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ACNM Policy Update - 8/13/2014

1. CMS Proposes Significant Change to Physician Certification Requirement
2. NQF Webinar to Announce Release of "Playbook" to Help Reduce Early Elective Deliveries
3. Proposed Legislation Includes CNMs Among Providers to Receive Increased Medicaid Primary Care Payments
4. ACNM Joins Amicus Brief Filed in Relation to Significant Supreme Court Case
5. Massachusetts CNMs Gain Full Practice Authority
6. AHRQ Publicizes Innovative Approaches to Increasing Breastfeeding


1. CMS Proposes Significant Change to Physician Certification Requirement

In a proposed regulation released last month, the Centers for Medicare and Medicaid Services (CMS) has proposed a significant change to its existing requirement that a physician certify the medical necessity of all inpatient admissions for Medicare patients. (see page 41056 of the proposal)

CMS indicates that as a result of public feedback and its experience with implementing the physician certification requirement, they have decided to propose that physician certifications for Medicare inpatient admissions be required only in cases where the hospital stay is expected to be 20 days or longer. Since almost no admissions for maternity care last 20 days or longer, if finalized as proposed, this rule would effectively mean that for almost all Medicare patients seen by CNMs, there would be no need to obtain a physician certification of the medical necessity of the inpatient admission. Hospitals that have opted to require physician certification for all patients, regardless of payer, would no longer have a reasonable basis for imposing such a requirement.

Clearly, ACNM will comment in strong support of this proposal and we believe there is a strong possibility that CMS will finalize the policy as proposed, most likely effective for discharges occurring on or after January 1, 2015. However, the existence of the proposal raises the question of what course we should follow with regard to H.R. 4663, a bill that would statutorily remove the requirement for a physician to certify an admission, of any length, ordered by a CNM, NP, PA or CNS.

There are two reasons to continue a strong grassroots push for passage of H.R. 4663. First, unless the proposed regulation is finalized as such, this change will not take effect. Second, the impetus for a statutory change arises from the existing requirement for a physician certification for all admissions. If the regulation changes, the basis for the statutory change largely goes away. It would be very useful, on the state level, to have the statutory change take place because we will be able to point it out to state lawmakers as evidence that the federal government is loosening requirements akin to physician oversight or supervision.

So please do visit ACNM's Action Center and write your Representative today, urging him or her to support H.R. 4663. Also, please take advantage of town halls they may be holding during August to speak to them personally about this issue.


2. NQF Webinar to Announce Release of "Playbook" to Help Reduce Early Elective Deliveries

Over the last few months, the Maternity Action Team (MAT) of the National Quality Forum (NQF) has been working to develop a "Playbook" designed to provide hospitals with an understanding of the importance of lowering their rate of early elective delivery and tools for doing so. ACNM has been an active participant on the MAT. The Playbook cites to specific tools consumers can use to understand the issue and clinicians can use to address it, including ACNM's Our Moment of Truth campaign and www.birthtools.org site.

On Monday, August 18, from 3:30 p.m. - 5:00 p.m. ET, the NQF will hold a webinar to announce the availability of the Playbook and review its contents. Several hospitals will also be on the line to discuss their own efforts to reduce the rate of early elective deliveries. You can register for the webinar here.


3. Proposed Legislation Includes CNMs Among Providers to Receive Increased Medicaid Primary Care Payments

On July 30, Senators Sherrod Brown (D-OH) and Patty Murray (D-WA) introduced S. 2694, the Ensuring Access to Primary Care for Women and Children Act. This legislation would extend and expand an existing requirement that state Medicaid programs pay primary care providers at a rate at least equivalent to Medicare's rates, for specified primary care services.

The existing program provides for such payments to certain primary care physicians and does not include CNMs. Further, the provision expires at the end of 2014. S. 2694 would extend the program for two years, through 2016 and expand the set of providers eligible for the increased payments to include CNMs, NPs, PAs and OBs.

ACNM will be putting out an Action Alert to facilitate grassroots support for this bill.


4. ACNM Joins Amicus Brief Filed in Relation to Significant Supreme Court Case

In early August, ACNM joined with the American Nurses Association and several other APRN groups to file an amicus brief with the Supreme Court in the North Carolina State Board of Dental Examiners v. Federal Trade Commission case. This case has important implications for how regulatory boards may behave with regard to competitive issues.

This case considers a situation in which the North Carolina State Board of Dental Examiners sought to prohibit certain non-dentist individuals from providing teeth whitening, based on complaints from dentists regarding the lower cost of services thus provided. The FTC contends that the State Board of Dental Examiners acted in a non-competitive fashion when it issued orders to the teeth whiteners to cease providing this service. Further, the FTC notes that the Board was made up of individuals appointed by the professional organization and thus had a compelling self interest in stifling competition, without any state oversight to curtail this action.

The amicus brief joined by ACNM argues that "States should be able, in amici’s view, to continue to staff healthcare professional board with a majority of the regulated professionals while also insuring through “active state supervision” that the decisions of the board accurately reflect the policy of the state."

We will report on the outcome of this case as events unfold.


5. Massachusetts CNMs Gain Full Practice Authority

The Massachusetts Board of Registration in Nursing announced this August the implementation of revised regulations governing the practice of APRNs. The amended regulations are intended to reflect the enactment of new laws as well as to make the regulation of APRN practice more consistent with the national APRN Consensus Model and the Institute of Medicine’s Future of Nursing report.

Specifically regarding the practice of CNMs, neither a supervising physician nor written guidelines for prescriptive practice are required. The new regulations clarify that the CNM is no longer required by law or regulation to have guidelines or a supervising physician.

This regulation comes after passage of legislation making these changes on as a result of a tremendous amount of work by ACNM members and other stakeholders in Massachusetts.

Congratulations to all of you in Massachusetts!


6. AHRQ Publicizes Innovative Approaches to Increasing Breastfeeding

Earlier today, the Agency for Healthcare Research and Quality (AHRQ) published information on a set of innovative approaches to increasing breastfeeding.

The featured Innovations describe three initiatives to promote breastfeeding, including a baby-friendly hospital designation for which participating hospitals adopt standard policies aimed at reducing formula feeding and encouraging breastfeeding; a breastfeeding education program to support low-income, minority women; and a voluntary citywide initiative for public and private hospitals to support breastfeeding mothers and eliminate practices that interfere with breastfeeding.





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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