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New Federal Laws Affect Homebirth Midwives & Consumers


By Jenny Carleton, Homebirth Access Sydney.

From 1st July 2010, the new national health practitioner regulations require all health practitioners to have professional indemnity insurance. This means that all homebirth midwives will need to purchase professional indemnity insurance from one of 2 policies currently being offered.

The first insurance policy sold by Mediprotect is only for antenatal and postnatal care. It is relatively low cost (starting at under $2000 per year) and does not have specific requirements regarding eligibility or collaboration.

The second insurance policy, sold by MIGA is subsidised by the Commonwealth Government, and is available only to “eligible midwives” according to the standard set by the Nursing and Midwifery Board of Australia. (It is worth noting that this eligibility criteria has not yet been finalised!)

It is much more expensive than the Mediprotect policy, starting at $5000/year for up to 29 births/year ($2250/year if not providing any intrapartum care in private practice) and ONLY covers births in hospital, not births at home! The policy document lists specific requirements for “collaborative arrangements” and include that the midwife must share certain information with a doctor or hospital.

The minimum requirement is for midwives to send a copy of each woman’s care plan to the hospital, and confirm that the hospital has received it, and send other items of information about the woman’s care to the hospital – with the woman’s consent.

What does insurance mean for homebirth families?

In the immediate term it seems we are likely to see some increase in the cost of homebirth as the costs of insurance are passed onto midwives’ clients. It is somewhat reassuring that midwives will now have insurance for antenatal and postnatal care, however it does not cover the birth at home, which is where it is needed most!

What about Medicare rebates?

From 1st November 2010, Medicare rebates will be payable for the services of eligible midwives in private practice, subject to certain conditions. Rebates for midwifery services will be paid for specific “items” or types of visits with a midwife, in the same way as visits to doctors. Currently labour and birth care at home is not rebatable, but antenatal and postnatal care for a woman planning a homebirth can be. The dollar value of rebates is not yet known, but it is highly unlikely it will cover the whole cost of each service. In theory these rebates, plus any Medicare Safetynet payments, will make care from eligible midwives significantly cheaper for women. However, it is hard to know how many privately practicing midwives will take up eligibility!

Although eligibility is yet to be finalised, at this stage midwives must:

  • have 3 years of full time experience accross the full scope of practice (pregnancy, birth, postnatal and neonatal)
  • have completed Midwifery Practice Review (a professional practice review process)
  • have completed (or undertake to complete within 18 months) a pharmacology course – and no course has yet been approved for this purpose
  • be competent to provide care to women across the full scope of pregnancy, birth, postnatal and neonatal
  • undertake 40 hours of continuing professional development (education) per year (standard requirement is 20 hours),and
  • demonstrate collaborative arrangements with doctors or hospitals.

The conditions for Medicare rebates include the requirement for each rebatable item of care to be provided under a “collaborative arrangement” with a doctor and require women to book into a hospital, even if only as a backup plan.

For women planning a homebirth, the collaborating doctor can be expected to be a doctor authorised by a public hospital to enter such an arrangement. This is likely to be reasonably difficult for midwives in the short term and HAS will be talking to the State Health Minister and Departments about the need to set up policies and processes with public hospitals about collaboration with eligible midwives.

There are likely to be some teething problems in the short term and we would like you to let us know if you experience difficulties with hospitals or doctors around the collaboration issues that you can’t resolve.

HAS would like to thank NSW midwives and the Maternity Coalition for assisting with this information.

This article was written and submitted by Jenny Carleton from Homebirth Access Sydney (HAS): http://www.homebirthsydney.org.au




Oct 25, 2010 | Category: Birth, Conception, Pregnancy | Comments: none | Tags: , , , , ,

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