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Thanks to your efforts and CAM’s advocacy work, California families will have expanded access to midwifery in 2016. We have heard your many questions about the implementation of Medi-Cal, CPSP, and the Midwife Assistant designation, and we are committed to keeping you-up-to-date on the details that are currently available.
Thanks to CAM advocacy, licensed midwives will soon be able to enroll in Medi-Cal without billing through a doctor.
Here are the implementation steps that need to occur before licensed midwives can begin to enroll as Medi-Cal providers:
The California Department of Health Care Services (DHCS) is submitting a State Plan Amendment (SPA) to the federally-administered Centers for Medicare and Medicaid Services (CMS). The SPA will authorize licensed midwives to enroll in California’s Medi-Cal plan independent of a supervising physician. CMS must approve this plan before California can begin to enroll licensed midwives in Medi-Cal.
After the SPA is approved, the California DHCS must update its regulations and enrollment forms.
Once the regulations and forms are updated, individual licensed midwives will be able to enroll as Medi-Cal providers.
We do not anticipate any hurdles in this process. We do anticipate that it will take some time to complete - at least until January 1, 2016 and probably longer. We are working with DHCS on this process and monitoring it closely. CAM will keep you up-to-date as the process continues.
How to enroll as a Medi-Cal provider:
Once the implementation process is complete (see above), enrollment forms will be available on the DHCS website alongside all the enrollment forms for all the different types of providers in California. CAM will also link to these forms on our website. We will let you know when these forms are available.
For all types of providers, Medi-Cal may take up to 180 days to process new provider applications.
As a reminder, you cannot balance bill for clients using Medi-Cal if you are a Medi-Cal provider. Each midwife choosing to enroll in Medi-Cal is responsible for reviewing and understanding Medi-Cal billing rules and regulations.
What is CPSP?
The Comprehensive Perinatal Services Program became a Medi-Cal benefit in 1987. Medi-Cal-eligible women receive comprehensive services, including prenatal care, health education, nutrition services, and psychosocial support for up to 60 days after delivery of their infants. Licensed midwives - who have long provided these services - will be eligible to bill for these services (following the implementation process) thanks to the passage of SB407.
Understanding CPSP practitioners and providers.
CPSP providers are billing entities, such as health clinics, licensed alternative birth centers, physician practices, and now, licensed midwifery practices. CPSP practitioners are employed by CPSP providers. Previously, licensed midwives were ineligible in either category. Thanks to SB407, licensed midwives can now be either CPSP practitioners or providers.
Here are the implementation steps that need to occur before licensed midwives can begin to enroll as CPSP practitioners:
No earlier than Jan 1, CA DHCS must update the existing CPSP regulations to enable licensed midwives to become CPSP practitioners.
Here are the implementation steps that need to occur before licensed midwives can begin to enroll as CPSP providers:
The effective date for DHCS to enable licensed midwives to be CPSP providers is the same effective date for the new regulations resulting from AB1308. The AB1308-related regulations are being created by the Medical Board.
CAM will continue to monitor both the process for regulations for AB1308 and for CPSP implementation.
How to enroll as a CPSP practitioner/provider:
All provider/practitioner applicants must complete a State of California training. These trainings are provided periodically with online or in-person options.
Once the implementation process is complete (see above), enrollment forms will be available on the California Department of Public Health website. CAM will also link to these forms on our website. We will let you know when these forms are available. There will be different forms for practitioners and providers.
Once implemented, the California Midwife Assistants statue will allow a 'midwife assistant' to legally assist a licensed midwife in out-of-hospital settings including midwife offices, birth centers or private homes. Previously, the opinion of the Medical Board is that only another licensed maternity care provider or a registered student at a board approved school can legally act as an assistant.
Here are the implementation steps that need to occur before Midwife Assistants can legally practice:
As dictated by the statute, the Medical Board of California staff must create a set of regulations for Midwife Assistants. These should be modelled on the medical assistant regulations.
The Medical Board will vote on the proposed regulations, which will define the exact training that is required. It is likely to offer two pathways: on-the-job training with an LM or CNM; or, a formal training program.
We will not know if any particular existing training programs qualifies until the Medical Board votes in the new training requirements.
Implementation will take place in 2016. The implementation process will be outlined at the October 29-30, 2015 quarterly Medical Board meeting.
CAM will continue to monitor and support the process for Midwife Assistant implementation.
How to become a Midwife Assistant:
The process for becoming a Midwife Assistant will be determined by the Medical Board as a part of implementation (see above).
Midwife Assistants will not be licensed, certified, or registered with the state.
Midwife Assistants must be directly supervised at all times by an LM or CNM and can only provide technical supportive services as defined by the statute.
PLEASE NOTE: the legal protections provided by this bill will not take effect until implementation is complete.
Questions? We look forward to keeping you up-to-date! Here’s some ways you can keep up-to-date:
CAM is hosting a webinar on implementation of Medi-Cal, CPSP, and Midwife Assistants.
Wednesday, Oct 21st, noon pacific
Click HERE to for FREE registration.
Note: As a part of our advocacy work on behalf of California licensed midwives, CAM volunteers have become very familiar with the ins-and-outs of the new statutes and their implications for our community. We look forward to sharing with you what we’ve learned. Please note that licensed midwives are responsible for reviewing and understanding the rules and regulations that apply to their practice. CAM webinars and other information cannot replace consultation with the appropriate state officials and your own legal counsel.