‘‘(A) such services furnished by a certified 
nurse-midwife (as defined in paragraph (2)); 
and 
‘‘(B) such services (and such supplies and 
services furnished as an incident to the nurse- 
midwife’s service) which— 
‘‘(i) the certified nurse-midwife is le-
gally authorized to perform under State 
law (or the State regulatory mechanism 
provided by State law) as would otherwise 
be covered if furnished by a physician; 
‘‘(ii) are furnished under the super-
vision of a certified-nurse midwife by an 
intern or resident-in-training (as described 
in subsection (b)(6)); 
‘‘(iii) would otherwise be described in 
subparagraph (A) if furnished by a cer-
tified nurse-midwife; and 
‘‘(iv) would otherwise be covered if 
furnished under the supervision of a physi-
cian.’’. 
(b) CLARIFYING PERMISSIBILITY OF USING CERTAIN 
GRANTS FOR CLINICAL TRAINING BY CERTIFIED NURSE- 
MIDWIVES.—Section 811(a)(1) of the Public Health Serv-
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ice Act (42 U.S.C. 296j(a)(1)) is amended by inserting 
‘‘, including clinical training,’’ after ‘‘projects’’. 
SEC. 302. IMPROVING MEDICARE PATIENT ACCESS TO 
HOME HEALTH SERVICES PROVIDED BY CER-
TIFIED NURSE-MIDWIVES. 
(a) IN GENERAL.—Section 1835(a) of the Social Se-
curity Act (42 U.S.C. 1395n(a)) is amended— 
(1) in paragraph (2)— 
(A) by inserting ‘‘or a certified nurse-mid-
wife (as defined in section 1861(gg)),’’ after ‘‘or 
a physician assistant (as defined in section 
1861(aa)(5)) who is working in accordance with 
State law,’’; and 
(B) in subparagraph (A)— 
(i) in each of clauses (ii) and (iii), by 
striking ‘‘or a physician assistant (as the 
case may be)’’ and inserting ‘‘a physician 
assistant, or a certified nurse-midwife (as 
the case may be)’’; and 
(ii) in clause (iv), by— 
(I) inserting ‘‘or by a certified 
nurse-midwife (as defined in section 
1861(gg))’’ after ‘‘(but in no case 
later than the date that is 6 months 
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pamtmann on DSKBC07HB2PROD with BILLS
after the date of the enactment of the 
CARES Act)’’; and 
(II) by striking ‘‘(as defined in 
section 1861(gg))’’; and 
(2) in the matter following paragraph (2), by 
striking ‘‘or physician assistant (as the case may 
be)’’ and inserting ‘‘physician assistant, or certified 
nurse-midwife (as the case may be)’’ each place it 
appears. 
(b) CONFORMING AMENDMENTS.—Section 1895 of 
the Social Security Act (42 U.S.C. 1395(fff)) is amend-
ed— 
(1) in subsection (c)(1), by inserting ‘‘a cer-
tified 
nurse-midwife 
(as 
defined 
in 
section 
1861(gg)),’’ after ‘‘clinical nurse specialist (as those 
terms are defined in section 1861(aa)(5)),’’; and 
(2) in subsection (e)(1)(A), by striking ‘‘a phy-
sician a nurse practitioner or clinical nurse spe-
cialist,’’ and inserting ‘‘a physician, a nurse practi-
tioner, a clinical nurse specialist, a certified nurse- 
midwife,’’. 
SEC. 303. IMPROVING ACCESS TO DMEPOS FOR MEDICARE 
BENEFICIARIES. 
Section 1834(a) of the Social Security Act (42 U.S.C. 
1395m(a)) is amended— 
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(1) in paragraph (1)(E)(ii) by striking ‘‘or a 
clinical nurse specialist (as those terms are defined 
in section 1861(aa)(5))’’ and inserting ‘‘, a clinical 
nurse specialist (as those terms are defined in sec-
tion 1861(aa)(5)), or a certified nurse-midwife (as 
defined in section 1861(gg))’’; and 
(2) in paragraph (11)(B)(ii)— 
(A) by striking ‘‘or a clinical nurse spe-
cialist (as those terms are defined in section 
1861(aa)(5))’’ and inserting ‘‘a clinical nurse 
specialist (as those terms are defined in section 
1861 (aa)(5)), or a certified nurse-midwife (as 
defined in 1861(gg))’’; and 
(B) by striking ‘‘or specialist’’ and insert-
ing ‘‘specialist, or nurse-midwife’’. 
SEC. 304. TECHNICAL CHANGES TO QUALIFICATIONS AND 
CONDITIONS WITH RESPECT TO THE SERV-
ICES OF CERTIFIED NURSE-MIDWIVES. 
Section 1861(gg)(2) of the Social Security Act (42 
U.S.C. 1395x(gg)(2)) is amended by striking ‘‘, or has 
been certified by an organization recognized by the Sec-
retary’’ and inserting ‘‘and has been certified by the Amer-
ican Midwifery Certification Board (or a successor organi-
zation)’’. 
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TITLE IV—IMPROVING FEDERAL 
HEALTH PROGRAMS FOR ALL 
ADVANCED 
PRACTICE 
REG-
ISTERED NURSES 
SEC. 401. REVISING THE LOCAL COVERAGE DETERMINA-
TION PROCESS UNDER THE MEDICARE PRO-
GRAM. 
(a) IN GENERAL.—Section 1862(l)(5) of the Social 
Security Act (42 U.S.C. 1395y(l)(5)) is amended— 
(1) in subparagraph (D), by adding at the end 
the following new clauses: 
‘‘(vi) Identification of any medical or 
scientific experts whose advice was ob-
tained by such contractor during the devel-
opment of such determination, whether or 
not such contractor relied on such advice 
in developing such determination. 
‘‘(vii) A hyperlink to any written com-
munication between such contractor and 
another entity that such contractor relied 
on when developing such determination. 
‘‘(viii) A hyperlink to any rule, guide-
line, protocol, or other criterion that such 
contractor relied on when developing such 
determination.’’; and 
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(2) by adding at the end the following new sub-
paragraphs: 
‘‘(E) PROHIBITION
ON
IMPOSITION
OF 
PRACTITIONER
QUALIFICATIONS.—The 
Sec-
retary shall prohibit a Medicare administrative 
contractor that develops a local coverage deter-
mination from imposing such determination on 
any coverage limitation with respect to the 
qualifications of a physician (as defined in sec-
tion 1861(r)) or a practitioner described in sec-
tion 1842(b)(18)(C) who may furnish the item 
or service that is the subject of such determina-
tion. 
‘‘(F) 
CIVIL
MONETARY
PENALTY.—A 
Medicare administrative contractor that devel-
ops a local coverage determination that fails to 
make information described in subparagraph 
(D) available as required by the Secretary 
under such subparagraph or comply with the 
prohibition under subparagraph (E) is subject 
to a civil monetary penalty of not more than 
$10,000 for each such failure. The provisions of 
section 1128A (other than subsections (a) and 
(b)) shall apply to a civil money penalty under 
the previous sentence in the same manner as 
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