Chief Patron: Morgan
Co-Patron(s): Pollard
Prenatal, OB and Pediatric Pilot Projects

Item 313 #1h

Language
Page 290, line 10, strike "$35,517,401" and insert "$36,267,401".
Page 291, after line 5, insert:
"E.1.   The State Board of Health is authorized to establish and implement pilot programs, as described in this item, to improve access to prenatal, obstetrical, and pediatric care in areas of the state where these services are severely limited.  The proposals for such pilot programs shall be jointly developed and submitted by a local or regional consortia which  include one or more nurse practitioners licensed in the category of certified nurse midwife, a perinatal center with subspecialty expertise in such areas as neonatology, perinatalogy, and high-risk obstetrics, and one or more community-based obstetrician or family physician, and pediatrician.
2.  Notwithstanding any provision of law or regulation to the contrary, a nurse practitioner licensed by the Boards of Nursing and Medicine in the category of certified nurse midwife may participate in an approved pilot without the requirement for physician supervision.  Such participating certified nurse midwives who hold a license for prescriptive authority may prescribe Schedules III through VI controlled substances without the requirement for either medical direction or a written agreement between the licensed nurse practitioner and a licensed physician.  Participating certified nurse midwives shall provide prenatal and delivery services only to women with low risk pregnancies who consent to enroll in, and receive care, under the pilot program protocols.  Participating perinatal centers shall provide administrative oversight of the respective pilots by (i) assisting in the development of appropriate clinical care protocols and clinical collaboration consistent with evidence based-practice and based on national standards that describe criteria for risk assessment, referral, and back-up, (ii) documenting the methods to measure and evaluate the quality and safety of care for women enrolled in the pilot, (iii) accepting transfers when necessary, and (iv) providing clinical consultation when requested.  Pilot sites that elect to include birthing centers as part of the system of care must be in close proximity to a health care facility equipped to perform emergency surgery, if needed.  Certified nurse midwives participating in a pilot program shall maintain adequate professional liability insurance as determined by the Bureau of Insurance.  Certified nurse midwives who do not participate in approved pilot programs shall not be eligible to practice without physician supervision or other requirements associated with prescriptive authority.
3.  Not later than October 1, 2005, VDH shall convene stake holders, including but not limited to certified nurse midwives, obstetricians, and family practitioners to define protocols to be used in the pilots.  VDH shall report to the Governor and Secretary of Health and Human Resources and the chairmen of the Health Welfare and Institutions and Education and Health Committees on the progress toward implementing the pilot not later than December 15, 2005.  The Department of Health Professions, the Department of Medical Assistance Services, and the Bureau of Insurance shall provide assistance to the Department of Health in implementing, monitoring, and evaluating pilot programs under this item. "

Explanation
(This amendment authorizes the State Board of Health to approve pilot projects that improve access to prenatal, obstetrical, and pediatric services and provides one-time funding to assist in implementing the pilots. Notwithstanding any provision of law or regulation to the contrary, a nurse practitioner licensed by the Boards of Nursing and Medicine in the category of certified nurse midwife who participates in the pilot and agrees to established protocols, will be permitted to provide prenatal and delivery services to women enrolled in the pilot without the requirement for physician supervision and without requiring a written agreement with a physician or medical review to prescribing drugs in Schedules III-VI. Additional general funds are provided in the second year for the pilot programs.)