[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3602 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 3602
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
December 20, 2001
Mr. Towns (for himself, Mr. Upton, Mrs. Capps, Ms. Millender-McDonald,
Mr. Waxman, Mr. Lewis of Georgia, Mr. Abercrombie, Mr. Rush, Mr. Leach,
Mr. Baldacci, Ms. Rivers, Mrs. Morella, Mr. Thompson of Mississippi,
Mr. Pallone, Mr. Hinchey, Mrs. Lowey, Mrs. Maloney of New York, Mrs.
Clayton, Mr. Price of North Carolina, Mr. Udall of New Mexico, Mr.
Oxley, Mr. Gillmor, Mr. Kennedy of Rhode Island, Mr. Kleczka, Mr.
Dingell, Mr. Owens, Mr. Moore, Mr. Strickland, Mr. Thompson of
California, Mr. Weiner, Mr. Davis of Illinois, Mr. Hilliard, Mr.
McNulty, Mrs. McCarthy of New York, Mr. McGovern, Ms. Kilpatrick, Ms.
Roybal-Allard, and Ms. Carson of Indiana) 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, 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 2001''.
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 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 services 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.
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