119-hr5202

[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.''.
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