MN Passes Bill to License Birth Centers, Save Midwives from Reduced Payments

by Brielle Stoyke, CNM

The efforts of midwives across the US who lobbied their federal
legislators for fair reimbursement of midwifery services has paid off big in Minnesota.

This year, a group of midwives worked on birth center licensure legislation – we wanted a basic bill to license birth centers in our state. Two birth centers opened in February, and at least two more are in the works. The Senate author for the bill was inspired by the birth center model of care AND the cost savings for the state’s bottom financial line. Our intention was just licensure, but because it included fiscal savings, the bill became a bit more complicated. The bill went through dozens of hearings, and was held onto (or held up) until the final moments of the legislative session, so that it could serve as a potential vehicle to carry all the other health care bills. In the end, it was not used as a vehicle, but because it was held until the last minute, it had the chance of either passing or NOT. Scary.

To thicken the plot, there was a cost-cutting proposal in MN to “rebase” all provider fees to match Medicare. We did not find out about this until seven days before the end of the session. Certified nurse-midwives (CNMs) in MN are currently paid at 100% of what physicians receive for their services under Medicaid, and we would have been brought down to the 65% Medicare rate. But, because of the new federal health care reform law that will raise Medicare reimbursement for CNMs to 100% beginning in January 2011, we were able to persuasively argue that imposing a 35% reimbursement cut would be unfair and contrary to the intent of federal policy. In the process of working with legislators and lobbyists, we were able to whip up an amendment to exempt CNMs from the Medicare rebasing! On the last day of the session, both our amendment and the birth center bill were passed by both houses, and the bill now awaits consideration by the Governor. We have our fingers crossed that the bill will soon become law. For the hard work it took to get this far, special thanks go to the American Association of Birth Centers (AABC), MN midwives, as well as midwives and their supporters across the US.

Bonus Video: Scroll to 2:35:00 to watch the MN House pass the birth center bill.

The Article that President Obama is Reading

According to an article in the New York Times, President Obama is singing the praises of Atul Gawande’s “The Cost Conundrum,” which was recently published in The New Yorker magazine. Gawande’s piece investigates the geographic variations in health care cost per person, in particular McAllen, TX—the most expensive place in the US for health care. The piece is certainly impressive, calling attention to the fact that higher spending is often not associated with better health outcomes.

How’s this for a fun fact? When it comes to maternity care and primary care, midwives achieve positive patient outcomes using minimal costly interventions. Want to give us a hand with improving access to midwives? Tell your legislator to support the Midwifery Care Access and Reimbursement Act of 2009 (HR 1101 and S 662).