Clean Up: Licensed Certified Midwife Practice Parity Bill – HB1635 (Cole)/SB1352 (Srinivasan)

The bill would  provide licensed Certified Midwives (LCMs) with the same practice authority as Certified Nurse Midwives (CNMs) in Virginia. Both LCMs and CNMs are considered advanced practice midwives due to their extensive education, training, and board certification that enables them to practice in hospital settings.

Under current law, APRN CNMs are eligible to practice 1) with a consultation agreement with a physician or another CNM and 2) practice without a consultation agreement after 1,000 clinical hours.

Licensed CMs (LCM) are only able to practice with a consultation agreement with a physician and have no pathway to autonomous practice despite having identical midwifery education, certification, and scope of practice as APRN CNM.

Click here to view the One Page about this bill.

MAMA Bill: Midwives and Maternal Access Insurance Parity – HB1923 (Ward), HB1600-288#15s (Ward), SB800-288#25h (Boysko)

Under current law…
APRN Certified Nurse-Midwives are reimbursed at 100% of the fee schedule (the same rate as OB/GYNs).
Licensed Midwives are reimbursed at roughly 75% of the fee schedule.
Licensed Certified Midwives are not guaranteed any level of reimbursement.

This is a bill and a budget amendment co-sponsored by VA ACNM and the Virginia Midwives Alliance. The bill would require commercial health plans in the Commonwealth to reimburse all midwives licensed in the Commonwealth at 100% of the fee schedule. The budget amendment will direct health plans under DMAS – Department of Medicaid Assistance Services – to reimburse all midwives licensed in the Commonwealth at 100% of the fee schedule.

Click here to view the One Page about this bill.

Hospital Privileges

An Enactment Clause in HB1635 and SB1352

This clause will direct the Department of Health to amend Administrative Code 12VACS-410-10 to include certified nurse-midwives and license certified midwives in the definition of “organized medical staff”.

Currently, the Code of Virginia directs the Department of Health to create regulations governing the licensure of hospitals, which includes governance structure and organization of the medical staff. An “organized medical staff” means a formal organization of physicians and dentists with the delegated responsibility and authority to maintain proper standards of medical care. Though hospitals may grant privileges to midwives to care for people in the hospital, when midwives are not considered FULL/REGULAR medical staff, they
1) cannot vote on hospital policies/procedures that determine their practice,
2) cannot provide care without physician sponsorship or supervision,
3) are often prohibited from admitting and discharging patients.

More information on this issue and how privileging influences midwifery practice is available from the American College of Nurse-Midwives.

PUSH Coalition

Virginia ACNM is a member of the Virginia Interfaith Center for Public Policy’s PUSH Coalition. These are bills our organization actively supports. For more information, visit VICPP’s website.

Unconscious (Implicit) Bias Training Licensing Criterion. Require unconscious (implicit) bias training become an eligibility criterion for all health care professionals licensed by the Virginia Board of Medicine.
Services to Incarcerated Pregnant Women. This would be budget language for a 1115 waiver to allow Medicaid to pay for services for services for pregnant women in jails (not prisons – yet). Partnering with Virginia Poverty Law Center (VPLC).
Presumptive Eligibility for Pregnant Women. Allow pregnant women to be immediately enrolled for Medicaid without waiting for up to 45 days for Medicaid paperwork to be processed. Mississippi just passed this. Partnering with VPLC.
Cover All Kids. Provide health insurance for undocumented children who would be eligible for Medicaid other than their immigration status.
Access to Care: VICPP helped expose the fact that Managed Care Organizations (MCOs) with the state Medicaid contracts were not adequately serving pregnant women. The press conference we organized explained that pregnant women were unable to get basic appointments, especially in the second and third trimesters. VICPP will support a budget amendment to ensure that MCOs increase the use of community-based providers shown to improve maternal health.