[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3365 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 3365
To amend title XIX of the Social Security Act to provide States with
the option to provide coordinated care through a pregnancy medical home
for high-risk pregnant women, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 13, 2025
Mr. Nunn of Iowa (for himself, Ms. Pressley, and Ms. Underwood)
introduced the following bill; which was referred to the Committee on
Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide States with
the option to provide coordinated care through a pregnancy medical home
for high-risk pregnant women, 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 ``Harnessing Effective and Appropriate
Long-Term Health for Moms On Medicaid Act of 2025'' or the ``HEALTH for
MOM Act of 2025''.
SEC. 2. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH HOME
FOR PREGNANT AND POSTPARTUM WOMEN.
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 WOMEN.
``(a) State Option.--
``(1) In general.--Notwithstanding section 1902(a)(1)
(relating to statewideness) and section 1902(a)(10)(B)
(relating to comparability), beginning 2 years after the date
of the enactment of this section, a State, at its option as a
State plan amendment and after consultation with health care
providers and individuals enrolled under such plan who are or
have been pregnant, may provide for medical assistance under
this title to an eligible woman 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 woman's maternity
health home for purposes of providing the woman 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 women under this section.
``(2) Eligible woman defined.--
``(A) In general.--In this section, the term
`eligible woman' means an individual who--
``(i) 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 waiver) that are not less in
amount, duration, or scope, or are determined
by the Secretary to be substantially
equivalent, to the medical assistance available
for an individual described in subsection
(a)(10)(A)(i); and
``(ii) is pregnant.
``(B) Continuation of eligibility.--An individual
described in subparagraph (A) shall be deemed to be
described in such subparagraph through the earlier of--
``(i) the end of the month in which the
individual's eligibility for medical assistance
under the State plan (or waiver) ends; and
``(ii) the last day of the 1-year period
that begins on the last day of the individual's
pregnancy.
``(C) Exclusion of individuals eligible for a
limited pregnancy-related only benefit package.--Such
term does not include an individual who had a pregnancy
end within the last 365 days and whose eligibility
under such plan (or waiver) is limited to coverage for
a limited type of benefits and services.
``(b) Qualification Standards.--The Secretary shall establish
standards for qualification as a maternity health home or as a
designated provider, 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. Such standards
shall include requiring designated providers, teams of health care
professionals operating with such providers, and health teams
(designated as a maternity health home) to demonstrate to the State the
ability to do the following:
``(1) Coordinate prompt care and access to maternity and
postpartum care services, including services provided by
specialists, and programs for an eligible woman during
pregnancy and during the period for which she remains eligible
as described in subsection (a)(2)(B).
``(2) Develop an individualized, comprehensive, patient-
centered care plan for each eligible woman 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 woman's
care plan, in a culturally and linguistically appropriate
manner consistent with the needs of the eligible woman, ongoing
home care, community-based primary care, inpatient care, social
support services, behavioral health services, local hospital
emergency care, oral health care, and to the extent,
applicable, care management and planning related to a change in
an eligible woman's eligibility for medical assistance or a
change in health insurance coverage.
``(4) Coordinate with pediatric care providers, community-
based providers, behavioral health providers, social service
providers, local hospital and emergency care providers, oral
health providers, specialists, and providers of early
intervention services to ensure full implementation of the
client's care plan, 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 with payments for the
provision of pregnancy and postpartum coordinated care
services, to each eligible woman that selects such provider,
team of health care professionals, or health team as the
woman's maternity health home or care provider. Payments made
to a maternity health home or care provider for such services
shall be treated as medical assistance for purposes of section
1903(a), except that, during the first 4 fiscal year quarters
that the State plan amendment is in effect, the Federal medical
assistance percentage applicable to such payments shall be
increased by 15 percentage points, but in no case may exceed 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 to an
eligible woman. Such methodology for determining payment--
``(A) may be based on--
``(i) a per-member per-month basis for each
eligible woman enrolled in the 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
(which may include a model developed under a
waiver under section 1115) proposed by the
State and approved by the Secretary;
``(B) may be adjusted to reflect, with respect to
each eligible woman--
``(i) the severity of the risks associated
with the woman's pregnancy;
``(ii) the severity of the risks associated
with the woman's postpartum health care needs;
and
``(iii) the level or amount of time of care
coordination required with respect to the
woman; 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 woman who seeks treatment in the emergency
department of such hospital for--
``(A) providing the woman with culturally and
linguistically appropriate information on the
respective treatment models and opportunities for the
woman to access a maternity health home and its
associated benefits; and
``(B) notifying the maternity health home in which
the woman is enrolled, or the designated provider, team
of health care professionals operating with such a
provider, or health team treating the woman, of the
woman's treatment in the emergency department and of
the protocols for the maternity health home, designated
provider, or team to be involved in the woman'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 women, including the process by which
such providers can participate in or refer
eligible women to an approved maternity health
home or a designated provider, team of health
care professionals operating with such a
provider, or health team; and
``(ii) educating eligible women, 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 relevant stakeholders 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 women.
``(4) Coordination of 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 women receiving
pregnancy and postpartum care coordinated 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, the Special Supplemental Nutrition Program
for Women, Infants, and Children, or under title V.
``(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 woman 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 women 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,
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 eligible women
who have selected such provider, team of health care
professionals, or health team as the womens maternity
health home.
``(B) Information on all applicable measures for
determining the quality of services provided by such
provider, team of health care professionals, or health
team, including, to the extent applicable, maternal,
perinatal, and child health quality measures under
section 1139B.
``(C) 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 frequency of every 12 months, and in
such form and manner determined by the Secretary to be
reasonable and minimally burdensome, including through
a health information exchange or other public health
data sharing entity, the following information:
``(i) Information described in paragraph
(1).
``(ii) The number and, to the extent
available and while maintaining all relevant
protecting privacy and confidentially
protections, disaggregated demographic
information of eligible women who have enrolled
in a maternity health home pursuant to this
section.
``(iii) The number of maternity health
homes in the State.
``(iv) The medical and behavioral health
conditions or factors that contribute to severe
maternal morbidity among eligible women
enrolled in maternity health homes in the
State.
``(v) The extent to which such women
receive health care items and services under
the State plan before, during, and after the
women's enrollment in such a maternity health
home.
``(vi) Where applicable, mortality data and
data for the associated causes of death for
eligible women 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.
``(vii) The type of delivery systems and
payment models used to provide health home
services to eligible individuals enrolled in a
maternal health home under such amendment.
``(viii) Information on hospitalizations,
morbidity, and mortality of eligible
individuals and their infants enrolled in a
maternal health home in such State alongside
comparable data from a State's maternal
mortality review committee.
``(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 woman enrolled in a maternity health home or any
maternal mortality case, and that all relevant confidentiality and
privacy protections, including the requirements under 1902(a)(7)(A),
are maintained.
``(h) Rule of Construction.--Nothing in this section shall be
construed to require--
``(1) an eligible woman 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 October 1, 2025, 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, but 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 women. 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 the 2-year period
beginning on the date of the enactment of this section, 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),
hospital, clinical practice or clinical group practice, rural
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 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) 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 is selected by an eligible
woman to provide pregnancy and postpartum coordinated care
services.
``(3) Health team.--The term `health team' has the meaning
given such term for purposes of section 3502 of Public Law 111-
148.
``(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 to an eligible woman
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) Comprehensive care
management.
``(II) Care coordination (including
with pediatricians, specialists, and
providers of early intervention
services, as appropriate), health
promotion, and providing access to the
full range of maternal, obstetric, and
gynecologic services, including
services from out-of-State providers.
``(III) Comprehensive transitional
care, including appropriate follow-up,
from inpatient to other settings.
``(IV) Patient and family support
(including authorized representatives).
``(V) Referrals to community and
social support services, if relevant.
``(VI) 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, pediatricians, and other
professionals such as physicians assistants,
advance practice nurses, including certified
midwives, 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 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, or provide care at the home of an
individual with respect to a home birth.''.
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