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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5262 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  2d Session
                                S. 5262

   To address maternity care shortages and promote optimal maternity 
   outcomes by expanding access to birth centers and exploring more 
effective payment models for birth center care, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           September 25, 2024

   Mr. Lujan introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
   To address maternity care shortages and promote optimal maternity 
   outcomes by expanding access to birth centers and exploring more 
effective payment models for birth center care, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Better Availability of Birth Centers 
Improves Outcomes and Expands Savings Act'' or the ``BABIES Act''.

SEC. 2. GRANTS TO IMPROVE ACCESS TO FREESTANDING BIRTH CENTER SERVICES.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following:

``SEC. 399V-8. STRONG START BIRTH CENTER GRANTS TO ASSIST BIRTH CENTERS 
              WITH START-UP OR EXPANSION COSTS TO EXPAND ACCESS TO 
              BIRTH CENTER SERVICES IN UNDERSERVED AREAS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, may award grants 
to eligible birth centers that are accredited, or intend to seek 
accreditation, as birth centers by a nationally recognized accrediting 
body such as the Commission for the Accreditation of Birth Centers, or 
that have the intention of seeking such accreditation, for the purposes 
described in subsection (b).
    ``(b) Use of Funds.--A birth center receiving a grant under this 
section may use such grant funds for any of the following purposes:
            ``(1) Renovation, expansion, or construction of a birth 
        center facility.
            ``(2) Purchasing or updating equipment for a birth center.
            ``(3) Accreditation and State licensure activities.
    ``(c) Grants; Grant Amounts.--For each of fiscal years 2025 through 
2029, the Secretary shall award grants under this section to up to 15 
birth centers, each in an amount of not less than $300,000 and not more 
than $500,000.
    ``(d) Special Considerations.--In awarding grants under this 
section, the Secretary shall give special consideration to an eligible 
birth center that--
            ``(1) is located in, or offers services to, a geographic 
        area that--
                    ``(A) has been designated under section 332 as a 
                health professional shortage area with respect to 
                maternity care; or
                    ``(B) has maternity care outcomes that are below a 
                threshold established by the Secretary; and
            ``(2) has not previously received a grant under this 
        section.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for the period of 
fiscal years 2025 through 2029.''.

SEC. 3. MEDICAID DEMONSTRATION PROGRAM TO IMPROVE FREESTANDING BIRTH 
              CENTER SERVICES.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(cc) Demonstration Program To Improve Freestanding Birth Center 
Services.--
            ``(1) Authority.--The Secretary shall conduct a 
        demonstration program for the purpose of exploring more 
        effective payment models for birth center care in order to 
        improve access to, and the quality and scope of, freestanding 
        birth center services for women with a low-risk pregnancy who 
        are eligible for medical assistance under the State plan under 
        this title or under a waiver of such plan.
            ``(2) Deadlines for participation criteria, prospective 
        payment system; planning grants.--
                    ``(A) Participation and prospective payment system 
                deadline.--Not later than 1 year after the date of the 
                enactment of this subsection, the Secretary shall do 
                the following:
                            ``(i) Publication of participation criteria 
                        for freestanding birth centers.--
                                    ``(I) In general.--The Secretary 
                                shall publish criteria for a 
                                freestanding birth center to be 
                                certified by a State for purposes of 
                                participating in a State demonstration 
                                program conducted under this 
                                subsection.
                                    ``(II) Requirements.--The criteria 
                                required to be published under 
                                subclause (I) shall include the 
                                following:
                                            ``(aa) Accreditation.--At 
                                        the time of certification for 
                                        purposes of participating in 
                                        the demonstration program 
                                        conducted under this 
                                        subsection, a freestanding 
                                        birth center must be accredited 
                                        or have completed the initial 
                                        phase of accreditation from an 
                                        approved, nationally-recognized 
                                        birth center accreditation 
                                        body, as determined by the 
                                        Secretary.
                                            ``(bb) Licensure and other 
                                        requirements.--A freestanding 
                                        birth center shall--

                                                    ``(AA) be licensed, 
                                                or otherwise approved, 
                                                by the State to provide 
                                                prenatal, labor and 
                                                delivery, postpartum, 
                                                newborn care, and other 
                                                ambulatory services for 
                                                which medical 
                                                assistance is available 
                                                under the State plan or 
                                                waiver under this 
                                                title; and

                                                    ``(BB) comply with 
                                                such other requirements 
                                                relating to the health 
                                                and safety of 
                                                individuals who receive 
                                                services furnished by 
                                                the facility as the 
                                                State shall establish.

                                            ``(cc) Care coordination.--
                                        A freestanding birth center 
                                        shall be able to meet care 
                                        coordination requirements 
                                        established by the Secretary, 
                                        including requirements to 
                                        coordinate care across settings 
                                        and providers to ensure 
                                        seamless transitions for 
                                        patients across the full 
                                        spectrum of health services, 
                                        and shall be able to engage in 
                                        consultation for higher level 
                                        maternity care services, non-
                                        maternity care services, and 
                                        behavioral health needs, which 
                                        may include plans for 
                                        consultation, collaboration and 
                                        referral, and arrangements with 
                                        the following:

                                                    ``(AA) Federally 
                                                qualified health 
                                                centers (and as 
                                                applicable, rural 
                                                health clinics) to 
                                                provide Federally 
                                                qualified health center 
                                                services (and as 
                                                applicable, rural 
                                                health clinic services) 
                                                to the extent such 
                                                services are not 
                                                provided directly 
                                                through the birth 
                                                center.

                                                    ``(BB) Other 
                                                outpatient clinics, 
                                                including licensed 
                                                midwifery and physician 
                                                practices.

                                                    ``(CC) Inpatient 
                                                acute care facilities 
                                                with obstetrical care 
                                                units.

                                            ``(dd) Scope of services.--
                                        As determined by the Secretary, 
                                        a freestanding birth center 
                                        shall be able to provide 
                                        peripartum care for women with 
                                        a low-risk pregnancy and for 
                                        newborns, consistent with 
                                        evidence-based guidelines.
                                            ``(ee) Capabilities.--A 
                                        freestanding birth center shall 
                                        have the following 
                                        capabilities:

                                                    ``(AA) In addition 
                                                to the requirements 
                                                specified under section 
                                                431.53 of title 42, 
                                                Code of Federal 
                                                Regulations, and any 
                                                successor regulation 
                                                (relating to assurance 
                                                of transportation), the 
                                                capability and 
                                                equipment to provide 
                                                prenatal, labor and 
                                                delivery, postpartum, 
                                                and newborn care for 
                                                women with a low-risk 
                                                pregnancy, readiness at 
                                                all times to initiate 
                                                emergency procedures to 
                                                meet unexpected needs 
                                                of such women and of 
                                                newborns within the 
                                                center, including at 
                                                least 2 qualified staff 
                                                on-site at every birth, 
                                                and the ability to 
                                                facilitate transport to 
                                                an acute care hospital 
                                                with an obstetrical 
                                                care unit when 
                                                necessary.

                                                    ``(BB) An 
                                                established transfer 
                                                plan with a receiving 
                                                hospital with an 
                                                obstetrical care unit 
                                                with policies and 
                                                procedures for timely 
                                                transport.

                                                    ``(CC) Medical 
                                                consultation available 
                                                from a licensed board-
                                                certified physician 
                                                with admitting 
                                                privileges in 
                                                obstetrics at a nearby 
                                                hospital, as defined by 
                                                State law or 
                                                regulation.

                                                    ``(DD) Data 
                                                collection, storage, 
                                                and retrieval, 
                                                including data on 
                                                intrapartum and 
                                                postpartum maternal and 
                                                newborn transfer rates 
                                                and hospital 
                                                admissions.

                                                    ``(EE) The ability 
                                                to initiate and 
                                                document quality 
                                                improvement programs as 
                                                required by 
                                                accreditation that 
                                                include efforts to 
                                                maximize patient 
                                                safety, such as safety 
                                                checklists, validated 
                                                training and competency 
                                                of staff, and emergency 
                                                preparedness and 
                                                drills.

                                            ``(ff) Health care 
                                        providers.--A freestanding 
                                        birth center shall employ, or 
                                        have care delivery arrangements 
                                        with, both of the following:

                                                    ``(AA) A physician 
                                                licensed to practice 
                                                within the State or 
                                                jurisdiction of the 
                                                birth center.

                                                    ``(BB) A midwife 
                                                that meets or exceeds 
                                                the education and 
                                                training standards of 
                                                the International 
                                                Confederation of 
                                                Midwives and who is 
                                                licensed to practice 
                                                within the jurisdiction 
                                                of the birth center.

                                            ``(gg) Non-duplication.--In 
                                        carrying out this subsection, 
                                        the Secretary shall, with 
                                        respect to a State 
                                        participating in the 
                                        demonstration program, 
                                        establish procedures to 
                                        prevent, to the greatest extent 
                                        practicable, the provision of, 
                                        or payment for, services under 
                                        the demonstration program for 
                                        which medical assistance is 
                                        available under the State plan 
                                        under this title or waiver of 
                                        such plan.
                            ``(ii) Guidance on development of 
                        prospective payment system for testing under 
                        state demonstration programs.--
                                    ``(I) In general.--The Secretary 
                                shall issue guidance for States 
                                participating in a demonstration 
                                program conducted under this subsection 
                                to establish a prospective payment 
                                system that shall only apply to 
                                freestanding birth center services 
                                that--
                                            ``(aa) meet the criteria 
                                        established under clause (i); 
                                        and
                                            ``(bb) are furnished by a 
                                        freestanding birth center 
                                        participating in such a 
                                        demonstration program.
                                    ``(II) Requirements.--The guidance 
                                issued by the Secretary under subclause 
                                (I) shall, to the greatest extent 
                                practicable, provide for--
                                            ``(aa) a partial facility 
                                        payment based on units in the 
                                        case that a pregnant woman is 
                                        admitted in labor and then 
                                        needs to be transferred to the 
                                        hospital in labor before the 
                                        birth of the baby;
                                            ``(bb) a facility payment 
                                        for therapeutic rest or for 
                                        observation short stays to rule 
                                        out labor;
                                            ``(cc) ensuring payment for 
                                        the newborn and mother as 2 
                                        separate facility payment 
                                        components;
                                            ``(dd) ensuring payment for 
                                        nitrous oxide and hydrotherapy 
                                        supplies costs for pain relief;
                                            ``(ee) ensuring payment for 
                                        all professional services of 
                                        health professionals involved 
                                        in the delivery of care in a 
                                        birth center, which may 
                                        include--

                                                    ``(AA) 3 or more 
                                                prenatal office visits;

                                                    ``(BB) observation 
                                                and triage;

                                                    ``(CC) newborn exam 
                                                and care; and

                                                    ``(DD) multiple 
                                                postpartum, mother, and 
                                                newborn visits, as 
                                                needed;

                                            ``(ff) ensuring payment for 
                                        partial prenatal and postpartum 
                                        care episodes or for prenatal 
                                        care only with planned delivery 
                                        in the hospital and returning 
                                        for postpartum care in the 
                                        birth center; and
                                            ``(gg) payment for services 
                                        provided within--

                                                    ``(AA) in the case 
                                                of a pregnant woman, 
                                                the period that 
                                                commences upon the 
                                                confirmation of 
                                                pregnancy when the 
                                                woman is accepted into 
                                                care at the 
                                                freestanding birth 
                                                center, continues 
                                                through prenatal care, 
                                                labor, and delivery, 
                                                and ends at the 
                                                completion of the 
                                                postpartum period (as 
                                                defined by State law or 
                                                regulation) with 
                                                documentation of a plan 
                                                for continued well 
                                                woman care, inclusive 
                                                of at least 2 
                                                postpartum care visits; 
                                                and

                                                    ``(BB) in the case 
                                                of a newborn, a period 
                                                that continues through 
                                                the first 28 days of 
                                                life with documentation 
                                                of continued infant 
                                                care.

                            ``(iii) Publication of an rfp for states to 
                        apply for the demonstration program.--
                                    ``(I) In general.--The Secretary 
                                shall publish a request for proposal 
                                (in this clause referred to as an 
                                `RFP') for States to establish and test 
                                a prospective payment system for 
                                freestanding birth center services 
                                that--
                                            ``(aa) meets the criteria 
                                        established under clause (i); 
                                        and
                                            ``(bb) are furnished by a 
                                        freestanding birth center 
                                        participating in a 
                                        demonstration program under 
                                        this subsection.
                                    ``(II) Requirements.--The RFP 
                                published by the Secretary under 
                                subclause (I) shall, to the greatest 
                                extent practicable, include the 
                                following parameters:
                                            ``(aa) States must have a 
                                        minimum number of established 
                                        or developing birth centers.
                                            ``(bb) States must have a 
                                        mechanism to recognize or 
                                        license birth centers.
                                            ``(cc) States must have at 
                                        least 1 area that has been 
                                        designated a maternity care 
                                        desert.
                                            ``(dd) States must have 
                                        areas with maternity care 
                                        outcomes that are below a 
                                        certain threshold, as 
                                        determined by the Secretary.
                                            ``(ee) States should 
                                        represent a diverse selection 
                                        of geographic areas, including 
                                        rural and underserved areas.
                                            ``(ff) Preference should be 
                                        given to States that 
                                        demonstrate the potential to 
                                        expand the availability of and 
                                        access to maternity care 
                                        services in a demonstration 
                                        area and increase the quality 
                                        of services provided by 
                                        freestanding birth centers 
                                        without increasing net Federal 
                                        spending, as determined by the 
                                        Secretary.
                                    ``(III) Required information.--A 
                                State application to conduct a 
                                demonstration program under this 
                                subsection shall include the following:
                                            ``(aa) A description of the 
                                        target population of 
                                        individuals who are eligible 
                                        for medical assistance under 
                                        the State plan under this title 
                                        or under a waiver of such plan 
                                        and are to be served under the 
                                        demonstration program.
                                            ``(bb) A list of the 
                                        participating freestanding 
                                        birth centers in the State.
                                            ``(cc) Verification that 
                                        each participating freestanding 
                                        birth center meets the 
                                        participation criteria 
                                        established in paragraph 
                                        (2)(A)(i).
                                            ``(dd) A description of the 
                                        scope of the freestanding birth 
                                        center services available under 
                                        the State plan under this title 
                                        or waiver of such plan for 
                                        women with a low-risk pregnancy 
                                        that will be paid for under the 
                                        prospective payment system 
                                        tested in the demonstration 
                                        program.
                                            ``(ee) Verification that 
                                        the State has agreed to pay for 
                                        such services at the rate 
                                        established under the 
                                        prospective payment system.
                                            ``(ff) An assurance that 
                                        the State will require 
                                        freestanding birth centers to 
                                        submit to the State, and that 
                                        the State will submit to the 
                                        Secretary, such information and 
                                        data as the State or Secretary 
                                        may require relating to the 
                                        demonstration program or an 
                                        episode of care for such a 
                                        pregnant woman or newborn.
                                            ``(gg) Such other 
                                        information as the Secretary 
                                        may require relating to the 
                                        demonstration program, 
                                        including with respect to 
                                        determining the soundness of 
                                        the proposed prospective 
                                        payment system.
                                    ``(IV) Deadlines for submission of 
                                rfp applications.--The deadline for a 
                                State to submit an application to 
                                participate in the demonstration 
                                program conducted under this subsection 
                                shall be the date that is 90 days after 
                                the date on which the Secretary 
                                publishes the RFP under subclause (I).
                    ``(B) Planning grants.--
                            ``(i) In general.--Not later than 18 months 
                        after the date of enactment of this subsection, 
                        the Secretary shall award a planning grant to 
                        up to 6 States for the purpose of developing a 
                        detailed proposal to conduct a demonstration 
                        program described in paragraph (3).
                            ``(ii) Use of funds.--A State awarded a 
                        planning grant under this subparagraph shall 
                        use the funds awarded under such grant to--
                                    ``(I) solicit input with respect to 
                                the development of the demonstration 
                                program from patients, providers 
                                (including certified nurse-midwives, 
                                other midwives licensed within the 
                                State, and physicians), and other 
                                stakeholders;
                                    ``(II) secure participation of 
                                freestanding birth centers that meet 
                                the criteria established under 
                                subparagraph (A)(i), including by 
                                providing support for such centers to 
                                meet that criteria (including 
                                accreditation) in order to maximize the 
                                number of freestanding birth centers 
                                participating in the demonstration 
                                program; and
                                    ``(III) in accordance with the 
                                guidance issued under subparagraph 
                                (A)(ii), establish a prospective 
                                payment system which the State shall 
                                use for making payments to freestanding 
                                birth centers participating in the 
                                demonstration program.
            ``(3) State demonstration programs.--
                    ``(A) In general.--Not later than 2 years after the 
                date of enactment of this subsection, the States 
                selected by the Secretary under paragraph (2)(B)(i) 
                shall launch their demonstration programs.
                    ``(B) Length of demonstration programs.--A State 
                conducting a demonstration program in accordance with 
                this paragraph shall conduct the program for a 4-year 
                period.
                    ``(C) Payment for services provided by freestanding 
                birth centers.--
                            ``(i) In general.--During the first 16 
                        fiscal quarter period (or any portion of such 
                        period) that the State participates in the 
                        demonstration program, the Secretary shall pay 
                        a State participating in a demonstration 
                        program under this subsection the Federal 
                        matching percentage specified in clause (ii) 
                        for amounts expended by the State to provide 
                        freestanding birth center services that meet 
                        the criteria established under paragraph 
                        (2)(A)(i) and are furnished by a freestanding 
                        birth center in accordance with the prospective 
                        payment system for such services established by 
                        the State pursuant to the guidance issued under 
                        paragraph (2)(A)(ii) to individuals who are 
                        enrolled in the State Medicaid program.
                            ``(ii) Federal matching percentage.--
                        Subject to clause (iii), the Federal matching 
                        percentage specified in this clause is, with 
                        respect to medical assistance described in 
                        clause (i) that is furnished by a State 
                        participating in an ongoing demonstration 
                        program under this subsection--
                                    ``(I) to a newly eligible 
                                individual described in paragraph (2) 
                                of section 1905(y), the matching rate 
                                applicable under paragraph (1) of that 
                                section (as increased under section 
                                1905(ii), if applicable); and
                                    ``(II) to an individual who is not 
                                a newly eligible individual (as so 
                                described) but who is eligible for 
                                medical assistance under the State 
                                Medicaid program, the enhanced FMAP 
                                applicable to the State.
                            ``(iii) Application of higher match.--
                        Clause (ii) shall not apply in the case of 
                        State expenditures described in such clause if 
                        the application of such clause would result in 
                        a lower Federal medical assistance percentage 
                        for such expenditures than would otherwise 
                        apply without the application of such clause.
                            ``(iv) Limitation.--Payments shall be made 
                        under this subparagraph to a State only for 
                        amounts expended by the State to provide 
                        medical assistance for freestanding birth 
                        center services that are described in the 
                        demonstration program application submitted by 
                        the State and approved by the Secretary.
                            ``(v) Administrative expenses.--Amounts 
                        expended by a State to conduct a demonstration 
                        program in accordance with this paragraph shall 
                        be considered, for purposes of subsection 
                        (a)(7), to be necessary for the proper and 
                        efficient administration of the State plan.
                    ``(D) Waiver of statewideness requirement.--The 
                Secretary shall waive the requirements of section 
                1902(a)(1) (relating to Statewideness), section 
                1902(a)(10)(B) (relating to comparability), and any 
                other provision of this title which would be directly 
                contrary to the authority under this subsection as may 
                be necessary for a State to conduct a demonstration 
                program in accordance with this paragraph.
                    ``(E) Annual reports.--
                            ``(i) In general.--Not later than 2 years 
                        after the date on which the first State is 
                        selected to conduct a demonstration program 
                        under this subsection, and annually thereafter, 
                        based on information and data submitted by 
                        States in accordance with the assurance 
                        provided under paragraph (2)(A)(iii)(III)(ff), 
                        the Secretary shall submit to Congress an 
                        annual report on all State demonstration 
                        programs conducted under this subsection. Each 
                        such report shall include with respect to each 
                        such State demonstration program--
                                    ``(I) an assessment of clinical 
                                outcomes for maternity services 
                                provided by freestanding birth centers 
                                participating in the demonstration 
                                program for individuals who are 
                                eligible for medical assistance under a 
                                State plan under this title or under a 
                                waiver of such plan and are women with 
                                a low-risk pregnancy with outcomes in 
                                comparable demographic and geographic 
                                areas, including with respect to--
                                            ``(aa) the number of births 
                                        and data on intrapartum and 
                                        postpartum maternal and newborn 
                                        transfer rates and hospital 
                                        admissions; and
                                            ``(bb) the rate of primary 
                                        and repeat cesarean sections, 
                                        preterm births, and neonatal 
                                        intensive care unit admissions; 
                                        and
                                    ``(II) an assessment of the impact 
                                of all the State demonstration programs 
                                conducted under this subsection on the 
                                Federal and State costs relating to 
                                providing freestanding birth center 
                                services for individuals who are 
                                eligible for medical assistance under a 
                                State plan under this title or under a 
                                waiver of such plan and are women with 
                                a low-risk pregnancy (including with 
                                respect to the provision of inpatient, 
                                emergency, and ambulatory services) and 
                                newborn care, compared to the Federal 
                                and State costs related to the 
                                provision of--
                                            ``(aa) freestanding birth 
                                        center services to such 
                                        individuals by freestanding 
                                        birth centers outside of such 
                                        demonstration programs; and
                                            ``(bb) traditional 
                                        maternity services as provided 
                                        in non-birth center clinics and 
                                        hospital programs.
                            ``(ii) Recommendations.--Not later than 6 
                        months after the end of the third year of the 
                        demonstration program conducted under this 
                        subsection, the Secretary shall submit to 
                        Congress recommendations concerning whether 
                        such demonstration program should be continued, 
                        expanded, modified, or terminated.
            ``(4) Funding.--
                    ``(A) In general.--Out of any funds in the Treasury 
                not otherwise appropriated, there is appropriated to 
                the Secretary--
                            ``(i) for purposes of carrying out 
                        paragraph (2)(B), $3,000,000; and
                            ``(ii) for purposes of carrying out the 
                        demonstration programs described in paragraph 
                        (3), $24,000,000, to be appropriated at the 
                        rate of $6,000,000 per year for 4 years.
                    ``(B) Availability.--Funds appropriated under 
                subparagraph (A) shall remain available until expended.
            ``(5) Definitions.--In this subsection:
                    ``(A) Freestanding birth center services.--The term 
                `freestanding birth center services' has the meaning 
                given that term under section 1905(l)(3)(A) and 
                includes such other services as the Secretary shall 
                determine for purposes of conducting the demonstration 
                programs described in paragraph (3).
                    ``(B) Low-risk pregnancy.--The term `low-risk 
                pregnancy' means an uncomplicated singleton term 
                pregnancy with a vertex presentation with an expected 
                uncomplicated birth.''.
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