[Congressional Record Volume 153, Number 22 (Tuesday, February 6, 2007)]
[Senate]
[Page S1648]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Ms. Collins, Ms. Cantwell, and Mr. 
        Durbin):
  S. 507. 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 Midwifery Care 
Access and Reimbursement Equity (M-CARE) Act of 2007. For too many 
years, certified nurse midwives (CNMs) have not received adequate 
reimbursement under the Medicare program. My legislation takes steps to 
improve reimbursement for these important healthcare providers.
  Since 1988, CNMs have been authorized to provide maternity-related 
services to Medicare-eligible women of child-bearing age. There are 
approximately three million disabled women of child-bearing age on 
Medicare; 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. This is not right and does not come close to offsetting the 
costs incurred by these professionals.
  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. In fact, the Commission recommended in 2002 
that CNMs' reimbursement be increased and acknowledged that the care 
provided by these individuals is at least comparable to similar 
providers.
  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. Several states have 
recognized this in their Medicaid programs--approximately 29 States 
reimburse at 100 percent of the physician fee schedule for out-of-
hospital services.
  In addition, the M-CARE Act 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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