BABIES Act

I 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 pay- ment 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) intro- duced 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 de- velop and advance innovative payment models for free- standing birth center services for women with a low- risk pregnancy, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Birth Access Bene- 4 fiting Improved Essential Facility Services Act’’ or the 5 ‘‘BABIES Act’’. 6 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 2 •HR 5189 IH SEC. 2. MEDICAID DEMONSTRATION PROGRAM TO IM- 1 PROVE FREESTANDING BIRTH CENTER SERV- 2 ICES. 3 Section 1903 of the Social Security Act (42 U.S.C. 4 1396b) is amended by adding at the end the following: 5 ‘‘(bb) DEMONSTRATION PROGRAM TO IMPROVE 6 FREESTANDING BIRTH CENTER SERVICES.— 7 ‘‘(1) AUTHORITY.—The Secretary shall estab- 8 lish a demonstration program for the purpose of 9 identifying ways to improve access to, and the qual- 10 ity and scope of, freestanding birth center services 11 for women with a low-risk pregnancy. 12 ‘‘(2) DEADLINES FOR CENTERS PARTICIPATION 13 CRITERIA, PROSPECTIVE PAYMENT SYSTEM; PLAN- 14 NING GRANTS.— 15 ‘‘(A) PARTICIPATION AND PROSPECTIVE 16 PAYMENT SYSTEM DEADLINE.—Not later than 17 one year after the date of the enactment of this 18 subsection, the Secretary shall do the following: 19 ‘‘(i) PUBLICATION OF PARTICIPATION 20 CRITERIA FOR FREESTANDING BIRTH CEN- 21 TERS.— 22 ‘‘(I) IN GENERAL.—Publish cri- 23 teria for a freestanding birth center to 24 be certified by a State for purposes of 25 participating in a State demonstration 26 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 3 •HR 5189 IH program conducted under this sub- 1 section. 2 ‘‘(II) REQUIREMENTS.—The cri- 3 teria required to be published under 4 subclause (I) shall include the fol- 5 lowing: 6 ‘‘(aa) ACCREDITATION.—A 7 freestanding birth center must 8 have a current accreditation cre- 9 dential from an approved nation- 10 ally recognized birth center ac- 11 creditation body, as determined 12 by the Secretary. 13 ‘‘(bb) LICENSURE AND 14 OTHER REQUIREMENTS.—A free- 15 standing birth center shall— 16 ‘‘(AA) be licensed, or 17 otherwise approved, by the 18 State to provide prenatal, 19 labor and delivery, 20 postpartum, newborn care, 21 and other ambulatory serv- 22 ices that are included in the 23 State Medicaid program; 24 and 25 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 4 •HR 5189 IH ‘‘(BB) comply with 1 such other requirements re- 2 lating to the health and 3 safety of individuals who re- 4 ceive services furnished by 5 the facility as the State shall 6 establish. 7 ‘‘(cc) CARE COORDINA- 8 TION.—A freestanding birth cen- 9 ter shall be able to meet care co- 10 ordination requirements, includ- 11 ing requirements to coordinate 12 care across settings and pro- 13 viders to ensure seamless transi- 14 tions for patients across the full 15 spectrum of health services, and 16 engage in consultation for higher 17 level maternity care services, 18 non-maternity care services, and 19 behavioral health needs, and 20 which may include plans for con- 21 sultation, collaboration and refer- 22 ral, and arrangements with the 23 following: 24 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 5 •HR 5189 IH ‘‘(AA) Federally-quali- 1 fied health centers (and as 2 applicable, rural health clin- 3 ics) to provide Federally- 4 qualified health center serv- 5 ices (and as applicable, rural 6 health clinic services) to the 7 extent such services are not 8 provided directly through 9 the birth center. 10 ‘‘(BB) Other outpatient 11 clinics, including licensed 12 midwifery and physician 13 practices. 14 ‘‘(CC) Inpatient acute 15 care facilities with obstet- 16 rical care units. 17 ‘‘(dd) SCOPE OF SERV- 18 ICES.—As determined by the Sec- 19 retary, a freestanding birth cen- 20 ter must be able to provide 21 peripartum care for women with 22 a low-risk pregnancy and for 23 newborns, consistent with evi- 24 dence-based guidelines. 25 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 6 •HR 5189 IH ‘‘(ee) CAPABILITIES.—A 1 freestanding birth center shall 2 have the following: 3 ‘‘(AA) The capability 4 and equipment to provide 5 prenatal, labor and delivery, 6 postpartum, and newborn 7 care for women with a low- 8 risk pregnancy, readiness at 9 all times to initiate emer- 10 gency procedures to meet 11 unexpected needs of such 12 women and of newborns 13 within the center, including 14 at least 2 qualified staff on- 15 site at every birth, and the 16 ability to facilitate transport 17 to an acute care hospital 18 with an obstetrical care unit 19 when necessary. 20 ‘‘(BB) An established 21 transfer plan with a receiv- 22 ing hospital with an obstet- 23 rical care unit with policies 24 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 7 •HR 5189 IH and procedures for timely 1 transport. 2 ‘‘(CC) Medical con- 3 sultation available from a li- 4 censed board-certified physi- 5 cian with admitting privi- 6 leges in obstetrics at a near- 7 by hospital. 8 ‘‘(DD) Data collection, 9 storage, and retrieval, in- 10 cluding data on intrapartum 11 and postpartum maternal 12 and newborn transfer rates 13 and hospital admissions. 14 ‘‘(EE) The ability to 15 initiate and document qual- 16 ity improvement programs 17 as required by accreditation 18 that include efforts to maxi- 19 mize patient safety, such as 20 safety checklists, validated 21 training and competency of 22 staff, and emergency pre- 23 paredness and drills. 24 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 8 •HR 5189 IH Nothing in subitem (AA) shall be 1 construed as affecting the State 2 plan requirement specified under 3 section 431.53 of title 42, Code 4 of Federal Regulations, or any 5 successor regulation (relating to 6 assurance of transportation). 7 ‘‘(ff) HEALTH CARE PRO- 8 VIDERS.—A freestanding birth 9 center must employ or have care 10 delivery arrangements with both 11 of the following: 12 ‘‘(AA) A physician or 13 physicians licensed to prac- 14 tice within the State or ju- 15 risdiction of the birth center. 16 ‘‘(BB) A midwife or 17 midwives that meet or ex- 18 ceed the education and 19 training standards of the 20 International Confederation 21 of Midwives and who are li- 22 censed to practice within the 23 jurisdiction of the birth cen- 24 ter. 25 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 9 •HR 5189 IH ‘‘(gg) NON-DUPLICATION.— 1 In carrying out this subsection, 2 the Secretary shall, to the great- 3 est extent practicable, prevent 4 the duplication of services cov- 5 ered under this subsection with 6 services otherwise covered under 7 the State plan under this title 8 and prevent payment under a 9 demonstration program under 10 paragraph (3) for services for 11 which payment is otherwise made 12 under the State plan under this 13 title. 14 ‘‘(ii) GUIDANCE ON DEVELOPMENT OF 15 PROSPECTIVE PAYMENT SYSTEM FOR 16 TESTING UNDER STATE DEMONSTRATION 17 PROGRAMS.— 18 ‘‘(I) IN GENERAL.—The Sec- 19 retary shall issue guidance for States 20 participating in a demonstration pro- 21 gram conducted under paragraph (3) 22 to establish a prospective payment 23 system that shall only apply to free- 24 standing birth center services that 25 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 10 •HR 5189 IH meet the criteria established under 1 clause (i) furnished by a freestanding 2 birth center participating in such 3 demonstration program. 4 ‘‘(II) REQUIREMENTS.—The 5 guidance issued by the Secretary 6 under subclause (I) shall, to the 7 greatest extent practicable, provide 8 for— 9 ‘‘(aa) partial facility pay- 10 ment based on units in the case 11 that a pregnant woman is admit- 12 ted in labor and then needs to be 13 transferred to the hospital in 14 labor before the birth of the 15 baby; 16 ‘‘(bb) facility payment for 17 observation short stays to rule 18 out labor or for therapeutic rest; 19 ‘‘(cc) ensuring payment for 20 the newborn and mother as two 21 facility payment components; 22 ‘‘(dd) ensuring payment for 23 nitrous oxide and hydrotherapy 24 supplies costs for pain relief; 25 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 11 •HR 5189 IH ‘‘(ee) ensuring payment for 1 all professional services of health 2 professionals involved in the de- 3 livery of care in a birth center 4 which may include 3 or more of- 5 fice visits; observation and triage; 6 newborn exam and care; and 7 multiple postpartum, mother, and 8 baby visits, as needed; 9 ‘‘(ff) ensuring payment for 10 partial prenatal and postpartum 11 care episodes or for prenatal care 12 only with planned delivery in the 13 hospital and client returning for 14 postpartum care in the birth cen- 15 ter; and 16 ‘‘(gg) payment for services 17 provided within— 18 ‘‘(AA) in the case of a 19 pregnant woman, the period 20 that commences upon the 21 confirmation of pregnancy 22 when the woman is accepted 23 into care at the freestanding 24 birth center, continues 25 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 12 •HR 5189 IH through prenatal care, labor 1 and delivery, and ends 60 2 days postpartum, inclusive 3 of at least 2 postpartum 4 care visits; and 5 ‘‘(BB) in the case of a 6 newborn, a period that con- 7 tinues through the first 28 8 days of life. 9 ‘‘(B) PLANNING GRANTS.— 10 ‘‘(i) IN GENERAL.—Not later than 18 11 months after the date of the enactment of 12 this subsection, the Secretary shall award 13 planning grants to States for the purpose 14 of developing proposals to conduct a dem- 15 onstration program described in paragraph 16 (3). 17 ‘‘(ii) USE OF FUNDS.—A State award- 18 ed a planning grant under this subpara- 19 graph shall use the funds awarded under 20 such grant to— 21 ‘‘(I) solicit input with respect to 22 the development of the demonstration 23 program from patients, providers (in- 24 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 13 •HR 5189 IH cluding certified nurse-midwives and 1 physicians) and other stakeholders; 2 ‘‘(II) secure participation of free- 3 standing birth centers that meet the 4 criteria established under subpara- 5 graph (A)(i), including by providing 6 support for such centers to meet that 7 criteria in order to maximize the num- 8 ber of freestanding birth centers par- 9 ticipating in the demonstration pro- 10 gram; and 11 ‘‘(III) in accordance with the 12 guidance issued under subparagraph 13 (A)(ii), establish a prospective pay- 14 ment system which States must use 15 for making payments to freestanding 16 birth centers participating in the dem- 17 onstration program. 18 ‘‘(3) STATE DEMONSTRATION PROGRAMS.— 19 ‘‘(A) IN GENERAL.—Not later than 24 20 months after the date of the enactment of this 21 subsection, from among the States awarded a 22 planning grant under paragraph (2)(B), the 23 Secretary shall select not more than 6 such 24 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 14 •HR 5189 IH States to conduct demonstration programs that 1 meet the requirements of this paragraph. 2 ‘‘(B) APPLICATION REQUIREMENTS.— 3 ‘‘(i) IN GENERAL.—The Secretary 4 shall solicit applications to conduct a dem- 5 onstration program under this subsection 6 from States awarded planning grants 7 under paragraph (2)(B). 8 ‘‘(ii) REQUIRED INFORMATION.—A 9 State application to conduct a demonstra- 10 tion program under this paragraph shall 11 include the following: 12 ‘‘(I) A description of the target 13 Medicaid population to be served 14 under the demonstration program. 15 ‘‘(II) A list of the participating 16 freestanding birth centers in the 17 State. 18 ‘‘(III) Verification that each par- 19 ticipating freestanding birth center 20 meets the participation criteria estab- 21 lished in paragraph (2)(A)(i). 22 ‘‘(IV) A description of the scope 23 of the freestanding birth center serv- 24 ices available under the State Med- 25 VerDate Sep 11 2014 01:36 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H5189.IH H5189 kjohnson on DSK79L0C42 with BILLS 15 •HR 5189 IH icaid program for women with a low- 1 risk pregnancy that will be paid for 2 under the prospective payment system 3 tested in the demonstration program. 4 ‘‘(V) Verification that the State 5 has agreed to pay for such services at 6 the rate established under the pro- 7 spective payment system. 8 ‘‘(VI) An assurance that the 9 State will require freestanding birth 10 centers to submit to the State, and 11 that the State will submit to the Sec- 12 retary, such information and data as 13 the State or Secretary may require re- 14 lating to the demonstration program 15 or an episode of care for such a preg- 16 nant woman or newborn. 17 ‘‘(VII) Such other information as 18 the Secretary may require relating to 19 the demonstration program, including 20 with respect to determining the 21 soundness of the proposed prospective 22 payment system. 23 ‘‘(C) LENGTH OF DEMONSTRATION PRO- 2 [Text truncated for display. 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