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ACNM Policy Update - 4/16/2014

1.  AHA Suit against CMS Includes Complaint about Physician Certification
2.  FTC Report Sparks Questions about Likelihood of Antitrust Action
3.  National Health Service Corps Opens Application for Site Approvals
4. NQF Maternity Action Team to Host Public Webinar on Reducing Early Elective Deliveries

1.  AHA Suit against CMS Includes Complaint about Physician Certification

In an April 14, 2014 complaint, filed in U.S. District Court, the American Hospital Association (AHA) challenges policies put into place by the Centers for Medicare and Medicaid Services (CMS) meant to define when hospital inpatient admissions will be accepted for payment by the agency.  In its suit, the AHA complains, among other things, that CMS’ requirement that all Medicare inpatient admissions be certified as medically necessary by a physician is an inadmissible interpretation of the statute. 

Section 1814(a)(3) of the Social Security Act requires that Medicare payment only be made:

[W]ith respect to inpatient hospital services (other than inpatient psychiatric hospital services) which are furnished over a period of time, a physician certifies that such services are required to be given on an inpatient. basis [emphasis added].

The AHA argues that Congress was intentional with the language regarding the requirement that certifications only be required when inpatient care is required for an extended period. 

The AHA points out that the language of the original Social Security Act, from 1965 required that payment be made for inpatient hospital services only if a physician certified that “such services are or were required to be given on an inpatient basis for such individual’s medical treatment[.]”

In 1967, the Congress modified that language to include the phrase about certification being required in cases where inpatient services were furnished over a period of time.  Both the House and Senate reports accompanying the 1967 amendment state that the effect of the change was to “eliminate the hospital insurance program requirement that there be a physician’s certification of medical necessity with respect to each admission to a general hospital, and to require such a certification only in cases of hospital stays of extended duration[.]”  The House report further explains the rationale for the amendment:  “[A]dmissions to general hospitals are almost always medically necessary and the requirement for a physician’s certification of this fact results in largely unnecessary paperwork.”

The question for the Court will be whether CMS’ interpretation goes beyond the bounds of what is permissible under the statute. 

ACNM and the American Association of Nurse Practitioners have met in person with CMS staff to discuss the problems associated with requiring physician certification of admission orders by CNMs/CMs.  During that meeting CMS affirmed its interpretation of the statute.  (Note that this provision does NOT apply to patients insured by programs other than Medicare, though some hospitals may choose to apply it unnecessarily beyond Medicare).

ACNM will be discussing with other APRN groups how we may contribute to the AHA’s effort.  ACNM has also begun efforts to discuss this situation with Congressional staff to secure a legislative resolution.

2.   FTC Report Sparks Questions about Likelihood of Antitrust Action

In the wake of the FTC’s new report on APRN regulation and ACNM’s attendance at a recent workshop on the same subject, questions are naturally arising from the membership about whether this presents a timely opening for possible antitrust action against physician groups that advocate against full practice authority for other providers types.

ACNM, in coalition with other provider groups, met with the FTC and antitrust attorneys some time ago to discuss the challenges faced by our respective members in realizing the ability to practice to the extent of their education and licensure.  During the meeting, certain important facts were highlighted.  Association activity by definition presents antitrust risks because it is seen as involving collaboration amongst competitors. However, petitioning, lobbying or legal advocacy by associations and their members is immunized from antitrust laws. This includes advocacy relating to national, state or local legislation; policymaking, rulemaking and enforcement activities of government agencies; and   decisions of judicial bodies. The protection extends even to efforts that are intended to or actually restrain competition. Antitrust actions can be challenging to mount because the laws are meant to protect competition, not competitors.

State regulatory boards, by contrast, are not protected in the same manner as association activities. The pending Supreme Court case, North Carolina Board of Medical Examiners vs. FTC, is a prime example of this. Members should be assured that ACNM is closely monitoring the rapidly changing landscape for any opportunities to advocate on behalf of midwifery.  


3.  National Health Service Corps Opens Application for Site Approvals

The National Health Service Corps (NHSC) has announced the opening of the 2014 New NHSC Site Application cycle to those who have never been approved as an NHSC site.

The benefits of being a NHSC approved site include access to: 

  • Providers receiving assistance through the NHSC Loan Repayment and Scholarship Programs are required to work in NHSC approved sites.   
  • The NHSC Jobs Center, where NHSC-approved sites post job openings and site profiles, which attracts over 22,000 unique visitors each month.
  • NHSC Virtual Job Fairs, which enable NHSC-approved sites the opportunity to recruit providers in a cost effective manner since interaction is facilitated online via the internet and phone.

All completed applications must be submitted by June 16, 2014, at 11:59 pm, ET to be considered for an award. Please refer to the NHSC’s Site Reference Guide for all of the program requirements. 

In order to apply to become an NHSC-approved site, a facility must submit an NHSC Site Application through the NHSC’s Customer Service Portal.

For the upcoming application cycle, only sites that have never been approved as NHSC sites are eligible to apply.  Previously-approved NHSC sites will have an opportunity to recertify in fall 2014.  The NHSC encourages eligible sites to apply as early as possible. On average the site application cycle can take 2-3 weeks from start to finish. 

Before applying to become an NHSC-approved site, make sure that your facility qualifies by closely reviewing the NHSC’s Site Reference Guide.  Please note that all auto-approved sites do not need to apply but must contact the Regional Office staff found on page two of the “ Resources in Your Community” document to add new sites to the NHSC system of record.  Auto-approved site types are listed in the NHSC’s Site Reference Guide.

A technical assistance conference call will take place on May 1, 1-3 pm ET. To access the call, you can dial 1-888-391-7045, passcode 2240736. An on-demand webinar will also be posted on the NHSC Website shortly after the New Site Application cycle opens.  You can view a video of Cuba Health Center, one of NHSC’s member sites, to learn about the benefits of becoming an NHSC-approved site. 

4.  NQF Maternity Action Team to Host Public Webinar on Reducing Early Elective Deliveries

The Maternity Action Team (of which ACNM is a member) of the National Quality Forum (NQF) will be hosting a public webinar on Monday, April 21, 2014 from 3:30 p.m. – 5:00 p.m.  The MAT will share plans for 2014 to support the goal of reducing early elective deliveries (EEDs) prior to 39 weeks gestation to 5 percent or less in every state.  The MAT will also solicit input on their efforts to help with data and measurement challenges in these areas.  The web meeting will also feature several groups who will share successes, barriers and lessons learned in their efforts to reduce EEDs.  The web meeting is open to the public.  You may register here.

Participation Details

1.  Direct your web browser to the following URL:

2.  Under “Enter a meeting,” type in the meeting number 902825 and click on “Enter.”

3. Public participants: Dial 1-855-599-0737 and use confirmation code 29961594


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. The deadline for the advance registration discount is May 7. Also, hotel rates will significantly rise as of April 28. So take advantage of ACNM's contracted rate as soon as you're able.

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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