I

103D CONGRESS

1ST SESSION H. R. 1771

To reduce infant mortality in rural, underserved areas by improving access

to needed health care services by pregnant women.

IN THE HOUSE OF REPRESENTATIVES

APRIL 21, 1993

Mr. ROWLAND (for himself, Mr. HALL of Texas, Mrs. VUCANOVICH, Mr.

THOMAS of Wyoming, Mr. EMERSON, Mr. LANCASTER, Mr. ROBERTS,

Mr. BEREUTER, Mr. SLATTERY, Mr. STENHOLM, Ms. SNOWE, and Mr.

DURBIN) introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

To reduce infant mortality in rural, underserved areas by

improving access to needed health care services by pregnant women.

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 ‘‘Rural Access to

5 Obstetrical Care Act of 1993’’.
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1 SEC. 2. MEDICAID DEMONSTRATION PROJECTS TO IM2 PROVE ACCESS IN RURAL, UNDERSERVED

3 AREAS TO OBSTETRIC SERVICES.

4 (a) IN GENERAL.—The Secretary of Health and

5 Human Services shall provide under this section for dem6 onstration projects by States that seek to reduce infant

7 mortality by improving access in rural, underserved areas

8 to obstetric services for eligible pregnant women under

9 title XIX of the Social Security Act.

10 (b) NATURE OF PROJECTS.—Demonstration projects

11 under this section shall incorporate innovative approaches

12 for increasing the participation of obstetric providers

13 under title XIX of the Social Security Act, such as—

14 (1) expediting reimbursement and using innova15 tive payment mechanisms, including global fees for

16 obstetric services with guaranteed periodic pay17 ments;

18 (2) special or enhanced reimbursement for early

19 prenatal care, risk-assessment, and high-risk serv20 ices;

21 (3) patient distribution or referral systems;

22 (4) subsidizing medical liability insurance pre23 miums, in whole or in part, for selected obstetric

24 providers;
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1 (5) paying for all or a portion of payments

2 made in settlement of malpractice claims by patients

3 of obstetric providers who meet certain criteria; and

4 (6) providing professional liability coverage

5 under the State tort claims act for certain obstetric

6 providers while treating a specified category of

7 patients.

8 Demonstration projects addressing reimbursement must

9 provide for integrated prenatal, delivery and postpartum

10 services.

11 (c) SUPPLEMENTAL FUNDING.—(1) With respect to

12 the additional expenditures for medical assistance made

13 under the State plan under title XIX of the Social Secu14 rity Act to carry out a demonstration project under this

15 section, the Federal medical assistance percentage (other16 wise determined under section 1905(b) of such Act) shall

17 be increased by 25 percentage points (but in no case to

18 a percentage greater than 95 percent).

19 (2) The amount of funds that may be expended as

20 medical assistance to carry out the purposes of this section

21 shall be $30,000,000 during the 5-fiscal-year period begin22 ning with fiscal year 1994.

23 (d) WAIVER AUTHORITY.—(1) Except as provided

24 under paragraphs (2) and (3), the Secretary is authorized

25 to waive the requirements of title XIX of the Social Secu-
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1 rity Act to the extent necessary to implement demonstra2 tion projects under this section.

3 (2) Except as permitted under section 1915(b)(1) of

4 the Social Security Act, the Secretary may not waive

5 under paragraph (1) the requirement of sections

6 1902(a)(23) and 1916 of such Act.

7 (3) The Secretary may not approve a demonstration

8 project under this section, or a waiver under paragraph

9 (1), that reduces the amount, duration, or scope of medi10 cal assistance made available under title XIX of the Social

11 Security Act or that results in a loss of eligibility for indi12 viduals otherwise eligible for such assistance.

13 (e) TIMELY ACTION ON APPLICATIONS.—A request

14 to the Secretary by a State for approval of a demonstra15 tion project under this section (and any accompanying

16 waiver of a requirement of title XIX of the Social Security

17 Act) shall be deemed granted unless the Secretary, within

18 90 days after the date of its submission to the Secretary,

19 either denies such request in writing or informs the State

20 in writing with respect to any additional information

21 which is needed in order to make a final determination

22 with respect to the request. After the date the Secretary

23 receives such additional information, the request shall be

24 deemed granted unless the Secretary, within 90 days of

25 such date, denies the request.
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1 (f) DURATION.—A demonstration project under this

2 section may be conducted for any portion of the period

3 beginning after the date of enactment of this Act and end4 ing December 31, 1997.

5 (g) EVALUATION.—Such projects must include a plan

6 for evaluating the effects of the demonstration projects on

7 provider participation.

8 (h) REPORT.—The Secretary shall report to Con9 gress, not later than March 1, 1998, on the demonstration

10 projects carried out under this section and on how the re11 sults of such projects may be used to implement programs

12 to lower infant mortality and morbidity through improving

13 the access of pregnant women to obstetric services in

14 rural, underserved areas.

15 (i) OBSTETRIC PROVIDER DEFINED.—In this sec16 tion, the term ‘‘obstetric provider’’ means an obstetrician,

17 obstetrician-gynecologist, family practitioner, certified

18 nurse midwife, or certified family nurse practitioner.

19 SEC. 3. ANNUAL COMPENDIUM ON STATE INITIATIVES.

20 (a) IN GENERAL.—The Secretary of Health and

21 Human Services, in consultation with the Office of Rural

22 Health Policy, shall develop and make available to the

23 public each year a compendium of the various State initia24 tives undertaken to address the obstetric access crisis in

25 rural areas.
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1 (b) NATURE OF COMPENDIUM.—The compendium

2 shall include information on State laws, regulations, pro3 grams and other initiatives undertaken to increase access

4 to obstetric care in rural areas. The compendium shall in5 clude information on activities addressing liability prob6 lems, efforts to retain and place providers of pregnancy7 related services in rural areas, and efforts to recruit and

8 retain providers of obstetric services under the Medicaid

9 program. The compendium shall also include information

10 on the results on any evaluations that have been conducted

11 on such initiatives.

12 SEC. 4. STUDY OF OBSTETRICAL MALPRACTICE CLAIMS.

13 (a) STUDY.—The Secretary of Health and Human

14 Services shall provide a grant to a public or private non15 profit organization to conduct a study on the rate of medi16 cal malpractice actions or claims relating to obstetrical

17 care for patients whose care is paid for by title XIX of

18 the Social Security Act as compared to those whose care

19 is paid for by private insurance. Such study shall include

20 a review of medical records at selected hospitals, including

21 rural hospitals, to determine the rates for each group.

22 (b) REPORT.—By not later than 2 years after the

23 date of the enactment of this Act, the Secretary shall sub24 mit to Congress a report on the study conducted under

25 subsection (a).
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1 (c) MEDICAL MALPRACTICE ACTION OR CLAIM DE2 FINED.—In this section, the term ‘‘medical malpractice

3 action or claim’’ has the meaning given such term in sec4 tion 431(7) of the Health Care Quality Improvement Act

5 of 1986 (42 U.S.C. 11151(7)).

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