Birth Access Benefiting Improved Essential Facility Services Act or the BABIES Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish a Medicaid demonstration program to improve freestanding birth center services for women with low-risk pregnancies.
Among other things, the CMS must (1) publish criteria for freestanding birth centers to participate in the program, including specified accreditation, licensure, and service requirements; (2) publish guidance for states to establish prospective payment systems under Medicaid for program participants; and (3) award planning grants for states to develop program proposals. The CMS may choose up to six states to participate in the program.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5189 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 5189
To require the Secretary of Health and Human Services to establish a
Medicaid demonstration program to develop and advance innovative
payment models for freestanding birth center services for women with a
low-risk pregnancy, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 20, 2019
Ms. Clark of Massachusetts (for herself and Mr. Carter of Georgia)
introduced the following bill; which was referred to the Committee on
Energy and Commerce
_______________________________________________________________________
A BILL
To require the Secretary of Health and Human Services to establish a
Medicaid demonstration program to develop and advance innovative
payment models for freestanding birth center services for women with a
low-risk pregnancy, and for other purposes.
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 ``Birth Access Benefiting Improved
Essential Facility Services Act'' or the ``BABIES Act''.
SEC. 2. MEDICAID DEMONSTRATION PROGRAM TO IMPROVE FREESTANDING BIRTH
CENTER SERVICES.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following:
``(bb) Demonstration Program To Improve Freestanding Birth Center
Services.--
``(1) Authority.--The Secretary shall establish a
demonstration program for the purpose of identifying ways to
improve access to, and the quality and scope of, freestanding
birth center services for women with a low-risk pregnancy.
``(2) Deadlines for centers participation criteria,
prospective payment system; planning grants.--
``(A) Participation and prospective payment system
deadline.--Not later than one year after the date of
the enactment of this subsection, the Secretary shall
do the following:
``(i) Publication of participation criteria
for freestanding birth centers.--
``(I) In general.--Publish criteria
for a freestanding birth center to be
certified by a State for purposes of
participating in a State demonstration
program conducted under this
subsection.
``(II) Requirements.--The criteria
required to be published under
subclause (I) shall include the
following:
``(aa) Accreditation.--A
freestanding birth center must
have a current accreditation
credential from an approved
nationally recognized birth
center accreditation body, as
determined by the Secretary.
``(bb) Licensure and other
requirements.--A freestanding
birth center shall--
``(AA) be licensed,
or otherwise approved,
by the State to provide
prenatal, labor and
delivery, postpartum,
newborn care, and other
ambulatory services
that are included in
the State Medicaid
program; and
``(BB) comply with
such other requirements
relating to the health
and safety of
individuals who receive
services furnished by
the facility as the
State shall establish.
``(cc) Care coordination.--
A freestanding birth center
shall be able to meet care
coordination requirements,
including requirements to
coordinate care across settings
and providers to ensure
seamless transitions for
patients across the full
spectrum of health services,
and engage in consultation for
higher level maternity care
services, non-maternity care
services, and behavioral health
needs, and which may include
plans for consultation,
collaboration and referral, and
arrangements with the
following:
``(AA) Federally-
qualified health
centers (and as
applicable, rural
health clinics) to
provide Federally-
qualified health center
services (and as
applicable, rural
health clinic services)
to the extent such
services are not
provided directly
through the birth
center.
``(BB) Other
outpatient clinics,
including licensed
midwifery and physician
practices.
``(CC) Inpatient
acute care facilities
with obstetrical care
units.
``(dd) Scope of services.--
As determined by the Secretary,
a freestanding birth center
must be able to provide
peripartum care for women with
a low-risk pregnancy and for
newborns, consistent with
evidence-based guidelines.
``(ee) Capabilities.--A
freestanding birth center shall
have the following:
``(AA) The
capability and
equipment to provide
prenatal, labor and
delivery, postpartum,
and newborn care for
women with a low-risk
pregnancy, readiness at
all times to initiate
emergency procedures to
meet unexpected needs
of such women and of
newborns within the
center, including at
least 2 qualified staff
on-site at every birth,
and the ability to
facilitate transport to
an acute care hospital
with an obstetrical
care unit when
necessary.
``(BB) An
established transfer
plan with a receiving
hospital with an
obstetrical care unit
with policies and
procedures for timely
transport.
``(CC) Medical
consultation available
from a licensed board-
certified physician
with admitting
privileges in
obstetrics at a nearby
hospital.
``(DD) Data
collection, storage,
and retrieval,
including data on
intrapartum and
postpartum maternal and
newborn transfer rates
and hospital
admissions.
``(EE) The ability
to initiate and
document quality
improvement programs as
required by
accreditation that
include efforts to
maximize patient
safety, such as safety
checklists, validated
training and competency
of staff, and emergency
preparedness and
drills.
Nothing in subitem (AA) shall
be construed as affecting the
State plan requirement
specified under section 431.53
of title 42, Code of Federal
Regulations, or any successor
regulation (relating to
assurance of transportation).
``(ff) Health care
providers.--A freestanding
birth center must employ or
have care delivery arrangements
with both of the following:
``(AA) A physician
or physicians licensed
to practice within the
State or jurisdiction
of the birth center.
``(BB) A midwife or
midwives that meet or
exceed the education
and training standards
of the International
Confederation of
Midwives and who are
licensed to practice
within the jurisdiction
of the birth center.
``(gg) Non-duplication.--In
carrying out this subsection,
the Secretary shall, to the
greatest extent practicable,
prevent the duplication of
services covered under this
subsection with services
otherwise covered under the
State plan under this title and
prevent payment under a
demonstration program under
paragraph (3) for services for
which payment is otherwise made
under the State plan under this
title.
``(ii) Guidance on development of
prospective payment system for testing under
state demonstration programs.--
``(I) In general.--The Secretary
shall issue guidance for States
participating in a demonstration
program conducted under paragraph (3)
to establish a prospective payment
system that shall only apply to
freestanding birth center services that
meet the criteria established under
clause (i) furnished by a freestanding
birth center participating in such
demonstration program.
``(II) Requirements.--The guidance
issued by the Secretary under subclause
(I) shall, to the greatest extent
practicable, provide for--
``(aa) partial facility
payment based on units in the
case that a pregnant woman is
admitted in labor and then
needs to be transferred to the
hospital in labor before the
birth of the baby;
``(bb) facility payment for
observation short stays to rule
out labor or for therapeutic
rest;
``(cc) ensuring payment for
the newborn and mother as two
facility payment components;
``(dd) ensuring payment for
nitrous oxide and hydrotherapy
supplies costs for pain relief;
``(ee) ensuring payment for
all professional services of
health professionals involved
in the delivery of care in a
birth center which may include
3 or more office visits;
observation and triage; newborn
exam and care; and multiple
postpartum, mother, and baby
visits, as needed;
``(ff) ensuring payment for
partial prenatal and postpartum
care episodes or for prenatal
care only with planned delivery
in the hospital and client
returning for postpartum care
in the birth center; and
``(gg) payment for services
provided within--
``(AA) in the case
of a pregnant woman,
the period that
commences upon the
confirmation of
pregnancy when the
woman is accepted into
care at the
freestanding birth
center, continues
through prenatal care,
labor and delivery, and
ends 60 days
postpartum, inclusive
of at least 2
postpartum care visits;
and
``(BB) in the case
of a newborn, a period
that continues through
the first 28 days of
life.
``(B) Planning grants.--
``(i) In general.--Not later than 18 months
after the date of the enactment of this
subsection, the Secretary shall award planning
grants to States for the purpose of developing
proposals to conduct a demonstration program
described in paragraph (3).
``(ii) Use of funds.--A State awarded a
planning grant under this subparagraph shall
use the funds awarded under such grant to--
``(I) solicit input with respect to
the development of the demonstration
program from patients, providers
(including certified nurse-midwives and
physicians) and other stakeholders;
``(II) secure participation of
freestanding birth centers that meet
the criteria established under
subparagraph (A)(i), including by
providing support for such centers to
meet that criteria in order to maximize
the number of freestanding birth
centers participating in the
demonstration program; and
``(III) in accordance with the
guidance issued under subparagraph
(A)(ii), establish a prospective
payment system which States must use
for making payments to freestanding
birth centers participating in the
demonstration program.
``(3) State demonstration programs.--
``(A) In general.--Not later than 24 months after
the date of the enactment of this subsection, from
among the States awarded a planning grant under
paragraph (2)(B), the Secretary shall select not more
than 6 such States to conduct demonstration programs
that meet the requirements of this paragraph.
``(B) Application requirements.--
``(i) In general.--The Secretary shall
solicit applications to conduct a demonstration
program under this subsection from States
awarded planning grants under paragraph (2)(B).
``(ii) Required information.--A State
application to conduct a demonstration program
under this paragraph shall include the
following:
``(I) A description of the target
Medicaid population to be served under
the demonstration program.
``(II) A list of the participating
freestanding birth centers in the
State.
``(III) Verification that each
participating freestanding birth center
meets the participation criteria
established in paragraph (2)(A)(i).
``(IV) A description of the scope
of the freestanding birth center
services available under the State
Medicaid program for women with a low-
risk pregnancy that will be paid for
under the prospective payment system
tested in the demonstration program.
``(V) Verification that the State
has agreed to pay for such services at
the rate established under the
prospective payment system.
``(VI) An assurance that the State
will require freestanding birth centers
to submit to the State, and that the
State will submit to the Secretary,
such information and data as the State
or Secretary may require relating to
the demonstration program or an episode
of care for such a pregnant woman or
newborn.
``(VII) Such other information as
the Secretary may require relating to
the demonstration program, including
with respect to determining the
soundness of the proposed prospective
payment system.
``(C) Length of demonstration programs.--A State
selected to conduct a demonstration program under this
paragraph shall conduct the program for a 4-year
period.
``(D) Requirements for selecting demonstration
programs.--In selecting States to conduct demonstration
programs under this paragraph, the Secretary shall--
``(i) ensure States meet the criteria
described in paragraph (2)(A)(i)(II);
``(ii) ensure that the States represent a
diverse selection of geographic areas,
including rural and underserved areas; and
``(iii) give preference to States that
demonstrate the potential to expand the
availability of and access to maternity care
services in a demonstration area and increase
the quality of services provided by
freestanding birth centers without increasing
net Federal spending.
``(E) Payment for services provided by freestanding
birth centers.--
``(i) In general.--Amounts expended by a
State to conduct a demonstration program under
this paragraph shall be treated as medical
assistance for purposes of subsection (a) of
this section. Under a demonstration program
conducted under this paragraph by a State,
payments shall be made by the State for
freestanding birth center services that meet
the criteria established under paragraph
(2)(A)(i) furnished by a freestanding birth
center in accordance with the prospective
payment system for such services established
pursuant to the guidance issued under paragraph
(2)(A)(ii).
``(ii) Limitations.--Payments shall be made
under this subparagraph to a State only for
freestanding birth center services that are--
``(I) described in the
demonstration program application
submitted by the State and approved by
the Secretary; and
``(II) provided to an individual
who is eligible for medical assistance
under the State Medicaid program.
``(iii) Prohibited payments.--Unless
included as part of a payment provided under a
prospective payment system established by a
State for the demonstration program pursuant to
the guidance issued under paragraph (2)(A(ii),
no payment shall be made under this
subparagraph for inpatient care or other non-
ambulatory services, as determined by the
Secretary.
``(F) Waiver of statewideness requirement.--The
Secretary shall waive section 1902(a)(1) (relating to
statewideness) as may be necessary for a State to
conduct a demonstration program in accordance with the
requirements of this paragraph.
``(G) Annual reports.--
``(i) In general.--Not later than 2 years
after the date on which the first State is
selected to conduct a demonstration program
under this paragraph, and annually thereafter,
based on information and data submitted by
States in accordance with the assurance
provided under subparagraph (B)(ii)(VI), the
Secretary shall submit to Congress an annual
report on all State demonstration programs
conducted under this paragraph. Each such
report shall include with respect to each such
State demonstration program--
``(I) an assessment of clinical
outcomes for maternity services
provided by freestanding birth centers
participating in the demonstration
program compared to outcomes for low-
risk pregnancy Medicaid patients in
comparable demographic and geographic
areas, including with respect to the
number of births and data on
intrapartum and postpartum maternal and
newborn transfer rates and hospital
admissions; and
``(II) an assessment of the impact
of all the State demonstration programs
conducted under this paragraph on the
Federal and State costs relating to
providing freestanding birth center
services for women with a low-risk
pregnancy (including with respect to
the provision of inpatient, emergency,
and ambulatory services) and newborn
care, compared to the Federal and State
costs related to the provision of
freestanding birth center services by
freestanding birth centers outside of
such demonstration programs.
``(ii) Recommendations.--Not later than the
end of the third year of the demonstration
program established under this subsection, the
Secretary shall submit to Congress
recommendations concerning whether the
demonstration programs under this paragraph
should be continued, expanded, modified, or
terminated.
``(4) Funding.--
``(A) In general.--Out of any funds in the Treasury
not otherwise appropriated, there is appropriated to
the Secretary--
``(i) for purposes of carrying out
paragraph (2)(B), $2,000,000; and
``(ii) for purposes of carrying out the
demonstration programs under paragraph (3),
$25,000,000.
``(B) Availability.--Funds appropriated under
subparagraph (A) shall remain available until expended.
``(5) Definitions.--In this subsection:
``(A) Freestanding birth center services.--The term
`freestanding birth center services' has the meaning
given that term under section 1905(l)(3)(A) and
includes such other services as the Secretary shall
determine for purposes of the demonstration programs
conducted under paragraph (3).
``(B) Low-risk pregnancy.--The term `low-risk
pregnancy' means an uncomplicated singleton term
pregnancy with a vertex presentation with an expected
uncomplicated birth.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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