Federal Policy Update. ACNM Annual Conference Educational Session May 14, 2014

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1 Federal Policy Update ACNM Annual Conference Educational Session May 14, 2014

2 Introduction Laura Jenson, CNM Chair, ACNM Government Affairs Committee

3 Please join us Friday 4-6pm, Tower Bldg, Windows, Level 2 Midwives-PAC can only solicit from ACNM members, so we rely on your support to help us raise the voice of midwives in DC. All funds raised at this 0% overhead event will be strategically distributed to federal legislators to help advance the profession of midwifery. Over 160 exciting auction items to bid on, as well as a wine pull! Purchase your ticket at the Registration Desk Tickets are $50 for midwives/guests and $15 for students Pick up your bid packet at the Midwives-PAC booth, Everything ACNM area Heather Bradford, Outgoing-Chair (425) Jennifer Jagger, Incoming-Chair (202)

4 ACNM Federal Policy Priorities Patrick Cooney ACNM s Federal Affairs Representative

5

6 ACNM Federal Policy Priorities in this 113 th Congress Establishment of Maternity Care Shortage Area designations across the U.S. similar to those that exist for primary care, dental and mental health services Resolving the Physician Certification requirement for Inpatient Hospital Stays Ordered by Midwives and other APRNs under Medicare Securing Medicare reimbursement for supervision of medical residents and midwifery students Securing eligibility for Medicaid primary care payments

7 Maternity Care Shortage Areas On April 3, 2014, Rep. Mike Burgess (R-TX) and Rep. Lois Capps (D-CA) introduced the Improving Access to Maternity Care Services Act (H.R.4385) As of May 12 th there were 6 cosponsors of the bill Senator Patty Murray has agreed to cosponsor in the Senate version of this bill

8 MCSA Continued H.R.4385 does the following: Requires the Secretary, acting through the Administrator of the Health Resources and Services Administration, to designate maternity care health professional shortage areas in the States and at least annually there after review and, as necessary, revise such designations. Requires the Secretary to collect and publish in the Federal Register data on health care professional shortage areas based on professional category of maternal health professionals providing full scope maternity health care by geographic region.

9 MCSA Continued The bill further establishes that: The term maternity care health professional shortage area means an area in an urban or rural area which the Secretary determines has a shortage of providers of full scope maternity care health services; a shortage of hospital or birth center labor and delivery units; or a population group in which shortages of providers and facilities exist. The term full scope maternity care health services includes during labor care, birthing, prenatal care, and postpartum care. The term medical facility is expanded to includes a freestanding birth center, as defined in Section 1905(l)(3)(B) of the Social Security Act.

10 Physician Certification for Medicare Inpatient Services The Centers for Medicare and Medicaid Services (CMS) issues guidance on September 5, 2013, entitled Hospital Inpatient Admission Order and Certification which has created confusion and frustration by requiring a physician certification for ALL inpatient hospital admissions under Medicare regardless of length of stay or the practitioner who ordered the admission to the facility This regulation has the impact of requiring a physician to certify admissions by CNMS, NPs, CNSs, and PAs under Medicare and may impact other payers as well since hospitals will want to establish a common standard for admissions ACNM met with CMS officials to discuss concerns Rep. Diane Black (R-TN) and Rep. Jan Schakowsky (D-IL) have agreed to introduce legislation shortly

11 Physician Certification Continued The Black/Schakowsky bill would clarify that: A CNM, NP, CNS, or PA, who has privileges at the hospital facility, can certify inpatient hospital services ordered by a CNM, NP, CNS, or PA. They would not be allowed to certify MD/DO services.

12 Medicaid Primary Care Payments The Affordable Care Act (ACA) initiated Medicaid primary care payments to physicians for 2013 and 2014 at 100% of the Medicare fee schedule for primary care services ACNM supported the introduction of the Protecting Access to Primary Care Act, (H.R.2986) by Rep. Bonamici (D-OR) and Rep. Walter Jones (R-NC) expanding eligibility for primary care payments to midwives and nurse practitioners ACNM is working with Senator Patty Murray (D-WA) on a bill in the Senate

13 Payment for Supervision of Residents and Midwifery Students The Medicare statute allows a physician to bill for the supervision and training of medical residents. However, many midwives are also involved in the supervision of medical residents. ACNM helped include a provision in the Maximizing Optimal Maternity Services for the 21 st (H.R.2286), which would enable midwives to bill for supervision of residents and student midwives under Medicare.

14 What is Midwives PAC and Why is it Important in Promoting Midwifery? Midwives PAC contributes to candidates for federal office (Senator and Representative) Midwives PAC can only solicit from ACNM members but others can contribute Contributions are given to midwifery supporters and those candidates/legislators with whom ACNM wishes to build relationships As an example, the sponsors of legislation relating to shortages maternity care providers are recipients of Midwives PAC contributions (Rep. Mike Burgess of Texas and Rep. Lois Capps of California) Efforts are made to connect local midwives with elected officials when Midwives PAC contributions are made

15 Jesse Bushman Director, Advocacy and Government Affairs

16 Essential Health Benefits All plans offered through the Health Insurance Marketplaces (and many outside) must cover the Essential Health Benefits (EHB) package. EHB includes ten categories of benefits, among them maternity and newborn care. EHB defined further through a benchmark approach

17 Maternity Benefits in the Benchmark Plans Prenatal and Postnatal Care Type of Coverage No. of Plans Coverage for prenatal and postnatal or maternity services 44 Coverage for routine prenatal and postpartum care 3 Coverage for physician services 2 Coverage for professional services 1 Coverage for obstetrical services 1 Based on ACNM analysis of benchmark documents available at:

18 Maternity Benefits in the Benchmark Plans Delivery and Maternity Services Type of Coverage No. of Plans Coverage of inpatient services 40 Coverage of maternity services 8 Coverage for obstetrical care 1 Coverage for labor and delivery 1 Non-specific coverage 1 Arizona s benchmark plan provides explicit coverage for birth centers. Connecticut s benchmark plan explicitly excludes home birth. Based on ACNM analysis of benchmark documents available at:

19 Other Benefits in the Benchmark Plans Coverage for Other Practitioner Office Visit Type of Coverage No. of Plans Covered 32 Coverage for Nurse (or Nurse practitioner), Physician Assistant services 11 Coverage for Primary Care Visit or PCP Services 3 Coverage for Nurse Midwife Services (among others) 2 Coverage for Various Advance Practice Individuals (not including Midwives) 3 Based on ACNM analysis of benchmark documents available at:

20 ACNM s Survey of Plans Standardized, publicly available information on coverage of maternity and newborn care is insufficiently detailed to know what the plans are doing with regard to midwifery. Hence the ACNM survey. Questions asked regarding: Inclusion of CNM/CM/CPMs in plan networks Type of products/plans in which they are included Payment vs. physician rates OOH birth Limitations on what is covered (beyond scope of practice) Listing in provider directories Coverage of birth centers

21 Note: The slides presenting results of the ACNM plan survey that were shown during the Annual Meeting displayed draft results and are not included in this final handout. When the survey results are complete, they will be made available to all ACNM members.

22 Provider Non-Discrimination Section 2706 of the Public Health Services Act, as amended by the Affordable Care Act An insurer cannot discriminate with respect to network participation against any health care provider who is acting within the scope of that provider s license or certification under applicable state law. Does not require contracting with any willing provider. Does not prohibit variation in reimbursement based on quality or performance measures.

23 Provider Non-Discrimination Agency Guidance Sec prohibits discrimination against providers authorized to provide covered services under a benefits plan. It does not: Require insurers to accept all types of providers into their networks Govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations.

24 Provider Non-Discrimination Senate Appropriations Report Insurers must provide members with access to a full range of licensed and certified providers Discrimination in reimbursement among providers is limited to quality and performance measures and market considerations cannot be taken into account.

25 Agency Request for Information On March 12, 2014, HHS/Labor/Treasury issued a notice soliciting comment on all aspects of implementation of Sec This is likely a prelude to regulation. Comments are due June 10, 2014.

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