RD215 - 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:
As an alternative way to improve access to obstetrical and pediatric care in areas without inpatient maternity services, the 2005 General Assembly (GA) passed HB2656 authorizing the State Board of Health to approve birthing center pilot projects. The passage ofHB2656 permitted the pilot projects to employ 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. Pilot projects have been developed in Emporia and in the Northern Neck.

HB2656 requires the Virginia Department of Health (VDH) to prepare an annual report to the Joint Commission on Health Care on the impact and effectiveness of the pilot programs to expand access to obstetrical and pediatric services in these communities. VDH issued reports in 2006, 2007 and 2008 to the Joint Commission on Health Care on the progress made to date on the development of birthing centers.

In FY09, new Memoranda of Agreements (MOA) were established with Southern Dominion Health Systems, Inc. (SDHS) for the Emporia/Greensville project and with Rappahannock Rural Health Development Center (RRHDC), formerly known as Rappahannock Area Health Education Center (RAHEC) for the Northern Neck project. The MOAs contained provisions to administer start-up funds and provide management oversight for the two projects. Over the past 12 months, stakeholders in both communities have continued to perform work in support of establishing birthing centers utilizing the services of CNMs in accordance with the Board of Health's recommendations.

Each project coordinator has worked with VDH to assure that the required work plan deliverables have been accomplished within the given time frames. While each center has moved closer to establishing a birth center, neither became operational in 2008. In 2008 SDH (a federally qualified health center) received approval from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) to expand its scope of service to provide women's health and obstetrical services. The women's health and birthing center facility will be located in Emporia.

The United States Department of Agriculture approved construction bids for The Family Maternity Center of Northern Neck (FMCNN) in April, 2009. The new facility will be located in Lancaster County. An application has been submitted for certification as a rural health clinic, serving both as a birthing center and as a primary care center for women's and children's services.

HB2656 stipulated that there must be mutually agreed upon practice protocols and that a Level III perinatal center must agree to provide administrative oversight and clinical consultation when requested. Both projects work with Virginia Commonwealth University (VCU), Obstetrics and Gynecology Department to develop the policies, procedures, and protocols that will govern the care provided in the proposed birthing centers.

U.S. Representatives Susan Davis, (D, CA) and Gus Bilirakis (R, FL) have introduced H.R. 2358, the Medical Birth Center Reimbursement Act, to ensure Medicaid birth center facility fee payment to states. The Family Center of Northern Neck is preparing to submit a Medicare application for certification as a rural health care clinic. SDHS will receive cost based reimbursement for obstetrical services rendered during its first year of operation. The facility uses a sliding scale fee-for-service for eligible patients and accepts all insurances.

The issue of Medicaid reimbursement for the two birthing centers continues to present challenges. Birthing centers are not licensed in Virginia therefore they are unable to seek a separate payment for a "facility fee." Clinician services are not included in the facility fee; Medicaid reimburses the professional services of a physician or nurse practitioner for prenatal and delivery care separately. Promulgation of any enhanced professional fee would require a state plan amendment from the Centers for Medicaid and Medicare and this is considered to be unlikely at this time.

VDH continues to serve as a primary contact for identifying and working on the implementation of project tasks and priorities and will provide technical assistance to expedite 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.