text: 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.
target: 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.
feat_title: Promoting Access to Medicare Midwifery Services Act of 2000