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ACNM Policy Update - 5/25/2015

State Issues

1.  Full Practice Authority Bill Introduced in Ohio
2.  Florida Announces Special Legislative Session
3.  Selected State Developments – Introductions and Progress - IL, LA, MS, OH, TN, TX
4.  Selected State Developments – New Laws - CT, MS, TN

Federal Issues

1.  NWLC Releases Report on Coverage of Breastfeeding Equipment, Support and Counseling
2.  “Women’s Health Issues” Publishes Commentary Calling for Expanded Access to Midwifery
3.  Joint Commission Releases Recording and Slides for Webinar on Perinatal Care Certification Program
4.  CDC Report Examines Maternal Morbidity Associated with Cesarean Birth
5.  Commonwealth Fund Health Insurance Survey Examines Issue of Underinsurnace
6.  KFF Releases Study of Consumer Experience with Non-Group Health Plans
7.  CMS to Host Virtual Office Hour Discussion of Physician Compare (which includes a few CNMs)
 
 


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.  Full Practice Authority Bill Introduced in Ohio
 
Ohio H.216 seeks to eliminate the requirement for a written collaborative agreement, eliminate the APRN formulary for prescribing, allow APRNs to be the attending provider of record for their own admitted patients, and establish an APRN advisory council within the Ohio Board of Nursing.  A favorable 2015 report from Rand Health on the impact of a modernization of advanced practice regulation helped to set the stage for the bill’s introduction. Members who would like to learn more about the bill can watch a May 19 press conference by bill sponsor Rep. Dorothy Pelanda, or visit the Ohio Association of Advanced Practice Nurses’ website.

 
2.  Florida Announces Special Legislative Session
 
Florida will hold a special legislative session beginning June 1 that is scheduled to last 20 days. Among the bills slated to be considered is H.281, which would authorize APRNs to order controlled substances in certain facilities, including hospitals.

 
3.  Selected State Developments – Introductions and Progress - IL, LA, MS, OH, TN, TX
 
Illinois H.1407 proposes to require r a hospital to provide information and instructional materials regarding sudden infant death syndrome, including information concerning safe sleep environments. The bill has passed both chambers as of May 19.
 
Louisiana HCR.165 directs the Department of Health and Hospitals to require by rule that obstetricians be on the premises of or on call for all free-standing birth centers during their hours of operation. It was first read on May 20. 
 
Mississippi H.910 creates the Infant Mortality Reduction Collaborative, which will annually make policy recommendations related to ensuring the availability, accessibility and affordability of a hormonal supplement that is used to prevent preterm deliveries in pregnant women; ensuring access to preconception health care; reducing the number of early elective deliveries; and the development of perinatal regions of care. The bill has been signed into law.
 
Ohio S.110 would permit CNMs to delegate to persons not otherwise authorized to administer drugs the authority to do so under specified conditions, among other things. The bill passed the Senate on May 6.
 
Ohio HCR.12 declare Ohio's rate of infant mortality a public health crisis that deserves significant and immediate action by all stakeholders to ensure equitable access to comprehensive preterm birth risk screening for all pregnant women, including cervical length screening. The resolution was adopted by the House on May 13.
 
Tennessee S.44 requires that every newborn be tested for lysosomal storage disorders. The bill became law on May 18.
 
Texas H.2131 would require one or more health care entities which provide comprehensive maternal, fetal, and neonatal health care for pregnant women with high-risk pregnancies complicated by one or more fetuses with anomalies, with genetic conditions, or with compromise caused by a pregnancy condition or by exposure to be designated as centers of excellence for fetal diagnosis and therapy. The bill passed the House on May 13.
 
Texas S.1128 would require pregnant women to be tested for syphilis no earlier than the 28th week of pregnancy. The bill would also require odd-numbered year reporting to the legislature the number of cases of early congenital syphilis and of late congenital syphilis that were diagnosed in the preceding biennium. The bill has passed both chambers as of May 18.

 
4.  Selected State Developments – New Laws - CT, MS, TN
 
Connecticut H.5525 requires a screening test for cytomegalovirus for newborns who fail a newborn hearing screening. The bill became law on May 19.

Mississippi H.910 creates the Infant Mortality Reduction Collaborative, which will annually make policy recommendations related to ensuring the availability, accessibility and affordability of a hormonal supplement that is used to prevent preterm deliveries in pregnant women; ensuring access to preconception health care; reducing the number of early elective deliveries; and the development of perinatal regions of care. The bill has been signed into law.

Tennessee S.44 requires that every newborn be tested for lysosomal storage disorders. The bill became law on May 18.

 
 
Federal Issues

1.  NWLC Releases Report on Coverage of Breastfeeding Equipment, Support and Counseling
 
The National Women’s Law Center (NWLC) has released a report on insurers’ coverage of breastfeeding equipment, support and counseling.  Under the Affordable Care Act (ACA), insurers are required to cover these items and services without cost sharing.  The NWLC’s consumer hotline received numerous reports of problems with this coverage and as a result, they conducted a study to evaluate the extent of these problems, reviewing over 100 plan documents from issuers in 15 states. 
 
NWLC identified three specific problems, including:
 
  • Some insurance companies impose restrictions and limitations on breastfeeding support and supplies that explicitly violate the ACA or undermine the intent of the law.
  • Some insurance companies do not have a network of lactation providers and are not following clear federal rules that allow women to obtain preventive services, including breastfeeding benefits, out-of-network, at no cost-sharing.
  • Some insurance companies impose major administrative barriers or offer insufficient coverage that prevents women from obtaining timely breastfeeding support and adequate equipment, as the ACA intended.
A copy of the report is available here.
 
On May 28, from 2:00 – 3:00 p.m. ET the NWLC will hold a webinar to review the content of their report.  Those who are interested may register to attend here.

 
2.  “Women’s Health Issues” Publishes Commentary Calling for Expanded Access to Midwifery
 
“Women’s Health Issues,” a peer reviewed journal, has published a commentary on legal impediments to midwifery.  After reviewing the legal climate and empirical evidence for midwifery practice, the authors (Y. Tony Yang, ScD, LLM, MPH and Katy B. Kozhimannil, PhD, MPA) conclude that, “The time has come for states to seriously reconsider seriously the potential legal impediments that may unnecessarily limit women’s choices of maternity care provider or birth settings.”  In closing, they assert that “At a time when states nationwide are feeling the effects of increasing health care costs, it is difficult to imagine what policy argument could be made for not revisiting the legal impediments that stand in the way of granting women greater access to a safe, effective care from a midwife.” 
 
The commentary is a concise, well sourced explanation of the value of midwifery and the barriers that should be removed to foster its growth.  It is available (to journal subscribers, or for purchase by others) here

 
3.  Joint Commission Releases Recording and Slides for Webinar on Perinatal Care Certification Program
 
The Joint Commission has releases a recording of a recent webinar on its Perinatal Care Certification Program, along with slides used during that event.  This webinar is a continuation to the April 28 webinar: Overview to The Joint Commission’s NEW Perinatal Care Certification and focuses primarily on Perinatal Care Core Performance Measures.
 
The recording and slides are available here.  

 
4.  CDC Report Examines Maternal Morbidity Associated with Cesarean Birth
 
A new report from the Centers for Disease Prevention and Control (CDC) examines the correlation between cesarean birth and maternal mortality, using birth 2013 certificate data.  The report concludes that:
 
Rates of maternal morbidity were higher for cesarean than vaginal deliveries—rates of transfusion (525.1 per 100,000) and ICU admission (383.1) were highest for primary cesarean deliveries, while rates of ruptured uterus (88.9) and unplanned hysterectomy (143.1) were highest for repeat cesarean deliveries. Higher rates of maternal morbidity for cesarean compared with vaginal deliveries were found for nearly all maternal age groups and for women of all races and ethnicities. Women with no previous cesarean delivery who had vaginal deliveries had lower rates for all maternal morbidities compared with those who had cesarean deliveries. Women with a previous cesarean delivery who labored and had vaginal birth generally had lower rates for most of the morbidities, but failed trials of labor were generally associated with higher morbidity than scheduled repeat cesarean deliveries, especially for ruptured uterus, which was seven times higher (495.4 per 100,000 compared with 65.6).
 
The report is available here
 
 
5.  Commonwealth Fund Health Insurance Survey Examines Issue of Underinsurance
 
New estimates from the Commonwealth Fund's Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more.
 
This information is pertinent to CNMs/CMs because of the high costs associated with birth and the fact that people are underinsured are less likely to be able to cover their deductible for these services, which may result in larger levels of bad debt incurred by midwives.
 

6.  KFF Releases Study of Consumer Experience with Non-Group Health Plans
 
The Kaiser Family Foundation (KFF) has released the results of a study of consumer experience with coverage available through non-group plans, including the health insurance marketplaces.  KFF found that most who are enrolled through the marketplace report being satisfied with a wide range of their plan’s coverage and features.
 
A large majority (74%) rate their coverage as excellent or good.  Most (59%) also say their plan is an excellent or good value for what they pay for it, though the share rating the value as “excellent” declined somewhat from 23 percent last year to 15 percent in the current survey.
 
Majorities also say they are "very" or "somewhat" satisfied with seven different features of their plans, including their choice of primary-care doctors (75%), hospitals (75%) and specialists (64%); what they have to pay out of pocket for doctor visits (73%), prescription drugs (70%) and annual deductible (60%); and their monthly premiums (65%).
A copy of the survey report is available here.

 
7.  CMS to Host Virtual Office Hour Discussion of Physician Compare (which includes a few CNMs)
 
On Tuesday, June 23, 2015 from 1:00 – 2:00 p.m. EDT, the Centers for Medicare and Medicaid Services (CMS) will host a one-hour Virtual Office Hour session to discuss the Physician Compare website. During this session, CMS will answer stakeholders' questions about Physician Compare and public reporting.
 
Physician Compare is the tool that CMS uses to report basic information as well as quality performance data for providers who independently bill the Medicare program.  It is, in essence, the provider directory for that key health care program and it does include data on CNMs who participate in Medicare.  (Note that CMs are not currently recognized as Medicare providers.)
 
Anyone interested in participating may register by sending an email to the Physician Compare support team at [email protected]. Please use the subject line "Physician Compare Virtual Office Hour"and include your name, organization, telephone number, and email address.
 
CMS is soliciting all questions in advance. You may include your questions with your registration email or send them separately to [email protected]  including the same subject line and contact information. In order to address as many participant questions as possible, you may submit up to three questions - one primary question and two secondary questions. All questions must be received by 5:00pm EDT on Monday, June 15, 2015.
 
For more information about Physician Compare, visit the Physician Compare Initiative page.


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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