[Congressional Record Volume 155, Number 48 (Thursday, March 19, 2009)]
[Senate]
[Pages S3574-S3575]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Ms. Collins, Mr. Wyden, Mr. Schumer, 
        Mr. Kerry, Ms. Klobuchar, and Mrs. Boxer):
  S. 662. 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 2009 with my colleague, 
Senator Collins. For too many years, certified nurse midwives, CNMs, 
have not received adequate reimbursement under the Medicare program. 
Our legislation takes steps to improve reimbursement and ensure access 
to these important providers.
  There are approximately three million disabled women of child-bearing 
age on Medicare, and since 1988, midwives have been providing high-
quality, low cost maternity services to these women. However, given 
outdated payment policies, CNMs are only reimbursed at 65 percent of 
the physician fee schedule. This makes it impossible to make a practice 
sustainable and is threatening access to CNMs across the country.
  The Medicare Payment Advisory Commission, MedPAC, agrees. In a 2002 
report, MedPAC recommended that CNMs' reimbursement be increased and 
acknowledged that the care provided by these individuals is comparable 
to similar providers.
  That is why we are introducing legislation that would provide payment 
equity for CNMs by reimbursing them at 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 fact, a majority of 
the states reimburse CNMs at 100 percent of the physician fee schedule 
for out-of-hospital services provided to Medicaid beneficiaries. The 
time has come to extend this policy to Medicare.
  In addition, the M-CARE Act would establish recognition for a 
certified midwife 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. Our bill would change this.
  A variety of national organizations have expressed their support for 
this legislation in the past. I am pleased to say that the National 
Rural Health Association, the National Perinatal Association, the 
American College of Obstetricians and Gynecologists, along with several 
nursing organizations, have endorsed this legislation.
  This bill will enhance access to ``well woman'' care for thousands of 
women in underserved communities. I urge my colleagues to support this 
legislation and end this inequity once and for all.

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