[Congressional Record Volume 151, Number 53 (Wednesday, April 27, 2005)]
[Senate]
[Page S4399]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD:
  S. 911. 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-Midwifery Care Act of 2005. For too many years, 
certified nurse midwives, CNMs, have not received adequate 
reimbursement under the Medicare program, despite evidence that shows 
the quality of care and outcomes for services provided by CNMs are 
comparable to obstetricians and gynecologists. My legislation takes 
important steps to improve reimbursement for these important healthcare 
providers.
  There are approximately three 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. 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 and has 
supported increasing reimbursement for CNMs.
  My legislation would make several changes to improve the ability of 
CNMs and certified midwives, CMs, to effectively serve the Medicare-
eligible population. First, and most importantly, my bill recognizes 
the need to increase Medicare reimbursement for CNMs by raising the 
reimbursement level from 65 percent to 100 percent of the physician fee 
schedule. CNMs provide the same care as physicians; therefore, it is 
only fair to reimburse CNMs at the same level.
  In addition, the Improving Access to Nurse-Midwifery Care Act would 
guarantee 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 CMs 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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