[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 911 Introduced in Senate (IS)]






109th CONGRESS
  1st Session
                                 S. 911

    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 SENATE OF THE UNITED STATES

                             April 27, 2005

   Mr. Conrad introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 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.
                                 <all>