RD324 - Annual Report to the Joint Commission on Health Care on the Impact and Effectiveness of the Pilot Programs to Expand Access to Obstetric, Prenatal, and Pediatric Services


Executive Summary:
The 2005 General Assembly and Governor enacted HB2656 to improve access to obstetrical care in areas without inpatient maternity services. The passage of HB 2656 permitted the State Board of Health to approve pilot projects that permitted certified nurse midwives (CNM)licensed by the Board of Medicine and Nursing to practice in collaboration with a physician rather than requiring a supervisory relationship with a physician. HB 2656 also permitted the use of birth centers as an alternative way to improve access to prenatal, obstetric and pediatric care. HB2656 required the Virginia Department of Health (VDH) to make an annual report to the Joint Commission on Health Care on the progress made in these communities to gain State Board of Health approval for such pilot projects and improve access to care.

VDH issued its first report to the Joint Commission on Health Care (November, 2006) on the progress made to date on the development of birthing centers. Of special note was the general fund allocation of $150,000 to support coordinators in Emporia-Greensville and the Northern Neck to maintain the momentum in these communities. VDH drafted a Memorandum of Agreement (MOA) with Virginia Commonwealth University (VCU) in September 2006 to administer that start-up funds and provide management oversight for the two projects. The agreement included a list of deliverables to assure forward progress. Shortly thereafter, VCU hired two project coordinators to organize the efforts of state and local supporters and move forward with implementing an OB pilot project in each assigned area.

The 2007 General Assembly continued the same level of funding in FY 08. The MOA with VCU expired in June 2007 and agreements were executed with 501 (c) (3) organizations located in each of the targeted communities (Emporia-Greensville and Northern Neck). Southern Dominion Health Systems, Inc became the fiscal agent for the pilot project in the Emporia-Greensville area and Rappahannock Area Health Education Center became the fiscal agent for the Northern Neck project beginning July 2007.

Over the past 12 months, stakeholders in both communities have continued to perform the work in support of establishing birth centers utilizing the services of CNMs who would work in collaboration with a community physician. The two project coordinators hired in November 2006 have continued working in their respective localities to develop and implement business processes required by the Commission for the Accreditation of Birth Centers in establishing an accredited birth center. Each community’s Task Force or Board has been hard at work developing policies and procedures for operation of a birth center in accordance with the Board of Health’s recommendations. Recognizing that a community’s commitment to this effort is essential to each center’s ability to become fully operational by the end of 2008, all the stakeholders have been very active in informing the public about the birthing center concept and garnering community support. Each project coordinator has worked collaboratively with the Department to assure that the required work plan deliverables have been accomplished within the given time frames.

In the Emporia-Greensville area it is anticipated that Southern Dominion Health Services, Inc. (a Federally Qualified Health Center) will receive approval from the U.S. Department of Health and Human Services, Health Resources and Services Administration to expand its scope of service and begin providing women’s health and obstetrical services early in 2008. In the Northern Neck area, the option to partner with a federally qualified community health center was not feasible, necessitating this group take a different approach. The stakeholders developed the Family Medical Center of Northern Neck as a corporation and received approval from the Internal Revenue Services to operate as a 501 (c) (3). This group estimates having a fully operational birth center will take longer and may not be operational until the end of 2008.

The local OB projects must pay close attention to the provisions in HB 2656 for increased collaboration, which are critical to ensuring success. Inadequate attention has been given to coordination with the regional perinatal center. HB 2656 specifically stipulates that there must be mutually agreed upon practice protocols and that the perinatal center agrees to provide administrative oversight and clinical consultation when requested.

The Department of Medical Assistance Services is researching a reimbursement structure under Medicaid for the birthing centers. It is anticipated that based on the projected payer mix for these two centers, there will be heavy reliance on Medicaid reimbursement. Promulgation of any regulatory changes to the existing reimbursement structure will take approximately 18 months, given the public participation requirements of the Virginia Administrative Process Act. Any changes to Medicaid reimbursement will likely affect the financial viability of these two projects.

During the continuation of this grant, VDH will serve as a primary contact for the purposes of collaborating on the implementation of project tasks and priorities and will provide technical assistance for the purpose of expediting the project. VDH will continue to monitor the progress of the pilot projects, and report on the impact and effectiveness of the pilot projects in meeting the program goals.