I 
111TH CONGRESS 
1ST SESSION H. R. 1101 
To amend title XVIII of the Social Security Act to provide for reimbursement 
of certified midwife services and to provide for more equitable reimburse-
ment rates for certified nurse-midwife services. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 13, 2009 
Mr. TOWNS (for himself, Mr. UPTON, Mr. COHEN, Ms. SCHWARTZ, Mr. HOLT, 
Ms. ROYBAL-ALLARD, and Mr. PAYNE) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
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 cer-
tified nurse-midwife services. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Midwifery Care Access 
and Reimbursement Equity Act of 2009’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) The Medicare program reimburses certified 
nurse-midwives for primary care services, as author-
ized by State law. 
(2) Since 1988, Congress has authorized reim-
bursement under the Medicare program to certified 
nurse-midwives for the provision of maternity-related 
services to Medicare-eligible women with disabilities 
who are of childbearing age. 
(3) Since 1993, Congress authorized reimburse-
ments under the Medicare program to certified 
nurse-midwives to also provide additional services 
outside the maternity cycle. 
(4) In its June 2002 report to Congress, the 
Medicare Payment Advisory Commission (MedPAC) 
unanimously recommended that the percentage of 
part B reimbursement for certified nurse-midwife 
services to be increased by Congress. MedPAC also 
highlighted the high quality of care provided by cer-
tified nurse-midwives. 
(5) Certified nurse-midwives and certified mid-
wives are highly educated health professionals. To 
practice in the United States as either a certified 
nurse-midwife or a certified midwife, an individual 
must complete a post-baccalaureate educational pro-
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gram and State licensure as well as pass a national 
certification examination. 
(6) While most State Medicaid programs reim-
burse certified nurse midwives and other obstetrical 
and gynecological providers at the same payment 
rate, the Medicare program reimburses such mid-
wives at a payment rate that is 35 percent lower 
than such other providers. 
(7) This disparity is a barrier to women’s ac-
cess to obstetrical and gynecological providers of 
their choice within the Medicare program. 
(8) Health disparities in the United States con-
tinue to be a critical problem. Midwives have histori-
cally cared for those populations most at risk for 
health disparities in areas of high infant mortality, 
preterm birth, low birth weight, sudden infant death 
syndrome, maternal mortality, breast and cervical 
cancer, and HIV/AIDS infection among women. 
(9) Providing more equitable reimbursement for 
the high quality primary care services of certified 
nurse-midwives and certified midwives will aid in en-
suring their services are available to women in need. 
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SEC. 3. MEDICARE PAYMENT FOR CERTIFIED NURSE-MID-
WIFE AND CERTIFIED MIDWIFE SERVICES. 
(a) CERTIFIED
MIDWIFE, CERTIFIED
MIDWIFE 
SERVICES DEFINED.—(1) Section 1861(gg) of the Social 
Security Act (42 U.S.C. 1395x(gg)) is amended by adding 
at the end the following new paragraphs: 
‘‘(3) The term ‘certified midwife services’ means such 
services furnished by a certified midwife (as defined in 
paragraph (4)) 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 physi-
cian’s service. 
‘‘(4) The term ‘certified midwife’ means an individual 
who has successfully completed a bachelor’s degree from 
an accredited educational institution and a program of 
study and clinical experience meeting guidelines prescribed 
by the Secretary, or has been certified by an organization 
recognized by the Secretary.’’. 
(2) The heading in section 1861(gg) of the Social Se-
curity Act (42 U.S.C. 1395x(gg)) is amended to read as 
follows: 
‘‘(gg) CERTIFIED NURSE-MIDWIFE SERVICES; CER-
TIFIED MIDWIFE SERVICES.—’’. 
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(b) CERTIFIED MIDWIFE SERVICE BENEFIT.— 
(1) MEDICAL AND OTHER SERVICES.—Section 
1861(s)(2)(L) of the Social Security Act (42 U.S.C. 
1395x(s)(2)(L)) is amended by inserting ‘‘and cer-
tified midwife services’’ before the semicolon. 
(2) PERMITTING HOSPITALS TO PROVIDE FOR 
PATIENTS
RECEIVING
CERTIFIED
NURSE-MIDWIFE 
SERVICES OR CERTIFIED MIDWIFE SERVICES TO BE 
UNDER THE CARE OF A CERTIFIED NURSE-MIDWIFE 
OR CERTIFIED MIDWIFE.—Section 1861(e)(4) of the 
Social Security Act (42 U.S.C. 1395x(e)(4)) is 
amended— 
(A) by inserting ‘‘(i)’’ after ‘‘except that’’; 
and 
(B) by inserting before the semicolon the 
following: ‘‘and (ii) a patient receiving certified 
nurse-midwife services or certified midwife serv-
ices (as defined in paragraphs (1) and (3), re-
spectively, of subsection (gg)) may be under the 
care of a certified nurse-midwife or certified 
midwife with respect to such services to the ex-
tent permitted under State law’’. 
(3) 
BENEFIT
UNDER
PART
B.—Section 
1832(a)(2)(B)(iii) of the Social Security Act (42 
U.S.C. 1395k(a)(2)(B)(iii)) is amended by inserting 
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