I 
119TH CONGRESS 
1ST SESSION H. R. 5202 
To address maternity care shortages and promote optimal maternity outcomes 
by expanding access to birth centers and exploring more effective pay-
ment models for birth center care, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 8, 2025 
Ms. MORRISON (for herself and Mrs. HINSON) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To address maternity care shortages and promote optimal 
maternity outcomes by expanding access to birth centers 
and exploring more effective payment models for birth 
center care, 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 ‘‘Better Availability of 
Birth Centers Improves Outcomes and Expands Savings 
Act’’ or the ‘‘BABIES Act’’. 
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SEC. 2. GRANTS TO IMPROVE ACCESS TO FREESTANDING 
BIRTH CENTER SERVICES. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399V–8. STRONG START BIRTH CENTER GRANTS TO 
ASSIST BIRTH CENTERS WITH START-UP OR 
EXPANSION COSTS TO EXPAND ACCESS TO 
BIRTH CENTER SERVICES IN UNDERSERVED 
AREAS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, may award grants to eligible birth centers 
that are accredited, or intend to seek accreditation, as 
birth centers by a nationally recognized accrediting body 
such as the Commission for the Accreditation of Birth 
Centers, or that have the intention of seeking such accred-
itation, for the purposes described in subsection (b). 
‘‘(b) USE OF FUNDS.—A birth center receiving a 
grant under this section may use such grant funds for any 
of the following purposes: 
‘‘(1) Renovation, expansion, or construction of 
a birth center facility. 
‘‘(2) Purchasing or updating equipment for a 
birth center. 
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‘‘(3) Accreditation and State licensure activi-
ties. 
‘‘(c) GRANTS; GRANT AMOUNTS.—For each of fiscal 
years 2026 through 2030, the Secretary shall award 
grants under this section to up to 15 birth centers, each 
in an amount of not less than $300,000 and not more 
than $500,000. 
‘‘(d) 
SPECIAL
CONSIDERATIONS.—In 
awarding 
grants under this section, the Secretary shall give special 
consideration to an eligible birth center that— 
‘‘(1) is located in, or offers services to, a geo-
graphic area that— 
‘‘(A) has been designated under section 
332 as a health professional shortage area with 
respect to maternity care; or 
‘‘(B) has maternity care outcomes that are 
below a threshold established by the Secretary; 
and 
‘‘(2) has not previously received a grant under 
this section. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$5,000,000 for the period of fiscal years 2026 through 
2030.’’. 
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SEC. 3. MEDICAID DEMONSTRATION PROGRAM TO IM-
PROVE FREESTANDING BIRTH CENTER SERV-
ICES. 
Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by adding at the end the following new 
subsection: 
‘‘(cc) DEMONSTRATION
PROGRAM
TO
IMPROVE 
FREESTANDING BIRTH CENTER SERVICES.— 
‘‘(1) AUTHORITY.—The Secretary shall conduct 
a demonstration program for the purpose of explor-
ing more effective payment models for birth center 
care in order to improve access to, and the quality 
and scope of, freestanding birth center services for 
women with a low-risk pregnancy who are eligible 
for medical assistance under the State plan under 
this title or under a waiver of such plan. 
‘‘(2) DEADLINES FOR PARTICIPATION CRITERIA, 
PROSPECTIVE
PAYMENT
SYSTEM; 
PLANNING 
GRANTS.— 
‘‘(A) PARTICIPATION
AND
PROSPECTIVE 
PAYMENT SYSTEM DEADLINE.—Not later than 
1 year after the date of the enactment of this 
subsection, the Secretary shall do the following: 
‘‘(i) PUBLICATION OF PARTICIPATION 
CRITERIA FOR FREESTANDING BIRTH CEN-
TERS.— 
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‘‘(I) IN
GENERAL.—The Sec-
retary shall publish criteria for a free-
standing birth center to be certified 
by a State for purposes of partici-
pating in a State demonstration pro-
gram conducted under this subsection. 
‘‘(II) REQUIREMENTS.—The cri-
teria required to be published under 
subclause (I) shall include the fol-
lowing: 
‘‘(aa) ACCREDITATION.—At 
the time of certification for pur-
poses of participating in the dem-
onstration 
program 
conducted 
under this subsection, a free-
standing birth center shall be ac-
credited or have completed the 
initial 
phase 
of 
accreditation 
from an approved, nationally rec-
ognized birth center accreditation 
body, as determined by the Sec-
retary. 
‘‘(bb) 
LICENSURE
AND 
OTHER REQUIREMENTS.—A free-
standing birth center shall— 
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‘‘(AA) be licensed, or 
otherwise approved, by the 
State to provide prenatal, 
labor 
and 
delivery, 
postpartum, newborn care, 
and other ambulatory serv-
ices for which medical as-
sistance is available under 
the State plan or waiver 
under this title; and 
‘‘(BB) 
comply 
with 
such other requirements re-
lating to the health and 
safety of individuals who re-
ceive services furnished by 
the facility as the State shall 
establish. 
‘‘(cc) 
CARE
COORDINA-
TION.—A freestanding birth cen-
ter shall be able to meet care co-
ordination requirements estab-
lished by the Secretary, including 
requirements to coordinate care 
across settings and providers to 
ensure seamless transitions for 
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patients across the full spectrum 
of health services, and shall be 
able to engage in consultation for 
higher level maternity care serv-
ices, non-maternity care services, 
and 
behavioral 
health 
needs, 
which may include plans for con-
sultation, collaboration and refer-
ral, and arrangements with the 
following: 
‘‘(AA) Federally quali-
fied health centers (and as 
applicable, rural health clin-
ics) to provide Federally 
qualified health center serv-
ices (and as applicable, rural 
health clinic services) to the 
extent such services are not 
provided 
directly 
through 
the birth center. 
‘‘(BB) Other outpatient 
clinics, 
including 
licensed 
midwifery 
and 
physician 
practices. 
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‘‘(CC) Inpatient acute 
care facilities with obstet-
rical care units. 
‘‘(dd) 
SCOPE
OF
SERV-
ICES.—As determined by the Sec-
retary, a freestanding birth cen-
ter shall be able to provide 
peripartum care for women with 
a low-risk pregnancy and for 
newborns, consistent with evi-
dence-based guidelines. 
‘‘(ee) 
CAPABILITIES.—A 
freestanding birth center shall 
have the following capabilities: 
‘‘(AA) In addition to 
the requirements specified 
under section 431.53 of title 
42, Code of Federal Regula-
tions, and any successor reg-
ulation (relating to assur-
ance of transportation), the 
capability and equipment to 
provide prenatal, labor and 
delivery, postpartum, and 
newborn care for women 
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with a low-risk pregnancy, 
readiness at all times to ini-
tiate emergency procedures 
to meet unexpected needs of 
such 
women 
and 
of 
newborns within the center, 
including at least 2 qualified 
staff on-site at every birth, 
and the ability to facilitate 
transport to an acute care 
hospital with an obstetrical 
care unit when necessary. 
‘‘(BB) An established 
transfer plan with a receiv-
ing hospital with an obstet-
rical care unit with policies 
and procedures for timely 
transport. 
‘‘(CC) 
Medical 
con-
sultation available from a li-
censed board-certified physi-
cian with admitting privi-
leges in obstetrics at a near-
by hospital, as defined by 
State law or regulation. 
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‘‘(DD) Data collection, 
storage, and retrieval, in-
cluding data on intrapartum 
and postpartum maternal 
and newborn transfer rates 
and hospital admissions. 
‘‘(EE) The ability to 
initiate and document qual-
ity improvement programs 
as required by accreditation 
that include efforts to maxi-
mize patient safety, such as 
safety checklists, validated 
training and competency of 
staff, and emergency pre-
paredness and drills. 
‘‘(ff) HEALTH
CARE
PRO-
VIDERS.—A freestanding birth 
center shall employ, or have care 
delivery arrangements with, both 
of the following: 
‘‘(AA) A physician li-
censed to practice within the 
State or jurisdiction of the 
birth center. 
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‘‘(BB) A midwife that 
meets or exceeds the edu-
cation and training stand-
ards of the International 
Confederation of Midwives 
and who is licensed to prac-
tice within the jurisdiction of 
the birth center. 
‘‘(gg) NON-DUPLICATION.— 
In carrying out this subsection, 
the Secretary shall, with respect 
to a State participating in the 
demonstration program, establish 
procedures to prevent, to the 
greatest extent practicable, the 
provision of, or payment for, 
services under the demonstration 
program for which medical as-
sistance is available under the 
State plan under this title or 
waiver of such plan. 
‘‘(ii) GUIDANCE ON DEVELOPMENT OF 
PROSPECTIVE
PAYMENT
SYSTEM
FOR 
TESTING
UNDER
STATE
DEMONSTRATION 
PROGRAMS.— 
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‘‘(I) IN
GENERAL.—The Sec-
retary shall issue guidance for States 
participating in a demonstration pro-
gram conducted under this subsection 
to establish a prospective payment 
system that shall only apply to free-
standing birth center services that— 
‘‘(aa) meet the criteria es-
tablished under clause (i); and 
‘‘(bb) are furnished by a 
freestanding birth center partici-
pating in such a demonstration 
program. 
‘‘(II) 
REQUIREMENTS.—The 
guidance issued by the Secretary 
under subclause (I) shall, to the 
greatest extent practicable, provide 
for— 
‘‘(aa) a partial facility pay-
ment based on units in the case 
that a pregnant woman is admit-
ted in labor and then needs to be 
transferred to the hospital in 
labor before the birth of the 
baby; 
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‘‘(bb) a facility payment for 
therapeutic rest or for observa-
tion short stays to rule out labor; 
‘‘(cc) ensuring payment for 
the newborn and mother as 2 
separate facility payment compo-
nents; 
‘‘(dd) ensuring payment for 
nitrous oxide and hydrotherapy 
supplies costs for pain relief; 
‘‘(ee) ensuring payment for 
all professional services of health 
professionals involved in the de-
livery of care in a birth center, 
which may include— 
‘‘(AA) 3 or more pre-
natal office visits; 
‘‘(BB) observation and 
triage; 
‘‘(CC) newborn exam 
and care; and 
‘‘(DD) 
multiple 
postpartum, 
mother, 
and 
newborn visits, as needed; 
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‘‘(ff) ensuring payment for 
partial prenatal and postpartum 
care episodes or for prenatal care 
only with planned delivery in the 
hospital 
and 
returning 
for 
postpartum care in the birth cen-
ter; and 
‘‘(gg) payment for services 
provided within— 
‘‘(AA) in the case of a 
pregnant woman, the period 
that commences upon the 
confirmation of pregnancy 
when the woman is accepted 
into care at the freestanding 
birth 
center, 
continues 
through prenatal care, labor, 
and delivery, and ends at 
the 
completion 
of 
the 
postpartum period (as de-
fined by State law or regula-
tion) with documentation of 
a plan for continued well 
woman care, inclusive of at 
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least 2 postpartum care vis-
its; and 
‘‘(BB) in the case of a 
newborn, a period that con-
tinues through the first 28 
days of life with documenta-
tion 
of 
continued 
infant 
care. 
‘‘(iii) PUBLICATION OF AN RFP FOR 
STATES TO APPLY FOR THE DEMONSTRA-
TION PROGRAM.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall publish a request for pro-
posal (in this clause referred to as an 
‘RFP’) for States to establish and test 
a prospective payment system for 
freestanding 
birth 
center 
services 
that— 
‘‘(aa) meets the criteria es-
tablished under clause (i); and 
‘‘(bb) are furnished by a 
freestanding birth center partici-
pating in a demonstration pro-
gram under this subsection. 
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‘‘(II) 
REQUIREMENTS.—The 
RFP published by the Secretary 
under subclause (I) shall, to the 
greatest extent practicable, include 
the following parameters: 
‘‘(aa) States shall have a 
minimum number of established 
or developing birth centers. 
‘‘(bb) States shall have a 
mechanism to recognize or license 
birth centers. 
‘‘(cc) States shall have at 
least 1 area that has been des-
ignated a maternity care desert. 
‘‘(dd) 
States 
shall 
have 
areas with maternity care out-
comes that are below a certain 
threshold, as determined by the 
Secretary. 
‘‘(ee) States shall represent 
a diverse selection of geographic 
areas, including rural and under-
served areas. 
‘‘(ff) Preference shall be 
given to States that demonstrate 
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the potential to expand the avail-
ability of and access to maternity 
care services in a demonstration 
area and increase the quality of 
services provided by freestanding 
birth centers without increasing 
net Federal spending, as deter-
mined by the Secretary. 
‘‘(III) 
REQUIRED
INFORMA-
TION.—A State application to conduct 
a demonstration program under this 
subsection shall include the following: 
‘‘(aa) A description of the 
target population of individuals 
who are eligible for medical as-
sistance under the State plan 
under this title or under a waiver 
of such plan and are to be served 
under the demonstration pro-
gram. 
‘‘(bb) A list of the partici-
pating freestanding birth centers 
in the State. 
‘‘(cc) Verification that each 
participating freestanding birth 
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center meets the participation 
criteria established in paragraph 
(2)(A)(i). 
‘‘(dd) A description of the 
scope of the freestanding birth 
center services available under 
the State plan under this title or 
waiver of such plan for women 
with a low-risk pregnancy that 
will be paid for under the pro-
spective payment system tested 
in the demonstration program. 
‘‘(ee) Verification that the 
State has agreed to pay for such 
services at the rate established 
under the prospective payment 
system. 
‘‘(ff) An assurance that the 
State will require freestanding 
birth centers to submit to the 
State, and that the State will 
submit to the Secretary, such in-
formation and data as the State 
or Secretary may require relating 
to the demonstration program or 
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an episode of care for such a 
pregnant woman or newborn. 
‘‘(gg) Such other informa-
tion as the Secretary may require 
relating to the demonstration 
program, including with respect 
to determining the soundness of 
the proposed prospective payment 
system. 
‘‘(IV) DEADLINES FOR SUBMIS-
SION
OF
RFP
APPLICATIONS.—The 
deadline for a State to submit an ap-
plication to participate in the dem-
onstration program conducted under 
this subsection shall be the date that 
is 90 days after the date on which the 
Secretary publishes the RFP under 
subclause (I). 
‘‘(B) PLANNING GRANTS.— 
‘‘(i) IN GENERAL.—Not later than 18 
months after the date of the enactment of 
this subsection, the Secretary shall award 
a planning grant to up to 6 States for the 
purpose of developing a detailed proposal 
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to conduct a demonstration program de-
scribed in paragraph (3). 
‘‘(ii) USE OF FUNDS.—A State award-
ed a planning grant under this subpara-
graph shall use the funds awarded under 
such grant to— 
‘‘(I) solicit input with respect to 
the development of the demonstration 
program from patients, providers (in-
cluding certified nurse-midwives, other 
midwives licensed within the State, 
and physicians), and other stake-
holders; 
‘‘(II) secure participation of free-
standing birth centers that meet the 
criteria established under subpara-
graph (A)(i), including by providing 
support for such centers to meet that 
criteria (including accreditation) in 
order to maximize the number of free-
standing birth centers participating in 
the demonstration program; and 
‘‘(III) in accordance with the 
guidance issued under subparagraph 
(A)(ii), establish a prospective pay-
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ment system which the State shall use 
for making payments to freestanding 
birth centers participating in the dem-
onstration program. 
‘‘(3) STATE DEMONSTRATION PROGRAMS.— 
‘‘(A) IN GENERAL.—Not later than 2 years 
after the date of the enactment of this sub-
section, the States selected by the Secretary 
under paragraph (2)(B)(i) shall begin con-
ducting the demonstration program under this 
paragraph. 
‘‘(B) LENGTH OF DEMONSTRATION PRO-
GRAMS.—A State conducting a demonstration 
program in accordance with this paragraph 
shall conduct the program for a 4-year period. 
‘‘(C) PAYMENT FOR SERVICES PROVIDED 
BY FREESTANDING BIRTH CENTERS.— 
‘‘(i) IN GENERAL.—For each quarter 
during the 4-year period during which a 
State participates in a demonstration pro-
gram under this subsection, the Secretary 
shall pay such State an amount equal to 
the Federal medical assistance percentage 
(as defined in section 1905(b)) of the total 
amount expended by such State during 
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such quarter under the prospective pay-
ment system established by such State 
pursuant to paragraph (2)(B)(III) to free-
standing birth centers for services that 
are— 
‘‘(I) furnished pursuant to the 
criteria established under paragraph 
(2)(A)(i) to individuals enrolled in the 
State plan (or waiver of such plan) of 
such State under this title; and 
‘‘(II) described in the demonstra-
tion program application submitted by 
such State and approved by the Sec-
retary. 
‘‘(ii) ADMINISTRATIVE
EXPENSES.— 
Amounts expended by a State to conduct a 
demonstration program in accordance with 
this paragraph shall be considered, for pur-
poses of subsection (a)(7), to be necessary 
for the proper and efficient administration 
of the State plan. 
‘‘(D) WAIVER
OF
STATEWIDENESS
RE-
QUIREMENT.—The Secretary shall waive the re-
quirements of section 1902(a)(1) (relating to 
Statewideness), section 1902(a)(10)(B) (relat-
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ing to comparability), and any other provision 
of this title which would be directly contrary to 
the authority under this subsection as may be 
necessary for a State to conduct a demonstra-
tion program in accordance with this para-
graph. 
‘‘(E) ANNUAL REPORTS.— 
‘‘(i) IN GENERAL.—Not later than 2 
years after the date on which the first 
State is selected to conduct a demonstra-
tion program under this subsection, and 
annually thereafter, based on information 
and data submitted by States in accord-
ance with the assurance provided under 
paragraph (2)(A)(iii)(III)(ff), the Sec-
retary shall submit to Congress an annual 
report on all State demonstration pro-
grams conducted under this subsection. 
Each such report shall include, with re-
spect to each such State demonstration 
program— 
‘‘(I) an assessment of clinical 
outcomes for maternity services pro-
vided by freestanding birth centers 
participating in the demonstration 
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program for individuals who are eligi-
ble for medical assistance under a 
State plan under this title or under a 
waiver of such plan and are women 
with a low-risk pregnancy with out-
comes in comparable demographic and 
geographic areas, including with re-
spect to— 
‘‘(aa) the number of births 
and data on intrapartum and 
postpartum maternal and new-
born transfer rates and hospital 
admissions; and 
‘‘(bb) the rate of primary 
and repeat cesarean sections, 
preterm births, and neonatal in-
tensive care unit admissions; and 
‘‘(II) an assessment of the im-
pact of all the State demonstration 
programs conducted under this sub-
section on the Federal and State costs 
relating to providing freestanding 
birth center services for individuals 
who are eligible for medical assistance 
under a State plan under this title or 
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under a waiver of such plan and are 
women with a low-risk pregnancy (in-
cluding with respect to the provision 
of inpatient, emergency, and ambula-
tory services) and newborn care, com-
pared to the Federal and State costs 
related to the provision of— 
‘‘(aa) freestanding birth cen-
ter services to such individuals by 
freestanding birth centers outside 
of such demonstration programs; 
and 
‘‘(bb) traditional maternity 
services as provided in non-birth 
center clinics and hospital pro-
grams. 
‘‘(ii) RECOMMENDATIONS.—Not later 
than 6 months before the the last day of 
the 4-year period for which demonstration 
programs are conducted under this sub-
section, the Secretary shall submit to Con-
gress recommendations concerning whether 
such demonstration programs shall be con-
tinued, expanded, modified, or terminated. 
‘‘(4) FUNDING.— 
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‘‘(A) IN GENERAL.—Out of any funds in 
the Treasury not otherwise appropriated, there 
is appropriated to the Secretary— 
‘‘(i) for fiscal year 2027, $3,000,000 
for purposes of carrying out paragraph 
(2)(B); and 
‘‘(ii) for each of fiscal years 2028 
through 2031, $6,000,000 for purposes of 
carrying out the demonstration programs 
described in paragraph (3). 
‘‘(B) AVAILABILITY.—Funds appropriated 
under subparagraph (A) shall remain available 
until expended. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) 
FREESTANDING
BIRTH
CENTER 
SERVICES.—The term ‘freestanding birth center 
services’ has the meaning given such term in 
section 1905(l)(3)(A) and includes such other 
services as the Secretary shall determine for 
purposes of conducting the demonstration pro-
grams described in paragraph (3). 
‘‘(B) LOW-RISK
PREGNANCY.—The term 
‘low-risk pregnancy’ means an uncomplicated 
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singleton term pregnancy with a vertex presen-
tation and an expected uncomplicated birth.’’. 
Æ 
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