2006 Code of Virginia § 32.1-11.5 - Pilot programs for obstetrical and pediatric care in underserved areas

32.1-11.5. Pilot programs for obstetrical and pediatric care in underservedareas.

A. The Board may approve pilot programs to improve access to (i) obstetricalcare, which for the purposes of this section includes prenatal, delivery, andpost-partum care; and (ii) pediatric care in areas of the Commonwealth wherethese services are severely limited. The proposals for such pilot programsshall be jointly developed and submitted to the Board by nurse practitionerslicensed in the category of certified nurse midwife, certain perinatalcenters as determined by the Board, obstetricians, family physicians, andpediatricians.

B. Nurse practitioners licensed by the Boards of Medicine and Nursing in thecategory of certified nurse midwife who participate in a pilot program shallassociate with perinatal centers recommended by the Board and communityobstetricians, family physicians, and pediatricians and, notwithstanding anyprovision of law or regulation to the contrary, shall not be required to havephysician supervision to provide obstetrical services to women with low-riskpregnancies who consent to receive care under the pilot program arrangements.Further, notwithstanding any provision of law or regulation to the contrary,a nurse practitioner licensed by the Boards of Medicine and Nursing in thecategory of certified nurse midwife holding a license for prescriptiveauthority may prescribe Schedules III through VI controlled substanceswithout the requirement for either medical direction or supervision or awritten agreement between the licensed nurse practitioner and a licensedphysician. Such perinatal center shall provide administrative oversight by(i) assisting in the development of appropriate clinical care protocols andclinical collaboration, (ii) accepting transfers when necessary, and (iii)providing clinical consultation when requested. Removal of the requirementfor physician supervision for participating nurse practitioners licensed bythe Boards of Medicine and Nursing in the category of certified nurse midwifeshall not extend beyond the pilot programs or be granted to certified nursemidwives who do not participate in approved pilot programs. Further, theremoval of the requirement of physician supervision shall not authorize nursepractitioners licensed by the Boards of Medicine and Nursing in the categoryof certified nurse midwife to provide care to women with high-riskpregnancies or care that is not directly related to a low-risk pregnancy anddelivery. Nurse practitioners licensed by the Boards of Medicine and Nursingin the category of certified nurse midwife participating in a pilot programshall maintain professional liability insurance as recommended by theDivision of Risk Management of the Department of the Treasury.

C. The Department shall convene stakeholders, including nurse practitionerslicensed by the Boards of Medicine and Nursing in the category of certifiednurse midwife, obstetricians, family physicians and pediatricians toestablish protocols to be used in the pilot programs no later than October 1,2005. The protocols shall include a uniform risk-screening tool for pregnantwomen to assure that women are referred to the appropriate provider based ontheir risk factors.

D. Pilot program proposals submitted for areas where access to obstetricaland pediatric care services is severely limited shall include mutually agreedupon protocols consistent with evidence-based practice and based on nationalstandards that describe criteria for risk assessment, referral, and backupand shall also document how the pilot programs will evaluate their model andquality of care.

E. Pilot sites that elect to include birthing centers as part of the systemof care shall be in close proximity to a health care facility equipped toperform emergency surgery, if needed. Birthing centers are facilities outsidehospitals that provide maternity services. Any birthing center that is partof the pilot program shall, at a minimum, maintain membership in the NationalAssociation of Childbearing Centers and annually submit such information asmay be required by the Commissioner. The pilot programs shall not provide orpromote home births.

F. The Department shall evaluate and report on the impact and effectivenessof the pilot programs in meeting the program goals. The evaluation shallinclude the number of births, the number of referrals for emergency treatmentservices, successes and problems encountered, the overall operation of thepilot programs, and recommendations for improvement of the program. TheDepartment shall submit a report to the Joint Commission on Health Care byNovember 15, 2006, and annually thereafter.

(2005, c. 926.)