,i #aafth ,,congress #ast ,session ,h4 ,r4 #eahi ,,in ,,the ,,house ,,of ,,representatives ,november #bj1 #bjai,ms4 ,clark of ,massachusetts 7for herself and ,mr4 ,carter of ,georgia7 introduced the following bill2 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 pregnancy1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,birth ,access ,benefiting ,improved ,essential ,facility ,services ,act or the ,,babies ,act4 #b4 ,medicaid demonstration program to improve freestanding birth center services ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following3 7bb7 ,demonstration program ,to improve freestanding birth center services 7#a7 ,authority ,the ,secretary shall establish a demonstration program for the purpose of identifying ways to improve access to1 and the quality and scope of1 freestanding birth center services for women with a low-risk pregnancy4 7#b7 ,deadlines for centers participation criteria1 prospective payment system2 planning grants 7,a7 ,participation and prospective payment system deadline ,not later than one year after the date of the enactment of this subsection1 the ,secretary shall do the following3 7i7 ,publication of participation criteria for freestanding birth centers 7,i7 ,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 subsection4 7,,ii7 ,requirements ,the criteria required to be published under subclause 7,i7 shall include the following3 7aa7 ,accreditation ,a freestanding birth center must have a current accreditation credential from an approved nationally recognized birth center accreditation body1 as determined by the ,secretary4 7bb7 ,licensure and other requirements ,a freestanding birth center shall-- 7,,aa7 be licensed1 or otherwise approved1 by the ,state to provide prenatal1 labor and delivery1 postpartum1 newborn care1 and other ambulatory services that are included in the ,state ,medicaid program2 and 7,,bb7 comply with such other requirements relating to the health and safety of individuals who receive services furnished by the facility as the ,state shall establish4 7cc7 ,care coordination ,a freestanding birth center shall be able to meet care coordination requirements1 including requirements to coordinate care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services1 and engage in consultation for higher level maternity care services1 non-maternity care services1 and behavioral health needs1 and which may include plans for consultation1 collaboration and referral1 and arrangements with the following3 7,,aa7 ,federally-qualified health centers 7and as applicable1 rural health clinics7 to provide ,federally-qualified health center services 7and as applicable1 rural health clinic services7 to the extent such services are not provided directly through the birth center4 7,,bb7 ,other outpatient clinics1 including licensed midwifery and physician practices4 7,,cc7 ,inpatient acute care facilities with obstetrical care units4 7dd7 ,scope of ,services ,as determined by the ,secretary1 a freestanding birth center must be able to provide peripartum care for women with a low-risk pregnancy and for newborns1 consistent with evidence-based guidelines4 7ee7 ,capabilities ,a freestanding birth center shall have the following3 7,,aa7 ,the capability and equipment to provide prenatal1 labor and delivery1 postpartum1 and newborn care for women with a low-risk pregnancy1 readiness at all times to initiate emergency procedures to meet unexpected needs of such women and of newborns within the center1 including at least #b qualified staff on-site at every birth1 and the ability to facilitate transport to an acute care hospital with an obstetrical care unit when necessary4 7,,bb7 ,an established transfer plan with a receiving hospital with an obstetrical care unit with policies and procedures for timely transport4 7,,cc7 ,medical consultation available from a licensed board-certified physician with admitting privileges in obstetrics at a nearby hospital4 7,,dd7 ,data collection1 storage1 and retrieval1 including data on intrapartum and postpartum maternal and newborn transfer rates and hospital admissions4 7,,ee7 ,the ability to initiate and document quality improvement programs as required by accreditation that include efforts to maximize patient safety1 such as safety checklists1 validated training and competency of staff1 and emergency preparedness and drills4 ,nothing in subitem 7,,aa7 shall be construed as affecting the ,state plan requirement specified under section #dca4ec of title #db1 ,code of ,federal ,regulations1 or any successor regulation 7relating to assurance of transportation74 7ff7 ,health care providers ,a freestanding birth center must employ or have care delivery arrangements with both of the following3 7,,aa7 ,a physician or physicians licensed to practice within the ,state or jurisdiction of the birth center4 7,,bb7 ,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 center4 7gg7 ,non-duplication ,in carrying out this subsection1 the ,secretary shall1 to the greatest extent practicable1 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 7#c7 for services for which payment is otherwise made under the ,state plan under this title4 7ii7 ,guidance on development of prospective payment system for testing under ,state demonstration programs 7,i7 ,in general ,the ,secretary shall issue guidance for ,states participating in a demonstration program conducted under paragraph 7#c7 to establish a prospective payment system that shall only apply to freestanding birth center services that meet the criteria established under clause 7i7 furnished by a freestanding birth center participating in such demonstration program4 7,,ii7 ,requirements ,the guidance issued by the ,secretary under subclause 7,i7 shall1 to the greatest extent practicable1 provide for-- 7aa7 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 baby2 7bb7 facility payment for observation short stays to rule out labor or for therapeutic rest2 7cc7 ensuring payment for the newborn and mother as two facility payment components2 7dd7 ensuring payment for nitrous oxide and hydrotherapy supplies costs for pain relief2 7ee7 ensuring payment for all professional services of health professionals involved in the delivery of care in a birth center which may include #c or more office visits2 observation and triage2 newborn exam and care2 and multiple postpartum1 mother1 and baby visits1 as needed2 7ff7 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 center2 and 7gg7 payment for services provided within-- 7,,aa7 in the case of a pregnant woman1 the period that commences upon the confirmation of pregnancy when the woman is accepted into care at the freestanding birth center1 continues through prenatal care1 labor and delivery1 and ends #fj days postpartum1 inclusive of at least #b postpartum care visits2 and 7,,bb7 in the case of a newborn1 a period that continues through the first #bh days of life4 7,b7 ,planning grants 7i7 ,in general ,not later than #ah months after the date of the enactment of this subsection1 the ,secretary shall award planning grants to ,states for the purpose of developing proposals to conduct a demonstration program described in paragraph 7#c74 7ii7 ,use of funds ,a ,state awarded a planning grant under this subparagraph shall use the funds awarded under such grant to-- 7,i7 solicit input with respect to the development of the demonstration program from patients1 providers 7including certified nurse-midwives and physicians7 and other stakeholders2 7,,ii7 secure participation of freestanding birth centers that meet the criteria established under subparagraph 7,a77i71 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 program2 and 7,,iii7 in accordance with the guidance issued under subparagraph 7,a77ii71 establish a prospective payment system which ,states must use for making payments to freestanding birth centers participating in the demonstration program4 7#c7 ,state demonstration programs 7,a7 ,in general ,not later than #bd months after the date of the enactment of this subsection1 from among the ,states awarded a planning grant under paragraph 7#b77;,b71 the ,secretary shall select not more than #f such ,states to conduct demonstration programs that meet the requirements of this paragraph4 7,b7 ,application requirements 7i7 ,in general ,the ,secretary shall solicit applications to conduct a demonstration program under this subsection from ,states awarded planning grants under paragraph 7#b77;,b74 7ii7 ,required information ,a ,state application to conduct a demonstration program under this paragraph shall include the following3 7,i7 ,a description of the target ,medicaid population to be served under the demonstration program4 7,,ii7 ,a list of the participating freestanding birth centers in the ,state4 7,,iii7 ,verification that each participating freestanding birth center meets the participation criteria established in paragraph 7#b77;,a77i74 7,,iv7 ,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 program4 7,v7 ,verification that the ,state has agreed to pay for such services at the rate established under the prospective payment system4 7,,vi7 ,an assurance that the ,state will require freestanding birth centers to submit to the ,state1 and that the ,state will submit to the ,secretary1 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 newborn4 7,,vii7 ,such other information as the ,secretary may require relating to the demonstration program1 including with respect to determining the soundness of the proposed prospective payment system4 7,c7 ,length of demonstration programs ,a ,state selected to conduct a demonstration program under this paragraph shall conduct the program for a #d-year period4 7,d7 ,requirements for selecting demonstration programs ,in selecting ,states to conduct demonstration programs under this paragraph1 the ,secretary shall-- 7i7 ensure ,states meet the criteria described in paragraph 7#b77;,a77i77,,ii72 7ii7 ensure that the ,states represent a diverse selection of geographic areas1 including rural and underserved areas2 and 7iii7 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 spending4 7,e7 ,payment for services provided by freestanding birth centers 7i7 ,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 7a7 of this section4 ,under a demonstration program conducted under this paragraph by a ,state1 payments shall be made by the ,state for freestanding birth center services that meet the criteria established under paragraph 7#b77;,a77i7 furnished by a freestanding birth center in accordance with the prospective payment system for such services established pursuant to the guidance issued under paragraph 7#b77;,a77ii74 7ii7 ,limitations ,payments shall be made under this subparagraph to a ,state only for freestanding birth center services that are-- 7,i7 described in the demonstration program application submitted by the ,state and approved by the ,secretary2 and 7,,ii7 provided to an individual who is eligible for medical assistance under the ,state ,medicaid program4 7iii7 ,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 7#b77;,a7ii71 no payment shall be made under this subparagraph for inpatient care or other non-ambulatory services1 as determined by the ,secretary4 7,f7 ,waiver of statewideness requirement ,the ,secretary shall waive section #aijb7;a77#a7 7relating to statewideness7 as may be necessary for a ,state to conduct a demonstration program in accordance with the requirements of this paragraph4 7,g7 ,annual reports 7i7 ,in general ,not later than #b years after the date on which the first ,state is selected to conduct a demonstration program under this paragraph1 and annually thereafter1 based on information and data submitted by ,states in accordance with the assurance provided under subparagraph 7,b77ii77,,vi71 the ,secretary shall submit to ,congress an annual report on all ,state demonstration programs conducted under this paragraph4 ,each such report shall include with respect to each such ,state demonstration program-- 7,i7 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 areas1 including with respect to the number of births and data on intrapartum and postpartum maternal and newborn transfer rates and hospital admissions2 and 7,,ii7 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 7including with respect to the provision of inpatient1 emergency1 and ambulatory services7 and newborn care1 compared to the ,federal and ,state costs related to the provision of freestanding birth center services by freestanding birth centers outside of such demonstration programs4 7ii7 ,recommendations ,not later than the end of the third year of the demonstration program established under this subsection1 the ,secretary shall submit to ,congress recommendations concerning whether the demonstration programs under this paragraph should be continued1 expanded1 modified1 or terminated4 7#d7 ,funding 7,a7 ,in general ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary-- 7i7 for purposes of carrying out paragraph 7#b77;,b71 #b1jjj1jjj2 and 7ii7 for purposes of carrying out the demonstration programs under paragraph 7#c71 #be1jjj1jjj4 7,b7 ,availability ,funds appropriated under subparagraph 7,a7 shall remain available until expended4 7#e7 ,definitions ,in this subsection3 7,a7 ,freestanding birth center services ,the term freestanding birth center services has the meaning given that term under section #aije7l77#c77;,a7 and includes such other services as the ,secretary shall determine for purposes of the demonstration programs conducted under paragraph 7#c74 7,b7 ,low-risk pregnancy ,the term low-risk pregnancy means an uncomplicated singleton term pregnancy with a vertex presentation with an expected uncomplicated birth4 4