[Congressional Record Volume 144, Number 150 (Tuesday, October 20, 1998)]
[Extensions of Remarks]
[Page E2263]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          THE CERTIFIED NURSE MIDWIFERY MEDICARE SERVICES ACT

                                 ______
                                 

                          HON. EDOLPHUS TOWNS

                              of new york

                    in the house of representatives

                       Tuesday, October 20, 1998

  Mr. TOWNS. Mr. Speaker, I am pleased to introduce ``The Certified 
Nurse Midwifery Medicare Services Act''. This legislation will correct 
several inequities in the nurse-midwives' ability to provide health 
care services to Medicare recipients. This bill specifically increases 
the reimbursement rate to 95 percent of physician payment as well as 
permitting free-standing birth centers to receive Medicare 
reimbursement.
  Currently, under the Medicare program, nurse-midwives are reimbursed 
for only 65 percent of physician's payment for providing the same 
services. Fifty-six percent of women who are cared for by CNMs live in 
areas that are designated as underserved, within inner city or rural 
areas. In fact, 70 percent of women and newborns seen by nurse-midwives 
are considered vulnerable by virtue of age, socioeconomic status, 
education, ethnicity, or place of residence. As of 1996, over 50,000 
women, in the Medicare program, had a primary diagnosis related to 
``pregnancy, childbirth and puerperium''. While Medicare has provided 
for coverage of the professional services of CNMs since July 1, 1988, 
the low 65 percent reimbursement rate results in payments of $800 to 
$1,200 for nine to ten months of care for pregnancy, including 
deliveries. At this level, nurse-midwives can not afford to serve the 
Medicare population, a population which is clearly increasingly in need 
of access to health care providers.
  The second major inequity corrected by this bill would allow free 
standing birth centers to be reimbursed. Currently, the Medicare 
program does not recognize free-standing birth centers. Birth centers 
have a 20 year history of providing quality services with excellent 
outcomes for mothers and babies. In fact, the first urban birth center 
was established in New York City in 1975. The excellent quality of care 
with great savings has been demonstrated in many research studies. The 
most recent data released by the Health Insurance Association of 
America and the National Association of Childbearing Centers showed 
that in 1995 there was a cost savings of over $3,000 per birth when 
comparing a birth center to a hospital birth. Medicare can realize 
considerable savings and improved outcomes for disabled women and their 
infants who use nurse-midwives and birth centers.
  Mr. Chairman, while this legislation is being introduced in the last 
days of the 105th Congress, I am confident that this measure will 
receive serious consideration in the next Congress. We must continue to 
work to increase access to health care for underserved populations. All 
too often chronically disabled women have specialists as their primary 
care providers who neglect their obstetrical and gynecological needs. I 
look forward to working with my colleagues to improve the payment 
restrictions on access to nurse-midwifery services for Medicare 
recipients.

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