,,ii #aahth ,,congress #b;d ,session ,s4 #ebfb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #be1 #bjbd,mr4 ,lujn introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 care1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,better ,availability of ,birth ,centers ,improves ,outcomes and ,expands ,savings ,act or the ,,babies ,act4 #b4 ,grants to improve access to freestanding birth center services ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,v-#h4 ,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 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 may award grants to eligible birth centers that are accredited1 or intend to seek accreditation1 as birth centers by a nationally recognized accrediting body such as the ,commission for the ,accreditation of ,birth ,centers1 or that have the intention of seeking such accreditation1 for the purposes described in subsection 7b74 7b7 ,use of funds ,a birth center receiving a grant under this section may use such grant funds for any of the following purposes3 7#a7 ,renovation1 expansion1 or construction of a birth center facility4 7#b7 ,purchasing or updating equipment for a birth center4 7#c7 ,accreditation and ,state licensure activities4 7c7 ,grants2 grant amounts ,for each of fiscal years #bjbe through #bjbi1 the ,secretary shall award grants under this section to up to #ae birth centers1 each in an amount of not less than #cjj1jjj and not more than #ejj1jjj4 7d7 ,special considerations ,in awarding grants under this section1 the ,secretary shall give special consideration to an eligible birth center that-- 7#a7 is located in1 or offers services to1 a geographic area that-- 7,a7 has been designated under section #ccb as a health professional shortage area with respect to maternity care2 or 7,b7 has maternity care outcomes that are below a threshold established by the ,secretary2 and 7#b7 has not previously received a grant under this section4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #e1jjj1jjj for the period of fiscal years #bjbe through #bjbi4 4 #c4 ,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 following new subsection3 7cc7 ,demonstration program ,to improve freestanding birth center services 7#a7 ,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 to1 and the quality and scope of1 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 plan4 7#b7 ,deadlines for participation criteria1 prospective payment system2 planning grants 7,a7 ,participation and prospective payment system deadline ,not later than #a 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 ,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 subsection4 7,,ii7 ,requirements ,the criteria required to be published under subclause 7,i7 shall include the following3 7aa7 ,accreditation ,at the time of certification for purposes of participating in the demonstration program conducted under this subsection1 a freestanding birth center must be accredited or have completed the initial phase of accreditation from an approved1 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 for which medical assistance is available under the ,state plan or waiver under this title2 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 requirements established by the ,secretary1 including requirements to coordinate care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services1 and shall be able to engage in consultation for higher level maternity care services1 non-maternity care services1 and behavioral health needs1 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 shall 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 following capabilities3 7,,aa7 ,in addition to the requirements specified under section #dca4ec of title #db1 ,code of ,federal ,regulations1 and any successor regulation 7relating to assurance of transportation71 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 hospital1 as defined by ,state law or regulation4 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 7ff7 ,health care providers ,a freestanding birth center shall employ1 or have care delivery arrangements with1 both of the following3 7,,aa7 ,a physician licensed to practice within the ,state or jurisdiction of the birth center4 7,,bb7 ,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 center4 7gg7 ,non-duplication ,in carrying out this subsection1 the ,secretary shall1 with respect to a ,state participating in the demonstration program1 establish procedures to prevent1 to the greatest extent practicable1 the provision of1 or payment for1 services under the demonstration program for which medical assistance is available under the ,state plan under this title or waiver of such plan4 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 this subsection to establish a prospective payment system that shall only apply to freestanding birth center services that-- 7aa7 meet the criteria established under clause 7i72 and 7bb7 are furnished by a freestanding birth center participating in such a demonstration program4 7,,ii7 ,requirements ,the guidance issued by the ,secretary under subclause 7,i7 shall1 to the greatest extent practicable1 provide for-- 7aa7 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 baby2 7bb7 a facility payment for therapeutic rest or for observation short stays to rule out labor2 7cc7 ensuring payment for the newborn and mother as #b separate 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 center1 which may include-- 7,,aa7 #c or more prenatal office visits2 7,,bb7 observation and triage2 7,,cc7 newborn exam and care2 and 7,,dd7 multiple postpartum1 mother1 and newborn 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 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 labor1 and delivery1 and ends at the completion of the postpartum period 7as defined by ,state law or regulation7 with documentation of a plan for continued well woman care1 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 life with documentation of continued infant care4 7iii7 ,publication of an ,,rfp for ,states to apply for the demonstration program 7,i7 ,in general ,the ,secretary shall publish a request for proposal 7in this clause referred to as an ,,rfp7 for ,states to establish and test a prospective payment system for freestanding birth center services that-- 7aa7 meets the criteria established under clause 7i72 and 7bb7 are furnished by a freestanding birth center participating in a demonstration program under this subsection4 7,,ii7 ,requirements ,the ,,rfp published by the ,secretary under subclause 7,i7 shall1 to the greatest extent practicable1 include the following parameters3 7aa7 ,states must have a minimum number of established or developing birth centers4 7bb7 ,states must have a mechanism to recognize or license birth centers4 7cc7 ,states must have at least #a area that has been designated a maternity care desert4 7dd7 ,states must have areas with maternity care outcomes that are below a certain threshold1 as determined by the ,secretary4 7ee7 ,states should represent a diverse selection of geographic areas1 including rural and underserved areas4 7ff7 ,preference should 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 spending1 as determined by the ,secretary4 7,,iii7 ,required information ,a ,state application to conduct a demonstration program under this subsection shall include the following3 7aa7 ,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 program4 7bb7 ,a list of the participating freestanding birth centers in the ,state4 7cc7 ,verification that each participating freestanding birth center meets the participation criteria established in paragraph 7#b77;,a77i74 7dd7 ,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 program4 7ee7 ,verification that the ,state has agreed to pay for such services at the rate established under the prospective payment system4 7ff7 ,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 7gg7 ,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,,iv7 ,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 #ij days after the date on which the ,secretary publishes the ,,rfp under subclause 7,i74 7,b7 ,planning grants 7i7 ,in general ,not later than #ah months after the date of enactment of this subsection1 the ,secretary shall award a planning grant to up to #f ,states for the purpose of developing a detailed proposal 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-midwives1 other midwives licensed within the ,state1 and physicians71 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 7including accreditation7 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 the ,state shall 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 #b years after the date of enactment of this subsection1 the ,states selected by the ,secretary under paragraph 7#b77;,b77i7 shall launch their demonstration programs4 7,b7 ,length of demonstration programs ,a ,state conducting a demonstration program in accordance with this paragraph shall conduct the program for a #d-year period4 7,c7 ,payment for services provided by freestanding birth centers 7i7 ,in general ,during the first #af fiscal quarter period 7or any portion of such period7 that the ,state participates in the demonstration program1 the ,secretary shall pay a ,state participating in a demonstration program under this subsection the ,federal matching percentage specified in clause 7ii7 for amounts expended by the ,state to provide freestanding birth center services that meet the criteria established under paragraph 7#b77;,a77i7 and are furnished by a freestanding birth center in accordance with the prospective payment system for such services established by the ,state pursuant to the guidance issued under paragraph 7#b77;,a77ii7 to individuals who are enrolled in the ,state ,medicaid program4 7ii7 ,federal matching percentage ,subject to clause 7iii71 the ,federal matching percentage specified in this clause is1 with respect to medical assistance described in clause 7i7 that is furnished by a ,state participating in an ongoing demonstration program under this subsection-- 7,i7 to a newly eligible individual described in paragraph 7#b7 of section #aije7y71 the matching rate applicable under paragraph 7#a7 of that section 7as increased under section #aije7;ii71 if applicable72 and 7,,ii7 to an individual who is not a newly eligible individual 7as so described7 but who is eligible for medical assistance under the ,state ,medicaid program1 the enhanced ,,fmap applicable to the ,state4 7iii7 ,application of higher match ,clause 7ii7 shall not apply in the case of ,state expenditures described in such clause if the application of such clause would result in a lower ,federal medical assistance percentage for such expenditures than would otherwise apply without the application of such clause4 7iv7 ,limitation ,payments shall be made under this subparagraph to a ,state only for amounts expended by the ,state to provide medical assistance for freestanding birth center services that are described in the demonstration program application submitted by the ,state and approved by the ,secretary4 7v7 ,administrative expenses ,amounts expended by a ,state to conduct a demonstration program in accordance with this paragraph shall be considered1 for purposes of subsection 7a77#g71 to be necessary for the proper and efficient administration of the ,state plan4 7,d7 ,waiver of ,statewideness requirement ,the ,secretary shall waive the requirements of section #aijb7;a77#a7 7relating to ,statewideness71 section #aijb7;a77#aj77;,b7 7relating to comparability71 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 paragraph4 7,e7 ,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 subsection1 and annually thereafter1 based on information and data submitted by ,states in accordance with the assurance provided under paragraph 7#b77;,a77iii77,,iii77ff71 the ,secretary shall submit to ,congress an annual report on all ,state demonstration programs conducted under this subsection4 ,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 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 areas1 including with respect to-- 7aa7 the number of births and data on intrapartum and postpartum maternal and newborn transfer rates and hospital admissions2 and 7bb7 the rate of primary and repeat cesarean sections1 preterm births1 and neonatal intensive care unit admissions2 and 7,,ii7 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 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-- 7aa7 freestanding birth center services to such individuals by freestanding birth centers outside of such demonstration programs2 and 7bb7 traditional maternity services as provided in non-birth center clinics and hospital programs4 7ii7 ,recommendations ,not later than #f months after the end of the third year of the demonstration program conducted under this subsection1 the ,secretary shall submit to ,congress recommendations concerning whether such demonstration program 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 #c1jjj1jjj2 and 7ii7 for purposes of carrying out the demonstration programs described in paragraph 7#c71 #bd1jjj1jjj1 to be appropriated at the rate of #f1jjj1jjj per year for #d years4 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 conducting the demonstration programs described in 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