[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1814 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 1814

  To direct the Secretary of Health and Human Services to provide for 
demonstration projects under the medicaid program to improve access to 
    obstetric services in underserved areas, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 22, 1993

Mr. Bilirakis (for himself, Mr. Rowland, Mr. Kildee, Mr. McDermott, Mr. 
LaFalce, Mr. Emerson, Mr. Romero-Barcelo, Mr. Smith of New Jersey, Mr. 
 Walsh, Mr. Skeen, Mrs. Byrne of Virginia, Mr. Clyburn, Mr. Scott, Ms. 
    Norton, Miss Collins of Michigan, Mrs. Clayton, Mr. Barrett of 
 Wisconsin, Mr. Evans, Mr. Glickman, and Mr. Blackwell) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
  To direct the Secretary of Health and Human Services to provide for 
demonstration projects under the medicaid program to improve access to 
    obstetric services in underserved areas, and for other purposes.

    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 ``Access to Obstetric Care Act of 
1993''.

SEC. 2. MEDICAID DEMONSTRATION PROJECTS TO IMPROVE ACCESS IN 
              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 urban and 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 such sums as may be 
appropriated 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 urban 
and 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 
urban and 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 underserved areas. The 
compendium shall include information on activities addressing liability 
problems, efforts to retain and place providers of pregnancy-related 
services in underserved 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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