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ACNM Policy Update - 4/29/2015

State Issues

1.  Selected State Updates -- Progress - AK, AR, CO, DE, HI, IL, ME, MD, TX
2.  Selected State Updates -- New Laws - IN, MD, NE, NM, ND, WA


Federal Issues

1.  ACNM Provides Issue Brief on Revisions to Medicare Physician Payments
2.  Sound Off on New Proposed 5-year Strategic Plan
3.  AHRQ Publication Highlights Innovative Approaches to Improving Birth Outcomes
4.  Kaiser Family Foundation Releases Report on Contraceptive Coverage under the ACA
5.  What Medicaid Pays for Global Fee for Vaginal Birth in Each State
6.  CABC Map of All Accredited Birth Centers
7.  ANA Seeks Input on Meaningful Use to Inform Regulatory Comments
8.  Joint Commission Webinar on Perinatal Care Certification
9.  Premier to Hold Webinars on Maternal Care Topics
10.  CMQCC Announces Webinar on Obstetric Hemorrhage Toolkit
 


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.  Selected State Updates -- Progress - AK, AR, CO, DE, HI, IL, ME, MD, TX


Alaska S.53, which implements the APRN credential, has passed the Senate.
 
Arkansas H.1165, proposed to grant Schedule II prescriptive authority to advanced practice nurses. The bill died in House committee. 



Colorado H.1111, initiated by the Colorado ACNM Affiliate, proposed to give the Colorado Department of Public Health and Environment (CDPHE) statutory authority over the currently established Maternal Mortality Review Committee (MMR), place confidentiality protections on members who serve on the MMR Committee and providers who submit their medical records to CDPHE, and require relevant providers and entities to submit maternal death records to the CDPHE. The bill successfully advanced through the House and its first Senate committee, but was unfortunately held in the Senate Finance Committee.
 
Colorado S.197, proposes to amend the requirements for obtaining prescriptive authority, which currently require 1,800 hours of prescribing in a preceptorship and 1,800 hours of prescribing in a mentorship. The bill reduces the requirement to achieve full prescriptive authority to 1,000 practice hours, and also requires the applicant to have at least 3 years of combined clinical work experience as a professional or advanced practice nurse in order to achieve full prescriptive authority. The bill has passed both chambers.
 
Delaware H.70, modernizes statutory consideration of CM and CPM practice by, among other things, iterating licensure requirements, establishing scope of practice, and establishing the Midwifery Advisory Council. The bill has passed the House. 

Delaware S.57 implements the APRN credential, updates the renewal and reinstatement requirements for advanced practice nursing licensure, and clarifies prescription requirements. The bill has passed the Senate.
 
Hawaii S.304, proposes to establish a Maternal Mortality Review Panel to conduct comprehensive, multidisciplinary reviews of maternal deaths in order to identify factors associated with the deaths and make recommendations for system changes to improve health care services for women. The bill includes a CNM position on the panel. It has passed the Senate.
 
Illinois H.184, requires the Department of Public Health to develop or approve and publish informational materials for women who may become pregnant, expectant parents, and parents of infants regarding cytomegalovirus. The bill has passed the House.
 
Illinois H.421, a full practice authority bill, has passed the House after significant amendment. The bill no longer eliminates the requirement for a written collaborative agreement, but does weaken its structure. There is also some positive advancements regarding prescriptive authority and ability to continue practicing for a specified period of time after losing a collaborating physician.

Maine LD.521, iterates health care practitioner transparency requirements, including requirements regarding display of licenses in a manner visible to patients and name badge requirements. The bill has passed both chambers.

Maryland H.9, a CPM licensure, passed the Senate unanimously after previously passing the House unanimously several weeks ago. The bill includes education requirements that satisfy the US MERA agreement and ACNM’s position on ICM Standards. The Maryland affiliate was an active participant in efforts to help stakeholders reach consensus and advance the bill.
 
Texas S.1753, a truth in advertising bill that requires hospital name badges to clearly state provider type, has passed the Senate.
 
Texas S.1128, requires physicians and other providers who may attend a pregnant woman during gestation or at delivery to test for syphilis. The bill has passed the Senate.
 

2.  Selected State Updates -- New Laws - IN, MD, NE, NM, ND, WA


Indiana H.1093, requires the Department of Health to collect certain information to be disseminated by health care facilities and health care providers to parents who receive prenatal test results for Down syndrome or any other condition diagnosed prenatally. The bill became law on April 27.
 
Maryland H.5, proposes to establish the Newborn Screening Program Fund to provide funding for the screening of newborn infants for certain hereditary and congenital disorders. The bill became law on April 14.
 
Maryland S.74, establishes 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 became law on April 14.
 
Nebraska L.627, clarifies and solidifies workplace protections for pregnant workers. It was signed into law on April 13.
 
New Mexico H.84, which provides for licensure of freestanding birth centers accredited by the Commission for Accreditation of Birth Centers (CABC) or its successor by the Department of Health, was signed into law on April 10.
 
New Mexico S.299, updates multiple sections of law to clarify that certain acts are within the CNM scope of practice, such as advance health care directives, pre-employment physicals, and applications for disability placards, among other things. The bill was signed into law on April 9.



North Dakota S.2367, creates a task force on substance exposed newborns for the purpose of researching the impact of substance abuse and neonatal withdrawal syndrome, evaluating effective strategies for treatment and prevention, and providing policy recommendations. The bill became law on April 15.
 
Washington H.1285, which would require providers to perform critical congenital heart disease screening using pulse oximetry before discharge of the newborn, became law on April 21. 


Federal Issues

1.  ACNM Provides Issue Brief on Revisions to Medicare Physician Payments

Recent legislation has significantly changed the way Medicare will pay physicians and other practitioners for their services.  Although the underlying fee-for-service RVU-based methodology remains in place, the ability to see any significant year over year increase in payments will largely hinge on value based performance or participation in payment models that are alternatives to the traditional fee-for-service approach.  With the assistance of Patrick Cooney, ACNM’s federal lobbyist, we have put together an issue brief outlining key aspects of this important piece of legislation, noting particularly its impact on midwives.  . The Congressional Research Service has prepared a very detailed summary of the entire bill, including those sections which do not deal directly with physician payments.


2.  Sound Off on New Proposed 5-year Strategic Plan

ACNM is putting the finishing touches on a new 5-year strategic plan for supporting and engaging each and every member and forging the future of our profession.    This new vision for ACNM reimagines our organization, our scope, and our goals – state-by-state and nationally, as well as in terms of how we engage with midwifery and maternal and newborn health globally. Please participate in the final review and comment period of our draft plan. Comments are due May 9.


3.  AHRQ Publication Highlights Innovative Approaches to Improving Birth Outcomes

The Agency for Healthcare Research and Quality (AHRQ) in a recent edition of its “Innovations Exchange” has focused on three approaches to improving birth outcomes, including a payment policy aimed at eliminating early, non-medically necessary elective induction, a pregnancy medical home model, and a program that provides free doula care to underserved women.  AHRQ also provided a toolkit to help expectant mothers get evidence-based care to improve birth outcomes; a toolkit that addresses quality improvement in prenatal care and offers a collection of “lessons learned” by health plans serving Medicaid beneficiaries; and a free mobile information service designed to promote maternal and child health.  


4.  Kaiser Family Foundation Releases Report on Contraceptive Coverage under the ACA

A new Kaiser Family Foundation report  examines how variations in how health insurance carriers are interpreting and implementing the Affordable Care Act's contraceptive coverage requirement is limiting contraceptive options for some women. The ACA requires most private health insurance plans to cover a range of preventive services for women, including prescribed FDA-approved contraceptives and services without cost sharing. The report specifically reviews how health carriers are applying medical management limitations to contraceptive coverage that affect women’s contraceptive options.    The report captured the attention of HHS and federal regulators have indicated a desire to look more closely at plan behavior in this arena.  


5.  What Medicaid Pays for Global Fee for Vaginal Birth in Each State

In case you didn’t catch it in a recent Quick eNews, ACNM staff have researched the fee-for-service Medicaid fee schedules in each state to find the amount each state pays midwives for CPT code 59400, which is the global code for prenatal care, a vaginal birth and a postpartum visit.  If a state does not pay the global code, we found the payment rate for 14 visits coded as mid-level evaluation and management visits (CPT 99213), a vaginal birth only (CPT 59410) and a postpartum visit (CPT 59430) and used the sum of those payments instead.  The results are enlightening.  The median payment across all 50 states and the District of Columbia is $1,410.  The average payment rate is $1,553.  Medicare’s national payment rate, by comparison, is $2,167, which means that the mean Medicaid payment for this service is 65% of what Medicare pays.  Notably, the lowest paying state (New Jersey) reimburses CNMs/CMs the munificent sum of $328.  Montana, which pays more than any other state, gives CNMs $3,258, ten times what New Jersey pays.  Keep in mind that in many states a significant number of women are covered through managed care plans.  These Medicaid plans are free to negotiate rates as they are able and their payments may differ significantly from fee-for-service payments.  Those wishing to go into business for themselves should couple reimbursement data with data on the percent of births covered by Medicaid to help them understand the business dynamics of birth in their state.  


6.  CABC Map of All Accredited Birth Centers

The Commission for the Accreditation of Birth Centers (CABC) has provided a very useful tool for those interested in locating accredited birth centers in the US.   Their new interactive map lets users search for birth centers in a specific geography, or by name.  Specific information on each birth center is provided, including its accreditation date, address, phone number and driving directions.   


7.  ANA Seeks Input on Meaningful Use to Inform Regulatory Comments

The American Nurses Association (ANA) is seeking input from NPs and CNMs to inform comments in response to a proposed rule entitled "Medicare and Medicaid Programs:  Electronic Health Record Incentive Program - Stage 3."  The proposed rule specifies the meaningful use criteria that eligible professionals and hospitals must meet in order to qualify for incentive payments.  

The ANA has developed a survey that details the request for comments and allows for input from individual practitioners.  If you are a participant in the Medicaid EHR incentive program, please take some time to provide input on this proposed regulation to best inform those comments.  The deadline for response to the survey is May 8.  


8.  Joint Commission Webinar on Perinatal Care Certification

The Joint Commission has made available slides from its April 28 webinar where the new Perinatal Care Certification program was discussed.    This new certification will be available to hospitals as of July 2015.  The requirements under that program were disturbed in draft form last year and ACNM and other maternal care organizations were able to submit comments.  A copy of the certification requirements themselves are available here.   


9.  Premier to Hold Webinars on Maternal Care Topics

Premier, Inc., an alliance of hospitals focused on quality improvement, will host two webinars in May that may be of interest to midwives. The first, scheduled for May 8 from 12:00 - 1:30 p.m. EST will provide an overview for timely recognition of and effective response to preeclampsia and resources for health care professionals and patients.    

The second webinar, scheduled for May 20 from 2:00 - 3:30 p.m. ET will focus on the topic of opioid use and how providers can respond to various challenges related to these drugs, including treatment options and outcomes of opioid dependence in pregnancy, including neonatal abstinence.  


10.  CMQCC Announces Webinar on Obstetric Hemorrhage Toolkit

The California Maternal Quality Care Collaborative (CMQCC) has announced that it will hold a public webinar to review its latest toolkit.  The Improving Health Care Response to Obstetric Hemorrhage:  Version 2.0 toolkit will be discussed during a webinar on May 27, at 3:30 p.m. EST/12:20 p.m. PST.  Registration for the webinar is available here.
 
 
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.

Don't have the time or energy to get involved, but still want to contribute?  Support the Midwives-PAC.
 


American College of Nurse-Midwives.
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