[Congressional Record Volume 150, Number 75 (Wednesday, June 2, 2004)]
[Senate]
[Pages S6362-S6363]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD:
  S. 2492. 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; to the Committee on Finance.
  Mr. CONRAD. Mr. President, today I am introducing the Improving 
Access to Nurse-Midwife Care Act of 2004. For too many years, certified 
nurse midwives (CNMs) have not received adequate reimbursement under 
the Medicare program. My legislation takes important steps to improve 
reimbursement for CNMs.
  There are approximately 2 million disabled women on Medicare who are 
of childbearing age; however, if they choose to utilize a CNM for 
``well women'' services, the CNM is only reimbursed at 65 percent of 
the physician fee schedule. In practical terms, the typical well-woman 
visit costs, on average, $50. But Medicare currently reimburses CNMs in 
rural areas only $14 for this visit, which could include a pap smear, 
mammogram, and other pre-cancer screenings. CNMs administer the same 
tests and incur the same costs as physicians but receive only 65 
percent of the physician fee schedule for these services. Other non-
physician providers, such as nurse practitioners and physician 
assistants are reimbursed at 85 percent of the physician fee schedule. 
This reduced payment is unfair and does not adequately reflect the 
services CNMs provide to beneficiaries. At this incredibly low rate of 
reimbursement, the Medicare Payment Advisory Committee (MedPAC) agrees 
that a CNM simply cannot afford to provide services to Medicare 
patients.
  In June of 2002, MedPAC issued a report titled, ``Medicare Payment to 
Advance Practice Nurses and Physician Assistants.'' In a 14-0 vote, 
MedPAC recommended to Congress that the percentage of reimbursement for 
CNM services be increased. Moreover, because practice expenses are much 
higher for CNMs--liability coverage costs for CNMs are 10-fold higher 
than for other non-physician providers--MedPAC signaled that CNMs 
should be paid more than 85 percent. My legislation would increase the 
level of reimbursement to 95 percent of the physician fee schedule, 
which more adequately reflects the cost of providing midwifery 
services.
  My legislation would also make several technical changes to current 
Medicare provisions that limit the ability of

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midwives to effectively serve the Medicare-eligible population. In 
particular, CNMs serve as faculty members of medical schools. For over 
20 years, they have supervised and trained interns and residents. The 
bill guarantees payment for graduate medical education and includes 
technical corrections that will clarify the reassignment of billing 
rights for CNMs who are employed by others. Finally, my bill would 
establish recognition for a certified midwife (CM) to provide services 
under Medicare. Despite the fact that CNMs and CMs provide the same 
services, Medicare has yet to recognize CNs as eligible providers. My 
bill would change this.
  This bill will enhance access to ``well woman'' care for thousands of 
women in underserved communities and make several needed changes to 
improve access to midwives. I urge my colleagues to support this 
legislation.

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