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108th CONGRESS
2d Session
S. 2492
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 certified nurse-midwife services.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 2, 2004
Mr. Conrad introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
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 certified nurse-midwife services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Access to Nurse-Midwife
Care Act of 2004''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Medicare covers approximately 2 million women with
disabilities that are of childbearing age.
(2) Women with disabilities give birth to 50,000 children
annually.
(3) The Agency for Healthcare Policy and Research reports
that these women are without appropriate access to primary care
services.
(4) Their average time between gynecological visits was 10-
12 years.
(5) They were less likely to have received a recent
mammogram.
(6) The medicare program reimburses Certified Nurse
Midwives (CNMs) at 65 percent of the physician fee schedule, on
average, only $14 per annual exam.
(7) CNMs who serve these women are forced to subsidize care
with their own money or turn away patients because they cannot
afford to operate at a financial loss.
(8) Professional liability premiums for CNMs are
skyrocketing, leaving no monies to subsidize care.
(9) CNMs are forced to leave the marketplace as other
public and private payers adopt Medicare payment policies.
(10) Midwives are highly educated and available to serve
this special population.
SEC. 3. MEDICARE PAYMENT FOR CERTIFIED NURSE-MIDWIFE AND 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 physician'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 such Act (42 U.S.C.
1395x(gg)) is amended to read as follows:
``Certified Nurse-Midwife Services; Certified Midwife Services''.
(b) Certified Midwife Service Benefit.--
(1) Medical and other services.--Section 1861(s)(2)(L) of
such Act (42 U.S.C. 1395x(s)(2)(L)) is amended by inserting
``and certified midwife services'' before the semicolon.
(2) Payment to hospital for patients under care of
certified nurse-midwife or certified midwife.--Section
1861(e)(4) of such 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 services
(as defined in paragraphs (1) and (3), respectively, of
subsection (gg)) may be under the care of a certified
nurse-midwife or certified midwife with respect to such
services to the extent permitted under State law''.
(3) Inpatient hospital service at teaching hospitals.--
Section 1861(b) of such Act (42 U.S.C. 1395x(b)) is amended--
(A) in paragraph (4), by inserting ``certified
midwife services,'' after ``certified nurse-midwife
services,'';
(B) in paragraph (6), by striking ``; or'' and
inserting ``or in the case of services in a hospital or
osteopathic hospital by an intern or resident-in-
training in the field of obstetrics and gynecology,
nothing in this paragraph shall be construed to
preclude a certified nurse-midwife or certified midwife
(as defined in paragraphs (1) and (3), respectively, of
subsection (gg)) from teaching or supervising such
intern or resident-in-training, to the extent permitted
under State law and as may be authorized by the
hospital; or'';
(C) in paragraph (7), by striking the period at the
end and inserting ``; or''; and
(D) by adding at the end the following new
paragraph:
``(8) a certified nurse-midwife or a certified midwife
where the hospital has a teaching program approved as specified
in paragraph (6), if (A) the hospital elects to receive any
payment due under this title for reasonable costs of such
services, and (B) all certified nurse-midwives or certified
midwives in such hospital agree not to bill charges for
professional services rendered in such hospital to individuals
covered under the insurance program established by this
title.''.
(4) Benefit under part b.--Section 1832(a)(2)(B)(iii) of
such Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended--
(A) by inserting ``(I)'' after ``(iii)'',
(B) by inserting ``certified midwife services,''
after ``certified nurse-midwife services,'', and
(C) by adding at the end the following new
subclause:
``(II) in the case of certified
nurse-midwife services or certified
midwife services furnished in a
hospital which has a teaching program
described in clause (i)(II), such
services may be furnished as provided
under section 1842(b)(7)(E) and section
1861(b)(8);''.
(5) Amount of payment.--Section 1833(a)(1)(K) of such Act
(42 U.S.C. 1395l(a)(1)(K)) is amended--
(A) by inserting ``and certified midwife services''
after ``certified nurse-midwife services'', and
(B) by striking ``65 percent'' each place it
appears and inserting ``95 percent''.
(6) Assignment of payment.--The first sentence of section
1842(b)(6) of such Act (42 U.S.C. 1395u(b)(6)) is amended--
(A) by striking ``and (F)'' and inserting ``(F)'';
and
(B) by inserting before the period the following:
``, and (G) in the case of certified nurse-midwife
services or certified midwife services under section
1861(s)(2)(L), payment may be made in accordance with
subparagraph (A), except that payment may also be made
to such person or entity (or the agent of such person
or entity) as the certified nurse-midwife or certified
midwife may designate under an agreement between the
certified nurse-midwife or certified midwife and such
person or entity (or the agent of such person or
entity)''.
(7) Clarification regarding payments under part b for such
services furnished in teaching hospitals.--(A) Section
1842(b)(7) of such Act (42 U.S.C. 1395u(b)(7)) is amended--
(i) in subparagraphs (A) and (C), by inserting
``or, for purposes of subparagraph (E), the conditions
described in section 1861(b)(8),'' after ``section
1861(b)(7),''; and
(ii) by adding at the end the following new
subparagraph:
``(E) In the case of certified nurse-midwife
services or certified midwife services furnished to a
patient in a hospital with a teaching program approved
as specified in section 1861(b)(6) but which does not
meet the conditions described in section 1861(b)(8),
the provisions of subparagraphs (A) through (C) shall
apply with respect to a certified nurse-midwife or a
certified midwife respectively under this subparagraph
as they apply to a physician under subparagraphs (A)
through (C).''.
(B) Not later than 180 days after the date of the enactment
of this Act, the Secretary of Health and Human Services shall
prescribe regulations to carry out the amendments made by
subparagraph (A).
SEC. 4. INTERIM, FINAL REGULATIONS.
Except as provided in section 3(b)(7)(B), in order to carry out the
amendments made by this Act in a timely manner, the Secretary of Health
and Human Services may first promulgate regulations, that take effect
on an interim basis, after notice and pending opportunity for public
comment, by not later than 6 months after the date of the enactment of
this Act.
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