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ACNM Policy Update - 4/3/2015

State Issues

1.  California Debuts New Website Devoted to Full Practice Authority Advocacy
2.  North Carolina Introduces Full Practice Bill
3.  Delaware CM-CPM Bill Introduced
4.  Media Coverage of Florida’s Full Practice Authority Bill
5.  Selected State Updates – Introductions and Progress - AR, CO, HI, MD, OR
6.  Selected State Updates – New Laws - KY

Federal Issues

1.  Supreme Court Victory for Pregnant Employees
2.  So, How Many CNMs Get Help from the NHSC?  More to the Point, How Much Cash is Involved?
3.  HRSA Clarifies that DNP/DNPH CNM Students Can Participate in the NHSC
4.  ACNM Submits Two Advocacy Letters to CMS
 


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.  California Debuts New Website Devoted to Full Practice Authority Advocacy
 
CNMA has created a website to help with advocacy efforts for A.1306, which proposes to remove physician supervision requirements. The development of the website was a group effort that included significant work by John Bartlett (CNM Kavita Noble’s husband) and CNM Michele Kazmier, among others. Congratulations to CNMA on a beautiful website and wonderful advocacy tool! ACNM will continue to offer updates on the progress of A.1306 and CNMA’s efforts as the session progresses. A committee hearing is anticipated in early April.
 
 
2. North Carolina Introduces Full Practice Bill
 
North Carolina S.695 is an APRN bill to remove physician supervision requirements. The affiliate is hopeful that the bill will be successful, thanks to a positive 2014 report on CNM regulation authored by a joint legislative subcommittee and the recent laudatory examination of the implications of autonomous APRN practice by Duke University economist Chris Conover. Unlike many full practice bills, the introduced version of the bill lacks transition to practice requirements.
 
 
3.  Delaware CM-CPM Bill Introduced
 
Delaware H.70 is a licensure bill for CMs and CPMs. While both credentials are currently recognized in the state, the existing statute is a brief authorization statement only. Administrative rules require a collaborative agreement with physicians, which has prevented midwives from pursuing licensure. H.70 will modernize statutory consideration of CM and CPM practice, including allowing for autonomous practice. The licensure requirements for CPMs are compliant with the US MERA agreement on accredited education.
 
Similar to the Maryland CPM bill, H.70 is the result of a long negation process with stakeholders, including active participation from the Delaware affiliate with assistance from ACNM’s CAMP committee. The Delaware affiliate is also working with other advanced practice nurses on a Consensus Model bill for CNMs, which has yet to be introduced.
 
 
4.  Media Coverage of Florida’s Full Practice Authority Bill
 
Florida’s full practice authority bill, H.547, had a small but meaningful victory last week when it passed out of the House Health Innovation Subcommittee on a 9-4 vote. Supporters of the bill anticipate that it will likely pass the House, but it is expected to stall in the Senate. The bill’s sponsor is approaching the work as a multi-year effort and is running H.547 primarily to keep the conversation about the appropriate use of advanced practice nurses in the legislative eye.
 
Healthy News Florida’s coverage of the committee hearing concluded with a frank assessment about the meaning and ultimate significance of H.547 – “The scope-of-practice dispute is a turf battle. One fueled by a declining number of doctors, and increased demands placed on the healthcare system as more people become insured. It’s also a fight physicians may not win for much longer. While physician-based groups oppose the bill, consumer groups, hospitals, and others—like it—and say its past time Florida stopped being one of the last holdouts and let nurses do more.” We couldn’t agree more.
 
 
5.  Selected State Updates – Introductions and Progress - AR, CO, HI, MD, OR
 
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 was signed into law on March 31.
 
Colorado S.197 proposes to amend the state’s current transition to practice requirements, under which an advanced practice nurse must complete 1,800 hours of prescribing in a preceptorship and an additional 1,800 hours of prescribing in a mentorship in order to achieve full prescriptive authority. The bill reduces the requirement to achieve full prescriptive authority to 1,000 practice hours. The bill also requires the advanced practice nurse 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 the Senate.
 
Hawaii H.467 requires birthing facilities to perform a pulse oximetry test or other medically accepted screening on newborns to screen for critical congenital heart defects. The bill has passed the House.
 
Hawaii H.782 requires the Department of Health to establish a public education program to inform and educate pregnant women and women who may become pregnant about cytomegalovirus, and requires the responsible physician of a newborn infant identified as or suspected of having a hearing impairment to test the newborn infant for the cytomegalovirus. The bill has passed the House.
 
Maryland H.9 proposes licensure for direct-entry midwives. The bill’s provisions are in compliance with the US MERA agreements regarding accredited education by 2020 as a prerequisite for licensure. The bill has passed the House.
 
Oregon HB.2648 establishes network adequacy requirements for insurers, specifically that they must maintain a network of sufficient number and type of providers to cover their benefits.  The act also incorporates federal statutory language on provider non-discrimination by insurers into Oregon's statutes.  This week the bill passed out of the Oregon House on a vote of 56-1.  It is now with the Senate.
 
Oregon HB.2930 requires hospitals granting privileges to CNMs to include admitting privileges, be consistent with privileges of other members of the medical staff and permit CNMs to exercise voting rights consistent with other members of the medical staff.  This week the bill passed the Oregon House on a vote of 59-0.  It is now with the Senate.  (Hopefully some of Oregon's magic fairy dust works its way into the ventilation systems in a few other state capitols!)
 
 
6.  Selected State Updates – New Laws - KY
 
Kentucky S.54 mandates priority access for pregnant women to substance abuse treatment or recovery service programs and prevents discrimination against pregnant women by substance abuse treatment or recovery service providers. The bill was signed into law on March 30.
 
 

Federal Issues
 
 
1.  Supreme Court Victory for Pregnant Employees
 
Last week’s decision in Young v. United Parcel Service, Inc. creates standing for pregnant employees to sue their employers even when they lack evidence of direct discrimination. The case stems from Peggy Young’s lawsuit against UPS when it denied her light duty during her pregnancy. As Politico reports, “Under the ruling, employers must grant pregnant employees accommodations if they have previously granted the same accommodations to large groups of other employees with similar physical limitations.” Numerous states have pregnancy discrimination bills under consideration this session, including KY, NY, ND, NE, RI, and TN.
 
ACNM joined an amicus brief in support of Peggy Young filed in connection with this suit.
 
 
2.  So, How Many CNMs Get Help from the NHSC?  More to the Point, How Much Cash is Involved?
 
A while back, I asked the Health Resources and Services Administration (HRSA) if they could provide ACNM with data on how many CNMs had applied to the National Health Service Corps scholarship and loan repayment programs, how many had received awards and how much money was spent on CNMs.  This week I got some interesting data back and thought I'd pass it along.
 
In FY 2014, under the NHSC Loan Repayment Program, there were 110 CNM applicants and 38 awardees.  Funds spent in that year for CNMs in the Loan Repayment Program totaled $1,763,509.  That works out to more than $46,000 per awardee, but HRSA cautions that the awards vary based on a number of factors and a straight average is not necessarily the most accurate way of looking at things.
 
In FY 2014, under the NHSC Scholarship program, there were 27 CNM applicants and 2 awardees.  Funds spent in that year for CNMs in the Scholarship Program totaled $214,748 (a pretty healthy scholarship indeed!).  The same caveat applies when considering what the average award might be.
 
Awardees agree to work in shortage areas for a given number of years.  The "Field Strength" for these programs includes all who are working off their commitment.
 
In FY 2014, HRSA had 122 CNMs working off Loan Repayment and 8 working off scholarships.  The number working off Loan Repayment likely includes most of the 38 awardees from 2014.
 
Keep in mind that receipt of an award is based on a number of factors, one of the main one of which is the shortage rating of the area where a CNM is working.  For specific details on these two programs, visit HRSA's site.
 
 
3.  HRSA Clarifies that DNP/DNPH CNM Students Can Participate in the NHSC
 
I have been sending out notices about the NHSC and technical calls to help people applying to those programs.  During one of the recent calls put on by HRSA, program staff stated that DNP CNM students would not be eligible for the NHSC programs.  After an inquiry from an ACNM member who attended that call I contacted HRSA and confirmed that this information was in error.
As of last year, the NHSC programs are open to DNP/DNPH CNM students.
 
 
4.  ACNM Submits Two Advocacy Letters to CMS
 
In the past month, ACNM has submitted a couple of advocacy letters to the Centers for Medicare and Medicaid Services (CMS) related to issues raised by ACNM members.
 
The first letter was submitted jointly with AABC and NACPM and requests that the agency promulgate regulations related to the birth center benefit under Medicaid.  To date CMS has not done so and there are significant issues related to how the states are implementing that benefit that are causing problems for birth centers in some places.  The letter was sent via email on March 11.
 
The second letter was prompted by a question from ACNM member Julie Bosak, who works in a critical access hospital (CAH).  Current CMS regulations require that the records for all CAH inpatients attended by CNMs, NPs, PAs, and CNSs be reviewed and signed by physicians.  In researching this topic, it became clear that there is potential for that requirement to be changed, at least insofar as CNMs are concerned.  ACNM's letter to CMS recommended that CMS make such a change after providing a statutory and regulatory basis for doing so.
 
The regulatory process isn't one that lends itself to rapid action, so we shouldn't expect any changes soon, but by sending the letters we have initiated a process that one day might result in positive change.  We will keep you apprised as things progress.
 
 
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. 



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