[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 872 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 872
To amend title XVIII of the Social Security Act to provide for
reimbursement of certified midwife services and to provide for more
equitable reimbursement rates for certified nurse-midwife services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 16, 2005
Mr. Towns (for himself and Mr. Upton) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addition
to the Committee on Energy and Commerce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for
reimbursement of certified midwife services and to provide for more
equitable reimbursement rates for certified nurse-midwife services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Access to Nurse-Midwifery
Care Act of 2005''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Since 1988, Congress has authorized certified nurse-
midwives (in this section referred to as ``CNMs'') to provide
maternity-related services to Medicare-eligible women who are
of childbearing age. Approximately 3,000,000 disabled women are
Medicare-eligible beneficiaries. In 1993, Congress authorized
CNMs to also provide additional services outside the maternity
cycle. Medicare reimburses CNMs for primary care services if
those services are part of the practitioner's State-regulated
scope of practice.
(2) In its June 2002 report to Congress, the Medicare
Payment Advisory Commission (MedPAC) unanimously recommended
that the percentage of part B reimbursement for certified
nurse-midwife services to be increased.
(3) In this same report, MedPAC also stated that research
shows the quality of care and outcomes for services provided by
CNMs are at least comparable to obstetricians and
gynecologists.
(4) A 1998 study from the National Center for Health
Statistics published Journal of Epidemiology and Community
Health found the risk of experiencing an infant death was 19
percent lower for births attended by CNMs than for births
attended by physicians. The risk of neonatal mortality (an
infant death occurring in the first 28 days of life) was 33
percent lower, and the risk of delivering a low birth weight
infant was 31 percent lower. Mean birth weight was 37 grams
heavier for the CNM-attended than for the physician-attended
births. Low birth weight is a major predictor of infant
mortality, subsequent disease, or developmental disabilities.
(5) The study also found that CNMs attended a greater
proportion of women who are at higher risk for poor birth
outcome: African Americans, American Indians, teenagers,
unmarried women, and those with less than a high school
education. Physicians attended a slightly higher proportion of
births with medical complications. However, birth outcomes for
CNMs were better even after socio-demographic and medical risk
factors were controlled for in statistical analyses.
(6) Medicare covers 3,000,000 women with disabilities that
are of childbearing age. These women give birth to
approximately 50,000 infants annually within the program.
(7) CNMs and certified midwives (in this section referred
to as ``CMs'') are highly educated health professionals.
Completion of a post-baccalaureate educational program,
licensure, and passage of a national certification examination
are required to become CNMs and CMs.
(8) Inequitable reimbursement for obstetrical and
gynecological services provided by CNMs or CMs jeopardizes
access for women (particularly those covered by Medicare) to
the health care provider of their choice.
SEC. 3. MEDICARE PAYMENT FOR CERTIFIED NURSE-MIDWIFE AND MIDWIFE
SERVICES.
(a) Certified Midwife, Certified Midwife Services Defined.--(1)
Section 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) is
amended by adding at the end the following new paragraphs:
``(3) The term `certified midwife services' means such services
furnished by a certified midwife (as defined in paragraph (4)) and such
services and supplies furnished as an incident to the certified
midwife's service which the certified midwife is legally authorized to
perform under State law (or the State regulatory mechanism provided by
State law) as would otherwise be payable under this title if furnished
by a physician or as an incident to a physician's service.
``(4) The term `certified midwife' means an individual who has
successfully completed a bachelor's degree from an accredited
educational institution and a program of study and clinical experience
meeting guidelines prescribed by the Secretary, or has been certified
by an organization recognized by the Secretary.''.
(2) The heading in section 1861(gg) of the Social Security Act (42
U.S.C. 1395x(gg)) is amended to read as follows:
``Certified Nurse-Midwife Services; Certified Midwife Services''.
(b) Certified Midwife Service Benefit.--
(1) Medical and other services.--Section 1861(s)(2)(L) of
the Social Security Act (42 U.S.C. 1395x(s)(2)(L)) is amended
by inserting ``and certified midwife services'' before the
semicolon.
(2) Payment to hospital for patients under care of
certified nurse-midwife or certified midwife.--Section
1861(e)(4) of the Social Security Act (42 U.S.C. 1395x(e)(4))
is amended--
(A) by inserting ``(i)'' after ``except that''; and
(B) by inserting before the semicolon the
following: ``and (ii) a patient receiving certified
nurse-midwife services or certified midwife services
(as defined in paragraphs (1) and (3), respectively, of
subsection (gg)) may be under the care of a certified
nurse-midwife or certified midwife with respect to such services to the
extent permitted under State law''.
(3) Inpatient hospital service at teaching hospitals.--
Section 1861(b) of the Social Security Act (42 U.S.C. 1395x(b))
is amended--
(A) in paragraph (4), by inserting ``certified
midwife services,'' after ``certified nurse-midwife
services,'';
(B) in paragraph (6), by striking ``; or'' and
inserting ``or in the case of services in a hospital or
osteopathic hospital by an intern or resident-in-
training in the field of obstetrics and gynecology,
nothing in this paragraph shall be construed to
preclude a certified nurse-midwife or certified midwife
(as defined in paragraphs (1) and (3), respectively, of
subsection (gg)) from teaching or supervising such
intern or resident-in-training, to the extent permitted
under State law and as may be authorized by the
hospital; or'';
(C) in paragraph (7), by striking the period at the
end and inserting ``; or''; and
(D) by adding at the end the following new
paragraph:
``(8) a certified nurse-midwife or a certified midwife
where the hospital has a teaching program approved as specified
in paragraph (6), if (A) the hospital elects to receive any
payment due under this title for reasonable costs of such
services, and (B) all certified nurse-midwives or certified
midwives in such hospital agree not to bill charges for
professional services rendered in such hospital to individuals
covered under the insurance program established by this
title.''.
(4) Benefit under part b.--Section 1832(a)(2)(B)(iii) of
the Social Security Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is
amended--
(A) by inserting ``(I)'' after ``(iii)'',
(B) by inserting ``certified midwife services,''
after ``certified nurse-midwife services,'', and
(C) by adding at the end the following new
subclause:
``(II) in the case of certified
nurse-midwife services or certified
midwife services furnished in a
hospital which has a teaching program
described in clause (i)(II), such
services may be furnished as provided
under section 1842(b)(7)(E) and section
1861(b)(8);''.
(5) Amount of payment.--Section 1833(a)(1)(K) of the Social
Security Act (42 U.S.C. 1395l(a)(1)(K)) is amended--
(A) by inserting ``and certified midwife services''
after ``certified nurse-midwife services'', and
(B) by striking ``65 percent'' each place it
appears and inserting ``100 percent''.
(6) Assignment of payment.--The first sentence of section
1842(b)(6) of the Social Security Act (42 U.S.C. 1395u(b)(6))
is amended--
(A) by striking ``and (F)'' and inserting ``(F)'';
and
(B) by inserting before the period the following:
``, and (G) in the case of certified nurse-midwife
services or certified midwife services under section
1861(s)(2)(L), payment may be made in accordance with
subparagraph (A), except that payment may also be made
to such person or entity (or the agent of such person
or entity) as the certified nurse-midwife or certified
midwife may designate under an agreement between the
certified nurse-midwife or certified midwife and such
person or entity (or the agent of such person or
entity)''.
(7) Clarification regarding payments under part b for such
services furnished in teaching hospitals.--(A) Section
1842(b)(7) of the Social Security Act (42 U.S.C. 1395u(b)(7))
is amended--
(i) in subparagraphs (A) and (C), by inserting
``or, for purposes of subparagraph (E), the conditions
described in section 1861(b)(8),'' after ``section
1861(b)(7),''; and
(ii) by adding at the end the following new
subparagraph:
``(E) In the case of certified nurse-midwife
services or certified midwife services furnished to a
patient in a hospital with a teaching program approved
as specified in section 1861(b)(6) but which does not
meet the conditions described in section 1861(b)(8),
the provisions of subparagraphs (A) through (C) shall
apply with respect to a certified nurse-midwife or a
certified midwife respectively under this subparagraph
as they apply to a physician under subparagraphs (A)
through (C).''.
(B) Not later than 180 days after the date of the enactment
of this Act, the Secretary of Health and Human Services shall
prescribe regulations to carry out the amendments made by
subparagraph (A).
SEC. 4. INTERIM, FINAL REGULATIONS.
Except as provided in section 3(b)(7)(B), in order to carry out the
amendments made by this Act in a timely manner, the Secretary of Health
and Human Services may first promulgate regulations, that take effect
on an interim basis, after notice and pending opportunity for public
comment, by not later than 6 months after the date of the enactment of
this Act.
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