Expanded Models

What is an expanded midwifery model?

An expanded midwifery model refers to midwives working in practice arrangements not funded by the traditional midwifery ‘course of care’ model. Sometimes, these arrangements involve work that is ‘expanded scope’; midwives provide additional care to clients to serve community need that they might not within the course of care model. It may also mean midwives are providing episodic care (rather than full courses of care) to marginalized populations. “Expanded Midwifery Care Model” (EMCM) refers to one of the funding mechanisms developed by the ministry of health to fund alternate practice arrangements (see more below).

When considering working in an expanded midwifery care model, there are three overarching areas for midwives to consider:

• funding support
• the regulatory framework
• insurance need

Funding

Expanded Midwifery Care Models funding was first negotiated by the AOM in 2017. Midwives can now apply to access even more support for working in ways that flex the traditional service model. For information on how to apply for this funding, consult the Memorandum of Understanding (MOU) between the Ministry and the AOM. Provisions are now made for midwives who:

• provide occasional care for physician patients in hospital (Schedule O)
• use their midwifery skills to improve access to pregnancy and newborn care and address community needs in a way that can’t sufficiently be compensated using BCCs or CVs (Schedule Q and EMCM)
• have needs related to a disability (Schedule R)

Compensation rates: should be indexed to course of care work. This is to ensure midwives working to provide care to equity deserving groups outside the course of care model are not disadvantaged.   For example, using the info found on page 52 of the current funding agreement, the hourly rate would be $61.02 for a level 6 midwife. This is based on the experience fee + retention incentive + secondary care fee, divided by the number of hours in a BCC (48). Current benefit rates (20% as of 2022-23) should also be included in your budget.
    
Operational support: consider what operational support is required for the proposed activities (midwives should have access to equipment funding regardless of whether they are billing caseload or compensated through a schedule). Consider also factoring in expenses associated with operational costs that are typically accounted for through the operational fee attached to BCCs. This will be especially important if funding is being requested for activities or a role that will amount to fewer courses of care billed by the MPG.

Regulatory Framework

Professional Standards for Midwives

The College of Midwives of Ontario (CMO) released new Professional Standards for Midwives (Professional Standards) in June 2018. The CMO addresses, in its Active Practice Requirements under the Registration Regulation, the process to maintain active practice for midwives who are (or who plan to be) working in an expanded midwifery model and who are not providing intrapartum care. Midwives can contact the CMO with questions regarding how the Professional Standards apply to their particular alternate practice model, or refer to the CMO website for more details.

Insurance

In order to remain registered with or re-register with the CMO you will need insurance, regardless of the model in which you are working. As you are thinking through the kind of care you will be providing, contact the AOM to discuss what type of insurance needs you will have.

As the insurance policy holder for midwives, the AOM will be able to advise you as to whether or not your existing coverage is suitable for your potential arrangement. If you need more (or less, as the case may be) professional liability coverage, we can discuss those needs with you and arrange with HIROC to ensure you are appropriately covered.

If your work diverges significantly from the current model of care— for example, you will be working under the authority/delegation of a physician and not providing care to newborns —please refer to the AOM’s policy on Insurance Coverage for Members Not Providing Midwifery Services. For support or questions about unique models of practice and insurance, please contact Allyson Booth.

Expanded Midwifery Care Models

The Ministry of Health, working jointly with the AOM, has developed a formal mechanism by which midwives can access funding for alternate arrangements, allowing them to leverage their skills and knowledge to practice in different models and in different health care settings. The ministry is currently accepting applications for new EMCM initiatives. Please note the deadline for applications is September 30, 2022.

Midwives interested in applying should contact the ministry to request an application and supporting guidance documents.

Midwives may also wish to consult the EMCM templates (Appendix C) developed during the last round of negotiations, which are part of the AOM's current Memorandum of Understanding (MOU) with the ministry

Proposed initiatives should meet the key EMCM criteria:

• Inability to provide these specific pregnancy and newborn services within the existing midwifery models (i.e. midwifery practice groups and Indigenous midwifery program).
• Addresses gaps in service provision and supports high quality and client-centered care
• Supports the effective use of health care resources
• Maximizes midwifery scope of practice
• Supports coordination and integration of pregnancy and newborn care with interprofessional primary care
• Contributes to an efficient and sustainable health care system and will not negatively impact or duplicate existing pregnancy and newborn services.

Currently Funded Expanded Midwifery Care Models Initiatives

Other Tools and Resources

The Ministry's slide deck on Expanded Midwifery Care Models (PDF, 991 KB) is available to members as a resource when applying for EMCM funding or considering working as an employee as part of an EMCM funded project.

The AOM can help and work with you to strategize what your compensation needs are, including exploring mechanisms for payment, benefits and contracts. For more information on funding, contact Anna Ianovskaia, A/Manager, Policy and Communications.