```

[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2523 Introduced in Senate (IS)]

106th CONGRESS
  2d Session
                                S. 2523

    To amend title XVIII of the Social Security Act to provide for 
   reimbursement of certified midwife services, to provide for more 
equitable reimbursement rates for certified nurse-midwife services, and 
                          for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              May 9, 2000

  Mr. Conrad (for himself and Mr. Murkowski) 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, to provide for more 
equitable reimbursement rates for certified nurse-midwife services, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Promoting Access 
to Medicare Midwifery Services Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Medicare payment for certified midwife services.
Sec. 3. Increased medicare payments for certified nurse-midwife 
                            services and certified midwife services.
Sec. 4. Clarification of hospital conditions of participation with 
                            respect to certified nurse-midwives and 
                            certified midwives.
Sec. 5. Medicare payment for freestanding birth center services.
Sec. 6. Clarification of billing rights of certified nurse-midwives and 
                            certified midwives.
Sec. 7. Clarification regarding payments for certified nurse-midwife 
                            services and certified midwife services 
                            furnished in teaching hospitals.
Sec. 8. Interim and final regulations.

SEC. 2. MEDICARE PAYMENT FOR CERTIFIED MIDWIFE SERVICES.

    (a) Certified Midwife and Certified Midwife Services Defined.--
Section 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) is 
amended--
            (1) in paragraph (1)--
                    (A) by striking ``(as defined in paragraph (2))'' 
                and inserting ``(as defined in subparagraph (B))''; and
                    (B) by inserting ``(A)'' after ``(1)'';
            (2) by redesignating paragraph (2) as subparagraph (B); and
            (3) by adding at the end the following new paragraph:
    ``(2)(A) The term `certified midwife services' means such services 
furnished by a certified midwife (as defined in subparagraph (B)) and 
such services and supplies furnished as an incident to the certified 
midwife's service which the certified midwife is legally authorized to 
perform under State law (or the State regulatory mechanism provided by 
State law) as would otherwise be payable under this title if furnished 
by a physician or as an incident to a physician's service.
    ``(B) The term `certified midwife' means an individual--
            ``(i) with a bachelor's degree from an accredited 
        educational institution who has completed a program of study 
        and clinical experience meeting guidelines established by the 
        Secretary of Education; or
            ``(ii) who has been certified in nurse-midwifery or 
        midwifery by an organization recognized by the Secretary of 
        Education.''.
    (b) Certified Midwife Benefit.--
            (1) Scope of benefits.--Section 1832(a)(2)(B)(iii) of the 
        Social Security Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended 
        by inserting ``, certified midwife services'' after ``certified 
        nurse-midwife services''.
            (2) Payment of benefits.--Section 1833(a)(1)(K) of the 
        Social Security Act (42 U.S.C. 1395l(a)(1)(K)) is amended by 
        inserting ``and certified midwife services'' after ``certified 
        nurse-midwife services''.
    (c) Conforming Amendments.--
            (1) Use of carriers for administration of benefits.--
        Section 1842(b)(18)(C)(iii) of the Social Security Act (42 
        U.S.C. 1395u(b)(18)(C)(iii)) is amended by striking ``(as 
        defined in section 1861(gg)(2))'' and inserting ``or a 
        certified midwife (as defined in paragraph (1)(B) and (2)(B), 
        respectively, of section 1861(gg))''.
            (2) Health care professional defined.--Section 
        1852(j)(3)(D) of the Social Security Act (42 U.S.C. 1395w-
        22(j)(3)(D)) is amended by striking ``and certified nurse-
        midwife'' and inserting ``certified nurse-midwife, and 
        certified midwife''.
            (3) Inpatient hospital services.--Section 1861(b)(4) of the 
        Social Security Act (42 U.S.C. 1395x(b)(4)) is amended by 
        inserting ``, certified midwife services,'' after ``certified 
        nurse-midwife services''.
            (4) Medical and other health services.--Section 
        1861(s)(2)(L) of the Social Security Act (42 U.S.C. 
        1395x(s)(2)(L)) is amended by inserting ``and certified midwife 
        services'' before the semicolon at the end.
            (5) Rural health clinic services and federally qualified 
        health clinic services.--Section 1861(aa) of the Social 
        Security Act (42 U.S.C. 1395x(aa)) is amended--
                    (A) in paragraph (2)(J), by striking ``, or a 
                certified nurse-midwife (as defined in subsection 
                (gg))'' and inserting ``, a certified nurse-midwife (as 
                defined in subsection (gg)(1)(B)), or a certified 
                midwife (as defined in subsection (gg)(2)(B))''; and
                    (B) in paragraph (7)(A), by striking ``or certified 
                nurse midwife'' and inserting ``, certified nurse-
                midwife, or certified midwife''.
            (6) Certified nurse-midwife services.--The heading of 
        section 1861(gg) of the Social Security Act (42 U.S.C. 
        1395x(gg)) is amended by adding at the end the following:

                   ``; Certified Midwife Services''.

            (7) Exclusions from coverage and medicare as secondary 
        payer.--Section 1862(a)(14) of the Social Security Act (42 
        U.S.C. 1395y(a)(14)) is amended by inserting ``, certified 
        midwife services'' after ``certified nurse-midwife services''.
            (8) Agreements with providers of services.--Section 
        1866(a)(1)(H)(i) (42 U.S.C. 1395cc(a)(1)(H)(i)) is amended by 
        inserting ``, certified midwife services'' after ``certified 
        nurse-midwife services''.
            (9) Exclusion from payment to skilled nursing facilities 
        for routine service costs.--Section 1888(e)(2)(A)(ii) of the 
        Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended 
        by inserting ``, certified midwife services'' after ``certified 
        nurse-midwife services''.
            (10) Medicaid definitions.--Section 1905 of the Social 
        Security Act (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)(17)--
                            (i) by striking ``a nurse-midwife (as 
                        defined in section 1861(gg)) which the nurse-
                        midwife is'' and inserting ``a certified nurse-
                        midwife or a certified midwife (as defined in 
                        paragraphs (1)(B) and (2)(B), respectively, of 
                        section 1861(gg)) which the certified nurse-
                        midwife or certified midwife, as the case may 
                        be, is''; and
                            (ii) by striking ``whether or not the 
                        nurse-midwife'' and inserting ``whether or not 
                        the certified nurse-midwife or certified 
                        midwife, as the case may be,''; and
                    (B) in subsection (t)(2)(B)(ii), by striking ``(as 
                defined in section 1861(gg))'' and inserting ``or a 
                certified midwife (as defined in paragraphs (1)(B) and 
                (2)(B), respectively, of section 1861(gg)(2)(B))''.
            (11) Medicaid managed care.--Section 1932(b)(3)(C) of the 
        Social Security Act (42 U.S.C. 1396u-2(b)(3)(C)) is amended by 
        striking ``and certified nurse-midwife'' and inserting 
        ``certified nurse-midwife, and certified midwife''.
    (d) Effective Date.--The amendments made by this section shall 
apply to payment for certified nurse-midwife services and certified 
midwife services furnished on or after the date of enactment of this 
Act.

SEC. 3. INCREASED MEDICARE PAYMENTS FOR CERTIFIED NURSE-MIDWIFE 
              SERVICES AND CERTIFIED MIDWIFE SERVICES.

    (a) Amount of Payment.--Section 1833(a)(1)(K) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)(K)) is amended by striking ``65 
percent of the prevailing charge that would be allowed for the same 
service performed by a physician, or, for services furnished on or 
after January 1, 1992, 65 percent'' and inserting ``95 percent''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to certified nurse-midwife services and certified midwife 
services furnished on or after the date of enactment of this Act.

SEC. 4. CLARIFICATION OF HOSPITAL CONDITIONS OF PARTICIPATION WITH 
              RESPECT TO CERTIFIED NURSE-MIDWIVES AND CERTIFIED 
              MIDWIVES.

    (a) Payment to Hospital for Patients Under Care of Certified Nurse-
Midwife or Certified Midwife.--Section 1861(e)(4) of the Social 
Security Act (42 U.S.C. 1395x(e)(4)) is amended to read as follows:
            ``(4) has a requirement that every patient with respect to 
        whom payment may be made under this title must be under the 
        care of a physician, except that--
                    ``(A) a patient receiving qualified psychologist 
                services (as defined in subsection (B)) may be under 
                the care of a clinical psychologist with respect to 
                such services to the extent permitted under State law; 
                and
                    ``(B) a patient receiving certified nurse-midwife 
                services or certified midwife services (as defined in 
                paragraphs (1)(B) and (2)(B), respectively, of 
                subsection (gg)) may be under the care of a certified 
                nurse-midwife or certified midwife, as the case may be, 
                with respect to such services to the extent permitted 
under State law;''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of enactment of this Act.

SEC. 5. MEDICARE PAYMENT FOR FREESTANDING BIRTH CENTER SERVICES.

    (a) Freestanding Birth Center Services and Freestanding Birth 
Center Defined.--Section 1861(gg) of the Social Security Act (42 U.S.C. 
1395x(gg)) (as amended by section 2(a)) is amended by adding at the end 
the following new paragraph:
    ``(3)(A) The term `freestanding birth center services' means items 
and services furnished by a freestanding birth center (as defined in 
subparagraph (B)) as would otherwise be covered if furnished by a 
hospital.
    ``(B)(i) The term `freestanding birth center' means a facility or 
institution--
            ``(I) in which births are planned to occur (outside the 
        mother's place of residence);
            ``(II) in which comprehensive health care services are 
        furnished; and
            ``(III) which has been approved by the Secretary or 
        accredited by an organization recognized by the Secretary for 
        purposes of accrediting freestanding birth centers.
    ``(ii) Such term does not include--
            ``(I) a rural health clinic, critical access hospital, or a 
        sole community hospital; or
            ``(II) a facility or institution that is a hospital or an 
        ambulatory surgical center, unless with respect to ambulatory 
        surgical centers, the State law or regulation that regulates 
        such centers also regulates freestanding birth centers in the 
        State.''.
    (b) Freestanding Birth Center Benefit.--
            (1) Scope of benefits.--Section 1832(a)(2) of the Social 
        Security Act (42 U.S.C. 1395l(a)(2)) is amended--
                    (A) in subparagraph (I), by striking ``and'' at the 
                end;
                    (B) in subparagraph (J), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(K) freestanding birth center services performed 
                in a freestanding birth center if the center has an 
                agreement in effect with the Secretary by which the 
                center agrees to accept the amount of payment 
                determined under section 1833(u) as full payment for 
                such services, and to accept assignment described in 
                section 1842(b)(3)(B)(ii) with respect to payment for 
                all such services furnished by the center to 
                individuals enrolled under this part.''.
            (2) Payment of benefits.--Section 1833 of the Social 
        Security Act (42 U.S.C. 1395l) is amended by adding at the end 
        the following new subsection:
    ``(u) Payment for Freestanding Birth Center Services.--The 
Secretary shall establish by regulation the amount of payment to be 
made for facility services furnished in connection with freestanding 
birth center services and furnished to an individual in a freestanding 
birth center under this title.''.
    (c) Conforming Amendments.--
            (1) Medical and other health services.--Section 
        1861(s)(2)(L) of the Social Security Act (42 U.S.C. 
        1395x(s)(2)(L)) is amended--
                    (A) by adding ``and'' at the end;
                    (B) by inserting ``(i)'' after ``(L)''; and
                    (C) by adding at the end the following new clause:
            ``(ii) freestanding birth center services;''.
            (2) Certified nurse-midwife services; certified midwife 
        services.--The heading of section 1861(gg) of the Social 
        Security Act (42 U.S.C. 1395x(gg)) (as amended by section 
        2(c)(6)) is amended by adding at the end the following:

               ``; Freestanding Birth Center Services''.

    (d) Effective Date.--The amendments made by this section shall 
apply to freestanding birth center services furnished on or after the 
date of enactment of this Act.

SEC. 6. CLARIFICATION OF BILLING RIGHTS OF CERTIFIED NURSE-MIDWIVES AND 
              CERTIFIED MIDWIVES.

    (a) Use of Carriers for Administration of Benefits.--The first 
sentence of section 1842(b)(6) of the Social Security Act (42 U.S.C. 
1395u(b)(6)) is amended--
            (1) by striking ``and'' before ``(F)''; and
            (2) by inserting before the period at the end the 
        following: ``, and (G) in the case of certified nurse-midwife 
        services or certified midwife services described in section 
        1861(s)(2)(L), payment may be made in accordance with 
        subparagraph (A), except that payment may also be made to such 
        individual or entity (or to the agent of such individual or 
        entity) as the certified nurse-midwife or certified midwife, as 
        the case may be, may designate under an agreement between the 
        certified nurse-midwife or certified midwife, as the case may 
        be, and such individual or entity (or the agent of such 
        individual or entity)''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to payment for certified nurse-midwife services and certified 
midwife services furnished on or after the date of enactment of this 
Act.

SEC. 7. CLARIFICATION REGARDING PAYMENTS FOR CERTIFIED NURSE-MIDWIFE 
              SERVICES AND CERTIFIED MIDWIFE SERVICES FURNISHED IN 
              TEACHING HOSPITALS.

    (a) Scope of Benefits.--Section 1832(a)(2)(B)(iii) of the Social 
Security Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended--
            (1) by inserting ``(I)'' after ``(iii)''; and
            (2) by adding at the end the following new subclause:
                            ``(II) in the case of certified nurse-
                        midwife services or certified midwife services 
                        furnished in a hospital which has a teaching 
                        program described in clause (i)(II), such 
                        services may be furnished as provided under 
sections 1842(b)(7)(E) and 1861(b)(8);''.
    (b) Clarification Regarding Payments Under Part B for Such Services 
Furnished in Teaching Hospitals.--
            (1) In general.--Section 1842(b)(7) of the Social Security 
        Act (42 U.S.C. 1395u(b)(7)) is amended--
                    (A) in subparagraph (A), in the matter preceding 
                clause (i), by inserting ``or, for purposes of 
                subparagraph (E), the conditions described in section 
                1861(b)(8),'' after ``section 1861(b)(7),'';
                    (B) in subparagraph (C), by inserting ``or, for 
                purposes of subparagraph (E), the conditions described 
                in section 1861(b)(8),'' after ``section 1861(b)(7),''; 
                and
                    (C) by adding at the end the following new 
                subparagraph:
    ``(E) In the case of certified nurse-midwife services or certified 
midwife services furnished to a patient in a hospital with a teaching 
program approved as specified in section 1861(b)(6) but which does not 
meet the conditions described in section 1861(b)(8), the provisions of 
subparagraphs (A) through (C) shall apply with respect to a certified 
nurse-midwife or a certified midwife, as the case may be, under this 
subparagraph as such provisions apply to a physician under such 
subparagraphs.''.
            (2) Regulations.--Not later than 6 months after the date of 
        enactment of this Act, the Secretary shall promulgate 
        regulations to carry out the amendments made by paragraph (1).
    (c) Inpatient Hospital Services.--Section 1861(b) of the Social 
Security Act (42 U.S.C. 1395x(b)) is amended--
            (1) in paragraph (6)--
                    (A) by inserting ``(A)'' after ``(6)''; and
                    (B) by adding at the end the following new 
                subparagraph:
            ``(B) in the case of services in a hospital or osteopathic 
        hospital, an intern or resident-in-training in the field of 
        obstetrics and gynecology taught or supervised by a certified 
        nurse-midwife or certified midwife (as defined in paragraphs 
        (1)(B) and (2)(B), respectively, of subsection (gg)) to the 
        extent permitted under State law and as may be authorized by 
        the hospital;'';
            (2) in paragraph (7), by striking the period at the end and 
        inserting ``; or''; and
            (3) by adding at the end the following new paragraph:
            ``(8) a certified nurse-midwife or a certified midwife 
        where the hospital has a teaching program approved as specified 
        in paragraph (6), if--
                    ``(A) the hospital elects to receive any payment 
                due under this title for reasonable costs of such 
                services; and
                    ``(B) all certified nurse-midwives and certified 
                midwives in such hospital agree not to bill charges for 
                professional services rendered in such hospital to 
                individuals covered under the insurance program 
                established by this title.''.

SEC. 8. INTERIM AND FINAL REGULATIONS.

    Except with respect to the amendments made by section 7(b), in 
order to carry out the amendments made by this Act in a timely manner, 
the Secretary of Health and Human Services may first promulgate 
regulations that take effect on an interim basis after notice and 
pending opportunity for public comment by not later than 1 year after 
the date of enactment of this Act.
                                 <all>
```