My Top Ten Legislative Wish List for 2010

by Heather Bradford, CNM, ARNP,
Chair, ACNM Government Affairs Committee

Because every woman deserves a midwife, here’s what I’ll be advocating for in the coming year:

1. Reimburse Midwives Fairly Under Medicare. I’m eagerly watching the health care reform package, which includes provisions from HR. 1101/S. 662 – the Midwifery Care Access and Reimbursement Equity Act of 2009. That’s right! After more than 20 years of work, our bill is part of both the House and Senate reform packages. This bill would allow for equitable reimbursement of certified nurse-midwife (CNM) services under the Medicare Part B fee schedule. Compared to physicians, we currently are reimbursed at just 65% for our services. Passage of health care reform will provide CNMs reimbursement equal to physicians under Medicare.
2. License Certified Midwives (CMs). Even though the CM credential is considered equivalent to the CNM credential, CMs are licensed to practice in only three states—New York, New Jersey, and Rhode Island. I want to see legislation introduced in at least 10 states that would provide full practice equity and licensure of CMs.
3. Reimburse Birth Centers Under Medicaid. HR. 2358/S. 1423 (The Medicaid Birth Center Reimbursement Act) would provide improved access to birth centers for pregnant women covered by Medicaid. It has already passed in both the House and the Senate as part of the health care reform package, and is awaiting final passage.
4. Reimburse Midwives Fairly Under Medicaid. I want to see legislation introduced in at least 10 states that would allow midwives to receive equitable reimbursement under Medicaid. Currently, only 28 states provide equitable reimbursement.
5. Recognize Midwives as Primary Care Providers. Midwives do more than care for pregnant women and babies. We specialize in women’s health throughout the reproductive life cycle. Therefore, midwives should be recognized in all state and federal legislation as primary care providers wherever the term is used.
6. Support Midwives Who Teach Students. More and more midwives are supervising students at academic health centers. However, there is no incentive for health centers to hire more, because midwives are not able to bill under Medicare for their supervisory role. Legislation needs to be introduced to address this.
7. Prevent Discrimination Against Midwives. We need a change to the Centers for Medicare and Medicaid Services (CMS) regulations to prohibit discrimination against midwives in hospital privileging.
8. Add Midwives to the VA. Midwives should provide care to female veterans covered by the Veterans Health Administration. All other advanced practice nursing groups are eligible providers, but midwives are not. The growing population of wounded women of childbearing age deserves a midwife, too.
9. Fund Nursing and Midwifery Education. I want additional funding for nursing and midwifery education within the Public Health Service Act (Title VIII) and the National Health Service Corps.
10. Protect Breastfeeding and Provide Tax Incentives for Businesses to Encourage it. As a breastfeeding mother of twins, I am ready for more legislation to be passed in this arena.
    

What would you like to see happen in 2010?