No official summary available for this bill.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5202 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 5202
To address maternity care shortages and promote optimal maternity
outcomes by expanding access to birth centers and exploring more
effective payment models for birth center care, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 8, 2025
Ms. Morrison (for herself and Mrs. Hinson) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To address maternity care shortages and promote optimal maternity
outcomes by expanding access to birth centers and exploring more
effective payment models for birth center care, 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 ``Better Availability of Birth Centers
Improves Outcomes and Expands Savings Act'' or the ``BABIES Act''.
SEC. 2. GRANTS TO IMPROVE ACCESS TO FREESTANDING BIRTH CENTER SERVICES.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-8. STRONG START BIRTH CENTER GRANTS TO ASSIST BIRTH CENTERS
WITH START-UP OR EXPANSION COSTS TO EXPAND ACCESS TO
BIRTH CENTER SERVICES IN UNDERSERVED AREAS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, may award grants
to eligible birth centers that are accredited, or intend to seek
accreditation, as birth centers by a nationally recognized accrediting
body such as the Commission for the Accreditation of Birth Centers, or
that have the intention of seeking such accreditation, for the purposes
described in subsection (b).
``(b) Use of Funds.--A birth center receiving a grant under this
section may use such grant funds for any of the following purposes:
``(1) Renovation, expansion, or construction of a birth
center facility.
``(2) Purchasing or updating equipment for a birth center.
``(3) Accreditation and State licensure activities.
``(c) Grants; Grant Amounts.--For each of fiscal years 2026 through
2030, the Secretary shall award grants under this section to up to 15
birth centers, each in an amount of not less than $300,000 and not more
than $500,000.
``(d) Special Considerations.--In awarding grants under this
section, the Secretary shall give special consideration to an eligible
birth center that--
``(1) is located in, or offers services to, a geographic
area that--
``(A) has been designated under section 332 as a
health professional shortage area with respect to
maternity care; or
``(B) has maternity care outcomes that are below a
threshold established by the Secretary; and
``(2) has not previously received a grant under this
section.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $5,000,000 for the period of
fiscal years 2026 through 2030.''.
SEC. 3. 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 new subsection:
``(cc) Demonstration Program To Improve Freestanding Birth Center
Services.--
``(1) Authority.--The Secretary shall conduct a
demonstration program for the purpose of exploring more
effective payment models for birth center care in order to
improve access to, and the quality and scope of, freestanding
birth center services for women with a low-risk pregnancy who
are eligible for medical assistance under the State plan under
this title or under a waiver of such plan.
``(2) Deadlines for participation criteria, prospective
payment system; planning grants.--
``(A) Participation and prospective payment system
deadline.--Not later than 1 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.--The Secretary
shall 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.--At
the time of certification for
purposes of participating in
the demonstration program
conducted under this
subsection, a freestanding
birth center shall be
accredited or have completed
the initial phase of
accreditation 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 for
which medical
assistance is available
under the State plan or
waiver under this
title; 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
established by the Secretary,
including requirements to
coordinate care across settings
and providers to ensure
seamless transitions for
patients across the full
spectrum of health services,
and shall be able to engage in
consultation for higher level
maternity care services, non-
maternity care services, and
behavioral health needs, 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
shall 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
capabilities:
``(AA) In addition
to the requirements
specified under section
431.53 of title 42,
Code of Federal
Regulations, and any
successor regulation
(relating to assurance
of transportation), 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, as defined by
State law or
regulation.
``(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.
``(ff) Health care
providers.--A freestanding
birth center shall employ, or
have care delivery arrangements
with, both of the following:
``(AA) A physician
licensed to practice
within the State or
jurisdiction of the
birth center.
``(BB) A midwife
that meets or exceeds
the education and
training standards of
the International
Confederation of
Midwives and who is
licensed to practice
within the jurisdiction
of the birth center.
``(gg) Non-duplication.--In
carrying out this subsection,
the Secretary shall, with
respect to a State
participating in the
demonstration program,
establish procedures to
prevent, to the greatest extent
practicable, the provision of,
or payment for, services under
the demonstration program for
which medical assistance is
available under the State plan
under this title or waiver of
such plan.
``(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 this subsection
to establish a prospective payment
system that shall only apply to
freestanding birth center services
that--
``(aa) meet the criteria
established under clause (i);
and
``(bb) are furnished by a
freestanding birth center
participating in such a
demonstration program.
``(II) Requirements.--The guidance
issued by the Secretary under subclause
(I) shall, to the greatest extent
practicable, provide for--
``(aa) a 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) a facility payment
for therapeutic rest or for
observation short stays to rule
out labor;
``(cc) ensuring payment for
the newborn and mother as 2
separate 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--
``(AA) 3 or more
prenatal office visits;
``(BB) observation
and triage;
``(CC) newborn exam
and care; and
``(DD) multiple
postpartum, mother, and
newborn 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 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 at the
completion of the
postpartum period (as
defined by State law or
regulation) with
documentation of a plan
for continued well
woman care, 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 with documentation
of continued infant
care.
``(iii) Publication of an rfp for states to
apply for the demonstration program.--
``(I) In general.--The Secretary
shall publish a request for proposal
(in this clause referred to as an
`RFP') for States to establish and test
a prospective payment system for
freestanding birth center services
that--
``(aa) meets the criteria
established under clause (i);
and
``(bb) are furnished by a
freestanding birth center
participating in a
demonstration program under
this subsection.
``(II) Requirements.--The RFP
published by the Secretary under
subclause (I) shall, to the greatest
extent practicable, include the
following parameters:
``(aa) States shall have a
minimum number of established
or developing birth centers.
``(bb) States shall have a
mechanism to recognize or
license birth centers.
``(cc) States shall have at
least 1 area that has been
designated a maternity care
desert.
``(dd) States shall have
areas with maternity care
outcomes that are below a
certain threshold, as
determined by the Secretary.
``(ee) States shall
represent a diverse selection
of geographic areas, including
rural and underserved areas.
``(ff) Preference shall be
given 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, as determined by the
Secretary.
``(III) Required information.--A
State application to conduct a
demonstration program under this
subsection shall include the following:
``(aa) A description of the
target population of
individuals who are eligible
for medical assistance under
the State plan under this title
or under a waiver of such plan
and are to be served under the
demonstration program.
``(bb) A list of the
participating freestanding
birth centers in the State.
``(cc) Verification that
each participating freestanding
birth center meets the
participation criteria
established in paragraph
(2)(A)(i).
``(dd) A description of the
scope of the freestanding birth
center services available under
the State plan under this title
or waiver of such plan for
women with a low-risk pregnancy
that will be paid for under the
prospective payment system
tested in the demonstration
program.
``(ee) Verification that
the State has agreed to pay for
such services at the rate
established under the
prospective payment system.
``(ff) 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.
``(gg) 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.
``(IV) Deadlines for submission of
rfp applications.--The deadline for a
State to submit an application to
participate in the demonstration
program conducted under this subsection
shall be the date that is 90 days after
the date on which the Secretary
publishes the RFP under subclause (I).
``(B) Planning grants.--
``(i) In general.--Not later than 18 months
after the date of the enactment of this
subsection, the Secretary shall award a
planning grant to up to 6 States for the
purpose of developing a detailed proposal 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,
other midwives licensed within the
State, 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 (including
accreditation) 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 the State shall
use for making payments to freestanding
birth centers participating in the
demonstration program.
``(3) State demonstration programs.--
``(A) In general.--Not later than 2 years after the
date of the enactment of this subsection, the States
selected by the Secretary under paragraph (2)(B)(i)
shall begin conducting the demonstration program under
this paragraph.
``(B) Length of demonstration programs.--A State
conducting a demonstration program in accordance with
this paragraph shall conduct the program for a 4-year
period.
``(C) Payment for services provided by freestanding
birth centers.--
``(i) In general.--For each quarter during
the 4-year period during which a State
participates in a demonstration program under
this subsection, the Secretary shall pay such
State an amount equal to the Federal medical
assistance percentage (as defined in section
1905(b)) of the total amount expended by such
State during such quarter under the prospective
payment system established by such State
pursuant to paragraph (2)(B)(III) to
freestanding birth centers for services that
are--
``(I) furnished pursuant to the
criteria established under paragraph
(2)(A)(i) to individuals enrolled in
the State plan (or waiver of such plan)
of such State under this title; and
``(II) described in the
demonstration program application
submitted by such State and approved by
the Secretary.
``(ii) Administrative expenses.--Amounts
expended by a State to conduct a demonstration
program in accordance with this paragraph shall
be considered, for purposes of subsection
(a)(7), to be necessary for the proper and
efficient administration of the State plan.
``(D) Waiver of statewideness requirement.--The
Secretary shall waive the requirements of section
1902(a)(1) (relating to Statewideness), section
1902(a)(10)(B) (relating to comparability), and any
other provision of this title which would be directly
contrary to the authority under this subsection as may
be necessary for a State to conduct a demonstration
program in accordance with this paragraph.
``(E) 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 subsection, and annually thereafter,
based on information and data submitted by
States in accordance with the assurance
provided under paragraph (2)(A)(iii)(III)(ff),
the Secretary shall submit to Congress an
annual report on all State demonstration
programs conducted under this subsection. 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 for individuals who are
eligible for medical assistance under a
State plan under this title or under a
waiver of such plan and are women with
a low-risk pregnancy with outcomes in
comparable demographic and geographic
areas, including with respect to--
``(aa) the number of births
and data on intrapartum and
postpartum maternal and newborn
transfer rates and hospital
admissions; and
``(bb) the rate of primary
and repeat cesarean sections,
preterm births, and neonatal
intensive care unit admissions;
and
``(II) an assessment of the impact
of all the State demonstration programs
conducted under this subsection on the
Federal and State costs relating to
providing freestanding birth center
services for individuals who are
eligible for medical assistance under a
State plan under this title or under a
waiver of such plan and are 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--
``(aa) freestanding birth
center services to such
individuals by freestanding
birth centers outside of such
demonstration programs; and
``(bb) traditional
maternity services as provided
in non-birth center clinics and
hospital programs.
``(ii) Recommendations.--Not later than 6
months before the the last day of the 4-year
period for which demonstration programs are
conducted under this subsection, the Secretary
shall submit to Congress recommendations
concerning whether such demonstration programs
shall 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 fiscal year 2027, $3,000,000 for
purposes of carrying out paragraph (2)(B); and
``(ii) for each of fiscal years 2028
through 2031, $6,000,000 for purposes of
carrying out the demonstration programs
described in paragraph (3).
``(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 such term in section 1905(l)(3)(A) and includes
such other services as the Secretary shall determine
for purposes of conducting the demonstration programs
described in paragraph (3).
``(B) Low-risk pregnancy.--The term `low-risk
pregnancy' means an uncomplicated singleton term
pregnancy with a vertex presentation and an expected
uncomplicated birth.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
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