[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5189 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 5189

 To require the Secretary of Health and Human Services to establish a 
   Medicaid demonstration program to develop and advance innovative 
payment models for freestanding birth center services for women with a 
              low-risk pregnancy, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 20, 2019

  Ms. Clark of Massachusetts (for herself and Mr. Carter of Georgia) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To require the Secretary of Health and Human Services to establish a 
   Medicaid demonstration program to develop and advance innovative 
payment models for freestanding birth center services for women with a 
              low-risk pregnancy, 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 ``Birth Access Benefiting Improved 
Essential Facility Services Act'' or the ``BABIES Act''.

SEC. 2. MEDICAID DEMONSTRATION PROGRAM TO IMPROVE FREESTANDING BIRTH 
              CENTER SERVICES.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following:
    ``(bb) Demonstration Program To Improve Freestanding Birth Center 
Services.--
            ``(1) Authority.--The Secretary shall establish a 
        demonstration program for the purpose of identifying ways to 
        improve access to, and the quality and scope of, freestanding 
        birth center services for women with a low-risk pregnancy.
            ``(2) Deadlines for centers participation criteria, 
        prospective payment system; planning grants.--
                    ``(A) Participation and prospective payment system 
                deadline.--Not later than one year after the date of 
                the enactment of this subsection, the Secretary shall 
                do the following:
                            ``(i) Publication of participation criteria 
                        for freestanding birth centers.--
                                    ``(I) In general.--Publish criteria 
                                for a freestanding birth center to be 
                                certified by a State for purposes of 
                                participating in a State demonstration 
                                program conducted under this 
                                subsection.
                                    ``(II) Requirements.--The criteria 
                                required to be published under 
                                subclause (I) shall include the 
                                following:
                                            ``(aa) Accreditation.--A 
                                        freestanding birth center must 
                                        have a current accreditation 
                                        credential from an approved 
                                        nationally recognized birth 
                                        center accreditation body, as 
                                        determined by the Secretary.
                                            ``(bb) Licensure and other 
                                        requirements.--A freestanding 
                                        birth center shall--

                                                    ``(AA) be licensed, 
                                                or otherwise approved, 
                                                by the State to provide 
                                                prenatal, labor and 
                                                delivery, postpartum, 
                                                newborn care, and other 
                                                ambulatory services 
                                                that are included in 
                                                the State Medicaid 
                                                program; and

                                                    ``(BB) comply with 
                                                such other requirements 
                                                relating to the health 
                                                and safety of 
                                                individuals who receive 
                                                services furnished by 
                                                the facility as the 
                                                State shall establish.

                                            ``(cc) Care coordination.--
                                        A freestanding birth center 
                                        shall be able to meet care 
                                        coordination requirements, 
                                        including requirements to 
                                        coordinate care across settings 
                                        and providers to ensure 
                                        seamless transitions for 
                                        patients across the full 
                                        spectrum of health services, 
                                        and engage in consultation for 
                                        higher level maternity care 
                                        services, non-maternity care 
                                        services, and behavioral health 
                                        needs, and which may include 
                                        plans for consultation, 
                                        collaboration and referral, and 
                                        arrangements with the 
                                        following:

                                                    ``(AA) Federally-
                                                qualified health 
                                                centers (and as 
                                                applicable, rural 
                                                health clinics) to 
                                                provide Federally-
                                                qualified health center 
                                                services (and as 
                                                applicable, rural 
                                                health clinic services) 
                                                to the extent such 
                                                services are not 
                                                provided directly 
                                                through the birth 
                                                center.

                                                    ``(BB) Other 
                                                outpatient clinics, 
                                                including licensed 
                                                midwifery and physician 
                                                practices.

                                                    ``(CC) Inpatient 
                                                acute care facilities 
                                                with obstetrical care 
                                                units.

                                            ``(dd) Scope of services.--
                                        As determined by the Secretary, 
                                        a freestanding birth center 
                                        must be able to provide 
                                        peripartum care for women with 
                                        a low-risk pregnancy and for 
                                        newborns, consistent with 
                                        evidence-based guidelines.
                                            ``(ee) Capabilities.--A 
                                        freestanding birth center shall 
                                        have the following:

                                                    ``(AA) The 
                                                capability and 
                                                equipment to provide 
                                                prenatal, labor and 
                                                delivery, postpartum, 
                                                and newborn care for 
                                                women with a low-risk 
                                                pregnancy, readiness at 
                                                all times to initiate 
                                                emergency procedures to 
                                                meet unexpected needs 
                                                of such women and of 
                                                newborns within the 
                                                center, including at 
                                                least 2 qualified staff 
                                                on-site at every birth, 
                                                and the ability to 
                                                facilitate transport to 
                                                an acute care hospital 
                                                with an obstetrical 
                                                care unit when 
                                                necessary.

                                                    ``(BB) An 
                                                established transfer 
                                                plan with a receiving 
                                                hospital with an 
                                                obstetrical care unit 
                                                with policies and 
                                                procedures for timely 
                                                transport.

                                                    ``(CC) Medical 
                                                consultation available 
                                                from a licensed board-
                                                certified physician 
                                                with admitting 
                                                privileges in 
                                                obstetrics at a nearby 
                                                hospital.

                                                    ``(DD) Data 
                                                collection, storage, 
                                                and retrieval, 
                                                including data on 
                                                intrapartum and 
                                                postpartum maternal and 
                                                newborn transfer rates 
                                                and hospital 
                                                admissions.

                                                    ``(EE) The ability 
                                                to initiate and 
                                                document quality 
                                                improvement programs as 
                                                required by 
                                                accreditation that 
                                                include efforts to 
                                                maximize patient 
                                                safety, such as safety 
                                                checklists, validated 
                                                training and competency 
                                                of staff, and emergency 
                                                preparedness and 
                                                drills.

                                        Nothing in subitem (AA) shall 
                                        be construed as affecting the 
                                        State plan requirement 
                                        specified under section 431.53 
                                        of title 42, Code of Federal 
                                        Regulations, or any successor 
                                        regulation (relating to 
                                        assurance of transportation).
                                            ``(ff) Health care 
                                        providers.--A freestanding 
                                        birth center must employ or 
                                        have care delivery arrangements 
                                        with both of the following:

                                                    ``(AA) A physician 
                                                or physicians licensed 
                                                to practice within the 
                                                State or jurisdiction 
                                                of the birth center.

                                                    ``(BB) A midwife or 
                                                midwives that meet or 
                                                exceed the education 
                                                and training standards 
                                                of the International 
                                                Confederation of 
                                                Midwives and who are 
                                                licensed to practice 
                                                within the jurisdiction 
                                                of the birth center.

                                            ``(gg) Non-duplication.--In 
                                        carrying out this subsection, 
                                        the Secretary shall, to the 
                                        greatest extent practicable, 
                                        prevent the duplication of 
                                        services covered under this 
                                        subsection with services 
                                        otherwise covered under the 
                                        State plan under this title and 
                                        prevent payment under a 
                                        demonstration program under 
                                        paragraph (3) for services for 
                                        which payment is otherwise made 
                                        under the State plan under this 
                                        title.
                            ``(ii) Guidance on development of 
                        prospective payment system for testing under 
                        state demonstration programs.--
                                    ``(I) In general.--The Secretary 
                                shall issue guidance for States 
                                participating in a demonstration 
                                program conducted under paragraph (3) 
                                to establish a prospective payment 
                                system that shall only apply to 
                                freestanding birth center services that 
                                meet the criteria established under 
                                clause (i) furnished by a freestanding 
                                birth center participating in such 
                                demonstration program.
                                    ``(II) Requirements.--The guidance 
                                issued by the Secretary under subclause 
                                (I) shall, to the greatest extent 
                                practicable, provide for--
                                            ``(aa) partial facility 
                                        payment based on units in the 
                                        case that a pregnant woman is 
                                        admitted in labor and then 
                                        needs to be transferred to the 
                                        hospital in labor before the 
                                        birth of the baby;
                                            ``(bb) facility payment for 
                                        observation short stays to rule 
                                        out labor or for therapeutic 
                                        rest;
                                            ``(cc) ensuring payment for 
                                        the newborn and mother as two 
                                        facility payment components;
                                            ``(dd) ensuring payment for 
                                        nitrous oxide and hydrotherapy 
                                        supplies costs for pain relief;
                                            ``(ee) ensuring payment for 
                                        all professional services of 
                                        health professionals involved 
                                        in the delivery of care in a 
                                        birth center which may include 
                                        3 or more office visits; 
                                        observation and triage; newborn 
                                        exam and care; and multiple 
                                        postpartum, mother, and baby 
                                        visits, as needed;
                                            ``(ff) ensuring payment for 
                                        partial prenatal and postpartum 
                                        care episodes or for prenatal 
                                        care only with planned delivery 
                                        in the hospital and client 
                                        returning for postpartum care 
                                        in the birth center; and
                                            ``(gg) payment for services 
                                        provided within--

                                                    ``(AA) in the case 
                                                of a pregnant woman, 
                                                the period that 
                                                commences upon the 
                                                confirmation of 
                                                pregnancy when the 
                                                woman is accepted into 
                                                care at the 
                                                freestanding birth 
                                                center, continues 
                                                through prenatal care, 
                                                labor and delivery, and 
                                                ends 60 days 
                                                postpartum, inclusive 
                                                of at least 2 
                                                postpartum care visits; 
                                                and

                                                    ``(BB) in the case 
                                                of a newborn, a period 
                                                that continues through 
                                                the first 28 days of 
                                                life.

                    ``(B) Planning grants.--
                            ``(i) In general.--Not later than 18 months 
                        after the date of the enactment of this 
                        subsection, the Secretary shall award planning 
                        grants to States for the purpose of developing 
                        proposals to conduct a demonstration program 
                        described in paragraph (3).
                            ``(ii) Use of funds.--A State awarded a 
                        planning grant under this subparagraph shall 
                        use the funds awarded under such grant to--
                                    ``(I) solicit input with respect to 
                                the development of the demonstration 
                                program from patients, providers 
                                (including certified nurse-midwives and 
                                physicians) and other stakeholders;
                                    ``(II) secure participation of 
                                freestanding birth centers that meet 
                                the criteria established under 
                                subparagraph (A)(i), including by 
                                providing support for such centers to 
                                meet that criteria in order to maximize 
                                the number of freestanding birth 
                                centers participating in the 
                                demonstration program; and
                                    ``(III) in accordance with the 
                                guidance issued under subparagraph 
                                (A)(ii), establish a prospective 
                                payment system which States must use 
                                for making payments to freestanding 
                                birth centers participating in the 
                                demonstration program.
            ``(3) State demonstration programs.--
                    ``(A) In general.--Not later than 24 months after 
                the date of the enactment of this subsection, from 
                among the States awarded a planning grant under 
                paragraph (2)(B), the Secretary shall select not more 
                than 6 such States to conduct demonstration programs 
                that meet the requirements of this paragraph.
                    ``(B) Application requirements.--
                            ``(i) In general.--The Secretary shall 
                        solicit applications to conduct a demonstration 
                        program under this subsection from States 
                        awarded planning grants under paragraph (2)(B).
                            ``(ii) Required information.--A State 
                        application to conduct a demonstration program 
                        under this paragraph shall include the 
                        following:
                                    ``(I) A description of the target 
                                Medicaid population to be served under 
                                the demonstration program.
                                    ``(II) A list of the participating 
                                freestanding birth centers in the 
                                State.
                                    ``(III) Verification that each 
                                participating freestanding birth center 
                                meets the participation criteria 
                                established in paragraph (2)(A)(i).
                                    ``(IV) A description of the scope 
                                of the freestanding birth center 
                                services available under the State 
                                Medicaid program for women with a low-
                                risk pregnancy that will be paid for 
                                under the prospective payment system 
                                tested in the demonstration program.
                                    ``(V) Verification that the State 
                                has agreed to pay for such services at 
                                the rate established under the 
                                prospective payment system.
                                    ``(VI) An assurance that the State 
                                will require freestanding birth centers 
                                to submit to the State, and that the 
                                State will submit to the Secretary, 
                                such information and data as the State 
                                or Secretary may require relating to 
                                the demonstration program or an episode 
                                of care for such a pregnant woman or 
                                newborn.
                                    ``(VII) Such other information as 
                                the Secretary may require relating to 
                                the demonstration program, including 
                                with respect to determining the 
                                soundness of the proposed prospective 
                                payment system.
                    ``(C) Length of demonstration programs.--A State 
                selected to conduct a demonstration program under this 
                paragraph shall conduct the program for a 4-year 
                period.
                    ``(D) Requirements for selecting demonstration 
                programs.--In selecting States to conduct demonstration 
                programs under this paragraph, the Secretary shall--
                            ``(i) ensure States meet the criteria 
                        described in paragraph (2)(A)(i)(II);
                            ``(ii) ensure that the States represent a 
                        diverse selection of geographic areas, 
                        including rural and underserved areas; and
                            ``(iii) give preference to States that 
                        demonstrate the potential to expand the 
                        availability of and access to maternity care 
                        services in a demonstration area and increase 
                        the quality of services provided by 
                        freestanding birth centers without increasing 
                        net Federal spending.
                    ``(E) Payment for services provided by freestanding 
                birth centers.--
                            ``(i) In general.--Amounts expended by a 
                        State to conduct a demonstration program under 
                        this paragraph shall be treated as medical 
                        assistance for purposes of subsection (a) of 
                        this section. Under a demonstration program 
                        conducted under this paragraph by a State, 
                        payments shall be made by the State for 
                        freestanding birth center services that meet 
                        the criteria established under paragraph 
                        (2)(A)(i) furnished by a freestanding birth 
                        center in accordance with the prospective 
                        payment system for such services established 
                        pursuant to the guidance issued under paragraph 
                        (2)(A)(ii).
                            ``(ii) Limitations.--Payments shall be made 
                        under this subparagraph to a State only for 
                        freestanding birth center services that are--
                                    ``(I) described in the 
                                demonstration program application 
                                submitted by the State and approved by 
                                the Secretary; and
                                    ``(II) provided to an individual 
                                who is eligible for medical assistance 
                                under the State Medicaid program.
                            ``(iii) Prohibited payments.--Unless 
                        included as part of a payment provided under a 
                        prospective payment system established by a 
                        State for the demonstration program pursuant to 
                        the guidance issued under paragraph (2)(A(ii), 
                        no payment shall be made under this 
                        subparagraph for inpatient care or other non-
                        ambulatory services, as determined by the 
                        Secretary.
                    ``(F) Waiver of statewideness requirement.--The 
                Secretary shall waive section 1902(a)(1) (relating to 
                statewideness) as may be necessary for a State to 
                conduct a demonstration program in accordance with the 
                requirements of this paragraph.
                    ``(G) Annual reports.--
                            ``(i) In general.--Not later than 2 years 
                        after the date on which the first State is 
                        selected to conduct a demonstration program 
                        under this paragraph, and annually thereafter, 
                        based on information and data submitted by 
                        States in accordance with the assurance 
                        provided under subparagraph (B)(ii)(VI), the 
                        Secretary shall submit to Congress an annual 
                        report on all State demonstration programs 
                        conducted under this paragraph. Each such 
                        report shall include with respect to each such 
                        State demonstration program--
                                    ``(I) an assessment of clinical 
                                outcomes for maternity services 
                                provided by freestanding birth centers 
                                participating in the demonstration 
                                program compared to outcomes for low-
                                risk pregnancy Medicaid patients in 
                                comparable demographic and geographic 
                                areas, including with respect to the 
                                number of births and data on 
                                intrapartum and postpartum maternal and 
                                newborn transfer rates and hospital 
                                admissions; and
                                    ``(II) an assessment of the impact 
                                of all the State demonstration programs 
                                conducted under this paragraph on the 
                                Federal and State costs relating to 
                                providing freestanding birth center 
                                services for women with a low-risk 
                                pregnancy (including with respect to 
                                the provision of inpatient, emergency, 
                                and ambulatory services) and newborn 
                                care, compared to the Federal and State 
                                costs related to the provision of 
                                freestanding birth center services by 
                                freestanding birth centers outside of 
                                such demonstration programs.
                            ``(ii) Recommendations.--Not later than the 
                        end of the third year of the demonstration 
                        program established under this subsection, the 
                        Secretary shall submit to Congress 
                        recommendations concerning whether the 
                        demonstration programs under this paragraph 
                        should be continued, expanded, modified, or 
                        terminated.
            ``(4) Funding.--
                    ``(A) In general.--Out of any funds in the Treasury 
                not otherwise appropriated, there is appropriated to 
                the Secretary--
                            ``(i) for purposes of carrying out 
                        paragraph (2)(B), $2,000,000; and
                            ``(ii) for purposes of carrying out the 
                        demonstration programs under paragraph (3), 
                        $25,000,000.
                    ``(B) Availability.--Funds appropriated under 
                subparagraph (A) shall remain available until expended.
            ``(5) Definitions.--In this subsection:
                    ``(A) Freestanding birth center services.--The term 
                `freestanding birth center services' has the meaning 
                given that term under section 1905(l)(3)(A) and 
                includes such other services as the Secretary shall 
                determine for purposes of the demonstration programs 
                conducted under paragraph (3).
                    ``(B) Low-risk pregnancy.--The term `low-risk 
                pregnancy' means an uncomplicated singleton term 
                pregnancy with a vertex presentation with an expected 
                uncomplicated birth.''.
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