Delivering continuity of midwifery care to Queensland women

MBS rebates are available for a range of midwifery services. More information is available
from www.health.gov.au/midwives-nurse-practitioners
Collaborative arrangements
At the time of writing payment of MBS rebates for services of eligible midwives is conditional
on the midwife providing the service under a ‘collaborative arrangement’ with one or
more ‘specified medical practitioners’. More details of what constitutes a collaborative
arrangement can be found in Appendix 13.02.
The requirement for ‘collaborative arrangements’ does not give doctors responsibility for
the practice of eligible midwives as they are separately regulated health practitioners.
Additionally, according to statements in Parliament, the requirement for ‘collaborative
arrangements’ is not intended ‘to provide a right of veto over another health professional’s
practice’. The purpose of the requirement, as described in the legislation, is to provide for
consultation, referral or transfer when the woman’s care requires it.
Insurance
All private practice (self-employed) midwives now require insurance to cover all aspects of
the care they provide. The only exception is intrapartum care in the home, which is exempt
from the insurance requirement until end June 2012 www.nursingmidwiferyboard.gov.au/
Registration-Standards.aspx
Eligible midwives can purchase the government-subsidised insurance package from MIGA
insurance www.miga.com.au/content.aspxp=164 This package requires midwives to fulfil
a number of additional requirements including participation in risk management programs.
The MIGA product does not cover birth in the woman’s home but does cover private birth
care in hospital.
The MIGA product requires midwives to either have a ‘collaborative arrangement’ or, if
this is not in place, to communicate a care plan to the woman’s booking hospital and to
ensure receipt of acknowledgement of the care plan. Generally this hospital is likely to be a
Queensland Health facility.
MIGA insurance does not cover care of an admitted public patient in hospital.
In addition to the government-subsidised MIGA product, insurance products are available
from other providers and more products are expected over time. Currently these products do
not require the midwife to meet eligibility criteria or other requirements. The current products
do not cover any element of birth care. It is important to carefully consider what insurance
does cover, including support in response to actions by regulators, and availability of advice
when problems arise.
Credentialing
With ‘eligible’ private midwives providing Medicare-rebatable services, there is now a
need for credentialing processes for midwives, similar to those for visiting medical officers
(VMOs). Credentialing will be required as part of any visiting access agreement for privately
practicing midwives providing care to women who are admitted as private hospital patients.
At the time of publishing, credentialing processes for eligible midwives had commenced
in Queensland and were being refined. It is likely that credentialing processes within
Queensland will be consistent with those used nationally.
Visiting access
For women to be able to receive continuity of carer from their private midwife, mechanisms
for visiting access by eligible midwives to public hospitals are necessary.
All Australian states and territories have committed to facilitating women’s access to inhospital
care by eligible midwives in the National Maternity Services Plan
www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesplan
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Delivering continuity of midwifery care to Queensland women