[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4872 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4872

    To amend title XVIII of the Social Security Act to provide for 
   reimbursement of certified midwife services, to provide for more 
equitable reimbursement rates for certified nurse-midwife services, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 20, 1998

Mr. Towns (for himself, Mrs. Morella, Mr. McDermott, Mr. LoBiondo, Mrs. 
Lowey, Mr. Cardin, Mr. Levin, Mr. Brown of Ohio, Mr. Waxman, Mr. Klink, 
Mr. Wynn, Mr. Schumer, Mr. Abercrombie, and Mrs. Capps) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
   and in addition to the Committee on 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, to provide for more 
equitable reimbursement rates for certified nurse-midwife services, 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 ``Certified Nurse Midwifery Medicare 
Services Act of 1998''.

SEC. 2. 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 such 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 
        such 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 such 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 such 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 
        such 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 such 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 ``95 percent''.
            (6) Assignment of payment.--The first sentence of section 
        1842(b)(6) of such 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 to 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 such 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 shall prescribe regulations to carry 
        out the amendments made by subparagraph (A).

SEC. 3. MEDICARE PAYMENT FOR FREESTANDING BIRTH CENTER SERVICES.

    (a) Freestanding Birth Center Services, Freestanding Birth Center 
Defined.--
            (1) In general.--(A) Section 1861(gg) of the Social 
        Security Act (42 U.S.C. 1395x(gg)), as amended in section 
        2(a)(1), is amended by adding at the end the following new 
        paragraphs:
    ``(5) The term `freestanding birth center services' means items and 
services furnished by a freestanding birth center (as defined in 
paragraph (6)) and such items and services furnished as an incident to 
the freestanding birth center's service as would otherwise be covered 
if furnished by a physician or as an incident to a physician's service.
    ``(6) The term `freestanding birth center' means a facility, 
institution, or site (other than a rural health clinic, critical access 
hospital, or a sole community hospital) (A) in which births are planned 
to occur (outside the mother's place of residence), (B) in which 
comprehensive health care services are furnished, and (C) which has 
been approved by the Secretary or accredited by an organization 
recognized by the Secretary for purposes of accrediting freestanding 
birth centers. Such term does not include a facility, institution, or 
site that is a hospital or an ambulatory surgical center, unless with 
respect to ambulatory surgical centers, the State law or regulation 
that regulates such centers also regulates freestanding birth centers 
in the State.''.
            (B) The heading in section 1861(gg) of such Act (42 U.S.C. 
        1395x(gg)), as amended in section 2(b)(2), is further amended 
        by adding at the end the following:

               ``; Freestanding Birth Center Services''.

            (2) Medical and other services.--Section 1861(s)(2)(L) of 
        such Act (42 U.S.C. 1395x(s)(2)(L)), as amended in section 
        2(b)(1), is further amended--
                    (A) by inserting ``(i)'' after ``(L)'';
                    (B) by adding ``and'' after the semicolon; and
                    (C) by adding at the end the following new clause:
            ``(ii) freestanding birth center services;''.
    (b) Part B Benefit.--
            (1) In general.--Section 1832(a)(2)(B)(iii) of such Act (42 
        U.S.C. 1395k(a)(2)(B)(iii)), as amended in section 2(b)(4), is 
        further amended by inserting ``freestanding birth center 
        services,'' after ``certified midwife services,''.
            (2) Amount of payment.--Section 1833(a)(1) of such Act (42 
        U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (S)'' and inserting in lieu 
                thereof ``(S)''; and
                    (B) by inserting before the semicolon the following 
                new subparagraph: ``, and (T) with respect to 
                freestanding birth center services under section 
                1861(s)(2)(L)(ii), the amount paid shall be made on an 
                assignment-related basis, and shall be 80 percent of 
                the lesser of (i) the actual charge for the services or 
                (ii) an amount established by the Secretary for 
                purposes of this subparagraph, such amount being 95 
                percent of the Secretary's estimate of the average 
                total payment made to hospitals and physicians during 
                1997 for charges for delivery and pre-delivery visits, 
                such amounts adjusted to allow for regional variations 
                in labor costs; except that (I) such estimate shall not 
                include payments for diagnostic tests, drugs, or the 
                cost associated with the transfer of a patient to the 
                hospital or the physician whether or not separate 
                payments were made under this title for such tests, 
                drugs, or transfers, and (II) such amount shall be 
                updated by applying the single conversion factor for 
                1998 under section 1848(d)(1)(C)''.

SEC. 4. INTERIM, FINAL REGULATIONS.

    Except as provided in section 2(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.
                                 <all>