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ACNM Policy Update - 4/3/2014

1.  Providers May be Left Unpaid if Marketplace Enrollees Don’t Pay Premiums
2.  CMS to Release Provider Payment Data
3.  Update on North Carolina’s Efforts for Practice Autonomy
4.  South Carolina Battles to Protect Birth Centers
5.  Selected State Legislative Developments from Iowa, Missouri, West Virginia


1.  Providers May be Left Unpaid if Marketplace Enrollees Don’t Pay Premiums

In recently final regulations issued under the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) requires insurers offering coverage through the Health Insurance Marketplaces to extend a 3-month grace period to enrollees who fail to pay their premiums, if those enrollees are recipients of the premium tax credit.  Most enrollees under the Marketplaces are expected to receive premium tax credits, so the 3-month grace period would likely apply to a significant proportion of enrollees who fail to pay their premiums. 

The complication arises because while CMS requires plans to pay for services provided during the first month of the grace period, the plan is not required to make payment for services received by the enrollee in the last two months of the grace period, instead, the plan may pend payment of those claims to see whether or not the enrollee pays the required premiums.  The termination date for enrollees who do not pay throughout their 3-month grace period is the last day of the first month of the grace period.  This means that providers who have rendered services during the last two months of the grace period would likely not be paid by the plan. 

A significant number of provider organizations have urged CMS to revisit its policy allowing plans to pend claims for the latter two months of the grace period.  They have argued as well that CMS should require plans to immediately notify providers when their enrollees enter the first month of the grace period.  This could be accomplished through eligibility inquiry transactions.

The AMA has developed a toolkit to help providers respond to this 3-month grace period which may also be of use to midwives serving this same population. 

2.  CMS to Release Provider Payment Data

In an April 2, 2014 letter to the AMA, the Centers for Medicare and Medicaid Services (CMS) has indicated that no sooner than April 9, the agency will begin publicly releasing “a data set on the types of services and procedures furnished by physicians and other health care professionals as well as certain payment and charge data related to those services, organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and whether the service was furnished in a facility or office setting.”  The data will, on a per-NPI/HCPCS basis include the number of services, average submitted charges and standard deviation in submitted charges, average allowed amount and standard deviation of allowed amount, average Medicare payment and standard deviation in Medicare payment, as well as a count of unique beneficiaries treated.

What this means, in plain English, is that the public will see exactly what is being paid by Medicare to any Medicare provider and will be able to see how payments compare among providers.  The agency notes that no personally identifiable patient information will be released and that any data based on 11 or fewer patients will also be withheld. 

3.  Update on North Carolina’s Efforts for Practice Autonomy

The North Carolina Joint Legislative Committee on Health and Human Services Subcommittee on Midwives met three times between January and March 2014 to consider the issue of independent practice for nurse-midwives. The committee’s final report was released on March 11. The committee’s recommendation is to support a bill to update and modernize the Midwifery Practice Act, which was originally enacted in 1983. In lieu of supervisory requirements, the bill would (1) allow the independent practice of midwifery by CNMs who have at least 2,400 hours and 24-months experience in the practice of midwifery under the supervision of a physician or a CNM with 4 or more years of experience and (2) provide for a 90-day grace period for a CNM to obtain a written practice agreement when the CNM's existing practice agreement is terminated. The full committee will vote on whether to accept these recommendations on April 17. If accepted, a bill will be introduced in the upcoming short session.

4.  South Carolina Battles to Protect Birth Centers

In fall 2013, the South Carolina Department of Health and Environmental Control (DHEC) reinterpreted existing statute to mean that a physician must be physically present at a birth center when medical assistance is needed. Unfortunately, this reinterpretation took place without the benefit of public input or comment. This new interpretation poses a significant threat to the state’s birth centers, as the physical presence of a physician is unnecessary and unworkable from both a safety and economic perspective. A bill to replace the problematic statutory language, H.5002, was introduced on March 27. The bill would repeal the provision which states that “a physician must be on call and available to provide medical assistance at all times that it is serving the public” with language that requires practice guidelines to address transfer procedures, among other things.

5.  Selected State Legislative Developments from Iowa, Missouri, West Virginia
Iowa S.2120 allows an advanced practice nurse to use the title "advanced registered nurse practitioner" and the abbreviation "ARNP." The bill also includes a title protection provision. The bill was signed into law on March 26.

Missouri H.2189 is a homebirth malpractice bill. The bill states in part that, “Any person certified and providing homebirth services shall, prior to the provision of such services, furnish to all individuals for whom such services will be provided, satisfactory evidence that such person has obtained and maintains a malpractice insurance policy with coverage of at least one million dollars prior to and for the duration of services rendered, including the standard postpartum period. Any person who fails, prior to the provision of such services, to present proof of such malpractice insurance coverage is guilty of a class B misdemeanor.” It was introduced on March 26.

West Virginia S.12 proposes to allow a health care professional who makes a clinical diagnosis of a sexually transmitted disease to 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 would be 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. The Governor vetoed the bill on March 25.

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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