Legislative exchange

O Pennsylvania's insurance law now requires reimbursement of CNM services. In only two years, the less than 100 CNMs in the state and their consumer supporters managed to get a bill to amend the state's Insurance Act introduced, unanimously passed in both houses of the legislature, and signed into law. The reimbursement bill was first introduced in the 1980 legislative session by State Sen. Michael O'Pake, but no real action was taken on the bill. In 1981, Sen. Henry Hager, President Pro Tem, introduced the bill in the Senate and by December 31, 1981, the bill was signed into law by Governor Richard Thornburgh. Maryann Arty, the only RN to serve in the Pennsylvania legislature, gave her energetic support to the bilrs passage. On January 27, 1982, the Governor held a signing ceremony, which received television, radio, and press coverage, and he distributed pens used to sign the law to several Pennsylvania CNMs. Birth centers have been included under Pennsylvania's Health Care Facilities Act since 1980, but the Health Department had not yet issued licensing regulations for birth centers when the new reimbursement law passed. Blue Cross is limited under Pennsylvania law to contracting only with licensed health care facilities, so Blue Cross had been unable to issue contracts to birth centers until February 8, 1982 when the State's Secretary of Health Mueller a n n o u n c e d that interim licenses would be issued to all existing birth Journal of Nurse-Midwifery

centers until the regulations could be finalized. Congratulations to the Pennsylvania CNMs and consumers! May their motto "Educate, Not Intimidate" guide the reimbursement campaign in other states.

CNMs got some wonderful national publicity this past winter. Dan Rather and CBS Evening News on December 31, 1981 featured a 5-minute clip on the practice problems of Tennessee CNMs Victoria Henderson and Suzanne Sizemore. The television report examined the barriers the CNMs have faced in their attempts to obtain hospital privileges and was quite supportive of the CNMs right to practice. The February 1982 issue of Parents Magazine featured a 5-page article "Rebirth of the American Midwife" by novelist and film producer Gay Courter. The article discussed the reasons why parents are choosing to birth with midwives, both nurse and empiric. The article emphasized out-of-hospital alternatives and included photos of Nancy Redfern C.N.M. of the Birthplace in Gainesville, FL. People Magazine's February 8, 1982 issue featured a 2-page spread on Barbara Brennan C.N.M., Director of the Midwifery Service at St. Luke's-Roosevelt Hospital in New York City. Barbara is pictured laboring with a couple whose birth story is detailed in the article. Both articles would make good

• Voi. 27, No. 3, May/June 1982

Copyright © 1982 by the American College of Nurse-Midwives

additions to press packets and information given to legislators about what nurse-midwives do.

Those federal employees who are covered under Blue Shield's Government-Wide Plans are now eligible for CNM services. Reimbursement of nurse-midwifery services was included in the new contracts negotiated in January 1982 for the Federal Employees Health Benefits Plans. Although legislation was introduced in 1981 by Sen. Daniel Inouye (D-HI) and Rep. Barbara Mikulski (D-MD), CNM reimbursement was included without requiring congressional mandate.

Controversy over how one becomes a "CNM" in the state of California continues. The Board of Registered Nursing (BRN) regulates nurse-midwifery practice in California under Article 2.5 of the Nurse Practice Act and under Rules and Regulations in Chapter 14, Article 6 of Title 16 of the California Administrative Code. The regulations spell out six ways an individual can receive a certificate to practice as a "CNM" in California. California's Consortium for NurseMidwifery, Incorporated (CNMI) is concerned in particular about the challenge mechanisms included in the regulations. The February 1982 CNMI Newsletter summarized the law and the regulations which include several equivalency routes and ap37 0091-2182/82/030037+2502.75

pointment of a Nurse-Midwife Committee composed of at least one public member and at least one nursemidwife and one physician who have demonstrated familiarity with consumer needs, collegial practice and accompanied liability, and related educational standards in the delivery of maternal-child health care. The six ways one can become a "CNM" in California follow. BRN Method 1 requires RN licensure and graduation from a BRN-approved educational program in nurse-midwifery. BRN Method 2 certifies RNs who have graduated from a nurse-midwifery program not meeting the BRN standards if the applicant corrects any deficiencies by taking courses in a BRN-approved program. BRN Method 3 certifies nursemidwives who have already been certified by a national or state organization whose standards are satisfactory to the BRN. BRN Method 4 is a challenge mechanism. If an applicant can successfully challenge the curriculum of a nurse-midwifery educational program and demonstrate clinical com-

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petence as verified by a "CNM" and a physician, California certification will be granted. BRN Method 5 is for RNs whose post-licensure training and practice in maternal-child health partially fulfill requirements for certification and who remedy the deficiencies by taking courses in a BRN approved nurse-midwifery program. BRN Method 6 certifies RNs who pass an examination given by the BRN and who have demonstrated clinical competence in the management of normal labor and delivery as verified by a "CNM" and a physiclan. The BRN planned to give the examination specified in Method 6 for the first time in April 1982. The exam was developed by Psychological Services, Inc. (PSI) of Los Angeles under contract to the BRN. PSI developed the exam based on information learned through a NurseMidwifery Job Analysis Questionnaire mailed to all nurse-midwives in California in September 1981 and from exam questions suggested by a group of nurse-midwives, MDs, social workers, lay-midwives, nutritionists,

and childbirth educators in November 1981. Graduates of ACNM-approved programs will be tested as a comparison group. The CNMI monitored development of the exam by PSI and feels that although it is technically sound, the Pass/Fail score will be a crucial decision. Demonstration of clinical competence as specified in Methods 4 and 6 must be verified by a "CNM" and a physician. The BRN approved two forms in January 1982 which will be used in evaluating clinical compefence. The CNMI feels there are serious deficiencies in this part of the equivalency route. Since the Nurse-Midwife Committee had not yet been appointed when the regulations were written, it is possible that their input may eventually influence the BRN to change some of the regulations.

Anyone wishing to contribute information or short articles on legislative or regulatory actions affecting CNMs on the state or federal level should contact Nancy Kraus, C.N.M., 277 West 10th Street, New York, NY 10014.

Journal of Nurse-Midwifery • Vol. 27, No. 3, May/June 1982