[Congressional Record Volume 149, Number 112 (Friday, July 25, 2003)]
[Extensions of Remarks]
[Page E1634]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          MEDICARE PAYMENT UPDATE FOR CERTIFIED-NURSE MIDWIVES

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                          HON. EDOLPHUS TOWNS

                              of new york

                    in the house of representatives

                         Friday, July 25, 2003

  Mr. TOWNS. Mr. Speaker, there are approximately 2 million women with 
disabilities in the Medicare program. The Agency for Healthcare Policy 
and Research reported that these women are without appropriate access 
to primary care services. Their average time between gynecological 
visits was 10-12 years. They were also less likely than the general 
population to have received a recent mammogram. Certified Nurse-
Midwives and Certified Midwives are qualified through their unique 
training to deliver the appropriate health services to this population.
  Research studies have shown that special populations seek out care 
from midwives and that their health outcomes are improved. The Medicare 
program reimburses Certified Nurse-Midwives at 65 percent of the 
physician fee schedule, resulting in an average payment of only $14 per 
annual exam. Midwives who serve these women are forced to subsidize 
care with their own money or turn away patients because they cannot 
afford to operate at a financial loss. Like physicians, skyrocketing 
professional liability premiums for midwives are leaving no monies to 
subsidize care. Congress has not provided an update in payment of 
midwifery services since 1988.
  The legislation that I have reintroduced today with my colleague, the 
gentleman from Michigan, Mr. Upton, increases the level of 
reimbursement to 95 percent of the physician fee schedule. This amount 
is based on studies using the relative value methodology. Additionally, 
Certified Nurse-Midwives serve as faculty members of medical schools. 
For over 20 years, they have supervised and trained residents. This 
legislation clarifies the fact that midwives who are medical school 
faculty members may bill for Medicare Part B services in accordance 
with CMS residency training regulations. The bill also includes 
technical corrections that will clarify the reassignment of billing 
rights for midwives who are employed by others and recognize that 
Certified Nurse-Midwives and Certified Midwives have hospital admitting 
privileges. I urge you to support this legislation, which is in the 
best interest of women with disabilities across this Nation.

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