[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5236 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 5236
To amend titles XIX and XXI of the Social Security Act to enhance
financial support for rural and safety net hospitals providing
maternity, labor, and delivery services to vulnerable populations, and
for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 25, 2024
Mr. Wyden (for himself, Ms. Hassan, Ms. Stabenow, Ms. Cantwell, Mr.
Carper, Mr. Cardin, Mr. Brown, Mr. Bennet, Mr. Casey, Mr. Warner, Mr.
Whitehouse, Ms. Cortez Masto, Ms. Warren, Mr. Helmy, Ms. Duckworth, Mr.
Booker, Mr. Merkley, and Mrs. Murray) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XIX and XXI of the Social Security Act to enhance
financial support for rural and safety net hospitals providing
maternity, labor, and delivery services to vulnerable populations, 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Keeping Obstetrics
Local Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--ENHANCING FINANCIAL SUPPORT FOR RURAL AND SAFETY NET HOSPITALS
THAT PROVIDE OBSTETRIC SERVICES
Sec. 101. State studies and HHS report on costs of providing maternity,
labor, and delivery services.
Sec. 102. Requiring adequate payment rates under Medicaid for
maternity, labor, and delivery services at
eligible hospitals.
Sec. 103. Increased Federal financial participation for maternity,
labor, and delivery services furnished by
eligible hospitals.
Sec. 104. Labor and delivery services anchor payments.
Sec. 105. Application of adequate payment requirement and increased
Federal financial participation
requirements to CHIP.
Sec. 106. Disregarding increased and additional payments to hospitals
for purposes of other supplemental payments
and upper payment limits.
TITLE II--EXPAND COVERAGE OF MATERNAL HEALTH CARE
Sec. 201. Requiring 12-month continuous, full benefit coverage for
pregnant individuals under Medicaid and
CHIP.
Sec. 202. Health homes for pregnant and postpartum women.
Sec. 203. Guidance on supporting and improving access to Medicaid and
CHIP coverage of services provided by
doulas and certain maternal health
professionals.
Sec. 204. Medicaid and CHIP increased financial support for depression
and anxiety screening during the perinatal
and postpartum periods.
Sec. 205. Presumptive eligibility for pregnant individuals.
TITLE III--INVEST IN THE MATERNAL HEALTH CARE WORKFORCE
Sec. 301. Emergency obstetric workforce support.
Sec. 302. Streamlined screening and enrollment of providers of
maternity, labor, and delivery services in
neighboring States.
TITLE IV--REQUIRING PUBLIC COMMUNICATION OF OBSTETRICS DATA AND UNIT
CLOSURES
Sec. 401. Timely notifications of impending hospital obstetric unit
closures.
Sec. 402. Collection of data relating to hospital labor and delivery
services.
TITLE I--ENHANCING FINANCIAL SUPPORT FOR RURAL AND SAFETY NET HOSPITALS
THAT PROVIDE OBSTETRIC SERVICES
SEC. 101. STATE STUDIES AND HHS REPORT ON COSTS OF PROVIDING MATERNITY,
LABOR, AND DELIVERY SERVICES.
(a) State Study.--
(1) In general.--In order to meet the requirement of
section 1902(a)(6) of the Social Security Act (42 U.S.C.
1396a(a)(6)), not later than 1 year after the date of enactment
of this Act, and every 5 years thereafter, each State (as such
term is defined in section 1101(a)(1) of the Social Security
Act (42 U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI
of such Act) shall conduct a study on the costs of providing
maternity, labor, and delivery services in hospitals and submit
the results of such study to the Secretary of Health and Human
Services (referred to in this section as the ``Secretary'').
(2) Content of study.--A State study required under
paragraph (1) shall include the following information with
respect to maternity, labor, and delivery services furnished by
hospitals located in the State:
(A) An estimate of the cost of providing maternity,
labor, and delivery services at hospitals for which
more than 50 percent of births are financed by the
Medicaid program or the Children's Health Insurance
Program, based on the expenditures a representative
sample of such hospitals incurred for providing such
services during the 2 most recent years for which data
is available.
(B) An estimate of the full cost of providing
maternity, labor, and delivery services at independent
rural hospitals with less than 300 births per year,
based on the expenditures a representative sample of
such hospitals incurred for providing such services
during the 2 most recent years for which data are
available.
(C) An estimate of the cost of providing maternity
services at hospitals that ceased providing labor and
delivery services within the past 5 years, based on the
expenditures a representative sample of such hospitals
incurred for providing such services during the 2 most
recent years for which data is available.
(D) To the extent data allows, an analysis of the
extent to which factors such as geographic location and
community population affect the cost of providing
maternity, labor, and delivery services at hospitals,
including the cost of hospital services that support
the provision of maternity, labor, and delivery
services.
(E) The amounts hospitals are paid for maternity,
labor, and delivery services, by geographic location
and hospital size, under Medicare, the State Medicaid
program, the State CHIP plan, and private health
insurance, including, with respect to the State
Medicaid program, the State CHIP plan, and private
health insurance, payment amounts for such services
under fee-for-service payment arrangements and under
managed care (as applicable).
(F) A comparative payment rate analysis--
(i) comparing maternity, labor, and
delivery services payment rates under the State
Medicaid fee-for-service program to payment
rates for such services under Medicare (as
described in section 447.203(b)(3) of title 42,
Code of Federal Regulations), other federally-
funded or State-funded programs (including, to
the extent data is available, Medicaid managed
care rates), and to the payment rates, to the
extent data is available, of private health
insurers within geographic areas of the State;
and
(ii) analyzing different payment methods
for such services, such as the use of bundled
payments, quality incentives, and low-volume
adjustments.
(G) An evaluation of whether each hospital located
in the State that furnishes maternity, labor, and
delivery services is expected to experience in the next
3 years--
(i) significant changes in particular
expenditures or types of reimbursement for
maternity, labor, and delivery services; or
(ii) any other significant change that is
likely to affect the hospital's ability to
continue to provide such services.
(3) Assistance to small hospitals in compiling cost
information.--There is appropriated to the Secretary for each
fiscal year beginning with fiscal year 2025, $10,000,000 for
the purpose of providing grants and technical assistance to
small rural obstetric hospitals to enable such hospitals to
compile detailed information on expenses incurred for
maternity, labor, and delivery services for use in the State
studies required under paragraph (1), to remain available until
expended.
(4) HHS report on state studies.--For each year in which
State studies are required to be conducted under paragraph (1),
the Secretary shall issue a public report that compiles and
details the results of such studies and includes the
information described in paragraph (2).
(b) HHS Report and Proposed Legislation.--Not later than 2 years
after the date of enactment of this Act, the Secretary shall submit to
Congress and make publicly available a report analyzing the first
studies conducted by States under subsection (a)(1) that includes--
(1) recommendations for improving data collection on the
cost of providing maternity, labor, and delivery services;
(2) guidance to States on the collection of such data; and
(3) if the Secretary determines it appropriate based on the
findings made by the Secretary in such report, proposed
legislation or administrative action, including, to the extent
the Secretary determines appropriate, issuance of regulations,
to adjust the amounts paid for maternity, labor, and delivery
services under Medicare, State Medicaid plans, and other
federally-funded payers, to more accurately compensate eligible
hospitals (as such term is defined in subsection (uu) of
section 1902 of the Social Security Act (42 U.S.C. 1396a), as
added by section 102) for the cost of providing such services.
SEC. 102. REQUIRING ADEQUATE PAYMENT RATES UNDER MEDICAID FOR
MATERNITY, LABOR, AND DELIVERY SERVICES AT ELIGIBLE
HOSPITALS.
(a) Fee-for-Service Payments.--Section 1902 of the Social Security
Act (42 U.S.C. 1396a) is amended--
(1) in subsection (a)(13)--
(A) by striking ``and'' at the end of subparagraph
(B);
(B) by adding ``and'' at the end of subparagraph
(C); and
(C) by adding at the end the following new
subparagraph:
``(D) for each fiscal year beginning with fiscal
year 2026, payment for maternity, labor, and delivery
services (as defined in subsection (uu)) furnished
during such fiscal year in an eligible hospital (as
defined in such subsection) at a rate that is not less
than the minimum payment rate specified for the fiscal
year in paragraph (4) of such subsection;''; and
(2) by adding at the end the following new subsection:
``(uu) Maternity, Labor, and Delivery Services and Eligible
Hospitals Defined.--For purposes of subsection (a)(13)(D)--
``(1) Maternity, labor, and delivery services.--
``(A) In general.--The term `maternity, labor, and
delivery services' means such inpatient hospital
services and outpatient hospital services, including
behavioral health services, that are provided in
relation to maternity care or labor and delivery,
identified by appropriate ICD and CPT codes, as the
Secretary shall specify after consultation with
professional or medical societies with expertise in
pregnancy, childbirth, and postpartum care.
``(B) Scope.--Such term shall not be limited in
application, for any eligible hospital, only to
services that relate to a birth that occurs in the
hospital.
``(C) Rulemaking.--Not later than July 1, 2025, the
Secretary shall issue an interim final rule specifying
which services shall be considered maternity, labor,
and delivery services for purposes of this subsection
and subsection (a)(13)(D).
``(2) Eligible hospital.--
``(A) In general.--The term `eligible hospital'
means, with respect to a State and fiscal year--
``(i) a hospital that is located in a rural
area (as defined by the Federal Office of Rural
Health Policy for the purpose of rural health
grant programs administered by such Office);
``(ii) a critical access hospital (as
defined in section 1861(mm)(1));
``(iii) a hospital operated by the Indian
Health Service or an Indian Tribe under the
Indian Self-Determination and Education
Assistance Act;
``(iv) a hospital for which, in the most
recent 12-month period for which data is
available, at least 50 percent of all births
for which the hospital provided maternity,
labor, and delivery services during such fiscal
year were qualifying births; or
``(v) a hospital that is able to
demonstrate, through a process to be determined
by the Secretary, that, for the applicable
fiscal year, the hospital projects that at
least 50 percent of all births for which the
hospital will provide maternity, labor, and
delivery services during such fiscal year will
be qualifying births.
``(B) Identification of eligible hospitals.--Each
State, subject to the approval of the Secretary, shall
identify the hospitals in the State that are eligible
hospitals with respect to a fiscal year.
``(3) Qualifying birth.--For purposes of paragraph (2), the
term `qualifying birth' means a birth for which any maternity,
labor, and delivery services associated with the birth--
``(A) were paid for under a State plan under this
title (or under a waiver of such a plan) or under a
State child health plan under title XXI (or under a
waiver of such a plan);
``(B) were paid for under title XVIII;
``(C) were provided by the Indian Health Service or
a Native Hawaiian health care system (as defined in
section 12 of the Native Hawaiian Health Care
Improvement Act); or
``(D) were provided to a patient who does not have
minimum essential coverage (as defined in section
5000A(f) of the Internal Revenue Code of 1986) and were
not fully paid for by such patient.
``(4) Minimum payment rate specified.--The minimum payment
rate specified in this paragraph is, with respect to an
eligible hospital and maternal, labor, and delivery services--
``(A) for fiscal year 2026, 150 percent of the
payment rate that would apply for such services and
hospital under title XVIII; and
``(B) for each period of 5 fiscal years beginning
with fiscal years 2027 through 2031, a payment rate
that is determined for such period by the Secretary to
accurately reflect the costs incurred by eligible
hospitals in providing such services, informed by the
results of the most recent State studies submitted to
the Secretary under section 101(a) of the Keeping
Obstetrics Local Act.''.
(b) Under Medicaid Managed Care Plans.--Section 1932(f) of the
Social Security Act (42 U.S.C. 1396u-2(f)) is amended--
(1) in the heading, by inserting ``and Maternity, Labor,
and Delivery Services at Eligible Hospitals'' after
``Services''; and
(2) by striking ``described in section 1902(a)(13)(C)'' and
inserting ``described in subparagraph (C) of section
1902(a)(13) or maternity, labor, and delivery services
described in subparagraph (D) of such section that are
furnished by an eligible hospital (as defined in section
1905(uu))''.
SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION FOR MATERNITY,
LABOR, AND DELIVERY SERVICES FURNISHED BY ELIGIBLE
HOSPITALS.
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(1) in subsection (b), by striking ``and (ii)'' and
inserting ``(ii), and (kk)''; and
(2) by adding at the end the following new subsection:
``(kk) Maternity, Labor, and Delivery Services.--
``(1) In general.--Notwithstanding subsection (b), with
respect to State expenditures for medical assistance for
maternity, labor, and delivery services furnished by an
eligible hospital (as such terms are defined in section
1902(uu)) in a fiscal quarter that begins on or after October
1, 2025--
``(A) the Federal medical assistance percentage
applicable to the enhanced payment rate amount of such
expenditures (as determined for the State and quarter
under paragraph (2)(A)) shall be equal to 100 percent;
and
``(B) subject to paragraph (3), the Federal medical
assistance percentage applicable to the base payment
rate amount of such expenditures (as determined for the
State and quarter under paragraph (2)(B)) shall be
equal to the enhanced FMAP determined for the State and
quarter under section 2105(b).
``(2) Determination of enhanced payment rate amount and
base payment rate amount.--
``(A) Enhanced payment rate amount.--
``(i) In general.--For purposes of
paragraph (1)(A), the enhanced payment rate
amount for a State and fiscal quarter is equal
to the amount of State expenditures for medical
assistance for maternity, labor, and delivery
services furnished by an eligible hospital (as
such terms are defined in section 1902(uu)) in
such fiscal quarter that is attributable to the
amount by which the minimum payment rate
required under section 1902(a)(13)(D) (or, by
application, section 1932(f)) exceeds the base
payment rate applicable to such services, as
determined for the State, quarter, and services
under clause (ii).
``(ii) Base payment rate.--For purposes of
clause (i), the base payment rate determined
for a State, a fiscal quarter, and maternity,
labor, and delivery services (as defined in
section 1902(uu)) shall be equal to--
``(I) the payment rate applicable
to such services under the State plan
(or under a waiver of such plan) as of
January 1, 2024; increased by
``(II) the percentage increase in
the medical care component of the
consumer price index for all urban
consumers from January of 2024 to the
month ending on the day before the 1st
day of such fiscal quarter.
``(B) Base payment rate amount.--For purposes of
paragraph (1)(B), the base payment rate amount for a
State and fiscal quarter is equal to--
``(i) the total amount of State
expenditures for medical assistance for
maternity, labor, and delivery services
furnished by an eligible hospital (as such
terms are defined in section 1902(uu)) in such
fiscal quarter; minus
``(ii) the enhanced payment rate amount
determined for the State and fiscal quarter
under subparagraph (A).
``(3) Application of higher match.--Subparagraph (B) of
paragraph (1) shall not apply in the case of State expenditures
described in such subparagraph if the application of such
subparagraph would result in a lower Federal medical assistance
percentage for such expenditures than would otherwise apply
without the application of such paragraph.
``(4) Exclusion of expenditures from territorial caps.--Any
payment made to a territory for medical assistance that is
subject to the Federal medical assistance percentage specified
in paragraph (1)(A) or the enhanced FMAP referred to in
paragraph (1)(B) shall not be taken into account for purposes
of applying payment limits under subsections (f) and (g) of
section 1108.''.
SEC. 104. LABOR AND DELIVERY SERVICES ANCHOR PAYMENTS.
(a) State Requirement.--Section 1902(a)(13)(A) of the Social
Security Act (42 U.S.C. 1396a(a)(13)(A)) is amended--
(1) in clause (iii), by striking ``and'' at the end;
(2) in clause (iv), by striking the semicolon at the end
and inserting ``, and''; and
(3) by adding at the end the following new clause:
``(v) in the case of hospitals, such rates
take into account (in a manner consistent with
section 1923A) the situation of low volume
obstetric hospitals (as such term is defined in
such section);''.
(b) Requiring Anchor Payments for Low Volume Obstetric Hospitals.--
Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is
amended by inserting the following after section 1923:
``SEC. 1923A. ANCHOR PAYMENTS FOR LABOR AND DELIVERY SERVICES PROVIDED
BY LOW VOLUME OBSTETRIC HOSPITALS.
``(a) Implementation of Requirement.--A State plan under this title
shall not be considered to meet the requirement of section
1902(a)(13)(A)(v) (insofar as it requires payments to hospitals to take
into account the situation of low volume obstetric hospitals), as of
October 1, 2025, unless the State has submitted to the Secretary, by
not later than such date, an amendment to such plan that provides for
an annual anchor payment to such hospitals, consistent with subsection
(c).
``(b) Definitions.--In this section:
``(1) Antenatal transfer.--The term `antenatal transfer'
means, with respect to a hospital, a pregnant individual who
was expected to receive labor and delivery services at the
hospital but who is transferred to a different hospital because
of a need for labor and delivery services that are not
available at the transferring hospital.
``(2) Delivery volume.--The term `delivery volume' means,
with respect to a hospital and a fiscal year, the total number
of births occurring in, and antenatal transfers made by, such
hospital during such year.
``(3) Labor and delivery revenue floor.--The term `labor
and delivery revenue floor' means, with respect to a low volume
obstetric hospital and a fiscal year, the amount equal to the
sum of--
``(A) the product of--
``(i) the delivery volume for such hospital
and fiscal year; and
``(ii) the per delivery amount for such
fiscal year; and
``(B) the standby capacity amount for such fiscal
year.
``(4) Labor and delivery services.--The term `labor and
delivery services' means such inpatient and outpatient hospital
services related to labor and delivery, including services
related to antenatal transfers, identified by appropriate ICD
and CPT codes, as the Secretary shall specify in consultation
with professional or medical societies with expertise in this
area.
``(5) Low volume obstetric hospital.--The term `low volume
obstetric hospital' means, with respect to a hospital and a
fiscal year, a hospital--
``(A) that is an eligible hospital (as defined in
section 1902(uu)(2));
``(B) in which the average number of births for
which the hospital provided labor and delivery services
during the preceding 3 fiscal years is less than 300
births per year;
``(C) that did not provide labor and delivery
services in the preceding fiscal year, but in which the
average number of births for which the hospital
provided labor and delivery services during the most
recent 3 fiscal years in which the hospital provided
labor and delivery services is less than 300 births per
year;
``(D) that is not described in subparagraph (B) or
(C) but, in the applicable fiscal year, provides labor
and delivery services for fewer than 300 births; or
``(E) that is not described in subparagraphs (B)
through (D) but is certified by the State in which the
hospital is located as meeting such criteria as the
Secretary shall establish for identifying hospitals
that are essential to meeting the needs of an
underserved population, such as serving a population
with limited English proficiency, serving specific
racial or ethnic populations, or other factors.
``(6) Medicaid labor and delivery revenue floor.--The term
`Medicaid labor and delivery revenue floor' means, with respect
to a low volume obstetric hospital and a fiscal year, the
product of--
``(A) the labor and delivery revenue floor for such
hospital and fiscal year; and
``(B) the percentage of the delivery volume of such
hospital in such fiscal year that were paid for under a
State plan under this title (or under a waiver of such
a plan) or under a State child health plan under title
XXI (or under a waiver of such a plan).
``(7) Per delivery amount.--
``(A) In general.--The term `per delivery amount'
means, with respect to a fiscal year, an amount, as
determined under subparagraph (B), that represents the
marginal cost to a low volume obstetric hospital of a
birth or an antenatal transfer.
``(B) Determination of per delivery amount.--
``(i) Fiscal year 2027.--For fiscal year
2027, the per delivery amount shall be $10,000.
``(ii) Indexing.--Subject to clause (iii),
for each fiscal year after fiscal year 2027,
the per delivery amount shall be the amount
that applied under this subparagraph for the
preceding fiscal year increased by the
percentage increase in the medical care
component of the consumer price index for all
urban consumers for the 12-month period ending
with September of such preceding fiscal year.
``(iii) Periodic revision of per delivery
amount.--Not less than once every 5 fiscal
years, the Secretary shall collect and analyze
data on the costs of labor and delivery
services at low volume obstetric hospitals and,
through rulemaking, shall establish a new per
delivery amount for purposes of this section to
ensure that such amount accurately reflects the
marginal cost to a low volume obstetric
hospital of a birth or an antenatal delivery.
``(8) Standby capacity amount.--
``(A) In general.--The term `standby capacity
amount' means, with respect to a fiscal year, an
amount, as determined under subparagraph (B), that
represents the minimum level of expenditures by a low
volume obstetric hospital that is necessary to ensure
that adequate personnel, equipment, and facilities are
available at all times to provide labor and delivery
services.
``(B) Determination of standby capacity amount.--
``(i) Fiscal year 2027.--For fiscal year
2027, the standby capacity amount shall be
$1,200,000.
``(ii) Indexing.--Subject to clause (iii),
for each fiscal year after fiscal year 2027,
the standby capacity amount shall be the amount
that applied under this subparagraph for the
preceding fiscal year increased by the
percentage increase in the medical care
component of the consumer price index for all
urban consumers for the 12-month period ending
with September of such preceding fiscal year.
``(iii) Periodic revision of standby
capacity amount.--Not less than once every 5
fiscal years, the Secretary shall collect and
analyze data on the costs of labor and delivery
services at low volume obstetric hospitals and,
through rulemaking, shall establish a new
standby capacity amount for purposes of this
section to ensure that such amount accurately
reflects the minimum level of expenditures by a
low volume obstetric hospital that is necessary
to ensure that adequate personnel, equipment,
and facilities are available at all times to
provide labor and delivery services.
``(c) Anchor Payment for Low Volume Obstetric Hospitals.--Not later
than 3 months after the end of each fiscal year beginning with fiscal
year 2027, each State shall pay to each low volume obstetric hospital
in the State an amount that is equal to the amount (if any) by which--
``(1) the Medicaid labor and delivery revenue floor for the
hospital and fiscal year; exceeds
``(2) the total amount of all payments made to the low
volume obstetric hospital under the State plan under this title
(or under a waiver of such plan) and under the State child
health plan under title XXI (or under a waiver of such plan)
(other than payments under this section) for labor and delivery
services provided by such hospital during such fiscal year.
``(d) Requirements for Receipt of Payments.--No anchor payment
shall be made to a low volume obstetric hospital under this section for
a fiscal year unless the hospital can satisfy the following
requirements:
``(1) Skills maintenance and training activities.--The
hospital demonstrates to the satisfaction of the State that the
hospital conducts and completes skills maintenance and training
activities, including continuing education and training to
support maintenance of obstetric skills, that satisfy such
requirements as the Secretary, taking into consideration
nationally recognized obstetrics skills, maintenance, and
training standards such as standards published by the American
College of Obstetricians and Gynecologists and the Association
of Women's Health, Obstetric, and Neonatal Nurses, shall
specify for the purposes of this section.
``(2) Continued provision of labor and delivery services.--
``(A) In general.--The hospital and the State enter
into a contract under which, in exchange for such
payment under this section for a fiscal year, the
hospital agrees to continue to provide labor and
delivery services--
``(i) for the period that begins with such
fiscal year and ends on the last day of the
second fiscal year that follows such fiscal
year; and
``(ii) at a level that is not less than the
level at which the hospital provided such
services in the fiscal year to which such
payment relates, unless the hospital can
demonstrate that the need for services in the
community has decreased and that the new level
of services will be adequate to meet that need.
``(B) Recovery of payment in the event of breach of
contract by hospital.--The terms of the contract
between a hospital and a State required under
subparagraph (A) shall provide that if the hospital
does not provide labor and delivery services as
required under the contract throughout the period
described in such subparagraph for any reason
(including in the event of the hospital's bankruptcy or
closure) the State may recover the full amount of the
payment under this section to which the contract
relates and in the event of the hospital's bankruptcy,
the State shall be given preferred creditor status for
purposes of the collection of such payment.
``(3) Utilization of funds for labor and delivery
services.--
``(A) In general.--The hospital and the State enter
into a contract under which, in exchange for such
payment under this section, the hospital agrees to
utilize funds received under such payment for the
provision of labor and delivery services in the
community served by the hospital.
``(B) Recovery of payment in the event of breach of
contract by hospital.--The terms of the contract
between a hospital and a State required under
subparagraph (A) shall provide that if the hospital
does not utilize payment funds for labor and delivery
services as required under the contract for any reason
(including in the event of the hospital's bankruptcy or
closure) the State may recover the full amount of the
payment under this section to which the contract
relates and in the event of the hospital's bankruptcy,
the State shall be given preferred creditor status for
purposes of the collection of such payment.
``(e) Treatment of Payments; Recovery of Payments.--
``(1) In general.--Payments made by a State under this
section for a fiscal year--
``(A) shall be in addition to any other payments
made to hospitals for labor and delivery services under
the State plan (or a waiver of such plan) under this
title, under the State child health assistance plan
under title XXI (or under a waiver of such plan), or
under title XVIII for the fiscal year, including
disproportionate share hospital payments under section
1923 or section 1886(d)(5)(F) and other supplemental
payments that are not made under this section; and
``(B) shall be treated as medical assistance for
which payment is made under section 1903(a), except
that the Federal medical assistance percentage
applicable to amounts expended by a State for such
payments shall be equal to the enhanced FMAP determined
for the State and fiscal year under section 2105(b).
``(2) Payments recovered by a state.--If a State recovers
any amount of a payment made by a State under this section
(whether pursuant to paragraph (2)(B) or (3)(B) of subsection
(d) or otherwise), the amount so recovered shall be treated as
an overpayment recovered by the State under section 1903(d).''.
(c) Conforming Amendments.--Title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) is amended as follows:
(1) In section 1903--
(A) in subsection (d)(6)(B)--
(i) by striking ``related to the total
amount'' and inserting the following: ``related
to--
``(i) the total amount'';
(ii) by striking the period at the end and
inserting ``; and''; and
(iii) by adding at the end the following
new clause:
``(ii) the total amount of payments made to
individual providers (by provider) under section 1923A
during such fiscal year.''; and
(B) in subsection (bb)(2)(B)--
(i) in the header, by inserting ``and low
volume obstetric hospital'' after ``DSH''; and
(ii) by inserting ``or a payment made to a
low volume obstetric hospital under section
1923A'' before the period.
(2) In section 1905--
(A) in subsection (cc), by striking ``section
1923'' the second place it appears and inserting
``section 1923 or 1923A''; and
(B) in subsection (ii)(2)(A), by inserting ``or
payments to low volume obstetric hospitals described in
section 1923A'' before the semicolon.
SEC. 105. APPLICATION OF ADEQUATE PAYMENT REQUIREMENT AND INCREASED
FEDERAL FINANCIAL PARTICIPATION REQUIREMENTS TO CHIP.
Section 2107(e)(1) of the Social Security Act (42 U.S.C.
1397gg(e)(1)) is amended--
(1) by redesignating subparagraphs (B) through (U) as
subparagraphs (C) through (V), respectively; and
(2) by inserting after subparagraph (A) the following new
subparagraph:
``(B) Section 1902(a)(13)(D) and section 1905(kk)
(relating to the minimum payment rate required for
maternity, labor, and delivery services furnished by an
eligible hospital and Federal financial participation
for State expenditures for such services).''.
SEC. 106. DISREGARDING INCREASED AND ADDITIONAL PAYMENTS TO HOSPITALS
FOR PURPOSES OF OTHER SUPPLEMENTAL PAYMENTS AND UPPER
PAYMENT LIMITS.
A hospital's eligibility for any federally-funded supplemental
payment (including a disproportionate share payment under section
1886(d)(5)(F) or 1923 of the Social Security Act (42 U.S.C.
1395ww(d)(5)(F), 1396r-4)), the determination of the amount of such
payment, and the application of any Federal limitation on the aggregate
amount of payments that a State may make to the hospital (including any
upper payment limitation), shall be determined without regard to the
amount of any increase to a payment received by a hospital or any
additional payment made to a hospital that is attributable to the
amendments made by this title.
TITLE II--EXPAND COVERAGE OF MATERNAL HEALTH CARE
SEC. 201. REQUIRING 12-MONTH CONTINUOUS, FULL BENEFIT COVERAGE FOR
PREGNANT INDIVIDUALS UNDER MEDICAID AND CHIP.
(a) Medicaid.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)--
(A) in paragraph (10), in the matter following
subparagraph (G), by striking ``(VII) the medical
assistance made available to an individual described in
subsection (l)(1)(A) who is eligible for medical
assistance only because of subparagraph (A)(i)(IV) or
(A)(ii)(IX) shall be limited to medical assistance for
services related to pregnancy (including prenatal,
delivery, postpartum, and family planning services),
medical assistance for services related to other
conditions which may complicate pregnancy, and medical
assistance for vaccines described in section
1905(a)(4)(E) and the administration of such vaccines
during the period described in such section,'' and
inserting ``(VII) [Repealed],'';
(B) in paragraph (86), by striking ``and'' at the
end;
(C) in paragraph (87), by striking the period at
the end and inserting ``; and''; and
(D) by inserting after paragraph (87) the following
new paragraph:
``(88) provide that the State plan is in compliance with
subsection (e)(16).''; and
(2) in subsection (e)(16)--
(A) in subparagraph (A), by striking ``At the
option of the State, the State plan (or waiver of such
State plan) may provide'' and inserting ``A State plan
(or waiver of such State plan) shall provide'';
(B) in subparagraph (B), in the matter preceding
clause (i), by striking ``by a State making an election
under this paragraph'' and inserting ``under a State
plan (or a waiver of such State plan)''; and
(C) in subparagraph (C)--
(i) by striking ``A State making an
election under this paragraph'' and inserting
``In the case of a State''; and
(ii) by striking ``shall also make the
election'' and inserting ``the State shall
provide coverage''.
(b) CHIP.--
(1) In general.--Subparagraph (K) of section 2107(e)(1) of
the Social Security Act (42 U.S.C. 1397gg(e)(1)), as
redesignated by section 105, is amended to read as follows:
``(K) Paragraphs (5) and (16) of section 1902(e)
(relating to the requirement to provide medical
assistance under the State plan or waiver consisting of
full benefits during pregnancy and throughout the 12-
month period that begins on the last day of the
individual's pregnancy and ends on the last day of the
month in which such 12-month period ends).''.
(2) Conforming amendment.--Section 2112(d)(2)(A) of the
Social Security Act (42 U.S.C. 1397ll(d)(2)(A)) is amended by
striking ``the month in which the 60-day period'' and all that
follows through ``pursuant to section 2107(e)(1),''.
(c) Effective Date.--
(1) In general.--Subject to paragraphs (2) and (3), the
amendments made by subsections (a) and (b) shall take effect on
the 1st day of the 1st calendar quarter that begins on or after
the date that is 1 year after the date of enactment of this
Act;
(2) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act or a
State child health plan under title XXI of such Act that the
Secretary of Health and Human Services determines requires
State legislation in order for the respective plan to meet any
requirement imposed by amendments made by this subsection, the
respective plan shall not be regarded as failing to comply with
the requirements of such title solely on the basis of its
failure to meet such an additional requirement before the 1st
day of the 1st calendar quarter beginning after the close of
the 1st regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
(3) State option for earlier effective date.--A State may
elect to have subsection (e)(16) of section 1902 of the Social
Security Act (42 U.S.C. 1396a) and subparagraph (K) of section
2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)),
as redesignated by section 105 and amended by subsection (b) of
this section, take effect with respect to the State on the 1st
day of any fiscal quarter that begins before the date described
in paragraph (1) and apply to amounts payable to the State for
expenditures for medical assistance, child health assistance,
or pregnancy-related assistance to pregnant or postpartum
individuals furnished on or after such day.
SEC. 202. HEALTH HOMES FOR PREGNANT AND POSTPARTUM WOMEN.
(a) Medicaid.--Title XIX of the Social Security Act (42 U.S.C. 1396
et seq.) is amended by inserting after section 1945A the following new
section:
``SEC. 1945B. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH
HOME FOR PREGNANT AND POSTPARTUM INDIVIDUALS.
``(a) State Option.--
``(1) In general.--Notwithstanding section 1902(a)(1)
(relating to statewideness) and section 1902(a)(10)(B)
(relating to comparability), beginning January 1, 2028, a
State, at its option as a State plan amendment, may provide for
medical assistance under this title to an eligible individual
who chooses to--
``(A) enroll in a maternity health home under this
section by selecting a designated provider, a team of
health care professionals operating with such a
provider, or a health team as the individual's
maternity health home for purposes of providing the
individual with pregnancy and postpartum coordinated
care services; or
``(B) receive such services from a designated
provider, a team of health care professionals operating
with such a provider, or a health team that has
voluntarily opted to participate in a maternity health
home for eligible individuals under this section.
``(2) Eligible individual defined.--In this section, the
term `eligible individual' means an individual--
``(A) who is eligible for medical assistance under
the State plan (or under a waiver of such plan) for all
items and services covered under the State plan (or
under a waiver of such plan);
``(B) who is not enrolled in a health home under
section 1945 or 1945A; and
``(C) either--
``(i) who is pregnant; or
``(ii) whose pregnancy has ended and is
within the 12-month period that begins on the
last day of the individual's pregnancy and ends
on the last day of the month in which such 12-
month period ends.
``(b) Qualification Standards.--The Secretary shall establish
standards for qualification as a maternity health home or as a
designated provider, a team of health care professionals operating with
such a provider, or a health team eligible for participation in a
maternity health home for purposes of this section. In establishing
such standards, the Secretary shall consider best practices and models
of care used by recipients of grants under section 330P of the Public
Health Service Act. Such standards shall include requiring a designated
provider, a team of health care professionals operating with such a
provider, and a health team designated as a maternity health home to
demonstrate to the State the ability to do the following:
``(1) Coordinate prompt care and access to necessary
maternity care services, including services provided by
specialists, and programs for an eligible individual during the
individual's pregnancy and the 365-day period beginning on the
last day of such pregnancy.
``(2) Develop an individualized, comprehensive, patient-
centered care plan for each eligible individual that
accommodates patient preferences and, if applicable, reflects
adjustments to the payment methodology described in subsection
(c)(2)(B).
``(3) Develop and incorporate into each eligible
individual's care plan, in a culturally and linguistically
appropriate manner consistent with the needs of the eligible
individual, ongoing home care, community-based primary care,
inpatient care, social support services, health-related social
needs services, behavioral health services, local hospital
emergency care, and, in the event of a change in income that
would result in the eligible individual losing eligibility for
medical assistance under the State plan (or under a waiver of
such plan), care management and planning related to a change in
the eligible individual's health insurance coverage.
``(4) Coordinate with pediatric care providers, as
appropriate.
``(5) Collect and report information under subsection
(f)(1).
``(c) Payments.--
``(1) In general.--A State shall provide a designated
provider, a team of health care professionals operating with
such a provider, or a health team designated as a maternity
health home with payments for the provision of health home
services to each eligible individual that selects such
provider, team of health care professionals, or health team as
the eligible individual's health home. Payments made to a
designated provider, a team of health care professionals
operating with such a provider, or a health team for such
services shall be treated as medical assistance for purposes of
section 1903(a), except that, during the first 8 fiscal year
quarters that the State plan amendment is in effect, the
Federal medical assistance percentage applicable to such
payments shall be equal to 90 percent.
``(2) Methodology.--The State shall specify in the State
plan amendment the methodology the State will use for
determining payment for the provision of pregnancy and
postpartum coordinated care services or treatment during an
eligible individual's pregnancy and the 365-day period
beginning on the last day of such pregnancy. Such methodology
for determining payment--
``(A) may be based on--
``(i) a per-member per-month basis for each
eligible individual enrolled in a maternity
health home;
``(ii) a prospective payment model, in the
case of payments to Federally qualified health
centers or a rural health clinics; or
``(iii) an alternate model of payment
proposed by the State and approved by the
Secretary;
``(B) may be adjusted to reflect, with respect to
each eligible individual--
``(i) the severity of the risks associated
with the individual's pregnancy;
``(ii) the severity of the risks associated
with the individual's postpartum health care
needs; and
``(iii) the level or amount of time of care
coordination required with respect to the
individual; and
``(C) shall be established consistent with section
1902(a)(30)(A).
``(d) Coordinating Care.--
``(1) Hospital notification.--A State with a State plan
amendment approved under this section shall require each
hospital that is a participating provider under the State plan
(or under a waiver of such plan) to establish procedures in the
case of an eligible individual who seeks treatment in the
emergency department of such hospital for--
``(A) providing the individual with culturally and
linguistically appropriate information supplied by the
State describing the respective treatment models and
opportunities for the individual to access a maternity
health home and its associated benefits; and
``(B) notifying the maternity health home in which
the individual is enrolled, or the designated provider,
team of health care professionals operating with such a
provider, or health team treating the individual, of
the individual's treatment in the emergency department
and of the protocols for the maternity health home,
designated provider, or team to be involved in the
individual's emergency care or post-discharge care.
``(2) Education with respect to availability of a maternity
health home.--
``(A) In general.--In order for a State plan
amendment to be approved under this section, a State
shall include in the State plan amendment a description
of the State's process for--
``(i) educating providers participating in
the State plan (or a waiver of such plan) on
the availability of maternity health homes for
eligible individuals, including the process by
which such providers can participate in or
refer an eligible individual to an approved
maternity health home or a designated provider,
team of health care professionals operating
such a provider, or health team designated as a
maternity health home; and
``(ii) educating eligible individuals, in a
culturally and linguistically appropriate
manner, on the availability of maternity health
homes.
``(B) Outreach.--The process established by the
State under subparagraph (A) shall include the
participation of entities or other public or private
organizations or entities that provide outreach and
information on the availability of health care items
and services to families of individuals eligible to
receive medical assistance under the State plan (or a
waiver of such plan).
``(3) Mental health coordination.--A State with a State
plan amendment approved under this section shall consult and
coordinate, as appropriate, with the Secretary in addressing
issues regarding the prevention, identification, and treatment
of mental health conditions and substance use disorders among
eligible individuals.
``(4) Social and support services.--A State with a State
plan amendment approved under this section shall consult and
coordinate, as appropriate, with the Secretary in establishing
means to connect eligible individuals receiving pregnancy and
postpartum coordinated care services under this section with
social and support services, including services made available
under maternal, infant, and early childhood home visiting
programs established under section 511 and services made
available under section 330H or title X of the Public Health
Service Act.
``(5) Coordination with grant program for integrated
services for pregnant and postpartum women.--A State with a
State plan amendment approved under this section shall consult
and coordinate, as appropriate, with the Secretary with respect
to the provision of medical assistance to eligible individuals
enrolled in a maternity health home under this section and
grantees delivering integrated health care services to pregnant
and postpartum women under section 330P of the Public Health
Service Act (including, if applicable, the State).
``(e) Monitoring.--A State shall include in the State plan
amendment--
``(1) a methodology for tracking reductions in inpatient
days and reductions in the total cost of care resulting from
improved care coordination and management under this section;
``(2) a proposal for use of health information technology
in providing an eligible individual with pregnancy and
postpartum coordinated care services as specified under this
section and improving service delivery and coordination across
the care continuum; and
``(3) a methodology for tracking prompt and timely access
to medically necessary care for eligible individuals from out-
of-State providers.
``(f) Data Collection.--
``(1) Provider reporting requirements.--In order to receive
payments from a State under subsection (c), a maternity health
home, or a designated provider, a team of health care
professionals operating with such a provider, or a health team
designated as a maternity health home, shall report to the
State, at such time and in such form and manner as may be
required by the State, including through a health information
exchange or other public health data sharing entity, the
following information:
``(A) With respect to each such designated
provider, team of health care professionals operating
with such a provider, and health team designated as a
maternity health home, the name, National Provider
Identification number, address, and specific health
care services offered to be provided to any eligible
individual who has selected such provider, team of
health care professionals, or health team as the
eligible individual's maternity health home.
``(B) Information on all other applicable measures
for determining the quality of services provided by
such provider, team of health care professionals, or
health team.
``(C) Information concerning the factors described
in paragraph (2)(A)(vi) received from health risk
assessments of eligible individuals conducted and
completed by the designated provider, team of health
care professionals operating with such a provider, or
health team designated as a maternity health home.
``(D) Such other information as the Secretary shall
specify in guidance.
``(2) State reporting requirements.--
``(A) Comprehensive report.--A State with a State
plan amendment approved under this section shall report
to the Secretary (and, upon request, to the Medicaid
and CHIP Payment and Access Commission), at such time,
but at a minimum annually, and in such form and manner
determined by the Secretary to be reasonable and
minimally burdensome, the following information:
``(i) Information described in paragraph
(1).
``(ii) The number and, to the extent
available and while maintaining all relevant
privacy and confidentially protections,
disaggregated demographic information
(including information on geography) of
eligible individuals who have enrolled in a
maternity health home pursuant to this section.
``(iii) The number of maternity health
homes in the State designated under this
section.
``(iv) The medical conditions or factors
that contribute to severe maternal morbidity
among eligible individuals enrolled in
maternity health homes in the State.
``(v) The extent to which such individuals
receive health care items and services under
the State plan before, during, and after an
individual's enrollment in such a maternity
health home.
``(vi) Where applicable, mortality data and
data for the associated causes of pregnancy-
related death for eligible individuals enrolled
in a maternity health home under this section,
in accordance with subsection (g). For deaths
occurring postpartum, such data shall
distinguish between deaths occurring up to 42
days postpartum and deaths occurring between 43
days to up to 1 year postpartum. Where
applicable, data reported under this clause
shall be reported alongside comparable data
from a State's maternal mortality review
committee, as established in accordance with
section 317K(d) of the Public Health Service
Act, for purposes of further identifying and
comparing statewide trends in maternal
mortality among populations participating in
the maternity health home under this section.
``(B) Implementation report.--Not later than 18
months after a State has a State plan amendment
approved under this section, the State shall submit to
the Secretary, and make publicly available on the
appropriate State website, a report on how the State is
implementing the option established under this section,
including through any best practices adopted by the
State.
``(g) Confidentiality.--A State with a State plan amendment under
this section shall establish confidentiality protections for the
purposes of subsection (f)(2)(A) to ensure, at a minimum, that there is
no disclosure by the State of any identifying information about any
specific eligible individual enrolled in a maternity health home or any
maternal mortality case, and that all relevant confidentiality and
privacy protections, including the requirements under section
1902(a)(7)(A), are maintained.
``(h) Rule of Construction.--Nothing in this section shall be
construed to require--
``(1) an eligible individual to enroll in a maternity
health home under this section; or
``(2) a designated provider or health team to act as a
maternity health home and provide services in accordance with
this section if the provider or health team does not
voluntarily agree to act as a maternity health home.
``(i) Planning Grants.--
``(1) In general.--Beginning January 1, 2027, from the
amount appropriated under paragraph (2), the Secretary shall
award planning grants to States for purposes of developing and
submitting a State plan amendment under this section. The
Secretary shall award a grant to each State that applies for a
grant under this subsection and meets the application criteria
established by the Secretary, and the Secretary may determine
the amount of the grant based on the merits of the application
and the goal of the State to prioritize health outcomes for
eligible individuals. A planning grant awarded to a State under
this subsection shall remain available until expended.
``(2) Appropriation.--There are authorized to be
appropriated to the Secretary $50,000,000 for fiscal year 2027,
for the purposes of making grants under this subsection, to
remain available until expended.
``(3) Limitation.--The total amount of payments made to
States under this subsection shall not exceed $50,000,000.
``(j) Additional Definitions.--In this section:
``(1) Designated provider.--The term `designated provider'
means a physician (including an obstetrician-gynecologist or,
if applicable, a certified nurse midwife, or certified
professional midwife who meets or exceeds the education and
training standards of the International Confederation of
Midwives and who is licensed to practice within the State), a
hospital, clinical practice or clinical group practice, rural
health clinic, community health center, community mental health
center, or any other entity or provider that is determined by
the State and approved by the Secretary to be qualified to be a
maternity health home on the basis of documentation evidencing
that the entity or provider has the systems, expertise, and
infrastructure in place to provide pregnancy and postpartum
coordinated care services. Such term may include providers who
are employed by, or affiliated with, a hospital.
``(2) Health team.--The term `health team' has the meaning
given such term for purposes of section 3502 of Public Law 111-
148.
``(3) Maternity health home.--The term `maternity health
home' means a designated provider (including a provider that
operates in coordination with a team of health care
professionals) or a health team that is selected by an eligible
individual to provide pregnancy and postpartum coordinated care
services.
``(4) Pregnancy and postpartum coordinated care services.--
``(A) In general.--The term `pregnancy and
postpartum coordinated care services' means items and
services related to the coordination of care for
comprehensive and timely high-quality, culturally and
linguistically appropriate, services described in
subparagraph (B) that are provided by a designated
provider, a team of health care professionals operating
with such a provider, or a health team designated as a
maternity health home.
``(B) Services described.--
``(i) In general.--The services described
in this subparagraph shall include with respect
to a State electing the State plan amendment
option under this section, any medical
assistance for items and services for which
payment is available under the State plan or
under a waiver of such plan.
``(ii) Other items and services.--In
addition to medical assistance described in
clause (i), the services described in this
subparagraph shall include the following:
``(I) Any item or service for which
medical assistance is otherwise
available under the State plan (or a
waiver of such plan) related to the
treatment of an individual during the
individual's pregnancy and the 1-year
period beginning on the last day of
such pregnancy, including mental health
and substance use disorder services.
``(II) Comprehensive care
management.
``(III) Care coordination
(including with pediatricians as
appropriate), health promotion, and
providing access to the full range of
maternal, obstetric, and gynecologic
services, including services from out-
of-State providers.
``(IV) Comprehensive transitional
care, including appropriate follow-up,
from inpatient to other settings.
``(V) Patient and family support
(including authorized representatives).
``(VI) Referrals to community and
social support services, if relevant.
``(VII) Use of health information
technology to link services, as
feasible and appropriate.
``(5) Team of health care professionals.--The term `team of
health care professionals' means a team of health care
professionals (as described in the State plan amendment under
this section) that may--
``(A) include--
``(i) physicians, including gynecologist-
obstetricians, certified nurse midwives, or
certified professional midwives who meet or
exceed the education and training standards of
the International Confederation of Midwives and
who are licensed to practice within the State,
family physicians, primary care physicians,
pediatricians, and other professionals such as
physicians assistants, advance practice nurses,
nurses, nurse care coordinators, dietitians,
nutritionists, social workers, behavioral
health professionals, physical counselors,
physical therapists, occupational therapists,
or any professionals that assist in prenatal
care, delivery, or postpartum care for which
medical assistance is available under the State
plan or a waiver of such plan and determined to
be appropriate by the State and approved by the
Secretary;
``(ii) an entity or individual who is
designated to coordinate such care delivered by
the team; and
``(iii) when appropriate and if otherwise
eligible to furnish items and services that are
reimbursable as medical assistance under the
State plan or under a waiver of such plan,
doulas, community health workers, translators
and interpreters, and other individuals with
culturally appropriate and trauma-informed
expertise; and
``(B) provide care at a facility that is
freestanding, virtual, or based at a hospital,
community health center, community mental health
center, rural health clinic, clinical practice or
clinical group practice, academic health center, or any
entity determined to be appropriate by the State and
approved by the Secretary.''.
(b) Applicability to CHIP.--Section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)), as amended by section 105, is
amended by adding at the end the following new subparagraph:
``(W) Section 1945B (relating to optional health
homes for pregnant and postpartum individuals).''.
SEC. 203. GUIDANCE ON SUPPORTING AND IMPROVING ACCESS TO MEDICAID AND
CHIP COVERAGE OF SERVICES PROVIDED BY DOULAS AND CERTAIN
MATERNAL HEALTH PROFESSIONALS.
Not later than 1 year after the date of the enactment of this Act,
the Secretary of Health and Human Services shall issue and publish
guidance for States concerning options for supporting and improving
access to coverage and payment under a State plan under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) or under a waiver of
such plan, and under a State child health plan under title XXI of such
Act (42 U.S.C. 1397aa et seq.) or under a waiver of such plan, for
services provided by doulas, certified nurse midwives, certified
midwives, or certified professional midwives, who meet or exceed the
education and training standards of the International Confederation of
Midwives and who are licensed to practice within the State and certain
maternal health professionals (specified by the Secretary)--
(1) in rural areas;
(2) across a continuum of care; and
(3) among varied provider settings and payment and care
models, including managed care.
SEC. 204. MEDICAID AND CHIP INCREASED FINANCIAL SUPPORT FOR DEPRESSION
AND ANXIETY SCREENING DURING THE PERINATAL AND POSTPARTUM
PERIODS.
(a) Medicaid.--Section 1905 of the Social Security Act (42 U.S.C.
1396d), as amended by section 103, is further amended--
(1) in the first sentence of subsection (b), by striking
``subsection (a)(4)(D)'' and inserting ``subsections (a)(4)(D)
and (ll)''; and
(2) by adding at the end the following:
``(ll) Increased FMAP for Depression and Anxiety Screening During
the Perinatal and Postpartum Periods.--
``(1) In general.--For purposes of clause (5) of the first
sentence of subsection (b), services described in this
subsection are screening services provided to an individual who
is eligible for such assistance on the basis of being pregnant
that include at a minimum--
``(A) during the perinatal period, at least 1
screening for depression and anxiety symptoms using a
standardized, validated tool; and
``(B) during the postpartum period, a full
assessment of mood and emotional well-being, including
screening for postpartum depression and anxiety, using
a standardized, validated tool.
``(2) Exclusion from territorial caps.--The additional
amount paid to a territory for expenditures for medical
assistance for services described in paragraph (1) as a result
of the application of clause (5) of the first sentence of
subsection (b) shall not be taken into account for purposes of
applying payment limits under subsections (f) and (g) of
section 1108.''.
(b) CHIP.--Section 2105(c) of the Social Security Act (42 U.S.C.
1397ee(c)) is amended by adding at the end the following new paragraph:
``(13) Enhanced payment for depression and anxiety
screening during the perinatal and postpartum periods.--
Notwithstanding subsection (b), the enhanced FMAP with respect
to payments under subsection (a) for expenditures under the
State child health plan (or a waiver of such plan) shall be
increased by 1 percentage point with respect to expenditures
for services described in section 1905(ll)(1) that are provided
under the plan (or waiver) to an individual who is eligible for
such assistance on the basis of being pregnant (including
pregnancy-related assistance provided to a targeted low-income
pregnant woman (as defined in section 2112(d)), pregnancy-
related assistance provided to an individual who is eligible
for such assistance through application of section
1903(v)(4)(A)(i) under section 2107(e)(1), or any other
assistance under the plan (or waiver) provided to an individual
who is eligible for such assistance on the basis of being
pregnant) and during the 12-month period that begins on the
last day of the individual's pregnancy and ends on the last day
of the month in which such 12-month period ends (including any
such assistance provided during the month in which such period
ends).''.
(c) Effective Date.--The amendments made by this section shall take
effect on the first day of the first fiscal quarter that begins on or
after the date that is 1 year after the date of enactment of this
section.
SEC. 205. PRESUMPTIVE ELIGIBILITY FOR PREGNANT INDIVIDUALS.
(a) In General.--
(1) Requirement.--Section 1920(a) of the Social Security
Act (42 U.S.C. 1396r-1(a)) is amended by striking ``may
provide'' and inserting ``shall provide''.
(2) Application.--Section 1920 of the Social Security Act
(42 U.S.C. 1396r-1) is amended by adding at the end the
following new subsection:
``(f) Application.--A State shall provide to a pregnant woman a
presumptive eligibility period in accordance with this section without
regard to whether the individual would otherwise qualify for a
presumptive eligibility period the State has elected to provide under
section 1920A, 1920B, or 1920C.''.
(b) Conforming Amendments.--
(1) Section 1902(a)(47) of the Social Security Act (42
U.S.C. 1396a(a)(47)) is amended to read as follows:
``(47) provide--
``(A)(i) for making ambulatory prenatal care
available to pregnant women during a presumptive
eligibility period in accordance with section 1920; and
``(ii) at the option of the State--
``(I) for making medical assistance for
items and services described in subsection (a)
of section 1920A available to children during a
presumptive eligibility period in accordance
with such section;
``(II) for making medical assistance
available to individuals described in
subsection (a) of section 1920B during a
presumptive eligibility period in accordance
with such section; and
``(III) for making medical assistance
available to individuals described in
subsection (a) of section 1920C during a
presumptive eligibility period in accordance
with such section; and
``(B) that any hospital that is a participating
provider under the State plan may elect to be a
qualified entity for purposes of determining, on the
basis of preliminary information, whether any
individual is eligible for medical assistance under the
State plan or under a waiver of the plan for purposes
of providing the individual with medical assistance
during a presumptive eligibility period, in the same
manner, and subject to the same requirements, as apply
with respect to populations described in section 1920,
1920A, 1920B, or 1920C (without regard to whether the
State has elected to provide for a presumptive
eligibility period under sections 1920A, 1920B, or
1920C), subject to such guidance as the Secretary shall
establish;''.
(2) Section 1920(e) of the Social Security Act (42 U.S.C.
1396r-1(e)) is amended--
(A) by striking ``If the State has elected the
option to provide a presumptive eligibility period
under this section or section 1920A, the'' and
inserting ``The''; and
(B) by striking ``1920A, subject to'' and inserting
``1920A (if the State has elected the option), subject
to''.
(3) Section 2107(e)(1)(R) of the Social Security Act (42
U.S.C. 1397gg(e)(1)(R)) is amended by inserting ``1920
(relating to presumptive eligibility for pregnant women and
section'' before ``1920A''.
(4) Section 2112(c) of the Social Security Act (42 U.S.C.
1397ll(c)) is amended--
(A) in the heading, by striking ``Option To
Provide''; and
(B) by striking ``may elect'' and inserting ``shall
elect''.
TITLE III--INVEST IN THE MATERNAL HEALTH CARE WORKFORCE
SEC. 301. EMERGENCY OBSTETRIC WORKFORCE SUPPORT.
(a) In General.--Section 203A of the Public Health Service Act (42
U.S.C. 204a) is amended--
(1) in subsection (a)--
(A) in paragraph (1), in the matter preceding
subparagraph (A), by inserting ``and urgent maternal
health care needs'' after ``public health care needs'';
(B) in paragraph (3), by inserting ``or urgent
maternal health care need'' after ``public health care
need'';
(C) in paragraph (5)--
(i) in subparagraph (C), by striking ``or''
at the end;
(ii) in subparagraph (D), by striking the
period at the end and inserting ``; or''; and
(iii) by adding at the end the following:
``(E) any urgent need, not rising to the level of
an emergency described in subparagraph (D), that, in
the judgment of the Secretary, if not addressed, could
result in an emergency that would be appropriate for
the deployment of the Commissioned Corps.''; and
(D) by adding at the end the following:
``(6) Urgent maternal health care need.--
``(A) In general.--For purposes of this section and
section 214, the term `urgent maternal health care
need', with respect to an area, means a maternal health
care need, as determined by the Secretary, in
consultation with the Attorney General, arising as a
result of the closure or imminent closure of a hospital
or other health care facility in such area, or the loss
of workers employed by such hospital or health care
facility who are trained to provide maternal health
care services.
``(B) Considerations.--In determining whether there
is an urgent maternal health care need for purposes of
subparagraph (A) with respect to an area, the Secretary
shall consider whether such closure, imminent closure,
or loss of workers has impacted access by individuals
in such area to a full range of maternal health care
services, including prenatal services, labor and
delivery services, postnatal services, maternal and
postpartum mental health services, behavioral health
services, and reproductive health services.'';
(2) in subsection (b)--
(A) in paragraph (1), by inserting ``or urgent
maternal health care needs'' after ``public health care
needs''; and
(B) in each of paragraphs (2) and (4)(B), by
inserting ``or urgent maternal health care need'' after
``public health care need''; and
(3) in subsection (c), by inserting ``or urgent maternal
health care need'' after ``public health care need''.
(b) Detail of Personnel.--Section 214 of the Public Health Service
Act (42 U.S.C. 215) is amended--
(1) by redesignating subsection (e) as subsection (f);
(2) by inserting after subsection (d) the following:
``(e)(1) Upon the request of an eligible entity with respect to a
hospital or other health care facility the closure, imminent closure,
or loss of workers of which led to an urgent maternal health care need
in an area, personnel may be detailed by the Secretary for the purpose
of assisting such eligible entity in work related to such urgent
maternal health care need.
``(2)(A) Personnel detailed under paragraph (1) shall be paid from
applicable appropriations of the Service.
``(B) In the case of detail of personnel under paragraph (1) to be
paid from applicable Service appropriations, the Secretary may
condition such detail on an agreement by the eligible entity concerned
that such eligible entity concerned shall reimburse the United States
for a portion of the amount of such payments made by the Service.
``(C) The services of personnel while detailed pursuant to this
subsection shall be considered as having been performed in the Service
for purposes of the computation of basic pay, promotion, retirement,
compensation for injury or death, and the benefits provided by section
212.
``(3) The Secretary may condition a detail of personnel under
paragraph (1) on an agreement by the eligible entity concerned that
such eligible entity concerned shall--
``(A) in the case of an imminent closure or a loss of
workers, as determined by the Secretary--
``(i) maintain the maternal health care services in
the applicable area to the maximum extent practicable,
including by hiring temporary workers, until the date
on which the personnel are detailed to such area; and
``(ii) submit to the Secretary a plan for hiring
and retaining health practitioners in the short- and
long-term, both during periods in which personnel are
detailed to such applicable area and periods in which
personnel are not detailed to such applicable area;
``(B) in the case of a closure, submit to the Secretary a
plan for working with, as applicable, State and local agencies
and local stakeholders to transition patients to alternate
sources of safe maternal health care services; and
``(C) commit to an assessment by the Secretary of the
workplace practices of such eligible entity concerned, if
applicable.
``(4) In this subsection--
``(A) the term `eligible entity' means--
``(i) a State;
``(ii) a political subdivision of a State; or
``(iii) a Tribal, nonprofit, or other health care
entity; and
``(B) the term `personnel' means an employee or officer of
the Commissioned Corps.''; and
(3) in subsection (f) (as so redesignated), by inserting
``or an urgent maternal health care need'' before the period at
the end.
(c) Funding for Commissioned Corps of the Public Health Service.--
Section 203 of the Public Health Service Act (42 U.S.C. 204) is amended
by adding at the end the following:
``(e) Operations of the Commissioned Corps of the Public Health
Service.--
``(1) In general.--The Secretary shall carry out duties and
responsibilities relating to the operations of the Commissioned
Corps of the Service, including the following:
``(A) Enhance the processes and systems of the
Service's Headquarters operations.
``(B) Maximize the force management, required
training opportunities (as determined by the Secretary
under section 203A(a)(1)), operational capacity, and
mission readiness of the Regular Corps, the Ready
Reserve Corps, and the Public Health Emergency Response
Strike Teams, a subcomponent of the Regular Corps.
``(C) Recruit and retain qualified professionals
suited to serving underserved and vulnerable
communities by--
``(i) improving onboarding timelines,
providing officer placements to align with
mission needs, ensuring adequate officer morale
and wellness resources, and incentivizing
recruiters and recruits; and
``(ii) expanding training opportunities,
including training of personnel to deliver
maternal health care services, providing
credentialing support for high demand skill
sets, and enriching leadership and research
potential.
``(D) Improve deployment processes and prepare
mission teams to execute routine and emergent public
health events.
``(E) Establish a legislative liaison office to
carry out legislative affairs functions under the
direction of the Secretary.
``(2) Authorization of appropriations.--In addition to
amounts otherwise authorized to be appropriated for the
Commissioned Corps of the Service, there is authorized to be
appropriated to the Secretary to carry out paragraph (1)
$150,000,000 for fiscal year 2026 and each fiscal year
thereafter.''.
SEC. 302. STREAMLINED SCREENING AND ENROLLMENT OF PROVIDERS OF
MATERNITY, LABOR, AND DELIVERY SERVICES IN NEIGHBORING
STATES.
(a) Application to Medicaid.--Section 1902(kk) of the Social
Security Act (42 U.S.C. 1396a(kk)) is amended by adding at the end the
following new paragraph:
``(10) Streamlined enrollment process for eligible out-of-
state providers of maternity, labor, and delivery services.--
``(A) In general.--The State adopts and implements
a process that enables an eligible out-of-State
provider to enroll as a provider in the State plan
without imposing any screening requirements that are in
addition to the requirements imposed on in-State
providers. An eligible out-of-State provider that
enrolls in the State plan through such process shall be
so enrolled for a 5-year period (unless the provider is
terminated or excluded from participation during such
period) and may revalidate such enrollment through such
process for subsequent 5-year periods.
``(B) Eligible out-of-state provider.--In this
paragraph, the term `eligible out-of-State provider'
means, with respect to a State, a provider--
``(i) that furnishes maternity, labor, and
delivery services (as defined in subsection
(uu)(1)), or provides orders or referrals for
such services, for which payment is available
under the State plan of the State;
``(ii) that is located in a neighboring
State (as defined by the Secretary);
``(iii) with respect to which the Secretary
has determined there is a limited risk of
fraud, waste, or abuse for purposes of
determining the level of screening to be
conducted under section 1866(j)(2)(B);
``(iv) that has been screened under such
section 1866(j)(2)(B) for purposes of enrolling
in the Medicare program under title XVIII or
the State plan of the State in which such
provider is located; and
``(v) that has not been excluded from
participation in the Medicare program under
such title or the Medicaid program under this
title.''.
(b) Conforming Amendments.--
(1) Section 1902(a)(77) of the Social Security Act (42
U.S.C. 1396a(a)(77)) is amended by inserting ``enrollment,''
after ``screening,''.
(2) Section 1902(kk) of such Act (42 U.S.C. 1396a(kk)), as
amended by subsection (a), is further amended--
(A) in the subsection heading, by inserting
``Enrollment,'' after ``Screening,''; and
(B) in paragraph (9), by striking ``Nothing'' and
inserting ``Except as provided in paragraph (10),
nothing''.
(c) Application to CHIP.--Section 2107(e)(1)(G) of such Act (42
U.S.C. 1397gg(e)(1)(G)) is amended by inserting ``enrollment,'' after
``screening,''.
(d) Guidance on Screening and Enrolling Out-of-State Providers of
Maternity, Labor, and Delivery Services.--Not later than January 1,
2027, the Secretary of Health and Human Services shall issue (and
update as the Secretary determines necessary) guidance to State
Medicaid and CHIP directors on best practices for screening and
enrolling out-of-State providers of maternity, labor, and delivery
services in accordance with paragraph (10) of section 1902(kk) of the
Social Security Act (42 U.S.C. 1396a(kk)) and section 2107(e)(1)(G) of
such Act (42 U.S.C. 1397gg(e)(1)(G)) (as added and amended by this
section) and including best practices for screening and enrolling out-
of-State providers in managed care plans.
(e) Effective Date.--The amendments made by this section take
effect on January 1, 2027.
TITLE IV--REQUIRING PUBLIC COMMUNICATION OF OBSTETRICS DATA AND UNIT
CLOSURES
SEC. 401. TIMELY NOTIFICATIONS OF IMPENDING HOSPITAL OBSTETRIC UNIT
CLOSURES.
(a) In General.--Section 1866(a)(1) of the Social Security Act (42
U.S.C. 1395cc(a)(1)) is amended--
(1) in subparagraph (X), by striking ``and'' at the end;
(2) in subparagraph (Y)(ii)(V), by striking the period and
inserting ``, and''; and
(3) by inserting after subparagraph (Y) the following new
subparagraph:
``(Z) beginning 180 days after the date of the
enactment of this subparagraph, in the case of a
hospital, not less than 180 days prior to the closure
of any obstetric unit of the hospital, to submit to the
Secretary, any relevant local and State agencies, and
the community a notification, which shall include--
``(i) a report analyzing the impact the
closure will have on the community, including
data on any adverse outcomes and increase in
costs relating to obstetric services for such
community;
``(ii) steps the hospital will take to
identify other health care providers that can
alleviate any service gaps as a result of the
closure;
``(iii) the cause of the closure of such
obstetric unit;
``(iv) data regarding historic
transportation costs related to obstetric
services in such community; and
``(v) any additional information as may be
required by the Secretary.''.
(b) State Requirement To Post Reports.--Section 1902(a) of the
Social Security Act (42 U.S.C. 1396a(a)), as amended by section
201(a)(1), is further amended--
(1) in paragraph (87), by striking ``and'' at the end;
(2) in paragraph (88), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (88) the following new
paragraph:
``(89) provide that the State will make publicly available,
on the website of any relevant State agency, any report
received by the State from a hospital pursuant to section
1866(a)(1)(Z)(i).''; and
SEC. 402. COLLECTION OF DATA RELATING TO HOSPITAL LABOR AND DELIVERY
SERVICES.
Section 1866(a)(1) of the Social Security Act (42 U.S.C.
1395cc(a)(1)), as amended by section 401, is amended--
(1) in subparagraph (Y)(ii)(V), by striking ``and'' at the
end;
(2) in subparagraph (Z), by striking the period and
inserting ``, and''; and
(3) by adding at the end the following new subparagraph:
``(AA) in the case of a hospital, to include in
cost reports submitted under this title for cost
reporting periods beginning on or after July 1, 2025--
``(i) the number of births that occurred at
such hospital during the cost reporting period,
delineated by the number of cesarean births and
vaginal births;
``(ii) the number of antenatal and
postpartum transfers from the hospital to other
hospitals;
``(iii) data on the number and
characteristics of the staff providing labor
and delivery services at such hospital;
``(iv) the expenses the hospital incurred
for providing labor and delivery services at
such hospital, including nursing care,
anesthesia, and operating room services;
``(v) the amount the hospital spent for on-
call coverage for labor and delivery services
by physicians and midwives; and
``(vi) the amount and sources of revenue
received by such hospital for labor and
delivery services, including payments received
for--
``(I) items and services furnished
to individuals eligible for coverage
under a State plan under title XIX (or
a waiver of such a plan);
``(II) items and services furnished
to individuals with other forms of
health insurance or third-party
coverage; and
``(III) items and services
furnished to individuals without health
insurance or other source of third-
party coverage.''.
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