Presentation is loading. Please wait.

Presentation is loading. Please wait.

The Affordable Care Act & Birth Centers

Similar presentations

Presentation on theme: "The Affordable Care Act & Birth Centers"— Presentation transcript:

1 The Affordable Care Act & Birth Centers
Jill Alliman, DNP, CNM Legislative Committee Chair American Association of Birth Centers

2 A brief history of birth centers in the US
1975- Maternity Center Association in NYC 1981-Cooperative Birth Center Network (14 centers) 1982 APHA published Guidelines for Regulating and Licensing Birth Centers 1983-Organization became NACC 1989-National Birth Center study published in NEJM 2005-NACC became AABC 2010-Medicaid Birth Center Reimbursement Act passed birth centers

3 What is the status of birth center birth in the US?
270 known birth centers in US 15,577 births in 2012 0.3% of all US births 42% increase in past 5 years (MacDorman et. al, 2014)

4 All OOH births in 2012 in US 53,635 births / 3,952,841
1.36% of all US births 35,184 at home and 15,577 in birth centers Up from 1.26% in 2011 Most increase among non-Hispanic white women-rate of 2.05% of all births (MacDorman, 2014)

5 Birth Center Midwifery Providers
61% CPMs or LMs 52% CNMs Midwifery Providers 61% CPMs or LMs 52% CNMs A growing number of birth centers have BOTH CPMs and CNMs. Of AABC member birth centers: Member Centers: Midwifery Providers 19% CNM & CPM together 28% CPMs 53% CNMs Source: AABC Medicaid Survey of Birth Centers 2009 Source: AABC Member Database 2014 (AABC Medicaid Survey of Birth Centers 2009)

6 Birth center outcomes of care
Low cesarean rates & improved outcomes Cost savings Increased client satisfaction (Rooks, 1989;Stapleton, 2013)

7 US spends more -- but our mothers and babies have higher risk of dying
US is 46th in maternal mortality (2 X higher than 31 other nations) US is 27th in infant mortality (6.1 deaths per live births)(WHO, 2012) Huge racial disparities make some at much higher risk Medicaid pays for 48% of US births Although the US health care system spends more on maternity care, we are not improving the health of mothers and babies. In fact, our global standing continues to drop! How do these statistics tie in with birth centers?

8 Triple Aim Innovative approaches should meet the Triple Aim of CMS Better Care Better Health Lower Costs Birth Center Care meets the Triple Aim and is a model for improving maternity care. Read slide, Our maternity care system needs a lot of changes, But birth centers can be part of that solution if barriers to our practice are addressed and removed.

9 Birth Centers by State Do you notice a pattern here? There are 5 states that have 142 of the 270 birth centers in the US. These are the states that have regulations with the fewest barriers for birth center operations. These states do not necessarily have the best Medicaid reimbursement of birth centers. But they do all have licensure for CPMs.

10 States where CPMs are legally authorized to practice
Where are CPMs legally authorized to practice? Where aren’t they? Where are families fighting Big Medicine for legal access to CPMs? CPMs are legally authorized to practice in 28 states (EMERALD GREEN states above) 26 States that regulate CPMs (Law Enacted / Rules in Some States) 2 States Legalized CPMs by Statute (Law Enacted) CPMs are not legally authorized to practice in 22 states 14 states have active CPM legislation (LIME GREEN states above) 3 states (and the District of Columbia) are planning CPM legislation (MUSTARD YELLOW states above) 5 states (and 2 territories) are organizing their CPM advocacy efforts (PLUM PURPLE states above) - See more at: Map courtesy of The Big Push for Midwives –

11 82% of States Have Regulations for Licensing Birth Centers
Of the states with no regulations, North Carolina is the only state that has regulations that allow Medicaid reimbursement of birth centers

12 AABC definition of Birth Center
A home-like setting where care providers, usually midwives, provide family-centered care to healthy pregnant women.

13 AABC definition of Birth Center AABC definition of Birth Center
Most are separate from hospitals A few are inside hospitals and must meet standards for independence and be separate from L & D unit AABC definition of Birth Center

14 Definition of Birth Center in Federal Law
USC § 1396(l)(3) (A) The term “freestanding birth center services” means services furnished to an individual at a freestanding birth center (as defined in subparagraph (B)) at such center. (B) The term “freestanding birth center” means a health facility— (i) that is not a hospital; (ii) where childbirth is planned to occur away from the pregnant woman’s residence; (iii) that is licensed or otherwise approved by the State Federal language is important in that it sets a definition that can be used in other places in law and sets a standard for consistency. An example is the Maternity Provider shortage act, that includes birth centers as sites where if maternity provider shortages exist, midwives can be recruited and placed. It references this definition of the freestanding birth center.

15 Definition of a birth center, cont.
(iii) continued To provide prenatal, labor and delivery or postpartum care and other ambulatory services that are included in the plan; and (iv) that complies with such other requirements relating to the health and safety of individuals furnished services by the facility as the State shall establish [42 U.S.C. § 1396(l)(3) (A), (B), & ( C)] Again, this definition gives the states the authority too establish requirements for licensed facilities in that state.

16 Birth Center Medicaid Reimbursement Act
Introduced by Sen Boxer (R co-sponsor Sen. Corker) AABC version did include both the facility and all licensed birth attendants CBO cost estimate—would save Medicaid $$$$ Amended by Sen Cantwell to add more language about types of birth attendants Added to ACA Bill Passed in 2010 as Section 2301 of ACA I will take just a few moments to go over the history of this bill and how it evolved and passed through Committees until it was added to the ACA

17 Original language of Bill-Attendant
The term ’licensed birth attendant’ means an individual who is licensed registered by the State involved to provide health care at childbirth and who provides such care within the scope of practice under which the individual is legally authorized to perform such care under State law (or the State regulatory mechanism provided by State law), regardless of whether the individual is under the supervision of, or associated with, a physician or other health care provider. Nothing in this subparagraph shall be construed as changing State law requirements applicable to a licensed birth attendant.". Original language by AABC did include both the facility and the attendant

18 Mandated Services under Medicaid
Section 1905 of SSA lists services that Medicaid (“Medical Assistance”) must cover “The term ‘medical assistance’ means payment of part or all of the cost of the following care and services or the care and services themselves, or both” Freestanding Birth Centers added as paragraph 28 to the list of mandated covered services as part of the cross referencing of this bill When writing a bill—it must connect to all relevant sections and amend them as necessary. So, this section shows that birth center reimbursement is clearly a mandate because birth centers are added under the list of covered services. The list of mandated covered services for Medicaid includes such other things as in-patient hospital services, out-patient hospital services, labs, prescriptions, hospice, and now— Freestanding birth centers!! In the past when new services are mandated, Rules have been issued by CMS, but not as of yet for the birth centers. Rules are still needed.

19 Harkin Amendment to the ACA
Applies to commercial/private insurance plans Provider non-discrimination—states that plans cannot discriminate against non-physician providers Not any willing provider Cannot discriminate against a whole class of providers (e.g. birth centers) The Harkin Amendment is a totally separate section of the ACA, Section 2706. It was added so non-physician providers would have a better chance of being included in all new health plans that would be created as a result of the law. Some of the provider associations- (chiropractors, nurse anesthetists, optometrists, ACNM, and AABC, continue to work to make sure this amendment is enforced. Senate just recently let the CMS know they are not happy with the way this law is NOT being implemented or enforced.

20 Implementation Steps States must submit a State Plan Amendment (SPA) stating they will cover birth centers and their birth attendants--at least 26 states have completed this step All the states that license or recognize birth centers are mandated to pay for the facility services and the professional service fees for midwives who attend births in those birth centers AABC position—CMS needs to issue Rules and Regulations so states will comply correctly Rules needs to state that Medicaid MCO’s must comply with Medicaid mandate Read summarize

21 Reimbursement levels and MCOs—the next hurdles for birth center access
Florida—implementation of facility services payment very slow. FABC’s worked to increase budget for the line item that covers birth centers. TX—Medicaid reimbursement too low for most centers to accept Medicaid Mediciad Managed Care Organizations won’t contract with birth centers in some places—need CMS Rules

22 Bottom Line . . . With the ACA
If you are a licensed provider, working in a licensed or otherwise recognized by the state birth center: Medicaid is mandated to pay your facility service fees and professional services of the birth attendant Commercial plans don’t have to contract with every birth center, but should offer access to consumers for birth centers in their coverage area

23 AABC Actions Submitted comments to FTC on barriers to practice for freestanding birth centers, and for the providers who practice in them Submitted comments to CMS/IRS/Department of Labor on the need to properly enforce the Harkin Amendment Continue to pressure CMS to issue Rules and Regulations so the Medicaid reimbursement mandate will be appropriately implemented by all states. The FTC comments and Harkin comments written by AABC contain a wealth of information and are available on the website

24 How Can You Get Involved?
If you are not receiving Medicaid reimbursement for birth center facility and birth attendant fees, then contact us: Or call the AABC office at: Join AABC if you are not yet a member. We can do so much more if we all work together!

25 References MacDorman, MF, Mathews, TJ, & DeClerq, E. (2014) Trends in out-of-hospital births in the United States, , NCHS Data Brief No 144, Hyattsville, MD: National center for Health Statistics. Rooks, J. P., Weatherby, N. L., Ernst, E. K. M., Stapleton, S., Rosen, D., & Rosenfield, A. (1989). Outcomes of care in birth centers. The national birth center study. New England Journal of Medicine, 321(26), Stapleton, S., Osborne, C., & Illuzzi, J. (2013). Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery and Women's Health, 58(1), doi: /jmwh.12003/full

Download ppt "The Affordable Care Act & Birth Centers"

Similar presentations

Ads by Google