2015 AABC Birth Institute October 4, 2015 Scottsdale, AZ

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1 Effecting Change in Your State at the Legislative and Policy Level 2015 AABC Birth Institute October 4, 2015 Scottsdale, AZ

2 State Licensure in New Mexico Abigail Lanin Eaves, CNM, MSN Melanie Yanke, CNM, MSN Dar a Luz Birth & Health Center AABC Legislative Panel Presentation

3 New Mexico: What s the Issue? New Mexico has not had birth center facility licensure since the 1960s (Maternity Homes) Not illegal to operate a birth center without a license NMDOH initially stated we could only be licensed as a special hospital if we wanted to be licensed

4 New Mexico: What s the Issue? Once ACA requirements were known, DOH stated they would add birth centers to existing outpatient regulations (August 2011) It would lump us in with ambulatory surgical centers, diagnostic treatment facilities, etc. Many regulations are similar to hospitals: room size, corridors, etc. Did not want to give birth centers their own special regulations within the existing regulations, just fitting the square peg into the round hole AIA Facility Guidelines Institute and 200 ft 2 for birth rooms (not including bathroom)

5 New Mexico: How Did We Solve (or attempt to solve) the Issue? We argued that there was no evidence to support AIA/FGI 200 ft 2 non-negotiable for birth room size- STALEMATE We created BIRTH ROOM ENVIRONMENT SURVEY to show birth room size did not affect safety of birth/birth outcomes (complete 6/1/14) Survey sent electronically to 252 birth centers 118 responded (47%) Total births in past year (when survey was sent): 12, total birth rooms: 24% ft 2, 35% ft 2, 24% ft 2 Very few emergency transfers

6 New Mexico: How Did We Solve (or attempt to solve) the Issue? By fall 2014, still no real movement/commitment from DOH Hired lobbyist, secured House Representative to carry the bill Nov 2014: met with Secretary of Health, DOH and Medicaid Secretary stated she WOULD support legislation and encouraged us to do so in order to add birth centers to list of licensed facilities Secretary mandated that DOH would create birth center specific regulations with our help and would be done within the next 60 days

7 New Mexico: What Went Well? Not So Well? HB 84 introduced in the 2015 legislative session Rep Trujillo (D) and Rep Harper (R) -> Excellent bipartisan support Senator Rodriguez (D) introduced bill simultaneously in the Senate (SB 176) HB84 passed through both House committees, house floor with unanimous Do Pass SB176 passed through both Senate committees with unanimous Do Pass, with amendment added in first committee (SB stopped here)

8 New Mexico: What Went Well? Not So Well? HB84 came over to the Senate, passed same committees that SB176 had been through, unanimous Do Pass HB84 came to the Senate floor where pro-life Senator (R) wanted to add abortion clinics -> massive freak-out (day before session ended) Rep Harper told him to let that go, support this bill for midwives and babies being born, passed Senate floor with unanimous Do Pass HB84 signed by Governor Martinez on March 20, 2015, two hours before the deadline Finished working with DOH in March working on regulations/language

9 New Mexico: What Did We Expect to Happen? We expected the bill to pass without drama: WRONG We expected the regulation process to be timely: WRONG We expected that DOH would remember/write down/make note of things that we already discussed/agreed upon: WRONG We expected to have a license application July 1, 2015 (per Secretary of State, DOH and HB84): WRONG We expected to have to fight for many things in the regulations (birth room size, janitor s closet, etc.): WRONG

10 New Mexico: What Actually Happened? Passed and made law a House Bill with excellent bipartisan and client support! Excellent representation on both sides: CNMs, LMs, DOH, Medicaid, legal, lobbyist, Young Women United Everyone was willing to listen to each other and hear each other out- true collaboration Excellent preparation on our part- having articles and evidence including ALL other state regulations

11 New Mexico: What Actually Happened? The work with DOH went slower than anticipated Long meetings, very collaborative though Pushed back ~6 months Open lines of communication Regulations got stuck in legal at DOH for 3-4 months No communication at all (except when we checked in)

12 New Mexico: Next Steps Hearing set for October 20 th Rules then in promulgation for 30 days Application for licensure should be available by the end of the year Tedious site visit Must work with Medicaid to set facility payment at a decent rate Get private and Medicaid payers to add birth centers as licensable facilities with competitive reimbursement

13 Dar a Luz Birth & Health Center

14 Improving Medicaid Reimbursement for Birth Centers in Maryland Ann Sober, RN, BSN Special Beginnings Birth and Women s Center AABC Legislative Panel Presentation

15 Maryland: What is the Issue? Expenses Accounting Pharmaceuticals (non-reimbursable Legal Fees Medical Supplies (non-reimbursable) Cleaning Electricity Telephone Maintenance/Repairs Laundry and Linens Office & Administrative Medical Waste Removal Trash Contracted Services Advertising Educational material Interest Expense Bank Charges Licenses and Permits Property Taxes

16 Maryland: What is the Issue? Expenses Medical Malpractice Insurance Employee Health Insurance Property Liability Insurance Workman s Compensation Dues and Subscriptions Accreditation/ Licensure Training Postage Depreciation Expense Infant Services Transport to Hospital (Transfers) Medical Director (required by Maryland State Law not billable as a professional fee) Pension Expenses* Payroll Expenses* Payroll Taxes* * professional fees insufficient to cover this expense Rent/Mortgage

17 Maryland: Working on the Issue Networking Who should you talk to? How should you make contact?

18 Maryland: Working on the Issue Be prepared for your meetings Be ready to support your position with hard facts Prepare a budget explaining why additional funds are needed to provide the service Explain why the birth center provides cost effective care

19 Removing Physician Supervision and Integrating Licensed Midwives into Medicaid in California Sarah Davis, CPM, LM, IBCLC Birth Roots AABC Legislative Panel Presentation

20 California Licensed Midwife Bills AB 1308 in 2013 Many issues including removal of Physician supervision SB 407 in 2015 Inclusion in enhanced Medi-Cal (California s Medicaid) service SB 408 in 2015 Creates Midwife Assistant role

21 California: Organizations and Consultants California Association of Midwives California Families for Access to Midwives Pro Bono lobbyists in 2013 Paul Hastings Law Firm Consultant, 2013 and 2015 Katie Prown Prown & Associates Social media, 2013 and 2015 Jeanette McCullough Birthswell Legal Counsel, 2015 Susan Jenkins, JD

22 California: Our Strategy Build and leverage consumer base Hands on lobbying Focus on access and equity Invest in our political education

23 Overcoming the Certificate of Need in Kentucky Mary Carol Akers, CNM, PhD, FACNM Education for Childbirth and Parenting AABC Legislative Panel Presentation

24 Kentucky: Certificate of Need Intent of Certificate of Need (CON) Cost of CON Reality

25 Kentucky: CON Cost Lawyer starting February 6, 2012 Experts CON Experts Building Experts Midwifery Experts Birth Center Experts

26 Kentucky: CON Process Application Found Lawyer, experts, contracts, architect Application fills a 3 3-ring binder Hearings February 20 and 21, March 13 and 26, 2013 Affected Parties Hardin Memorial Hospital, Twin Lakes Regional Medical Center and Flaget Hospital Depositions prior to hearings Testimony 4 days of the hearings Heard by an administrative law judge

27 Kentucky: CON Findings Conclusions of Law: (August 1, 2013) Affected parties have refuted need In accordance with KRS 216B.096 (4), if the facility or service for which a capital expenditure is proposed is not found to be required, the certificate of need cannot be approved The proposed capital expenditure of $852,590 relates to the lease of a building and its equipment Application denied

28 Kentucky: Appeal Process Going to court again October 29, 2014 Findings: Final order reversed February 23, 2015 Hospitals are not affected parties Licensure requirements should not be considered in certificate of need

29 Kentucky: Appealing the Appeal So, of course, the hospitals are appealing the findings of the appellate judge This sets up the place in which we find ourselves now

30 Questions?? Activism is something that no one can fake. You get angry. You cry. But you never throw in your towel, because that anger is what is propelling you to further action. Leymah Gbowee Nobel Peace Laureate and Oxfam Ambassador

American Association of Birth Centers

American Association of Birth Centers America's Birth Center Resource 3123 Gottschall Road - Perkiomenville, PA 18074 - Tel: 215-234-8068 - Fax: 215-234-8829 - aabc@birthcenters.org - www.birthcenters.org