article: SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) Short Title.--This Act may be cited as the ``Promoting Access to Medicare Midwifery Services Act of 2000''. (b) Table of Contents.--The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Medicare payment for certified midwife services. Sec. 3. Increased medicare payments for certified nurse-midwife services and certified midwife services. Sec. 4. Clarification of hospital conditions of participation with respect to certified nurse-midwives and certified midwives. Sec. 5. Medicare payment for freestanding birth center services. Sec. 6. Clarification of billing rights of certified nurse-midwives and certified midwives. Sec. 7. Clarification regarding payments for certified nurse-midwife services and certified midwife services furnished in teaching hospitals. Sec. 8. Interim and final regulations. SEC. 2. MEDICARE PAYMENT FOR CERTIFIED MIDWIFE SERVICES. (a) Certified Midwife and Certified Midwife Services Defined.-- Section 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) is amended-- (1) in paragraph (1)-- (A) by striking ``(as defined in paragraph (2))'' and inserting ``(as defined in subparagraph (B))''; and (B) by inserting ``(A)'' after ``(1)''; (2) by redesignating paragraph (2) as subparagraph (B); and (3) by adding at the end the following new paragraph: ``(2)(A) The term `certified midwife services' means such services furnished by a certified midwife (as defined in subparagraph (B)) 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. ``(B) The term `certified midwife' means an individual-- ``(i) with a bachelor's degree from an accredited educational institution who has completed a program of study and clinical experience meeting guidelines established by the Secretary of Education; or ``(ii) who has been certified in nurse-midwifery or midwifery by an organization recognized by the Secretary of Education.''. (b) Certified Midwife Benefit.-- (1) Scope of benefits.--Section 1832(a)(2)(B)(iii) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended by inserting ``, certified midwife services'' after ``certified nurse-midwife services''. (2) Payment of benefits.--Section 1833(a)(1)(K) of the Social Security Act (42 U.S.C. 1395l(a)(1)(K)) is amended by inserting ``and certified midwife services'' after ``certified nurse-midwife services''. (c) Conforming Amendments.-- (1) Use of carriers for administration of benefits.-- Section 1842(b)(18)(C)(iii) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)(iii)) is amended by striking ``(as defined in section 1861(gg)(2))'' and inserting ``or a certified midwife (as defined in paragraph (1)(B) and (2)(B), respectively, of section 1861(gg))''. (2) Health care professional defined.--Section 1852(j)(3)(D) of the Social Security Act (42 U.S.C. 1395w- 22(j)(3)(D)) is amended by striking ``and certified nurse- midwife'' and inserting ``certified nurse-midwife, and certified midwife''. (3) Inpatient hospital services.--Section 1861(b)(4) of the Social Security Act (42 U.S.C. 1395x(b)(4)) is amended by inserting ``, certified midwife services,'' after ``certified nurse-midwife services''. (4) Medical and other health services.--Section 1861(s)(2)(L) of the Social Security Act (42 U.S.C. 1395x(s)(2)(L)) is amended by inserting ``and certified midwife services'' before the semicolon at the end. (5) Rural health clinic services and federally qualified health clinic services.--Section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)) is amended-- (A) in paragraph (2)(J), by striking ``, or a certified nurse-midwife (as defined in subsection (gg))'' and inserting ``, a certified nurse-midwife (as defined in subsection (gg)(1)(B)), or a certified midwife (as defined in subsection (gg)(2)(B))''; and (B) in paragraph (7)(A), by striking ``or certified nurse midwife'' and inserting ``, certified nurse- midwife, or certified midwife''. (6) Certified nurse-midwife services.--The heading of section 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) is amended by adding at the end the following: ``; Certified Midwife Services''. (7) Exclusions from coverage and medicare as secondary payer.--Section 1862(a)(14) of the Social Security Act (42 U.S.C. 1395y(a)(14)) is amended by inserting ``, certified midwife services'' after ``certified nurse-midwife services''. (8) Agreements with providers of services.--Section 1866(a)(1)(H)(i) (42 U.S.C. 1395cc(a)(1)(H)(i)) is amended by inserting ``, certified midwife services'' after ``certified nurse-midwife services''. (9) Exclusion from payment to skilled nursing facilities for routine service costs.--Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting ``, certified midwife services'' after ``certified nurse-midwife services''. (10) Medicaid definitions.--Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended-- (A) in subsection (a)(17)-- (i) by striking ``a nurse-midwife (as defined in section 1861(gg)) which the nurse- midwife is'' and inserting ``a certified nurse- midwife or a certified midwife (as defined in paragraphs (1)(B) and (2)(B), respectively, of section 1861(gg)) which the certified nurse- midwife or certified midwife, as the case may be, is''; and (ii) by striking ``whether or not the nurse-midwife'' and inserting ``whether or not the certified nurse-midwife or certified midwife, as the case may be,''; and (B) in subsection (t)(2)(B)(ii), by striking ``(as defined in section 1861(gg))'' and inserting ``or a certified midwife (as defined in paragraphs (1)(B) and (2)(B), respectively, of section 1861(gg)(2)(B))''. (11) Medicaid managed care.--Section 1932(b)(3)(C) of the Social Security Act (42 U.S.C. 1396u-2(b)(3)(C)) is amended by striking ``and certified nurse-midwife'' and inserting ``certified nurse-midwife, and certified midwife''. (d) Effective Date.--The amendments made by this section shall apply to payment for certified nurse-midwife services and certified midwife services furnished on or after the date of enactment of this Act. SEC. 3. INCREASED MEDICARE PAYMENTS FOR CERTIFIED NURSE-MIDWIFE SERVICES AND CERTIFIED MIDWIFE SERVICES. (a) Amount of Payment.--Section 1833(a)(1)(K) of the Social Security Act (42 U.S.C. 1395l(a)(1)(K)) is amended by striking ``65 percent of the prevailing charge that would be allowed for the same service performed by a physician, or, for services furnished on or after January 1, 1992, 65 percent'' and inserting ``95 percent''. (b) Effective Date.--The amendments made by subsection (a) shall apply to certified nurse-midwife services and certified midwife services furnished on or after the date of enactment of this Act. SEC. 4. CLARIFICATION OF HOSPITAL CONDITIONS OF PARTICIPATION WITH RESPECT TO CERTIFIED NURSE-MIDWIVES AND CERTIFIED MIDWIVES. (a) Payment to Hospital for Patients Under Care of Certified Nurse- Midwife or Certified Midwife.--Section 1861(e)(4) of the Social Security Act (42 U.S.C. 1395x(e)(4)) is amended to read as follows: ``(4) has a requirement that every patient with respect to whom payment may be made under this title must be under the care of a physician, except that-- ``(A) a patient receiving qualified psychologist services (as defined in subsection (B)) may be under the care of a clinical psychologist with respect to such services to the extent permitted under State law; and ``(B) a patient receiving certified nurse-midwife services or certified midwife services (as defined in paragraphs (1)(B) and (2)(B), respectively, of subsection (gg)) may be under the care of a certified nurse-midwife or certified midwife, as the case may be, with respect to such services to the extent permitted under State law;''. (b) Effective Date.--The amendment made by subsection (a) shall take effect on the date of enactment of this Act. SEC. 5. MEDICARE PAYMENT FOR FREESTANDING BIRTH CENTER SERVICES. (a) Freestanding Birth Center Services and Freestanding Birth Center Defined.--Section 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) (as amended by section 2(a)) is amended by adding at the end the following new paragraph: ``(3)(A) The term `freestanding birth center services' means items and services furnished by a freestanding birth center (as defined in subparagraph (B)) as would otherwise be covered if furnished by a hospital. ``(B)(i) The term `freestanding birth center' means a facility or institution-- ``(I) in which births are planned to occur (outside the mother's place of residence); ``(II) in which comprehensive health care services are furnished; and ``(III) which has been approved by the Secretary or accredited by an organization recognized by the Secretary for purposes of accrediting freestanding birth centers. ``(ii) Such term does not include-- ``(I) a rural health clinic, critical access hospital, or a sole community hospital; or ``(II) a facility or institution that is a hospital or an ambulatory surgical center, unless with respect to ambulatory surgical centers, the State law or regulation that regulates such centers also regulates freestanding birth centers in the State.''. (b) Freestanding Birth Center Benefit.-- (1) Scope of benefits.--Section 1832(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)) is amended-- (A) in subparagraph (I), by striking ``and'' at the end; (B) in subparagraph (J), by striking the period at the end and inserting ``; and''; and (C) by adding at the end the following new subparagraph: ``(K) freestanding birth center services performed in a freestanding birth center if the center has an agreement in effect with the Secretary by which the center agrees to accept the amount of payment determined under section 1833(u) as full payment for such services, and to accept assignment described in section 1842(b)(3)(B)(ii) with respect to payment for all such services furnished by the center to individuals enrolled under this part.''. (2) Payment of benefits.--Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection: ``(u) Payment for Freestanding Birth Center Services.--The Secretary shall establish by regulation the amount of payment to be made for facility services furnished in connection with freestanding birth center services and furnished to an individual in a freestanding birth center under this title.''. (c) Conforming Amendments.-- (1) Medical and other health services.--Section 1861(s)(2)(L) of the Social Security Act (42 U.S.C. 1395x(s)(2)(L)) is amended-- (A) by adding ``and'' at the end; (B) by inserting ``(i)'' after ``(L)''; and (C) by adding at the end the following new clause: ``(ii) freestanding birth center services;''. (2) Certified nurse-midwife services; certified midwife services.--The heading of section 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) (as amended by section 2(c)(6)) is amended by adding at the end the following: ``; Freestanding Birth Center Services''. (d) Effective Date.--The amendments made by this section shall apply to freestanding birth center services furnished on or after the date of enactment of this Act. SEC. 6. CLARIFICATION OF BILLING RIGHTS OF CERTIFIED NURSE-MIDWIVES AND CERTIFIED MIDWIVES. (a) Use of Carriers for Administration of Benefits.--The first sentence of section 1842(b)(6) of the Social Security Act (42 U.S.C. 1395u(b)(6)) is amended-- (1) by striking ``and'' before ``(F)''; and (2) by inserting before the period at the end the following: ``, and (G) in the case of certified nurse-midwife services or certified midwife services described in section 1861(s)(2)(L), payment may be made in accordance with subparagraph (A), except that payment may also be made to such individual or entity (or to the agent of such individual or entity) as the certified nurse-midwife or certified midwife, as the case may be, may designate under an agreement between the certified nurse-midwife or certified midwife, as the case may be, and such individual or entity (or the agent of such individual or entity)''. (b) Effective Date.--The amendment made by subsection (a) shall apply to payment for certified nurse-midwife services and certified midwife services furnished on or after the date of enactment of this Act. SEC. 7. CLARIFICATION REGARDING PAYMENTS FOR CERTIFIED NURSE-MIDWIFE SERVICES AND CERTIFIED MIDWIFE SERVICES FURNISHED IN TEACHING HOSPITALS. (a) Scope of Benefits.--Section 1832(a)(2)(B)(iii) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended-- (1) by inserting ``(I)'' after ``(iii)''; and (2) 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 sections 1842(b)(7)(E) and 1861(b)(8);''. (b) Clarification Regarding Payments Under Part B for Such Services Furnished in Teaching Hospitals.-- (1) In general.--Section 1842(b)(7) of the Social Security Act (42 U.S.C. 1395u(b)(7)) is amended-- (A) in subparagraph (A), in the matter preceding clause (i), by inserting ``or, for purposes of subparagraph (E), the conditions described in section 1861(b)(8),'' after ``section 1861(b)(7),''; (B) in subparagraph (C), by inserting ``or, for purposes of subparagraph (E), the conditions described in section 1861(b)(8),'' after ``section 1861(b)(7),''; and (C) 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, as the case may be, under this subparagraph as such provisions apply to a physician under such subparagraphs.''. (2) Regulations.--Not later than 6 months after the date of enactment of this Act, the Secretary shall promulgate regulations to carry out the amendments made by paragraph (1). (c) Inpatient Hospital Services.--Section 1861(b) of the Social Security Act (42 U.S.C. 1395x(b)) is amended-- (1) in paragraph (6)-- (A) by inserting ``(A)'' after ``(6)''; and (B) by adding at the end the following new subparagraph: ``(B) in the case of services in a hospital or osteopathic hospital, an intern or resident-in-training in the field of obstetrics and gynecology taught or supervised by a certified nurse-midwife or certified midwife (as defined in paragraphs (1)(B) and (2)(B), respectively, of subsection (gg)) to the extent permitted under State law and as may be authorized by the hospital;''; (2) in paragraph (7), by striking the period at the end and inserting ``; or''; and (3) 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 and 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.''. SEC. 8. INTERIM AND FINAL REGULATIONS. Except with respect to the amendments made by section 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 1 year after the date of enactment of this Act.
summary: Increases Medicare payments for certified nurse-midwife and certified midwife services. Amends SSA with regard to: (1) hospital conditions of participation with respect to certified nurse-midwives and certified midwives; (2) billing rights of such practitioners; and (3) payments for the services of such practitioners furnished in teaching hospitals.