I
103D CONGRESS
1ST SESSION
H. R. 1814
To direct the Secretary of Health and Human Services to provide for dem-
onstration projects under the medicaid program to improve access to
obstetric services in underserved areas, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
APRIL 22, 1993
Mr. BILIRAKIS (for himself, Mr. ROWLAND, Mr. KILDEE, Mr. MCDERMOTT,
Mr. LAFALCE, Mr. EMERSON, Mr. ROMERO-BARCELO´, Mr. SMITH of
New Jersey, Mr. WALSH, Mr. SKEEN, Mrs. BYRNE of Virginia, Mr.
CLYBURN, Mr. SCOTT, Ms. NORTON, Miss COLLINS of Michigan, Mrs.
CLAYTON, Mr. BARRETT of Wisconsin, Mr. EVANS, Mr. GLICKMAN, and
Mr. BLACKWELL) introduced the following bill; which was referred to the
Committee on Energy and Commerce
A BILL
To direct the Secretary of Health and Human Services to
provide for demonstration projects under the medicaid
program to improve access to obstetric services in under-
served areas, and for other purposes.
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 ‘‘Access to Obstetric
Care Act of 1993’’.
SEC. 2. MEDICAID DEMONSTRATION PROJECTS TO IM-
PROVE ACCESS IN UNDERSERVED AREAS TO
OBSTETRIC SERVICES.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall provide under this section for dem-
onstration projects by States that seek to reduce infant
mortality by improving access in urban and rural under-
served areas to obstetric services for eligible pregnant
women under title XIX of the Social Security Act.
(b) NATURE OF PROJECTS.—Demonstration projects
under this section shall incorporate innovative approaches
for increasing the participation of obstetric providers
under title XIX of the Social Security Act, such as—
(1) expediting reimbursement and using innova-
tive payment mechanisms, including global fees for
obstetric services with guaranteed periodic pay-
ments;
(2) special or enhanced reimbursement for early
prenatal care, risk-assessment, and high-risk serv-
ices;
(3) patient distribution or referral systems;
(4) subsidizing medical liability insurance pre-
miums, in whole or in part, for selected obstetric
providers;
(5) paying for all or a portion of payments
made in settlement of malpractice claims by patients
of obstetric providers who meet certain criteria; and
(6) providing professional liability coverage
under the State tort claims act for certain obstetric
providers while treating a specified category of pa-
tients.
Demonstration projects addressing reimbursement must
provide for integrated prenatal, delivery and postpartum
services.
(c) SUPPLEMENTAL FUNDING.—(1) With respect to
the additional expenditures for medical assistance made
under the State plan under title XIX of the Social Secu-
rity Act to carry out a demonstration project under this
section, the Federal medical assistance percentage (other-
wise determined under section 1905(b) of such Act) shall
be increased by 25 percentage points (but in no case to
a percentage greater than 95 percent).
(2) The amount of funds that may be expended as
medical assistance to carry out the purposes of this section
shall be such sums as may be appropriated during the 5-
fiscal-year period beginning with fiscal year 1994.
(d) WAIVER AUTHORITY.—(1) Except as provided
under paragraphs (2) and (3), the Secretary is authorized
to waive the requirements of title XIX of the Social Secu-
rity Act to the extent necessary to implement demonstra-
tion projects under this section.
(2) Except as permitted under section 1915(b)(1) of
the Social Security Act, the Secretary may not waive
under paragraph (1) the requirement of sections
1902(a)(23) and 1916 of such Act.
(3) The Secretary may not approve a demonstration
project under this section, or a waiver under paragraph
(1), that reduces the amount, duration, or scope of medi-
cal assistance made available under title XIX of the Social
Security Act or that results in a loss of eligibility for indi-
viduals otherwise eligible for such assistance.
(e) TIMELY ACTION ON APPLICATIONS.—A request
to the Secretary by a State for approval of a demonstra-
tion project under this section (and any accompanying
waiver of a requirement of title XIX of the Social Security
Act) shall be deemed granted unless the Secretary, within
90 days after the date of its submission to the Secretary,
either denies such request in writing or informs the State
in writing with respect to any additional information
which is needed in order to make a final determination
with respect to the request. After the date the Secretary
receives such additional information, the request shall be
deemed granted unless the Secretary, within 90 days of
such date, denies the request.
(f) DURATION.—A demonstration project under this
section may be conducted for any portion of the period
beginning after the date of enactment of this Act and end-
ing December 31, 1997.
(g) EVALUATION.—Such projects must include a plan
for evaluating the effects of the demonstration projects on
provider participation.
(h) REPORT.—The Secretary shall report to Con-
gress, not later than March 1, 1998, on the demonstration
projects carried out under this section and on how the re-
sults of such projects may be used to implement programs
to lower infant mortality and morbidity through improving
the access of pregnant women to obstetric services in
urban and rural underserved areas.
(i) OBSTETRIC PROVIDER DEFINED.—In this sec-
tion, the term ‘‘obstetric provider’’ means an obstetrician,
obstetrician-gynecologist, family practitioner, certified
nurse midwife, or certified family nurse practitioner.
SEC. 3. ANNUAL COMPENDIUM ON STATE INITIATIVES.
(a) IN GENERAL.—The Secretary of Health and
Human Services, in consultation with the Office of Rural
Health Policy, shall develop and make available to the
public each year a compendium of the various State initia-
tives undertaken to address the obstetric access crisis in
urban and rural areas.
(b) NATURE
OF COMPENDIUM.—The compendium
shall include information on State laws, regulations, pro-
grams and other initiatives undertaken to increase access
to obstetric care in underserved areas. The compendium
shall include information on activities addressing liability
problems, efforts to retain and place providers of preg-
nancy-related services in underserved areas, and efforts to
recruit and retain providers of obstetric services under the
Medicaid program. The compendium shall also include in-
formation on the results on any evaluations that have been
conducted on such initiatives.
SEC. 4. STUDY OF OBSTETRICAL MALPRACTICE CLAIMS.
(a) STUDY.—The Secretary of Health and Human
Services shall provide a grant to a public or private non-
profit organization to conduct a study on the rate of medi-
cal malpractice actions or claims relating to obstetrical
care for patients whose care is paid for by title XIX of
the Social Security Act as compared to those whose care
is paid for by private insurance. Such study shall include
a review of medical records at selected hospitals, including
rural hospitals, to determine the rates for each group.
(b) REPORT.—By not later than 2 years after the
date of the enactment of this Act, the Secretary shall sub-
mit to Congress a report on the study conducted under
subsection (a).
(c) MEDICAL MALPRACTICE ACTION OR CLAIM DE-
FINED.—In this section, the term ‘‘medical malpractice
action or claim’’ has the meaning given such term in sec-
tion 431(7) of the Health Care Quality Improvement Act
of 1986 (42 U.S.C. 11151(7)).
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