Federal Government Releases 2027 ACA Payment Parameters
The Centers for Medicare & Medicaid Services (CMS) and HHS have released the Notice of Benefit and Payment Parameters for 2027 under the Affordable Care Act. While the notice does not specify new maternity care quality measures, these regulations shape the insurance landscape and define essential health benefits. The ongoing rulemaking will affect provider reimbursement and coverage requirements for maternal health and midwifery services.
- The Bureau of Labor Statistics projects that the overall employment of nurse anesthetists, nurse midwives, and nurse practitioners will grow by 35% between 2024 and 2034, a rate significantly faster than the average for all occupations. This projection anticipates about 32,700 job openings for these roles each year, largely due to retirements and professionals transferring to other occupations. - Recent Virginia legislation established Medicaid reimbursement parity for all licensed midwives, ensuring they are paid at the same rate as a licensed physician or certified nurse-midwife for the same service. Previously, some licensed midwives were reimbursed at 75% of the rate of other midwives for the same billing codes. - The proposed 2027 rule would give states operating their own health insurance exchanges more flexibility in defining network adequacy, moving away from strict time and distance standards. It would also lower the minimum threshold for essential community providers (ECPs) in a network from 35% to 20%, which could impact the inclusion of providers like freestanding birth centers. - While the Affordable Care Act mandates that individual and small group plans cover maternity and newborn care as an essential health benefit, states have flexibility in defining the specific services covered. For instance, coverage for different types of breast pumps and the extent of childbirth education classes can vary significantly from one state's benchmark plan to another. - Studies have shown that ACA Medicaid expansions are associated with increased use of Certified Nurse-Midwives (CNMs) for deliveries, particularly in states that have Medicaid reimbursement parity. Increased access to midwives is linked to improved birth outcomes, including lower rates of C-sections and preterm births. - A significant nursing shortage is projected to impact the healthcare workforce, with one report indicating that around 800,000 nurses intend to leave the profession by 2027 due to burnout and stressful working conditions. A separate study found that 100,000 nurses left the workforce during the pandemic. - Digital health platforms are an emerging part of maternal care, offering remote monitoring for conditions like high-risk pregnancies and virtual support for mental health, breastfeeding, and postpartum care. Companies like Pomelo Care and Babyscripts partner with providers to supplement in-person visits with 24/7 virtual access to a care team that can include midwives, therapists, and lactation consultants. - Evidence-based practices that improve birth outcomes include nutritional interventions, such as balanced energy and protein supplements to improve gestational weight gain, and low-dose aspirin to reduce the risk of pre-eclampsia. The integration of doulas has also been shown to reduce the likelihood of birth complications and low birthweight babies.
