text: 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)).
target: 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.
feat_title: Access to Obstetric Care Act of 1993