II 

110TH CONGRESS 

1ST SESSION S. 507 

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. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 6, 2007 

Mr. CONRAD (for himself, Ms. COLLINS, Ms. CANTWELL, and Mr. DURBIN) 

introduced the following bill; which was read twice and referred to the 

Committee on Finance 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Midwifery Care Access 

5 and Reimbursement Equity Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


pwalker on PROD1PC71 with BILLS
2 

•S 507 IS

1 (1) The Medicare program reimburses certified 

2 nurse-midwives for primary care services, as author3 ized by State law. 

4 (2) Since 1988, Congress has authorized reim5 bursement under the Medicare program to certified 

6 nurse-midwives for the provision of maternity-related 

7 services to Medicare-eligible women with disabilities 

8 who are of childbearing age. 

9 (3) Since 1993, Congress authorized reimburse10 ments under the Medicare program to certified 

11 nurse-midwives to also provide additional services 

12 outside the maternity cycle. 

13 (4) In its June 2002 report to Congress, the 

14 Medicare Payment Advisory Commission (MedPAC) 

15 unanimously recommended that the percentage of 

16 part B reimbursement for certified nurse-midwife 

17 services to be increased by Congress. MedPAC also 

18 highlighted the high quality of care provided by cer19 tified nurse-midwives. 

20 (5) Certified nurse-midwives and certified mid21 wives are highly educated health professionals. To 

22 practice in the United States as either a certified 

23 nurse-midwife or a certified midwife, an individual 

24 must complete a post-baccalaureate educational proVerDate Aug 31 2005 23:29 Feb 08, 2007 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S507.IS S507

pwalker on PROD1PC71 with BILLS
3 

•S 507 IS

1 gram and State licensure as well as pass a national 

2 certification examination. 

3 (6) While most State Medicaid programs reim4 burse certified nurse-midwives and other obstetrical 

5 and gynecological providers at the same payment 

6 rate, the Medicare program reimburses such mid7 wives at a payment rate that is 35 percent lower 

8 than such other providers. 

9 (7) This disparity is a barrier to women’s ac10 cess to obstetrical and gynecological providers of 

11 their choice within the Medicare program. 

12 (8) Health disparities in the United States con13 tinue to be a critical problem. Midwives have histori14 cally cared for those populations most at risk for 

15 health disparities in areas of high infant mortality, 

16 preterm birth, low birth weight, sudden infant death 

17 syndrome, maternal mortality, breast and cervical 

18 cancer, and HIV/AIDS infection among women. 

19 (9) Providing more equitable reimbursement for 

20 the high quality primary care services of certified 

21 nurse-midwives and certified midwives will aid in en22 suring their services are available to women in need. 


pwalker on PROD1PC71 with BILLS
4 

•S 507 IS

1 SEC. 3. MEDICARE PAYMENT FOR CERTIFIED NURSE-MID2 WIFE AND MIDWIFE SERVICES. 

3 (a) CERTIFIED MIDWIFE, CERTIFIED MIDWIFE

4 SERVICES DEFINED.—(1) Section 1861(gg) of the Social 

5 Security Act (42 U.S.C. 1395x(gg)) is amended by adding 

6 at the end the following new paragraphs: 

7 ‘‘(3) The term ‘certified midwife services’ means such 

8 services furnished by a certified midwife (as defined in 

9 paragraph (4)) and such services and supplies furnished 

10 as an incident to the certified midwife’s service which the 

11 certified midwife is legally authorized to perform under 

12 State law (or the State regulatory mechanism provided by 

13 State law) as would otherwise be payable under this title 

14 if furnished by a physician or as an incident to a physi15 cian’s service. 

16 ‘‘(4) The term ‘certified midwife’ means an individual 

17 who has successfully completed a bachelor’s degree from 

18 an accredited educational institution and a program of 

19 study and clinical experience meeting guidelines prescribed 

20 by the Secretary, or has been certified by an organization 

21 recognized by the Secretary.’’. 

22 (2) The heading in section 1861(gg) of the Social Se23 curity Act (42 U.S.C. 1395x(gg)) is amended to read as 

24 follows: 


pwalker on PROD1PC71 with BILLS
5 

•S 507 IS

1 ‘‘Certified Nurse-Midwife Services; Certified Midwife 

2 Services’’. 

3 (b) CERTIFIED MIDWIFE SERVICE BENEFIT.— 

4 (1) MEDICAL AND OTHER SERVICES.—Section 

5 1861(s)(2)(L) of the Social Security Act (42 U.S.C. 

6 1395x(s)(2)(L)) is amended by inserting ‘‘and cer7 tified midwife services’’ before the semicolon. 

8 (2) PERMITTING HOSPITALS TO PROVIDE FOR

9 PATIENTS RECEIVING CERTIFIED NURSE-MIDWIFE

10 SERVICES OR CERTIFIED MIDWIFE SERVICES TO BE

11 UNDER THE CARE OF A CERTIFIED NURSE-MIDWIFE

12 OR CERTIFIED MIDWIFE.—Section 1861(e)(4) of the 

13 Social Security Act (42 U.S.C. 1395x(e)(4)) is 

14 amended— 

15 (A) by inserting ‘‘(i)’’ after ‘‘except that’’; 

16 and 

17 (B) by inserting before the semicolon the 

18 following: ‘‘and (ii) a patient receiving certified 

19 nurse-midwife services or certified midwife serv20 ices (as defined in paragraphs (1) and (3), re21 spectively, of subsection (gg)) may be under the 

22 care of a certified nurse-midwife or certified 

23 midwife with respect to such services to the ex24 tent permitted under State law’’. 


pwalker on PROD1PC71 with BILLS
6 

•S 507 IS

1 (3) BENEFIT UNDER PART B.—Section 

2 1832(a)(2)(B)(iii) of the Social Security Act (42 

3 U.S.C. 1395k(a)(2)(B)(iii)) is amended by inserting 

4 ‘‘certified midwife services,’’ after ‘‘certified nurse5 midwife services,’’. 

6 (4) AMOUNT OF PAYMENT.—Section 

7 1833(a)(1)(K) of the Social Security Act (42 U.S.C. 

8 1395l(a)(1)(K)) is amended— 

9 (A) by inserting ‘‘and certified midwife 

10 services’’ after ‘‘certified nurse-midwife serv11 ices’’; and 

12 (B) by striking ‘‘65 percent’’ and inserting 

13 ‘‘100 percent’’ each place it appears. 

14 SEC. 4. INTERIM, FINAL REGULATIONS. 

15 In order to carry out the amendments made by this 

16 Act in a timely manner, not later than 6 months after 

17 the date of the enactment of this Act, the Secretary of 

18 Health and Human Services shall promulgate regulations, 

19 that take effect on an interim basis, after notice and pend20 ing opportunity for public comment. 

Æ 


pwalker on PROD1PC71 with BILLS