Monday, November 22, 2010

Letters to public hospitals requesting collaborative arrangements

Midwives practising privately are now able to apply to be noted by the Nursing and Midwifery Board of Australia as eligible for Medicare, and clients of these midwives are now able to claim rebate on the midwife's fees.  Women enquiring about private midwifery services are now asking midwives, "will I be able to claim Medicare rebate on your fees?"

There are just a few midwives in the country who are able to offer Medicare rebate.  Others are working towards it.

One of the hurdles that a midwife needs to successfully negotiate in order to achieve this status is to comply with the National Health (Collaborative arrangements for midwives) Determination 2010.

Midwives who are continuing to provide private midwifery services for women planning homebirth are seeking an arrangement to cover collaboration in situations when women in their care are referred to a public hospital for obstetric review, such as for prenatal assessment or monitoring when indicated, or transfer of care.

With reference to the (Collaborative arrangements for midwives) Determination, the pathway which we have been advised is suitable for public hospitals providing collaborative arrangements for midwives whose clients are planning home birth is as follows:

[Excerpts from National Health (Collaborative arrangements for midwives) Determination 2010]
4 Specified medical practitioners
For the definition of authorised midwife in subsection 84 (1) of the Act, the following kinds of medical practitioner are specified:
(c) a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.

5 Collaborative arrangements — general
(1) For the definition of authorised midwife in subsection 84 (1) of the Act, each of the following is a kind of collaborative arrangement for an eligible midwife:
(b) a patient is referred, in writing, to the midwife for midwifery treatment by a specified medical practitioner;
(c) an agreement mentioned in section 6 for the midwife;
6 Agreement between eligible midwife and 1 or more specified medical practitioners
(1) An agreement may be made between:
(a) an eligible midwife; and
(b) 1 or more specified medical practitioners.
(2) The agreement must be in writing and signed by the eligible midwife and the other parties mentioned in paragraph (1) (b).

In the case of an authorised midwife providing care for a woman ‘W’, having a collaborative arrangement under section 4(c) above with the director of obstetrics or another doctor ‘D’ authorised by the hospital to participate in a collaborative arrangement, the midwife would write a letter to the doctor, and keep a copy of the letter in the woman’s notes, stating that Doctor D is the specified medical practitioner under whom the woman would be admitted if admission to hospital was indicated. The letter would say something like
“Dear Dr D, Ms W is a woman in my care who is planning home birth, who has booked in to your hospital for backup if indicated. At present there is no indication, and I will contact you should any problems or concerns arise. This collaborative agreement is required so that Ms W can claim Medicare rebate on my fees.”

Please note that this collaborative arrangement does not apply to intrapartum care, after transfer of women who had planned home birth from private care in the community to a public hospital. There is no Medicare item number for intrapartum midwifery care for planned homebirth. The intrapartum options for midwives, covered by Medicare are outlined in the Federal Register of Legislative Instruments F2010L02640. These items refer to planned hospital births at which the midwife is in attendance, privately employed by the woman. This option requires visiting access arrangements to be in place, including collaborative arrangements for intrapartum obstetric referral.

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