article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Access to Obstetric Care Act of 1993''. SEC. 2. MEDICAID DEMONSTRATION PROJECTS TO IMPROVE ACCESS IN UNDERSERVED AREAS TO OBSTETRIC SERVICES. (a) In General.--The Secretary of Health and Human Services shall provide under this section for demonstration projects by States that seek to reduce infant mortality by improving access in urban and rural underserved 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 innovative payment mechanisms, including global fees for obstetric services with guaranteed periodic payments; (2) special or enhanced reimbursement for early prenatal care, risk-assessment, and high-risk services; (3) patient distribution or referral systems; (4) subsidizing medical liability insurance premiums, 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 patients. 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 Security Act to carry out a demonstration project under this section, the Federal medical assistance percentage (otherwise 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 Security Act to the extent necessary to implement demonstration 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 medical assistance made available under title XIX of the Social Security Act or that results in a loss of eligibility for individuals otherwise eligible for such assistance. (e) Timely Action on Applications.--A request to the Secretary by a State for approval of a demonstration 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 ending 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 Congress, not later than March 1, 1998, on the demonstration projects carried out under this section and on how the results 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 section, 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 initiatives 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, programs 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 pregnancy-related services in underserved areas, and efforts to recruit and retain providers of obstetric services under the Medicaid program. The compendium shall also include information 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 nonprofit organization to conduct a study on the rate of medical 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 submit to Congress a report on the study conducted under subsection (a). (c) Medical Malpractice Action or Claim Defined.--In this section, the term ``medical malpractice action or claim'' has the meaning given such term in section 431(7) of the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11151(7)).
summary: Access to Obstetric Care Act of 1993 - Directs the Secretary of Health and Human Services to: (1) provide for demonstration projects to improve access to obstetric services in underserved urban and rural areas for eligible pregnant women under title XIX (Medicaid) of the Social Security Act; (2) develop and make public each year a compendium of State initiatives to address the obstetric access crisis; and (3) provide a grant for the study of obstetrical malpractice claims.