The implementation of Affordable Care Act (ACA) has greatly influenced the healthcare industry across United States. Study shows that ACA has reduced the number of uninsured people to historically low levels and helped more people access health care services, especially low-income people and people of color. However, the law’s effects on the cost and quality of health care services are difficult to discern given the complexity of our health system.
Since its passage, midwives gained opportunities to provide better maternal health access to mothers as the ACA helped to improve the quality of coverage for pregnant and birthing people by requiring individual and small group plans, as well as Medicaid expansion plans, to cover maternity and newborn care.
What is Affordable Care Act?
Signed into law on March 23, 2010, the Affordable Care Act (ACA) contains numerous provisions impacting a wide range of health care related issues. The overarching goals of the legislation were to increase the number of people with insurance coverage, improve the design of existing policies, and increase the quality of care provided in the U.S., all while taking significant steps to control costs.
Key issues for midwives include:
Under the law, all individual and small employer insurance plans, including those you get through the Marketplace, must cover maternity and newborn care -- before and after your baby is born.* In the past, most plans sold outside your job didn’t offer much maternity coverage. Some didn't cover it at all.
The ACA doesn't spell out all of the specific benefits that must be covered while you're pregnant and after the baby is born. But many preventive care services must be covered without extra out-of-pocket costs, like co-pays, co-insurance, or deductibles. For mothers, that includes preventive services for preconception and prenatal care and well-baby check-ups plus comprehensive lactation support, counseling, and breastfeeding equipment. Listed below are the codes included in the Affordable Care Act (ACA) that midwives can bill as they provide services.
2. GONORRHEA SCREENING LAB TEST*
3. HIV SCREENING LAB TEST*
4. SYPHILIS SCREENING LAB TEST*
5. BEHAVIORAL COUNSELING TO PREVENT SEXUALLY TRANSMITTED INFECTIONS(If the patient has sign, symptom, or has been exposed to an infection, use appropriate ICD-10 code and 99201–99215)
6. CONTRACEPTIVE COUNSELING(If the patient has a side effect from current method or menstrual irregularity, use ICD-10 code for sign or symptom and 99201–99215. When a patient presents with a problem, it is not appropriate to report a preventive CPT code)
7. WELL WOMAN VISIT(Some payers expect that many of these ACA preventive services—counseling, screening, and immunizations—occur during the annual preventive exam and may not reimburse separately for these on the same day or at subsequent visits.)
8. HUMAN PAPILLOMAVIRUS (HPV) VACCINATIONS
(If not administered during an annual wellness exam, some payers will also reimburse for an office visit)
9. HPV DNA LAB TESTING
10. HEPATITIS (Hep) A IMMUNIZATION (If not administered during an annual wellness exam, some payers will also reimburse for an office visit)
11. HEPATITIS (Hep) B IMMUNIZATION I(If not administered during an annual wellness exam, some payers will also reimburse for an office visit.)
12. Sexually transmitted infection prevention counseling
Adviser, C. S. S., Seeberger, C., Adviser, S., Director, M. C. A., Coleman, M., Director, A., Shepherd Director, M., Shepherd, M., Director, Director, E. L. A., Lofgren, E., Gordon Director, P., Gordon, P., Director, J. P. S., Parshall, J., Director, S., Williamson, H., Taylor, J., Tausanovitch, A., … Conner, A. (2022, June 9). Building on the ACA: Administrative actions to improve maternal health. Center for American Progress. Retrieved September 28, 2022, from https://www.americanprogress.org/article/building-aca-administrative-actions-improve-maternal-health/
Affordable care act (ACA) - glossary. Glossary | HealthCare.gov. (n.d.). Retrieved September 28, 2022, from https://www.healthcare.gov/glossary/affordable-care-act/
Lamboley, L. (2022, September 19). List of Aca Preventive Services and CPT codes [Prevounce Quick Guide]. Prevounce Blog. Retrieved September 28, 2022, from https://blog.prevounce.com/list-of-aca-preventive-services-and-cpt-codes-prevounce-quick-guide
List of Aca Preventive Services and CPT Codes - Std Tac. (n.d.). Retrieved September 28, 2022, from http://stdtac.org/wp-content/uploads/2014/06/List-of-ACA-Preventative-Services-and-CPT-Codes-_STDTAC.pdf