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News & Press: Legislative Alerts

AABC Submits Comments to the Departments of Treasury, Labor and Health & Human Services

Thursday, June 12, 2014   (0 Comments)
Posted by: Kelly Shaw

In response to the Centers for Medicare and Medicaid Services, Federal Registry CMS-9942-NC: Request for Information Regarding Provider Nondiscrimination, the American Association of Birth Centers (AABC) submitted comments detailing concerns birth centers are currently experiencing regarding discrimination with insurance provider contracts.  Consumers feel overwhelmed, powerless and often, bullied when dealing with their health plans and health insurance carriers. AABC has been particularly aware of the extent of this problem in the context of refusals of care for pregnancy and birth. Although birth centers are growing around the country, the inability to be able to successfully contract with insurance providers can hamper future birth center sustainability.

The Harkin Amendment was attached to the Affordable Care Act with the intent not to discriminate against other state licensed or otherwise recognized health providers.  Because clear rules or regulations have not been created or implemented to define this, discrimination against birth centers continues.  Certified nurse-midwives are licensed in all 50 states and the District of Columbia; certified professional midwives are licensed in 26 states and recognized through certification in two others; certified midwives are licensed in four states; freestanding birth centers are presently licensed in 41 states and the District of Columbia. Based upon AABC's general knowledge of its industry, and the specific information it has generated through its recent member survey, we know that AABC member birth centers and/or midwives, despite being licensed and acting within the scope of that licensure, have been denied participant status, or denied payment on even an out-of-network basis, by one or more health plans since this law went into effect.

Some health plans and insurers have claimed that because they offer access to hospital and physician care, particularly where the hospital calls part of its labor and delivery unit a "birthing center" they are not required by this law to offer out-of-hospital midwifery care in a freestanding birth center. However, since FSBCs and FSBC-based midwives are licensed providers, while hospital in-house units are neither FSBCs nor licensed, health plans should not be permitted to substitute these unlicensed units for freestanding licensed providers.

AABC advocates that patients have the right to access covered health services from the full range of providers licensed and certified in their State. The regulations that need to be created should have teeth to enforce this and should provide a user-friendly mechanism for beneficiaries and providers to file complaints and have those complaints resolved promptly and efficaciously.  The complete letter is available on our website.


About the American Association of Birth Centers
The American Association of Birth Centers (AABC) is a multi‐disciplinary membership organization comprised of birth centers, and individuals and organizations that support the birth center concept including certified nurse midwives (CNMs), certified professional midwives (CPMs), physicians, nurses, women and their families. Founded in 1983, AABC is dedicated to developing quality holistic services for childbearing families that promote self‐reliance and confidence in birth and parenting. AABC publishes materials on birth centers, sets national standards for birth center operation, and promotes state regulations for licensure and national accreditation by the Commission for the Accreditation of Birth Centers. More information about AABC can be found at:

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