarship and a loan repayment program for certain professionals willing to work in health professionals shortage areas after graduation.  CNMs are currently listed among the provider types eligible for these two programs.  CMs are not currently identified as potentially eligible for these programs.  ACNM has had initial conversations with HRSA about the possibility of expanding the set of providers that may receive funding under these programs.

We anticipate that the creation of maternity care health professionals shortage area designations under this new legislation will expand the possibilities for CNMs to participate in the scholarship and loan repayment programs.  For more information, visit ACNM's website.

This legislation needs your support!  You should have received an email that will take you to ACNM’s Action Center through which you can send a customized email to your representative with a single click.  If you have not done so, visit ACNM’s Action Center to write your representative.

3. Open Enrollment is Over – But Special Enrollment Periods Still Apply to Many

As you are likely aware, the first annual open enrollment period for plans offered through the Health Insurance Marketplaces has come to an end.  However, for a significant number of people, opportunities to enroll in Marketplace plans will continue to occur throughout the year, under “special enrollment periods” that are triggered by specified qualifying events.  Included among these qualifying events is the birth of a child.  Additionally, individuals eligible for Medicaid or the Children’s Health Insurance Program (CHIP) may apply for coverage through the Marketplaces at any time.  For a complete list of special enrollment periods, click here. 

4.  Update on Kansas APRN Independent Practice Bill

Kansas APRNs have tried for multiple legislative sessions to advance an independent practice bill. This year their efforts have again stalled in the legislature. The bill has not received a hearing in either the House or the Senate to date, and it is likely too late for any serious consideration of the bill to begin this session. Chairs of the Senate Public Health and Welfare Committee and the House Health and Human Services Committee have both been reluctant to hear the bills until the APRNs and the state medical society, perhaps the bill’s most vocal opponent, have worked out compromise language. The medical society has indicated that it is not necessarily opposed to changes to the law, but has also stated that the current requirement for a written collaborative agreement is close to striking the appropriate balance in physician involvement in APRN practice. The groups are expected to begin meeting later this spring.

5.  Selected State Legislative Developments

South Carolina’s
Senate and House passed resolutions naming April 3, 2014 “Nurse Practitioner and Certified Nurse Midwife Day.” The text of the resolutions is particularly interesting given the state’s supervision requirements. It cites to the recent FTC report, outcomes data, and patient satisfaction, at times specifically making comparisons between NPs/CNMs and physicians.

Washington H.1773 requires the Secretary of Health to write rules to bridge the gap between national and state requirements for direct-entry midwives, specifically considering national certification of certified professional midwives versus state requirements for licensure. The bill became law on April 2.

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. A mother may breast feed a child in any location, public or private, where the mother and child are otherwise authorized to be." It was signed into law on March 28.


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 the 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.



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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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