February 2018 Health Policy Update
AB2682: New Bill — Same Goal
Hello, all — our new bill, AB 2682, was been introduced late last week. Same concept (removal of physician supervision), new language. The difference is that we are meeting with CMA and ACOG regularly to wordsmith. Our next meeting is next Tuesday (2/27).
The bill is currently limited to removal of supervision (and defining when physician involvement takes place), but we intend to next tackle furnishing, ordering supplies and episiotomy repair at home — all key elements of AB 1612.
After introduction, the bill will be assigned by the Rules Committee to the Business and Professions Committee. This should occur in the three weeks following introduction.
This language cannot be amended until a few weeks after it is introduced in bill form, so we have time to continue these discussions with CMA and ACOG.
The deadline for the policy committee (Assembly B+P) is April 27. The bill remains keyed “fiscal” so it will be refereed to Appropriations Committee after passing the Business and Professions Committee.
We will have lobby day on March 20, in time to make an impact on B+P vote in April.
Appropriations Committee Members and Twitter Handles
Lorena Gonzalez Fletcher: Dist 80
Frank Bigelow: Dist 5
Richard Bloom: Dist 50
Rob Bonta: Dist 18
William Brough: Dist 73
Ian Calderon: Dist 57
Wendy Carillo: Dist 51
Ed Chau: Dist 49
Susan Eggman: Dist 13
Vince Fong: Dist 34
Laura Friedman: Dist 43
James Gallagher: Dist 3
Eduardo Garcia: Dist 56
Adrin Nazarian: Dist 46
Jay Obernolte: Dist 43
Eloise Gomez Reyes: Dist 47
Bill Quirk: Dist 20
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Worth a Listen!
We applaud Freakonomics for their astute podcast of “Nurses to the Rescue.” This podcast is worth the listen!!! Like Nurse Practitioners (NPs), Certified Nurse-Midwives (CNMs) are Advanced Practice Nurses with graduate level education and rigorous training. In California, our current Bill (AB1612) to remove physician supervision for CNMs has been met with similar opposition from CMA. This is our third attempt to remove physician supervision for CNMs in order to meet the growing demand for women’s health and maternity care services throughout the State. Nine California counties do not have an OBGYN! This podcast explains why full practice authority for Advanced Practice Nurses is so important.
Current regulations make it difficult for nurse-midwives to practice equitable, team-based care. In effective team-based care, each provider is integral to the team and each is able to offer the full scope of what they have to offer, which ultimately provides better health care overall. The “supervision” concept creates a sense of hierarchy that is antithetical to effective team-based care. As providers tethered to physicians, CNMs are unable to promote midwifery care without supervisory permission. Physician supervision also fosters interprofessional tension because of the erroneous idea that the physician is legally responsible for the CNM’s actions.
Midwives are often invisible within the healthcare system by not being counted/included as providers by insurance companies or hospitals. Currently, Medi-Cal and private health plans do not track where CNMs work and what we do. That means our impact is often invisible to policy makers, insurance companies, and the general public—but not to budget administrators, who may well eliminate a CNM “line item” because our worth is not known.
Removal of the word “supervision” would expand market opportunities for CNMs and the physicians with whom we collaborate. It will also make it easier for a CNM to obtain hospital privileges and become a full hospital staff member; to work with physicians who are no longer fearful of liability issues; to start a midwife-owned private practice; and to contract with health plans. Likewise, it will be easier for hospitals to hire the appropriate number of CNMs and physicians required for optimal patient care rather than basing hiring decisions on supervision ratios. Removal of supervisory requirements does not, of course, preclude a CNM from working within a physician or hospital group if she or he so chooses.
The Health Policy Committee is responsible for assisting in the fulfillment of these specific purposes of the California Nurse-Midwives Association (CNMA):
- Represent the membership regarding issues impacting the practice of midwifery in the state of California in accordance with the bylaws and policy guidelines of the American College of Nurse-Midwives.
- Promote the health and well-being of women and families in the state of California by furthering the profession of midwifery.
- Establish a mechanism for cooperation with other groups and organizations in promoting the health and well-being of California families.
- Achieve legislation and regulation that is favorable to midwifery practice.
- Support and foster appropriate professional licensure regulations and legislation related to midwifery and women’s health issues in California.
Wondering how to get involved?
Join fellow CNMA members that are active proponents of our health policy goals, in either the Health Policy Committee (3 yr commitment) or the Health Policy Workgroup for smaller projects:
- Engage locally: Determine what is going on in your local chapter. Does your chapter have a Health Policy liaison? What issues face your local CNM community?; Where do CNMs work in your community? Can you identify local supporters? Build a relationship with your local representatives.
- Attend CNMA Lobby Day! Volunteer to help organize!
- Make in-district lobbying visits with your legislator, closer to home!
- Help CNMA fundraise!
- Represent CNMA at coalition, BRN, or other meetings!
Contact the Chair or Vice Chair of the CNMA Health Policy Committee to find out how you can help.