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Return to Learn > Professional Resources and News Releases > News Releases > New Survey Examines Coverage of Midwifery Care through Marketplace Plans (September 18, 2014)

For Immediate Release

Contact: Damaris Hay
Email: [email protected]
Office: (240) 485-1856












Download the PDF here.



New Survey Examines Coverage of Midwifery
Care through Marketplace Plans






American
College of Nurse-Midwives Says Insurers, Policy Makers Have Significant
Opportunity to Increase Access to High-Value Maternity, Newborn Care









Silver Spring, MD - A
new survey by the American College of Nurse-Midwives (ACNM) of health insurers
offering coverage through the health insurance marketplaces created under the
Affordable Care Act (ACA) found that many plans are not fully utilizing the
high value care offered by certified nurse-midwives (CNMs) and certified
midwives (CMs). The results also
indicate that policymakers need to do more to ensure plans take advantage of
the cost-effective services and high quality outcomes associated with midwifery
care.





Summaries
of benefits describing plans available through the marketplaces do not describe
the extent to which midwifery services are covered by marketplace plans. Using a methodology developed by the National
Nursing Centers Consortium (NNCC), ACNM conducted its own survey between March
and July 2014 to address this lack of clarity.






Collectively, CNMs and CMs attend
approximately 8% of all US births, though the number varies widely by
state. In several states, CNMs and CMs
attend 10 to 20% of births. In New
Mexico, CNMs attend more than 27%. CNMs are legally recognized in all 50 states
and the District of Columbia. CMs are
legally recognized in 5 states.





ACNM
was able to survey 85 of the 277 marketplace insurers or 30.7%, located in 33
different states. While not every plan
was able to respond to every question, ACNM found that 20% of responding plans
do not contract with CNMs and 60% do not contract with CMs. Forty-seven percent of plans do not contract
with birth centers, facilities for birth that are largely run by midwives.





"Certified
nurse-midwives and certified midwives are proven providers of high value
care. While most insurers have
recognized this fact, it is a concern that a significant number have not yet
taken advantage of the savings available under the midwifery model, which
emphasizes physiologic birth and individualized, evidence-based care," said
ACNM President Ginger Breedlove, CNM, PhD, APRN, FACNM. "This is a loss to both the plans and their
enrollees. As major providers of maternity and
newborn care, a required benefit category for marketplace plans, midwives
should be included in all plans' provider networks."





The
scope of practice for CNMs and CMs, defined by ACNM and incorporated into many
state laws and regulations, includes primary care, gynecologic, and family
planning services. The survey found,
however, that 17% of plans do not cover primary care services provided by CNMs
and that 14% restrict what CNMs can do beyond what is permitted under state
laws or regulations.





"Inadequate
inclusion of CNMs/CMs in provider networks limits choices available to women
and reduces the value of the plans available to them," Breedlove said. "At a time when the nation is facing a
significant shortfall of primary care providers and where many areas of our
country have limited or no access to maternity care providers, this is a
shortsighted approach. We encourage
insurers to re-examine their practices and work with midwives to improve the
value of the products they offer."





Half
of the surveyed plans pay CNMs at a rate lower than they pay physicians when
they perform the same service. "When a
health insurer inequitably reimburses midwives, it can discourage them from
participating in the plan's provider network, making their services less
accessible to women enrolled in that plan," Breedlove said. "Congress recognized this fact in 2010 when
it modified federal law to require Medicare, the nation's largest payer, to
reimburse CNMs at the same rate as physicians."






The
ACA contained a provision prohibiting insurers from discriminating against
providers who render care in accordance with their state scope of practice
requirements.





"This
survey clearly demonstrates that many plans are excluding midwives from their
networks, or paying them at reduced rates for services they are legally allowed
to perform, solely because of the type of license they hold," Breedlove
said. "While we do not know why plans
have made these decisions, we do know that policymakers have a responsibility
to enforce provisions of law that prohibit provider discrimination and to put
in place requirements that encourage the inclusion of high value providers in
plan networks." 





"Whereas
obstetricians are experts in providing care to women with high-risk pregnancies,
midwives are experts in caring for women with low-risk pregnancies and meeting
the everyday health care needs of women throughout the lifecycle. There is a
critical need for both obstetricians and for midwives, and both should be
reimbursed equitably for their services," she added.





Reputable
studies over decades published in multiple Cochrane reviews, the Journal of Midwifery & Women's Health,
Women's Health Issues, The Lancet, the British Medical Journal, and the Australian Health Review, among others, have demonstrated the value
of midwifery care both in terms of outcomes and cost savings.





According
to Breedlove, "Most insurers have recognized the proven value of midwifery care
and have taken appropriate steps to include them in their networks and cover
their services, but there is real room for improvement. To the extent plans not currently contracting
with midwives bring their practices in line with the majority, they will be
able to offer their beneficiaries better service and better respond to the
desires of hundreds of thousands of women to have access to the unique model of
care offered by midwives." 





###





Full survey results are available on ACNM's website. An executive summary
can be found
here. Questions about the survey
can be directed to Jesse Bushman, ACNM's Director of Advocacy and Government
Affairs, at
[email protected] or 240-485-1843.





For more information, please contact ACNM Media
Relations, Social Media & Marketing Specialist Damaris Hay at 240-485-1856
or
[email protected].


The American College of Nurse-Midwives (ACNM)
is the professional association that represents certified nurse-midwives (CNMs)
and certified midwives (CMs) in the United States. ACNM promotes excellence in
midwifery education, clinical practice, and research. With roots dating to
1929, our members are primary care providers for women throughout the lifespan,
with a special emphasis on pregnancy, childbirth, and gynecologic and
reproductive health. ACNM provides research, administers and promotes
continuing education programs, establishes clinical practice standards, and
creates liaisons with state and federal agencies and members of Congress to
increase the visibility and recognition of midwifery care.


8403 Colesville Road, Ste. 1550, Silver Spring, MD
20910-6374 * Phone: (240) 485-1800 * Fax: (240) 485-1818 * www.midwife.org





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