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The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

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Notes for California Licensed Midwives

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2009 Licensed Midwife Annual Reporting Form Online!
CAM has created a great 19-minute instructional video.  Thank you, CAM!
Written clarifications and a link to download the instruction video can be found on the State Statistics page.
The online form is due March 31, 2010.
 

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There are several groups that have been focused on LM politics:

California Association of Midwives - CAM (800-829-5791)

California Citizens for Health Freedom
Frank Cuny has a lot of experience with California law
pertaining to alternative health care practitioners.
He has also accompanied midwives to their interviews with
Medical Board investigators, when requested.  Frank is
also a regular at the Medical Board meetings.

California College of Domiciliary Midwives
Representing the Legal & Legislative Issues of California
Licensed Midwives.  Faith Gibson is a regular at
the Medical Board meetings.

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If you're a midwife and you haven't yet contributed and started
organizing your clients, do it now.  You need to be ready to act
quickly, even if it's during a time you're busy with births.
Don't think about how tired you are and how many other things
you need to do with your limited time and energy.
Do it now!
It takes a lot less time and energy than responding to a Medical Board investigation.
Believe me, I know!
Do it now!

It is imperative that we organize for political action.
"If we do not hang together we will all hang separately." - Benjamin Franklin
 

 Professional Organizing, Acitivizing and Support
General Information about Licensed Midwives in California
Getting Licensed
Midwifery Licensing Program Co-ordinator
Religious Exemptions Clause
Mandated Paperwork
Physician Supervision and Backup
VBAC
Lab Privileges
Discounted CPM Certification for LM's
Liability Insurance / Malpractice Insurance
 Prenatal Screening
Prophylactic Eye Ointment (Ophthalmic Erythromycin Ointment)
Newborn Screen (aka PKU)
Birth Certificates and SSNs  and Passports
Disability Insurance Claims and Paid Family Leave
Health Insurance Reimbursement
AIM and Medi-Care or Medi-Cal Coverage
WIC Programs
Continuing Education (CEUs)
Filing an Annual Report of Practice Statistics
About Being "Investigated"
About Student Midwives
Placenta Disposal
Sharps Disposal
Reporting Requirements
Links into the California Legal Code and Regulations
Other Relevant Links
Other Midwifery Organizations
Miscellaneous
 

Informal Guidelines for implementation of  SB 1479 by Licensed Midwives
including full text of SB 1479  &  Text of Sample Form [from the California College of Midwives - Join Now!]
 

Text of Adopted Decision in case against California Licensed Midwife Alison Osborn Administrative Law Judge dismissed charges after extensive hearing (August 20, 1999).

Amicus brief filed by California Citizens for Health Freedom

Amicus brief filed by California Citizens for Health Freedom

Professional Organizing, Acitivizing and Support

Alison Osborn's legal expenses were over $50,000. Generous donations and client fundraisers paid off her debts.  We still all owe Alison a huge debt of gratitude for being out there on the front lines.

If you want to make sure that you don't end up in a similar situation, be sure to support your midwifery organizations so those who have the energy can lobby and organize activism on your behalf.  If you find yourself saying that you can't afford to pay membership fees to all these organizations and possibly send in additional donations, then you're not charging your clients enough.  They should be willing to pay for their right to choose where and with whom to give birth, and they should be willing to pay you adequately to support business expenses such as membership in essential professional organizations:

In order to stay current with the ever-changing political situation in California, you can join these mailing lists:

General Information about Licensed Midwives in California

The Medical Board of California's web pages about Licensed Midwives, and a Licensed Search for Licensed Midwives.

They also have a new web page with helpful information for Licensed Midwives, including regulations and standards of care.  Here is the Standard of Care for California Licensed Midwives.

Licensed Midwives in California practice under The Licensed Midwifery Practice Act of 1993 and the Medical Board of California as our licensing body; we have a Midwifery Licensing Program Co-ordinator who can help with some administrative issues.
You can search for references to midwives and midwifery in the California Law database - the most relevant code sections are "Business and Professions Code" and "Insurance Code".  [Relevant links into the California Legal Code]

Efforts to amend The Licensed Midwifery Practice Act of 1993 to make it workable were largely successful - read more about SB1479.  There is lots of additional legislative information at Faith Gibson's excellent Web site.  In particular, here's a letter from Norcal Insurance Company May 1999 stating that doctors “cannot supervise, consult with or back-up any midwife for home birth”.  (Norcal is one of the 3 malpractice insurance carriers in California; they are all owned by physicians.)

For midwives ready to qualify to apply for California licensure, contact Sandy Szala, CCP Coordinator, Seattle Midwifery School, 406-322-8834x114.

Getting Licensed

[From DW 8/07] There are only two challenge mechanisms at the moment.
The one is offered by Maternidad La Luz. It's basically their three-year program condensed into one year. Has to be completed on-site.
The other is a challenge exam through NMI. You can read the details on their site at www.nationalmidwiferyinstitute.com.

Once you are licensed, you need to renew your license every other year.  In order to do that, you need to continue to get CEUs and to file an annual report of practice statistics.

Midwifery Licensing Program Co-ordinator

Robin Jones, Associate Analyst????, Medical Board of California, Midwifery Licensing Program, 1426 Howe Avenue, Suite 54, Sacramento, CA 95825, 916-263-2393

As of Jan., 2009, Robin Jones is now in this position.
As of Nov. 1?, 2007, Mike McCormick has also moved on from this position, and it's currently empty.
As of Feb. 16, 2007, Herman Hill is no longer the Midwifery Licensing Program Co-ordinator.  For now, his colleagues are all pitching in with the program until the position gets filled.
In the meantime, you can call (916) 263-2392 or email Webmaster@dca.ca.gov.
In a pinch, ask for Kathi Burns, Manager, Licensing Operations Section, Medical Board of California  

Religious Exemptions Clause

You do not have to be a religious practitioner in order to provide care under the Religious Exemptions Clause; anyone can ask for care under this clause.  It was from the original medical practice act (in 1876?), which also has the emergency care clause.  You can search for #2063??? or ask Faith Gibson for details.

Mandated Paperwork

We are required to have certain forms and information in our paperwork:

Licensed Midwife Disclosure Form

Client Disclosure Form ~ Required by the LMPA Midwifery Scope of Practice, Medical Interface, Emergency Arrangements, Malpractice Insurance Disclosure, Reporting Unsatisfactory Care to MBC (this is an example from Faith Gibson) 

Physician Supervision and Backup

When asked for your supervising physician at a hospital, you can reply that you are an independent practitioner.

When asked for your supervising physician on paperwork, you can write "N/A" for "Not applicable" or "Not Available".

The issue of physician supervision and backup varies radically from one area to the next, even within regions.  Here are some reports of local situations:
 

Region 1:
Region 2:
Region 3: San Francisco, Berkeley, Marin - Friendly, no supervision, but some official backup and good transports
    San Mateo and Santa Clara County - Generally hostile.  Some private hospitals are relatively friendly, and county hospitals are almost reliably friendly.
Region 4:
Region 5:
Region 6:
Region 7:
Region 8: Quite a few LM's  have supervision again, in both LA and Ventura County.
Region 9:
Region 10:
 

VBAC

The Medical Board has some special requirements for homebirth VBACs.  The San Diego midwives have contributed an excellent VBAC informed consent, as required by our regulations.
 

Lab Privileges

Feb., 2012:  The Medical Board mailed out a statement RE: Licensed Midwives Laboratory Accounts.  They say, "[I]t is the position of the Medical Board of California that licensed midwives, as licensed healing arts practitioners, are independently eligible to open laboratory accounts for medical diagnostic testing within their scope of practice, pursuant to Business and Professions Code 1288, which provides: 'Any person conducting or operating a clinical laboratory may accept assignments for tests only from and make reports only to persons licensed under the provisions of law relating to the healing arts or their representatives.'"  It's available online.

Update from the Medical Board meeting in Sacramento Dec. 9, 2010:
"At the previous Council meeting in August, Linda Whitney (executive director of the Medical Board) appointed an agency staff person (Ms Simoes) to meet with the staff at the Department of Public Health and discuss the issue of LMs being denied access to lab services. Specifically, many LMs with laboratory accounts have received letters informing them they must produce a signed document from a supervising OB or their account will be closed. New midwives are being turned down for lab services. . . . At today's Council meeting, Ms. Simoes reported the best of news. It turns out that the law is actually on our side already, as all state licensed health care professionals are authorized to have lab accounts."

From a midwife in southern California: "I made a list of the types of labs that I wanted to order. Pick a lab and call the person in charge of new accounts. Tell them that you are currently unhappy with your present lab (no need to give name!) and that you want to find better pricing for your CASH paying patients (their words:)) I just rattled off that I wanted a few prices for say oh a prenatal panel, 1hour GTT, gbs or what ever and can they call you back with a price that you want to begin an account if the prices are to YOUR liking.I was called back right away with the prices. I sent a copy of my license and billing information. While you are signing up mention where they can send the lab reqs and supplies or that you will pick them up. You can usually get a lock box brought to your home!! Just put it out there-it is for your business and you are generating income for them and service for your clients. I have also made the lab bill a priority to be paid super quick-they have not raised my prices in almost 10 years."

Herman Hill at the Medical Board has suggested having labs call him if they have objections to giving LM's lab privileges.

We are licensed to order and interpret labs, so should be able to get accounts.  As a last resort, you could request a restricted account, with privileges to order pregnancy-related tests only.

Oxygen

Some midwives have had success with approaching oxygen dispensers, explaining that they use it for emergencies only,  not on a prescription basis, and that they are licensed to carry and use it when necessary.  Again, it might make sense to refer them to the Midwifery Licensing Program Co-ordinator.

LabCorp
CAM has an account with LabCorp.  As of 2/15/13, Tammy - 530-225-8014 is the new contact person at LABCORP for the CAM account. chabollt@labcorp.com  or call Client Services at 1-800-888-1113.

Discounted CPM Certification for LM's

From Debbie Pulley at NARM

"CA Licensed midwives can come straight into the CPM Certification Application process as a midwife with Legal Recognition in States Previously Evaluated for Educational Equivalency. You will need to fill out an application and provide the required documentation (License, CPR, etc.). You will not be required to go through the PEP Application or the Skills Assessment. The fee for CPM Certification is $700 minus what you paid for the NARM exam [as the California licensing exam].

"You can order an application by sending a $50 money order to NARM Applications, PO Box 140508, Anchorage, AK 99514. For more information you might want to check out "How to Become a CPM" on our webpage at www.narm.org."
 

Liability Insurance / Malpractice Insurance

Faith Gibson has lots of information about this on her web page about Legal, Legislative & Liability issues for Professional Midwives

Prenatal Screening

We don't always think of screening for Hepatitis B as "Prenatal Screening", but we're also required to screen for HepB and report positive cases:  "To ensure identification and treatment of at-risk infants, prenatal medical care providers in California are mandated to test their patients for hepatitis B surface antigen (HBsAg) and to report all HBsAg positive pregnant women to the local health department (California Health and Safety Code sections 125080 and 125085)."  from Medical Board of California Newsletter Vol. 111, July 2009, p. 9.

California Prenatal Screening Program - here's the announcement from Apr. 1, 2009.  Please use only the most recent forms!  [And here's the list of Registerered NT Practitioners 2013 - the ultrasonographers who are registered to perform the Nuchal Translucency assessment.]

Patient Booklet and Consent (PDF)

"Regulations require the clinician to inform every patient [client] in prenatal care before the 20th week of gestation of the availability of screening and to obtain a consent (or decline) to participate in the Program.  The Program supplies educational booklets that must be given to each patient as part of this process.  The patient should sign the consent/refusal form provided in the booklet.  The signed form, plus any notes with respect to specific questions or discussion, is to be filed in the patient's record.  Rarely, a patient may decline to be screened but refuse to sign the consent/refusal form.  The Program strongly recommends that the clinician document the offer, as well as the discussion and refusal of screening, in the patient's record."

The cost of the blood test is $162.

Free copies of publications (education booklet with consent form/waiver) and supplies (special collection tubes and mailing envelopes) relevant to this requirement can be obtained from the Prenatal Screening Program - Here's the order form.


Prophylactic Eye Ointment (Ophthalmic Erythromycin Ointment)

CALIFORNIA CODES
BUSINESS AND PROFESSIONS CODE
SECTION 550-558
 

Newborn Screen

The State of California requires that newborns be screened for a variety of congenital disorders.  Blood samples must be obtained before the end of the baby's sixth day unless the parents sign a refusal form based on religious reasons.

Insurance coverage of the Newborn Screen:

Insurance coverage of the Newborn Screen is mandated by law.  If you have any trouble with insurance reimbursement for the newborn screen, contact Tracey Bishop
phone 510-412-6213
email TBishop@dhs.ca.gov
850 marina bay parkway
richmond, ca 94804
[You'll need to get permission from your clients to release this information to the NBS program folks.]
 

First request for newborn screen (NBS) materials:

As of 2/15/13, there is a new contact for the Newborn Screen: Jessica Brown, (510) 412-1507, Jessica.Brown@cdph.ca.gov

This information is old and might be incorrect: To set up an account as a provider who collects blood samples for the newborn screen, call Tracey Bishop (510-412-6213) of the Genetic Disease Branch.  She is the one who initially signs up providers, gives you a summary of the NBS program and then arranges to have a startup kit mailed to you.  (Note - They moved in mid-April, 2003.  If this phone number doesn't work, try the main number: 510-412-1502.)  The startup kit consists of:  The supplies will be sent via UPS, and you should receive your kit within a week.  You'll also get a provider #, which you'll need when placing repeat requests.  (The prepaid envelopes used to send the specimen collection forms to your local laboratory will be sent separately from that laboratory and should arrive within a couple of weeks.)

I encourage all Licensed Midwives to call Leslie to join the program; you owe it to your clients to make this information available to them and to learn how to collect a good specimen in the most humanely possible way if they choose to have their baby tested.  The NBS folks are very eager to have as many Licensed Midwives signed up as possible.

The NBS folks are very willing to work with you to support you in offering the NBS to your clients as easily as possible.  They can send out small numbers of specimen forms if you have a low-volume practice.  If you serve a large number of low-income people who are ineligible for Medicare, consider contacting the NBS folks and asking about setting up a special arrangement whereby they subsidize the lab processing fee.

Even if you choose not to do the heelsticks yourself, you are still responsible for providing your clients with information about the NBS.  Most pediatricians will write orders and send newborns to local hospital labs to have the heelstick done.  If you aren't thrilled with recommending that your clients take their newborn to the infection-rich hospital environment, you might ask around among your local peds and family practice docs to see if some of them have skilled personnel to do the heelstick in their office. 

Repeat requests for NBS materials:

as of Oct. 30, 2013.
You can now order NBS materials by completing an order form online and then emailing it to the NBS office.  This includes the parent information booklets and the specimen collection form, as well as all other NBS forms.  (I have to order the special envelopes from my local mailing location.)

Other numbers:

Genetic Disease Branch Main Number 510-412-1502
Newborn Screening Results Request Line 510-412-1541
Newborn Screening Fax Machine 510-412-1559

Important Information For Parents About the Newborn Screening Test (PDF, English)  [Links to other languages]

Guidelines for Midwives drawing Newborn Screens on Kaiser infants

General Information

A copy of the results will be sent to whomever is reported as the baby's primary care provider, usually a pediatrician or family practice doc, and another copy is sent to the provider that collected the specimen (i.e. you, although usually it's a facility such as a hospital).

Money

Any time you request NBS-I forms (i.e. the filter paper specimen collection forms), you'll be billed the following month, with a charge of $1 per form that is sent to you..

When you send the test in, you will be billed $101.75 (as of 1/1/2010) for each test.  You can bill the client up to an additional $7 for collecting the specimen.  There are no problems with any insurance company or Medicare allowing the full charges for the lab tests, although they may not cover the entire collection fee.  Some will deny part of the fee and you may have to argue for it, but they're legally required to cover it.

Related Online Resources

How to Order Newborn Screen Forms

California Department of Health Services - Genetic Disease Branch - The California Newborn Screening Program

Newborn Screening Coordinators at Area Genetic Centers
 

Test Refusal

The state allows parents to refuse the newborn screen for religious reasons only.  Midwives should protect themselves professionally by making sure they provide good informed consent on the issue and by getting a signed waiver from the parents.  Alternatively, if the parents would refuse the heelstick but are open to having cord blood tested, the labs will process a cord blood sample:  On the specimen collection form, put the date/time of birth as the date/time of collection; where the form asks, "Heelstick or other", check "cord blood."  Include a note that the parents know this won't be valid for PKU and hypothyroidism.
 

Newborn Screens for Kaiser Subscribers

From Pat E. McMahon, RN MS, March, 2009

"The following are questions we are researching--please let us know if there are others.
What should midwives put in the "facility/submitter drawing specimen" section of the test request form?
What "hospital/submitter code" should be entered?
Which Kaiser lab should the speciment be delivered to?  Will the closest one be OK?  The one indicated on the "facility" section of the form?
Can anyone (i.e. family member) deliver the specimen to the lab?  (We think the answer is "yes" but we are double-checking to be sure).
We need to perform "QA" functions if there are documentation errors made on the forms or the blood is qns/contaminated, etc.  If we don't know who you are, we can't communicate with you.  Is there a place on the form your name and contact number could be included?
Can we set up a system whereby you call us after the newborn screen specimen is delivered so we can trouble-shoot if it doesn't show up on our state database?   This is particularly a problem if the family delays in registering the birth--there is one less cross-check in identifying newborns who may have missed the screen.

Pat E. McMahon, RN MS
Nurse Coordinator
Newborn Screening and Infectious Disease Programs
Oakland Genetics Department
(510) 752-2820
8 (492) 2820"
 
 

Newborn Hearing Screening

In 1998, the California legislature passed AB 2780 [abridged version], the Newborn and Infant Hearing Screening, Tracking and Intervention Act, HEALTH AND SAFETY CODE SECTION 124115-124120.5.  "The tests -- which are simple and can be done while the baby sleeps -- cost $50 to $60. Funding is provided to cover the uninsured and those on Medi-Cal ".  It appears that this is not yet mandatory, but it seems ethically important to notify clients about the availability of this screening.  Their pediatrician should be able to help them get access into the medical system to have the screening done.

The toll-free information  number for the statewide California Newborn Hearing Screening program is 1-877-388-5301.

Birth Certificates

Here's the March, 2008, booklet on How To Register an Out-of-Hospital Birth
And here are the instructions for the 2007 "New Information Items"; I couldn't find the form itself online; it's possible that each county has its own form.

Here are some fill-in .pdf forms that anyone can use.  I e-mail the first one to my clients, and they e-mail it back to me.  Then I can copy the information directly into the final form that I send to the county.  Here are the forms:

I know that San Mateo County has a different form, and I'll add it once I get it converted to PDF.  (03/09 - They're accepting the other form!)
Fax number for San Mateo County Vital Records: 650-573-2576.  They also like to have a "Proof of Pregnancy" letter from the midwife.
Fax number for Santa Clara County Vital Records: 408-885-4899.  They also like to have a "Proof of Pregnancy" letter from the midwife.

As of 1/2006, there's a new Medical Data Supplemental Worksheet (Page 1 and Page 2) and a new Race/Ethnicity and Education Worksheet
Overview of Birth Certificate Worksheet/List Changes For AVSS Version 4.15

In California, birth certificates are recorded by the Office of Vital Records, (sometimes referred to as the Bureau of Vital Statistics), which is contained within the Center for Health Statistics, a subsidiary of the California Department of Health Services.

The state maintains Web pages with contact information for all of the County Health Officers, Registrars and Recorders.  In addition, some counties maintain their own county-specific Web pages.

The law states that the birth attendant must file a birth certificate for each live birth within 10 days of the birth. But the county governments, citing regulations meant to discourage welfare and immigration fraud, will not let OOH midwives (and physicians, for that matter) file birth certificates.

It's helpful to remind parents also to apply for a Social Security number for their baby so they can claim the child as a dependent when they file taxes:  Baby's First Number-A Social Security Number
 

About Birth Certificates for Midwife-Attended Homebirths

Current information about Birth Registration is best found at Faith Gibson's site.  [Update - Winter quarter, 2001]

In short, the midwife does NOT need to be present to register a birth as an attending.

Complaints, suggestions and requests go to Don Fields, Chief of Policy, Compliance and  Standards Section, Office of Vitals Records 304 S Street, Sacramento, CA  94244-0241 [Please also e-mail a copy to Faith Gibson.]
 

Social Security Numbers

Sometimes, Social Security offices will say some pretty stupid things about getting a SSN for a newborn - e.g. they'll ask if they have a driver's license or credit cards.  Ha, ha!  If you're having trouble getting a SSN for a newborn, ask them to look up their regulations for babies less than 30 days old - it should be sufficient to present them with a copy of the birth certificate and the letter of affidavit from your birth attendant, which should include all pertinent information related to proof of pregnancy, date, time, location of birth, baby's name, parent's information,midwife's information..

OR, if you want to cover all bases, you can razzle dazzle them with a Vaccination Record Form.  Ha, Ha!  The baby doesn't need to have received any vaccinations.  They just need to have the form.  Apparently this is very impressive to many state and federal offices!  Here's a nice one recommended by the CDC.


 
Please note that this is OLD information.  I'm leaving it here because it probably still works, but it is not the most up-to-date

The new regulations no longer allow homebirth midwives simply to complete, sign and mail in a birth certificate, as hospital-based practitioners do.  Instead, the parents of the new baby must register the birth by appearing in person at their local office. [For additional information about this odd change, please visit Faith Gibson's pages.

Typically, the new parents call their county Registrar of Births, who will send them a packet.  (Alternatively, parents can go in person to the office to pick up a packet, but you will still need to return another time to sign the completed form.)  The parents complete the worksheet and return it with the following items:

  • Proof of residency, such as copy of rent receipt, PG&E bill for the residence where baby was born, etc.
  • Proof of pregnancy, i.e. letter by doctor seen during prenatal care and verification that baby was seen by a pediatrician
  • Some kind of identification (not clear what this is - phone numbers of parents?)
  • They'll take a few days or weeks to create the birth certificate electronically and print it out.  They'll notify you when it's ready and make an appointment for it to be signed by the mother and another adult present at the birth.

    From the CAM Spring, 1997, newsletter

    Birth Registration Update by Jen Clapp

    New regulations were handed down from Sacramento over a year ago detailing the procedures to be followed when registering a birth which occurs outside of a hospital setting.  These regulations came in an attempt to have all counties in California uniform in their procedures for registering home birth and, supposedly, to crack down on the registration of "illegal immigrants" who deliver at home.  Unfortunately, the procedure Sacramento wants home birth parents and midwives to follow is time consuming, inconvenient and, in my opinion, unnecessary.  And, each county continues to interpret the new regulations in its own special way.

    One of the problems with the new system is that it prevents the midwife who attends a home birth from signing the birth certificate, unless she goes with the family to the health department to register the birth.  Since most midwives are unable to do this, the midwife's signature is replaced by that of another person who was present at the birth, usually the woman's partner.  Thus, the birth is recorded as an unattended home birth.

    As a new parent, I had occasion to test out these regulations when I went to register my son's birth in San Francisco.  Following is the procedure I followed so that my midwife's signature would be on my son's birth certificate.  You might try this in your own county and see what results you get.

  • Call Jean Lewis at the Department of Health Services/Vital Statistics and make an appointment.  Tell her you plan to have your midwife sign as the attendant.
  • Fax her the following:  a letter from your midwife stating that you were pregnant; date of LMP; date and address where the birth took place; copy of a bill sent to your home around the time of the birth (i.e., phone, gas, and electric); "mock" birth certificate form completely filled out.
  • Meet with Jean Lewis with your baby.  She should have a completed birth certificate form for you to sign.  You will also sign a form stating that she gave this form to you.  You may then take the birth certificate back to your midwife for her to sign and sent it to Jean by mail.  If you include a check for $14.00, Jean will process the birth certificate and send you the certified copy in the mail.
  • I strongly recommend that parents write letters complaining about the inconvenience of these regulations, both to the Department of Health Services and your legislators.  Parents are also welcome to call me for more information about the whole issue at 415-282-5872.  I also recommend being civil toward people like Jean Lewis.  She and other clerks are not happy with the current arrangement and can be our allies down the road.  We'd like them to be our friends!

    [From the San Francisco Bay Area Newsletter, CAM Region 3, Mid-Spring Edition, 1997]
     


    Specific County Contacts

    This is a very incomplete list, but maybe it will be helpful to some midwives: This section still under development. Please e-mail me any information you have about updated regulations or about specific county contact phone numbers of Web pages.  Thank you!
     

    Passports

    Some homebirth families have had a passport application denied for having a "non-institutional" birth certificate.  Apparently, having a  birth certificate and SS card are no longer enough to get a passport. The letter they sent requested an unspecified combination of seven things, including "medical records from the year you were born".

    One midwife says, "One of my clients contacted their local member of Congress's office, and they were very helpful to them."

    Another midwife says, "When I had this experience with a client I wrote a notarized letter with a copy of my CA License stating that I'd provided prenatal care; attended the birth and provided postpartum care. They also had their birth certificate and Social Security card and a letter from pediatrician. That was it. Passport went through."

    Disability Insurance Claims and Paid Family Leave


    You can now file Disability claims online at edd.ca.gov, which is convenient when it works well.  I had persistent errors when I used Firefox, but it worked fine when I used Internet Explorer.  When they ask for your license number, be sure to include the LM at the front.

    EDD has a special phone number for providers: 855-342-3645.

    State Disability Insurance (SDI) Overview

    State Disability Insurance Information for Employers

    State Disability Insurance (SDI) - Pregnancy FAQ

    Form DE 2501, First Claim for Disability Insurance, is preprinted with the appropriate field office address, and may be found directly online or by  filling out a form online.

    Paid Family Leave Insurance
    [The Family Medical Leave Act (FMLA) allows a dad to take 12 weeks off for baby bonding but FMLA is UNPAID. However, in the state of California, there is now the Paid Family Leave which will pay you up to 6 weeks at 55% of your salary.  (maxes out at $840 per week)] In addition, some companies pay several days for paternity leave.

    Health Insurance Reimbursement

    The Midwife Archives contains lots of information to help you get started with the details of understanding insurance and how to file claims.

    I have a subsection about California laws against "demonstrable and unjust payment pattern" of reimbursement.

    I'm also starting a new page about followup with insurance companies in California.

    One of the older hurdles in talking with people about filing claims for services provided by Licensed Midwives is the physician supervision issue; as of 2013, this appears to be a rare problem.  Most insurance claims filed by midwives are filed by hospital-based CNM's under the auspices of their supervising physician.  Almost all Licensed Midwives (and homebirth CNM's) in California do not have supervising physicians.  When someone brings this up, I inform them that Licensed Midwife is a legal designation that is completely independent of the CNMdesignation, that we have a different licensing law and a different supervisory body.  I tell them that we are independently licensed practitioners and that we can submit insurance claims under our own license.  I tell them that our independent status was established in case law (Ruling of Judge Jaime Rene' Roman,  Case No. 1M-98-83794, Alison Osborn, LM, OAH No. N-1999040052, Aug. 20, 1999) and then codified by SB1479 (signed into law by Gov. Davis on September 1, 2000, effective January 1, 2001, repealed and added Section 2508 of the Business and Professions Code and amended Section 102415 of the Health and Safety Code).  I tell them that if they have questions about the issue of physician supervision, they may want to talk with the person in charge of the midwifery program: Barbara Miller - (916) 263-2393.

    In California, state law requires insurance companies who cover maternity care to cover care for a minimum of 48 hours after a vaginal birth and 96 hours after a cesarean birth. (California Codes, Health and Safety Code, Section 1367.62) "[C]overage for inpatient hospital care may be for a time period less than 48 or 96 hours if both of the following conditions are met: . . . The policy covers a postdischarge followup visit for the mother and newborn within 48 hours of discharge, when prescribed by the treating physician [ed.: or midwife].  The visit shall be provided by a licensed health care provider whose scope of practice includes postpartum care and newborn care.  The visit shall include, at a minimum, parent education, assistance and training in breast or bottle feeding, and the performance of any necessary maternal or neonatal physical assessments.  . . . The treating physician, in consultation with the mother, shall determine whether the postdischarge visit shall occur at home, the contracted facility, or the treating physician's office after assessment of certain factors.  These factors shall include, but not be limited to, the transportation needs of the family, and environmental and social risks."  This legal requirement for the coverage of postpartum care can be used to justify using the "Mandated Services" Modifier 32 for all procedures provided within 48 hours of the birth.

    If insurance companies refuse to provide reasonable coverage for midwifery services, your clients can contact The Consumer Communications Bureau, which serves as an information clearinghouse for consumers with insurance-related questions or problems. The Bureau, staffed by insurance experts, provide immediate assistance to callers whenever possible.  Consumer comments, suggestions, and requests for assistance should be directed to:

    For general questions or inquires only please click contact us.

    California Department of Insurance
    Consumer Communications Bureau
    300 South Spring Street, South Tower
    Los Angeles, CA 90013

     BY TELEPHONE:

      a.. Call our Consumer Hotline at 800-927-HELP (4357)
      b.. Out-of-State Callers use 213-897-8921
      c.. Telecommunication Device for the Deaf dial 800-482-4TDD (4833)
      d.. Telephone Lines are open from 8:00 AM to 6:00 PM Monday through Friday, excluding state holidays

    Please be mindful that insurance fraud is a felony, so be attentive to your billing and keep a good oversight on your billing service or office staff.

    Other Relevant Laws

    California's INSURANCE CODE SECTION 10350-10354 contains:


    10353.  (a) Every policy of disability insurance issued, amended, or
    renewed on or after January 1, 1992, that offers coverage for
    perinatal services shall contain a provision providing for direct
    reimbursement to certified nurse-midwives and nurse practitioners for
    perinatal services. The certified nurse-midwife or nurse
    practitioner may collect payment for any unpaid portion of his or her
    fee, as provided for under the plan for other providers.
     . . .

    10354.  (a) (1) Every policy of disability insurance issued,
    amended, or renewed on or after January 1, 1994, that offers coverage
    for perinatal services shall contain a provision for direct
    reimbursement to licensed midwives for perinatal services rendered
    under terms and conditions as may be agreed upon between the
    policyholder and the insurer.

    People will sometimes say that this means that licensed midwives should be paid just as CNMs.

    ************************************************

    This is a rough section with notes from Jackie Speier's web pages.

    Health Insurance Provider Complaints
    SB 367 gives health care providers rights under the Department of Insurance (DOI) to file complaints about health insurance companies, similar to those under the Department of Managed Health Care.  It also requires health insurers to have dispute resolution process for providers and requires the DOI to help ensure access to its complaint process, respond to complaints in a timely manner and provide an explanation of the department's decision about a complaint to the affected provider and patient.

    Health Insurance Consumer and Provider Rights
    SB 634 improves the protections that health care consumers and providers have from insurance companies regulated by the Department of Insurance, making them similar to protections from HMOs and preferred provider organizations (PPOs) regulated by the Department of Managed Health Care.  Consumers will have more information about their potential costs for services from an out-of-network provider.  Providers will be better informed about payment practices, fee schedules and payment rules, and will be offered reasonable deadlines to submit reimbursement claims.
     

     COMPLETE BILL HISTORY
     

    BILL NUMBER  : S.B. No. 244
    AUTHOR : Speier
    TOPIC : Continuity of care.

    TYPE OF BILL :
                    Inactive
                    Non-Urgency
                    Non-Appropriations
                    Majority Vote Required
                    State-Mandated Local Program
                    Fiscal
                    Non-Tax Levy

    BILL HISTORY
    2003
    Sept. 29   Chaptered by Secretary of State.  Chapter   590, Statutes of  2003.
    Sept. 28   Approved by Governor.

    about Health Insurance coverage spanning change of insurance
    enforced by employer.
     

    Thursday, August 19, 2004

    State Politics & Policy

          California Assembly To Vote on Measure That Would Require Health Plans To Include Maternity Health Benefits

          The California Assembly on Wednesday was expected to vote on a bill (SB 1555) that would require all health plans to include maternity benefits, the Sacramento Bee reports. The bill, which was sponsored by state Sen. Jackie Speier (D) and has passed the state Senate, would make California the first state to ban health plans that do not include maternity benefits. The legislation was drafted in response to health insurance policies sold by insurers Blue Cross of California and Health Net, which offer lower-cost health coverage that does not include maternity benefits (Rapaport, Sacramento Bee, 8/18). The bill would affect an estimated 354,000 insured state residents whose plans are not sponsored by employers and do not cover maternity care. Employer-sponsored health plans must provide maternity benefits under federal law, according to the Los Angeles Times. If the state Assembly approves the measure, it will go to Gov. Arnold Schwarzenegger (R), who has not taken a position on the measure, according to the Times. However, Scott Reid, Schwarzenegger's insurance adviser, wrote in a letter to Speier that the measure "would limit choice in the marketplace and increase costs for consumers who desire a lower-cost insurance product that excludes maternity coverage" (Lifsher, Los Angeles Times, 8/18).
     

    AIM and Medi-Care or Medi-Cal Coverage

    Access for Infants and Mothers (AIM) - 800-433-2611 - low cost health insurance to pregnant women and their infants who are not eligible for no-cost Medi-Cal or health insurance.  [As of Feb., 2008, I'm told that LMs aren't covered by AIM unless you can accept Medi-Cal.  One midwife said that she believed that the AIM program limits the number of providers in an area?]

    [One CNM who is a Medi-Cal provider confirmed that she had received AIM coverage for her services: "Yes, I recently had AIM pay for a birth I attended with Health Net as the insurance. The Health net rep had me 'pre approved' with a form she faxed to me that I filled out with the fee that I was charging . The actual subject 'homebirth' wasn't discussed, but the billing went smoothly and they paid my full labor & birth  fee.  Like Medi-Cal, one has to agree to accept what they will pay, without charging the patient the difference."

    I received another report from an LM in Santa Clara County who says that in her phone conversations with the AIM people, they told her that  homebirth is a covered expense and an in-network exception will be granted if there are no providers for this service in network, which is always the case. So, in theory, homebirth midwives in Santa Clara County should be able to take AIM, even though it's an HMO. It's a different plan in each county, so it doesn't necessarily apply all over the state.]

    [Another LM writes, "I've been paid my full fee by AIM. Each county has a different plan, though, so not every plan will pay the same. And some plans don't cover midwives without a referral from one of the doctors in the network (good luck with that, I've been unsuccessful). Some counties are Kaiser, some Blue Cross, etc. it's not uniform across the state, so each midwife might get different results.]

    Q: Why can't we get a medi-cal number to be able to accept Medi-Cal clients?

    A: The general consensus seems to be: Medi-Cal requires supervising physician to be listed and for providers to carry malpractice insurance. So it is theoretically possible for LM's but those two requirements must be met.

    The Medi-Cal Provider application has the details.


    WIC Programs

    WIC gives motors who are breastfeeding and working Medela breast pumps.  They provide free hospital grade pumps to mothers who are separated from their babies or have compromised breastfeeding. They provide free breastfeeding support from both peer counselors and from lactation consultants.  They are required to provide referrals to families to other health and social service programs when they see a need.

    A family of 4 who makes $42,000 a year qualifies for WIC.

    WIC provides food vouchers for families, and there have been changes in what WIC offers. now clients can buy fresh fruits and vegetables, and they can be organic. they offer less fruit juice than in past years but offer more whole grain options.


    Continuing Education (CEUs)

    Summary: You need 36 CEUs accumulated in the two-year period between license renewals; half of those must be in person.

    Approved Continuing Education Programs from the California Code of Regulations, TITLE 16. Professional And Vocational Regulations, Division 13. Medical Board of California, Chapter 4. Licensed Midwives.

    [Local copy - It can be really hard to find these on the state web pages, so I've got a copy stashed here.]

    Faith Gibson's web pages for the California College of Midwives has an excellent web page about CEUs for Professional Midwives.

    My first and strongest recommendation for CEUs is the APPPAH conference, which is typically held in California.  They are usually approved for CMEs as well as CEUs.  HURRAY!.  I almost felt more supported here than at a midwifery conference!  These folks REALLY appreciate what midwives and doulas do to help babies. If you've been feeling any kind of burnout, going to an APPPAH conference is a sure-fire cure.

    Other California CEU/CME resources:

    Spirit Rock Meditation Center sometimes offers one-day workshops with 6 CEUs from the BRN.  They're in the hills west of San Rafael and Novato.

    Renaissance Midwifery (near Oakland) is also offering a lot of classes, especially now that Linda Arnold from Casa de Nacimiento has returned to the Bay Area.

    UCSF Office of Continuing Medical Education

    As of 2003, you may take BRN approved classes and count them towards the 36 hours of required continuing education.  [The newsletter also contains a very helpful list of suggestions for getting CEUs.]

    In order to renew your license, you must acquire 36 hours of continuing education during each two-year period preceding the renewal.  Here's the relevant section from the law:

    2518.  (a) Licenses issued pursuant to this article shall be renewable every two years upon payment of the fee prescribed by Section 2520 and submission of documentation that the licenseholder has completed 36 hours of continuing education in areas that fall within the scope of the practice of midwifery, as specified by the board.
    I don't know the official source of this document, but in August, 1999, Barbara Miller faxed me a copy of p. 103 from some document from the Medical Board of California, labeled Title 16, with additional numbers 1379.26 [Approved Continuing Education Programs] and 1379.26 [Criteria for Acceptability of Courses].

    Summarized from section a), continuing education credits are approved for programs offered by:

    At least half of your CEUs (18) must be from programs where you're personally present.  (Although a local peer review group may be considered for MANA-CPM CEUs, the California Medical Board doesn't recognize CEUs for peer review.  Alas.  However, if you're near a hospital that has grand rounds, they may offer CMEs for this.)  For the other half, there are lots of opportunities for earning CEUs through online programs.

    General Information about Getting CEUs
     

    Where to Get CEUs

    The CAM Conference and the APPPAH conferences are great ways to get CEUs in California and may allow you to remain on-call if they're close to your home.
    Renaissance Midwifery is also offering a lot of classes, especially now that Linda Arnold from Casa de Nacimiento has returned to the Oakland care.

    General Information about Getting CEUs
     

    Filing an Annual Report of Practice Statistics

    In order to remain licensed, you must file an annual report of practice statistics, due March 1 of each year.  (Or at least, due 3/1/08 for the first year they're required.)

    About Being "Investigated"

    In the style of "The Simpsons", imagine a brochure entitled, "So . . . You're Being Investigated by the Medical Board."

    First, read what Donna Russell (Legislative Advocate for California Citizens for Health Freedom) wrote about "What to Do if You Have Licensing Problems".

    Second, if you haven't already done so, this would be an ideal time to encourage all your clients to join California Association of Midwives - CAM
    Even low-income clients can usually afford to pledge a small monthly contribution on their credit card - even $5 or $10 per month for the Midwife Defense Fund makes a difference if they all do it!  You might also take a moment to learn more about the Medical Board and check the calendar for the Medical Board meetings to make a note of when they will next be meeting in your part of California.  Ask your clients to reserve this date now, in case you need them there and then.

    Here are some tips from midwives who've been there:  [coming soon . . .]:

    If you're being investigated and need more information, don't hesitate to prod me to flesh out this section.
     

    About Student Midwives

    If you happen to get to a birth before the midwife, and the mom suddenly starts pushing, what would you do?  I think we can all agree that informed consent is very important for the family, who may not understand the limitations of a doula or a student.  You might be sure to say to the family, "I'm not equipped to provide medical care.  Do you want me to call 911?"  They can always decline treatment from EMS, but if they're available to help resuscitate a baby in trouble, that could be life saving, and that's a decision to leave to the family.

    [Update from CAM Newsletter Fall 2004]:  "The law making it OK for LMs to supervise students passed and will become law Jan. 1, 2005.  It requires that the LM be practicing within the scope of her law, that the student be in a bona fide midwifery education program (not defined), and that the supervising LM  be on the premises at all times."

    Student Midwives Cannot Assist With Midwifery!
    Here's the text of the letter from the Medical Board dated Jan. 26, 2004, in which they state
    that midwifery students may not assist in the provision of midwifery care.

    For those of you interested in the latest information regarding the status of midwifery students and the California Medical Board, please see the latest post by Faith Gibson, LM, CPM Midwifery Liason to the CA Medical Board:

    Update from Medical Board Meeting on January 30th, 2004
     

    Placenta Disposal

    [This is from a midwife in CAM Region 5: "First, this is what the health department says: They would like us to be responsible for all the medical waste created at a birth. I said we all do water birth, so there is not really any waste besides a placenta. They would like us to be responsible for Disposing of the placenta, although by law they can't do anything if parents throw them in the garbage (something that we all agreed we would rather not see). She says that the law makes concession for burying their own placenta in their own yard.

    For a midwife to carry a placenta in her car and take it anywhere (if she is to operate within the limits of the law), she must have a small quantity generator permit and a small load variance so she may transport this pathological waste (which is what the state has declared placenta). It is not possible to get either of these things unless you have a clinic with a doctor as director. As usual, the laws are not set up to make it easy for us to practice and stay strictly within the boundaries of the law. If we never take the placenta away from the home and make parents responsible, we should then be OK with the health department.

    The solution I came up with involves a crime scene clean up company, HYJENK TECH. He will go anywhere in sacramento, amador or placer counties (if you make contact with him, ask him for the counties, I may have left something out).  [Dave at Hyjenk Tech………………916-601-1987]

    For $26.00 he will go to the home where the birth took place and take the placenta, and dispose of it by incineration, which is how the state wants it done. This is not the perfect solution (the state would still rather we be responsible for disposing of it), but it is one the dept. of health is willing to accept. I told them it is impossible for us to set up our own accounts with stericycle. Also, it is prohibitively expensive to go through them.

    My plan is to make the parents responsible by leaving the placenta with them (most of us do this now). If they wish to bury it, that is fine. If they prefer to have it disposed of, I will call Dave and he will pick it up. Parents will pay the fee.

    DIRECTIONS FOR PREPARING THE PLACENTA FOR PICK-UP It must be in a medical waste disposal bag and should be double bagged. You can purchase these, or he may be able to supply them for you. IT MUST NOT BE TIED. If the bag is tied, it is considered medical waste and not household waste, and he cannot by law pick it up. It must be in a 5 gallon bucket with a lid (you or your client may have a container from laundry detergent or whatever, or you could buy one). He will also take needles in a rigid or sharps container. Just put it into the same container that the placenta is in. Have a check from your clients ready for him when he comes to get it.
     

    Sharps Disposal

    Allied Waste accepts syringes from the home environment at The Recycling Center (Gate #1), 333 Shoreway Road, San Carlos, CA 94070, (650) 592-0255

    The Sunnyvale Materials Recovery and Transfer Station (SMaRT Station®) accepts sharps and lists other nearby disposal locations.

    Reporting Requirements

    The California Association of Midwives maintains a printable pdf file of the law that contains the reporting requirement.  "The way this particular bit of legislation is written midwives report in aggregate (which means giving totals, not reporting details of individual births) to OSHPPD who in turn reports a list of which midwives submitted statistics to the medical board and an aggregate result of all the reports submitted. One of the things we are hoping that these statistics will make clear is that there are no licensed midwives attending homebirths who have a supervising physician willing to go on record as their supervisor, yet many of us have managed to find physicians who are willing to have a consultative relationship or who have agreed to take our transports and referrals.  We are continuously working to get the supervision clause out of our law and every bit of ammunition helps!"

    Revised California Licensed Midwife Annual Report for 2008 (as of 2/16/09, I'm still not finding this at the web page they sent in our annual reporting letter.)
     

    Links into the California Legal Code and Regulations

    Other Relevant Links

    Other Midwifery Organizations

    These are organizations of which I have been a member, but I would no longer recommend membership in this organization because of a serious conflict of interest that arose between this group and Licensed Midwives in January, 2005.
  • MANA
  • Miscellaneous

    If you're self-employed, you may apply for Elective Coverage (EC) under State Disability Insurance (SDI). SDI coverage includes Disability Insurance and Paid Family Leave insurance benefits.

    If you can't get to another NRP course, you can get certified by taking an online course and then a brief in-person check in Dublin at 800-483-3615,
    Pediatric Advanced Life Support (PALS)
     
     


    This information collected and provided by Ronnie Falcao, LM MS

    You can send email to Ronnie Falcao, the author of this web page, to username "ronnie" at this domain.


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