[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1771 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 1771

  To reduce infant mortality in rural, underserved areas by improving 
        access to needed health care services by pregnant women.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 21, 1993

   Mr. Rowland (for himself, Mr. Hall of Texas, Mrs. Vucanovich, Mr. 
    Thomas of Wyoming, Mr. Emerson, Mr. Lancaster, Mr. Roberts, Mr. 
   Bereuter, Mr. Slattery, Mr. Stenholm, Ms. Snowe, and Mr. Durbin) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To reduce infant mortality in rural, underserved areas by improving 
        access to needed health care services by pregnant women.

    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 ``Rural Access to Obstetrical Care Act 
of 1993''.

SEC. 2. MEDICAID DEMONSTRATION PROJECTS TO IMPROVE ACCESS IN RURAL, 
              UNDERSERVED AREAS TO OBSTETRIC SERVICES.

    (a) In General.--The Secretary of Health and Human Services shall 
provide under this section for demonstration projects by States that 
seek to reduce infant mortality by improving access in rural, 
underserved areas to obstetric services for eligible pregnant women 
under title XIX of the Social Security Act.
    (b) Nature of Projects.--Demonstration projects under this section 
shall incorporate innovative approaches for increasing the 
participation of obstetric providers under title XIX of the Social 
Security Act, such as--
            (1) expediting reimbursement and using innovative payment 
        mechanisms, including global fees for obstetric services with 
        guaranteed periodic payments;
            (2) special or enhanced reimbursement for early prenatal 
        care, risk-assessment, and high-risk services;
            (3) patient distribution or referral systems;
            (4) subsidizing medical liability insurance premiums, in 
        whole or in part, for selected obstetric providers;
            (5) paying for all or a portion of payments made in 
        settlement of malpractice claims by patients of obstetric 
        providers who meet certain criteria; and
            (6) providing professional liability coverage under the 
        State tort claims act for certain obstetric providers while 
        treating a specified category of patients.
Demonstration projects addressing reimbursement must provide for 
integrated prenatal, delivery and postpartum services.
    (c) Supplemental Funding.--(1) With respect to the additional 
expenditures for medical assistance made under the State plan under 
title XIX of the Social Security Act to carry out a demonstration 
project under this section, the Federal medical assistance percentage 
(otherwise determined under section 1905(b) of such Act) shall be 
increased by 25 percentage points (but in no case to a percentage 
greater than 95 percent).
    (2) The amount of funds that may be expended as medical assistance 
to carry out the purposes of this section shall be $30,000,000 during 
the 5-fiscal-year period beginning with fiscal year 1994.
    (d) Waiver Authority.--(1) Except as provided under paragraphs (2) 
and (3), the Secretary is authorized to waive the requirements of title 
XIX of the Social Security Act to the extent necessary to implement 
demonstration projects under this section.
    (2) Except as permitted under section 1915(b)(1) of the Social 
Security Act, the Secretary may not waive under paragraph (1) the 
requirement of sections 1902(a)(23) and 1916 of such Act.
    (3) The Secretary may not approve a demonstration project under 
this section, or a waiver under paragraph (1), that reduces the amount, 
duration, or scope of medical assistance made available under title XIX 
of the Social Security Act or that results in a loss of eligibility for 
individuals otherwise eligible for such assistance.
    (e) Timely Action on Applications.--A request to the Secretary by a 
State for approval of a demonstration project under this section (and 
any accompanying waiver of a requirement of title XIX of the Social 
Security Act) shall be deemed granted unless the Secretary, within 90 
days after the date of its submission to the Secretary, either denies 
such request in writing or informs the State in writing with respect to 
any additional information which is needed in order to make a final 
determination with respect to the request. After the date the Secretary 
receives such additional information, the request shall be deemed 
granted unless the Secretary, within 90 days of such date, denies the 
request.
    (f) Duration.--A demonstration project under this section may be 
conducted for any portion of the period beginning after the date of 
enactment of this Act and ending December 31, 1997.
    (g) Evaluation.--Such projects must include a plan for evaluating 
the effects of the demonstration projects on provider participation.
    (h) Report.--The Secretary shall report to Congress, not later than 
March 1, 1998, on the demonstration projects carried out under this 
section and on how the results of such projects may be used to 
implement programs to lower infant mortality and morbidity through 
improving the access of pregnant women to obstetric services in rural, 
underserved areas.
    (i) Obstetric Provider Defined.--In this section, the term 
``obstetric provider'' means an obstetrician, obstetrician-
gynecologist, family practitioner, certified nurse midwife, or 
certified family nurse practitioner.

SEC. 3. ANNUAL COMPENDIUM ON STATE INITIATIVES.

    (a) In General.--The Secretary of Health and Human Services, in 
consultation with the Office of Rural Health Policy, shall develop and 
make available to the public each year a compendium of the various 
State initiatives undertaken to address the obstetric access crisis in 
rural areas.
    (b) Nature of Compendium.--The compendium shall include information 
on State laws, regulations, programs and other initiatives undertaken 
to increase access to obstetric care in rural areas. The compendium 
shall include information on activities addressing liability problems, 
efforts to retain and place providers of pregnancy-related services in 
rural areas, and efforts to recruit and retain providers of obstetric 
services under the Medicaid program. The compendium shall also include 
information on the results on any evaluations that have been conducted 
on such initiatives.

SEC. 4. STUDY OF OBSTETRICAL MALPRACTICE CLAIMS.

    (a) Study.--The Secretary of Health and Human Services shall 
provide a grant to a public or private nonprofit organization to 
conduct a study on the rate of medical malpractice actions or claims 
relating to obstetrical care for patients whose care is paid for by 
title XIX of the Social Security Act as compared to those whose care is 
paid for by private insurance. Such study shall include a review of 
medical records at selected hospitals, including rural hospitals, to 
determine the rates for each group.
    (b) Report.--By not later than 2 years after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
on the study conducted under subsection (a).
    (c) Medical Malpractice Action or Claim Defined.--In this section, 
the term ``medical malpractice action or claim'' has the meaning given 
such term in section 431(7) of the Health Care Quality Improvement Act 
of 1986 (42 U.S.C. 11151(7)).

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