[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 662 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 662

    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

                             March 19, 2009

   Mr. Conrad (for himself, Ms. Collins, Mr. Wyden, Mr. Schumer, Mr. 
 Kerry, Ms. Klobuchar, and Mrs. Boxer) 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 ``Midwifery Care Access and 
Reimbursement Equity Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Medicare program reimburses certified nurse-
        midwives for primary care services, as authorized by State law.
            (2) Since 1988, Congress has authorized reimbursement under 
        the Medicare program to certified nurse-midwives for the 
        provision of maternity-related services to Medicare-eligible 
        women with disabilities who are of childbearing age.
            (3) Since 1993, Congress authorized reimbursements under 
        the Medicare program to certified nurse-midwives to also 
        provide additional services outside the maternity cycle.
            (4) 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 by Congress. MedPAC also 
        highlighted the high quality of care provided by certified 
        nurse-midwives.
            (5) Certified nurse-midwives and certified midwives are 
        highly educated health professionals. To practice in the United 
        States as either a certified nurse-midwife or a certified 
        midwife, an individual must complete a post-baccalaureate 
        educational program and State licensure as well as pass a 
        national certification examination.
            (6) While most State Medicaid programs reimburse certified 
        nurse midwives and other obstetrical and gynecological 
        providers at the same payment rate, the Medicare program 
        reimburses such midwives at a payment rate that is 35 percent 
        lower than such other providers.
            (7) This disparity is a barrier to women's access to 
        obstetrical and gynecological providers of their choice within 
        the Medicare program.
            (8) Health disparities in the United States continue to be 
        a critical problem. Midwives have historically cared for those 
        populations most at risk for health disparities in areas of 
        high infant mortality, preterm birth, low birth weight, sudden 
        infant death syndrome, maternal mortality, breast and cervical 
        cancer, and HIV/AIDS infection among women.
            (9) Providing more equitable reimbursement for the high 
        quality primary care services of certified nurse-midwives and 
        certified midwives will aid in ensuring their services are 
        available to women in need.

SEC. 3. MEDICARE PAYMENT FOR CERTIFIED NURSE-MIDWIFE AND CERTIFIED 
              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:
    ``(gg) 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) Permitting hospitals to provide for patients receiving 
        certified nurse-midwife services or certified midwife services 
        to be under the care of a 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) 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 by inserting ``certified midwife services,'' after 
        ``certified nurse-midwife services,''.
            (4) 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'' and inserting ``100 
                percent'' each place it appears.

SEC. 4. INTERIM, FINAL REGULATIONS.

    In order to carry out the amendments made by this Act in a timely 
manner, not later than 6 months after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall promulgate 
regulations, that take effect on an interim basis, after notice and 
pending opportunity for public comment.
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