[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2289 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 2289
To amend titles XIX and XXI of the Social Security Act to improve
maternal health coverage under Medicaid and CHIP, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 15, 2025
Mr. Grassley (for himself and Ms. Hassan) 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 improve
maternal health coverage under Medicaid and CHIP, 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 ``Healthy Moms and
Babies Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
Sec. 3. Mandatory reporting by State Medicaid programs on adult health
care quality measures of maternal and
perinatal health.
Sec. 4. Medicaid quality improvement initiatives to reduce rates of
cesarean sections; Medicare requirement for
hospitals to report on data on cesarean
births.
Sec. 5. State option to provide coordinated care through a health home
for pregnant and postpartum women.
Sec. 6. Guidance on care coordination to support maternal health.
Sec. 7. National reskilling of the maternity care workforce.
Sec. 8. MACPAC study on doulas and community health workers; guidance
on increasing access to doula services
under Medicaid.
Sec. 9. Demonstration projects to improve the delivery of maternal
health care through telehealth.
Sec. 10. CMS report on coverage of remote physiologic monitoring
devices and impact on maternal and child
health outcomes under Medicaid.
Sec. 11. Guidance on community-based maternal health programs.
Sec. 12. Developing guidance on maternal mortality and severe morbidity
reduction for maternal care providers
receiving payment under the Medicaid
program.
Sec. 13. Program related to reducing cesarean births and increasing
rates of vaginal birth after cesarean.
Sec. 14. Collection of information related to social determinants of
the health of Medicaid and CHIP
beneficiaries.
Sec. 15. Report on payment methodologies for transferring pregnant
women between facilities before, during,
and after childbirth.
Sec. 16. Medicaid guidance on State options to address social
determinants of health for pregnant and
postpartum women.
Sec. 17. Payment error rate measurement (PERM) audit and improvement
requirements.
SEC. 2. DEFINITIONS.
In this Act:
(1) CHIP.--The term ``CHIP'' means the Children's Health
Insurance Program established under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.).
(2) Comptroller general.--The term ``Comptroller General''
means the Comptroller General of the United States.
(3) Group health plan; health insurance issuer, etc.--The
terms ``group health plan'', ``health insurance coverage'',
``health insurance issuer'', ``group health insurance
coverage'', and ``individual health insurance coverage'' have
the meanings given such terms in section 2791 of the Public
Health Service Act (42 U.S.C. 300gg-91).
(4) Medicaid.--The term ``Medicaid'' means the Medicaid
program established under title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.).
(5) Medicaid managed care organization.--The term
``medicaid managed care organization'' has the meaning given
that term in section 1903(m)(1)(A) of the Social Security Act
(42 U.S.C. 1396b(m)(1)(A)).
(6) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(7) State.--The term ``State'' has the meaning given that
term for purposes of titles V, XIX, and XXI of the Social
Security Act (42 U.S.C. 701 et seq., 1396 et seq., 1397aa et
seq.).
SEC. 3. MANDATORY REPORTING BY STATE MEDICAID PROGRAMS ON ADULT HEALTH
CARE QUALITY MEASURES OF MATERNAL AND PERINATAL HEALTH.
Section 1139B of the Social Security Act (42 U.S.C. 1320b-9b) is
amended--
(1) in subsection (b)--
(A) in paragraph (3)(B)--
(i) in the subparagraph heading, by
inserting ``and maternal and perinatal health''
after ``behavioral health'';
(ii) by striking ``all behavioral health''
and inserting ``all behavioral health and
maternal and perinatal health''; and
(iii) by inserting ``and of maternal and
perinatal health care for Medicaid eligible
adults'' after ``Medicaid eligible adults'';
and
(B) in paragraph (5)(C)--
(i) in the subparagraph heading, by
inserting ``and maternal and perinatal health''
after ``behavioral health''; and
(ii) by inserting ``and, with respect to
Medicaid eligible adults, maternal and
perinatal health measures'' after ``behavioral
health measures''; and
(2) in subsection (d)(1)(A), by inserting ``and maternal
and perinatal health'' after ``behavioral health''.
SEC. 4. MEDICAID QUALITY IMPROVEMENT INITIATIVES TO REDUCE RATES OF
CESAREAN SECTIONS; MEDICARE REQUIREMENT FOR HOSPITALS TO
REPORT ON DATA ON CESAREAN BIRTHS.
(a) Medicaid State Plan Amendment.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (86), by striking ``and'' after the
semicolon;
(2) in paragraph (87), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (87) the following:
``(88) provide that, not later than January 1, 2027, and
annually thereafter through January 1, 2037, the State shall
submit a report to the Secretary, that shall be made publicly
available, which contains with respect to the preceding
calendar year--
``(A) the rate of low-risk cesarean delivery, as
defined by the Secretary in consultation with relevant
stakeholders, for pregnant women eligible for medical
assistance under the State plan or a waiver of such
plan in the State, as compared to the overall rate of
cesarean delivery in the State;
``(B) a description of the State's quality
improvement activities to safely reduce the rate of
low-risk cesarean delivery (as so defined) for pregnant
women eligible for medical assistance under the State
plan or a waiver of such plan in the State reported
under subparagraph (A), including initiatives aimed at
reducing racial and ethnic health disparities,
hospital-level quality improvement initiatives, taking
into account hospital type and the patient population
served, and, if applicable, partnerships with State or
regional perinatal quality collaboratives;
``(C) for each report submitted after January 1,
2027, the percentage change (if any) in the rate of
low-risk cesarean delivery (as so defined) for pregnant
women eligible for medical assistance under the State
plan or a waiver of such plan in the State reported
under subparagraph (A) from the rate reported for the
most recent previous report; and
``(D) such other relevant data and information as
determined by the Secretary, and in consultation with
relevant stakeholders, such as State initiatives and
evaluations of quality improvement activities, cesarean
delivery rates, and health outcomes.''.
(b) GAO Study Regarding Medicaid Payment Rates Cesarean Births.--
(1) Study.--The Comptroller General shall conduct a study
regarding payment rates for cesarean births and vaginal births
under State Medicaid programs. To the extent feasible and data
are available, the study shall include analyses of the
following:
(A) Payment rates for cesarean births and vaginal
births paid by fee-for-service Medicaid programs and by
Medicaid programs that contract with Medicaid managed
care organizations to furnish medical assistance under
such programs;
(B) What is known about how Medicaid payment rates
have changed over time;
(C) What is known about how payment rates for
cesarean and vaginal births by Medicaid programs
compare with the payment rates for such births by other
sources of insurance coverage; and
(D) Such other factors related to payment rates for
cesarean and vaginal births under Medicaid as the
Comptroller General determines appropriate.
(2) Report.--Not later than 18 months after the date of
enactment of this Act, the Comptroller General shall submit to
Congress a report containing the results of the study conducted
under paragraph (1), together with recommendations for such
legislation and administrative action as the Comptroller
General determines appropriate.
(c) GAO Study on Racial Disparities in Cesarean Births.--
(1) In general.--The Comptroller General shall conduct a
study on racial disparities in the frequency of cesarean
births. To the extent feasible and data are available, the
study shall compare such information on low- and high-risk
cesarean births, differences by payer (such as Medicaid and
private payers), and hospital characteristics (such as location
or hospital type). Such study may consider other factors
related to racial disparities in maternal health as the
Comptroller General deems appropriate.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit to
Congress a report containing the results of the study conducted
under paragraph (1), together with recommendations for such
legislation and administrative action as the Comptroller
General determines appropriate.
(d) Medicare Requirement for Hospitals To Report Data on Cesarean
Births.--
(1) Requirement.--Section 1866(a)(1) of the Social Security
Act (42 U.S.C. 1395cc(a)(1)) is amended--
(A) by moving the indentation of subparagraph (W) 2
ems to the left;
(B) in subparagraph (X)--
(i) by moving the indentation 2 ems to the
left; and
(ii) by striking ``and'' at the end;
(C) in subparagraph (Y), by striking the period at
the end and inserting ``; and''; and
(D) by inserting after subparagraph (Y) the
following new subparagraph:
``(Z) in the case of a hospital, to submit, in a form and
manner, and at a time, specified by the Secretary, data on the
Nulliparous, Term, Singleton, Vertex Cesarean section (NTSV C-
section) rate with respect to the hospital for the preceding
year.''.
(2) Incorporation into hospital quality reporting.--Section
1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C.
1395ww(b)(3)(B)(viii)) is amended by adding at the end the
following new subclause:
``(XIII) Effective for payments beginning with fiscal year 2027, in
expanding the number of measures under subclause (III), the Secretary
shall adopt a measure relating to the Nulliparous, Term, Singleton,
Vertex Cesarean section (NTSV C-section) rate for hospitals in
inpatient settings. Not later than 2027, the Secretary shall
incorporate such measure into the designation of maternity care quality
hospitals, as described in the final rule entitled `Medicare Program;
Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals
and the Long Term Care Hospital Prospective Payment System and Policy
Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare
Promoting Interoperability Program Requirements for Eligible Hospitals
and Critical Access Hospitals; Costs Incurred for Qualified and Non-
Qualified Deferred Compensation Plans; and Changes to Hospital and
Critical Access Hospital Conditions of Participation' (87 Fed. Reg.
48780 (August 10, 2022)).''.
SEC. 5. 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 April 1, 2028, a State,
at its option as a State plan amendment, 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.--In this section, the term
`eligible woman' 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
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
``(B) who--
``(i) is pregnant; or
``(ii) had a pregnancy end within the last
365 days.
``(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. 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 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 necessary
maternity care services, including services provided by
specialists, and programs for an eligible woman during her
pregnancy and the 365-day period beginning on the last day of
her pregnancy.
``(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, 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 woman losing eligibility for medical assistance under
the State plan or waiver, care management and planning related
to a change in the eligible woman'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 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).
``(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 woman's pregnancy and the 365-day period beginning on
the last day of her pregnancy. 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 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 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 women.
``(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 women 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.
``(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 women's maternity
health home.
``(B) Information on measures from the core sets of
child health quality measures and adult health quality
measures under sections 1139A and 1139B that are
identified by the Secretary as being relevant to
maternal, perinatal, or infant health.
``(C) Information on all other applicable measures
for determining the quality of services provided by
such provider, team of health care professionals, or
health team.
``(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 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 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.
``(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, 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, 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 period of
fiscal years 2026 through 2028, 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, a
medicaid managed care organization, as defined in section
1903(m)(1)(A), a prepaid inpatient health plan, as defined in
section 438.2 of title 42, Code of Federal Regulations (or any
successor regulation), a prepaid ambulatory health plan, as
defined in such section (or any successor regulation), 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 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 a woman during the woman's
pregnancy and the 1-year period
beginning on the last day of her
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, pediatricians, and other
professionals such as physicians assistants,
advance practice nurses, including certified
nurse 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.''.
SEC. 6. GUIDANCE ON CARE COORDINATION TO SUPPORT MATERNAL HEALTH.
Not later than 2 years after the date of enactment of this Act, the
Secretary shall issue guidance for State Medicaid programs on improved
care coordination, continuity of care, and clinical integration to
support the needs of pregnant and postpartum women for services
eligible for Medicaid payment. Such guidance shall identify best
practices for care coordination for such women, both with respect to
fee-for-service State Medicaid programs and State Medicaid programs
that contract with Medicaid managed care organizations or other
specified entities to furnish medical assistance for such women, and
shall illustrate strategies for--
(1) enhancing primary care and maternity care coordination
with specialists, including cardiologists, specialists in
gestational diabetes, dentists, lactation specialists, genetic
counselors, and behavioral health providers;
(2) integrating behavioral health providers to provide
screening, assessment, treatment, and referral for behavioral
health needs, including substance use disorders, maternal
depression, anxiety, intimate partner violence, and other
trauma;
(3) integrating into care teams or coordinating with
nonclinical professionals, including (if licensed or
credentialed by a State or State-authorized organization)
doulas, peer support specialists, and community health workers,
and how these services provided by such professionals may be
eligible for Federal financial participation under Medicaid;
(4) screening pregnant and postpartum women for social
needs and coordinating related services during the prenatal and
postpartum periods to ensure social and physical supports are
provided for such women during such periods and for their
children;
(5) supporting women who have had a stillbirth;
(6) screening for maternal health, behavioral health, and
social needs during well-child and pediatric care visits; and
(7) streamlining and reducing duplication in care
coordination efforts across and among providers, plans, and
other entities for such women.
SEC. 7. NATIONAL RESKILLING OF THE MATERNITY CARE WORKFORCE.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317L-1 the following:
``SEC. 317L-2. NATIONAL RESKILLING OF THE MATERNITY CARE WORKFORCE.
``(a) Establishment of National Expert Group.--
``(1) In general.--The Secretary shall establish a national
expert group to evaluate national education on, and practice
of, best birthing practices.
``(2) Members.--
``(A) In general.--The group established under
paragraph (1) shall be composed of such members as the
Secretary appoints, including--
``(i) obstetricians and gynecologists,
family medicine physicians, midwifes, and
nursing leaders;
``(ii) hospital administrators;
``(iii) graduate medical education leaders;
``(iv) doula leaders;
``(v) individuals with experience in
community birth settings;
``(vi) patients;
``(vii) high-risk birth experts; and
``(viii) quality improvement leaders.
``(B) Geographic diversity.--In appointing members
under subparagraph (A), the Secretary shall ensure a
balance of members representing rural areas and members
representing urban areas.
``(b) Duties.--The group established under subsection (a) shall--
``(1) examine evidence, trends, and differential use or
access by income, geographic area, and race and ethnicity
associated with birthing practices that include--
``(A) cesarean sections, repeat cesarean, and
vaginal birth after cesarean;
``(B) electronic fetal monitoring and intermittent
auscultation;
``(C) birth positions, including upright
positioning and ambulation;
``(D) labor with doula support;
``(E) evaluating indications for cesarean delivery,
including cervical dilation and duration of pushing;
``(F) operative vaginal deliveries;
``(G) manual fetal rotation;
``(H) amnioinfusion and scalp stimulation; and
``(I) cervical ripening methods;
``(2) assess the role of the culture of care, maternity
care financing, and health education with respect to the trends
under paragraph (1); and
``(3) identify case studies of the provision of exemplary
birthing care.
``(c) Recommendations.--The group established under subsection (a)
shall, not later than 1 year after such establishment, issue--
``(1) best practices for--
``(A) evaluating birthing skills;
``(B) improving curricula for health professionals
engaged in birthing; and
``(C) the incorporation of midwives and doulas into
residency curricula for obstetricians; and
``(2) recommendations for policies and practices to improve
maternity care overall.''.
SEC. 8. MACPAC STUDY ON DOULAS AND COMMUNITY HEALTH WORKERS; GUIDANCE
ON INCREASING ACCESS TO DOULA SERVICES UNDER MEDICAID.
(a) MACPAC Study on Doulas and Community Health Workers.--
(1) In general.--As part of the first report required under
section 1900(b)(1) of the Social Security Act (42 U.S.C.
1396(b)(1)) after the date that is 1 year after the date of
enactment of this Act, the Medicaid and CHIP Payment and Access
Commission (referred to in this section as ``MACPAC'') shall
include with such report a report on the coverage of doula
services and the role of community health workers under State
Medicaid programs, which shall include the following:
(A) Information about coverage for doula services
and community health worker services under State
Medicaid programs that currently provide coverage for
such services, including the type of doula services
offered (such as prenatal, labor and delivery,
postpartum support, and traditional doula services) and
information on the prevalence of doulas that care for
individuals in their own communities.
(B) An analysis of strategies to facilitate the
appropriate use of doula services in order to provide
better care and achieve better maternal and infant
health outcomes, including strategies that States may
use to assist with services for which Federal financial
participation is eligible under a State Medicaid plan
or a waiver of such a plan by recruiting, training, and
certifying a diverse doula workforce, particularly from
underserved communities, communities of color, and
communities facing linguistic or cultural barriers.
(C) Provide examples of community health worker
access in State Medicaid programs and strategies
employed by States to encourage a broad care team to
manage Medicaid patients.
(D) An assessment of the impact of the involvement
of doulas and community health workers on maternal
health outcomes.
(E) Recommendations, as MACPAC deems appropriate,
for legislative and administrative actions to increase
access to services that improve maternal health.
(2) Stakeholder consultation.--In developing the report
required under paragraph (1), MACPAC shall consult with
relevant stakeholders.
(b) Guidance on Increasing Access to Doula Services Under
Medicaid.--
(1) In general.--Not later than 1 year after the date that
MACPAC publishes the report required under subsection (a), the
Secretary shall issue guidance to States on increasing access
to doula services under Medicaid. Such guidance shall at a
minimum include--
(A) options for States to provide medical
assistance for doula services under State Medicaid
programs;
(B) best practices for ensuring that doulas,
including community-based doulas, receive reimbursement
for doula services provided under a State Medicaid
program, at a level that allows doulas to earn a living
wage that accounts for their time and costs associated
with providing care and community-based doula program
administration; and
(C) best practices for increasing access to doula
services, including services provided by community-
based doulas, under State Medicaid programs.
(2) Stakeholder consultation.--In developing the report
required under paragraph (1), the Secretary shall consult with
relevant stakeholders.
(c) Relevant Stakeholders.--For purposes of subsections (a)(2) and
(b)(2), relevant stakeholders shall include--
(1) States;
(2) organizations representing consumers, including those
that are disproportionately impacted by poor maternal health
outcomes;
(3) organizations and individuals representing doula
services providers and community health workers, including
community-based doula programs and those who serve underserved
communities, communities of color and communities facing
linguistic or cultural barriers; and
(4) organizations representing health care providers.
SEC. 9. DEMONSTRATION PROJECTS TO IMPROVE THE DELIVERY OF MATERNAL
HEALTH CARE THROUGH TELEHEALTH.
(a) In General.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall award grants to States to
conduct demonstration projects under this section that are designed to
expand the use of telehealth in State Medicaid programs for the
delivery of health care to eligible pregnant or postpartum women.
(b) Eligible Pregnant or Postpartum Woman Defined.--
(1) In general.--In this section, the term ``eligible
pregnant or postpartum woman'' means a woman who is eligible
for and receiving medical assistance under a State Medicaid
plan (or waiver of such plan) and who is or becomes pregnant.
(2) Postpartum women.--Such term includes a woman described
in paragraph (1) through the end of the month in which the 365-
day period beginning on the last day of the woman's pregnancy
ends, without regard to any change in income of the family of
which she is a member.
(c) Application; Selection of States; Duration.--
(1) Application.--
(A) In general.--To conduct a demonstration project
under this section, a State shall submit an application
to the Secretary at such time and in such manner as the
Secretary shall require. Under the demonstration
project, a State may include multiple proposed uses of
grant funds, and propose to focus on multiple
populations, as otherwise allowable under this section,
within a single application.
(B) Required information.--A State application to
conduct a demonstration project under this section
shall include the following:
(i) The population (such as individuals
residing in rural or medically underserved
areas) that the demonstration project will
target.
(ii) A description of how the State
proposes to use funds awarded under this
section to conduct the demonstration project to
integrate or increase the integration of
telehealth into the State Medicaid program's
existing delivery system for furnishing medical
assistance to and improving the health care
outcomes of eligible pregnant or postpartum
women.
(iii) A description of how the State will
use funds to address racial or ethnic
disparities in access to maternal health
services or maternal health outcomes, barriers
to care, including in rural or medically
underserved communities, other barriers to
using telehealth, such as those experienced by
individuals with disabilities and individuals
with limited English proficiency, and as
applicable, barriers to the use of telehealth
in tribal communities.
(iv) A certification that the application
meets the requirements of subparagraph (C).
(v) Such other information as the Secretary
shall require.
(C) Consultation with health care stakeholders.--
Prior to the submission of an application to conduct a
demonstration project under this section, a State shall
consult with health care systems and providers, health
plans (if relevant), consumer organizations and
beneficiary advocates, and community-based
organizations or other stakeholders in the area that
the demonstration project will target to ensure that
the proposed project addresses the health care needs of
eligible pregnant or postpartum women in such area.
(2) Selection of states and duration of projects.--
(A) In general.--The Secretary shall award grants
to States that apply and meet the application
requirements to conduct 4-year demonstration projects
under this section. A State may request, and the
Secretary shall determine the appropriateness of, an
application of up to $10,000,000.
(B) Selection of projects.--In selecting a State to
conduct a demonstration project under this section, the
Secretary shall ensure that the State is aware of the
4-year duration of the project and shall determine the
State has satisfied the application requirements.
(3) Waiver of statewideness and comparability
requirement.--The Secretary shall waive compliance with section
1902(a)(1) of the Social Security Act (42 U.S.C. 1396a(a)(1))
(relating to statewideness) and section 1902(a)(10)(B) of such
Act (42 U.S.C. 1396a(a)(10)(B)) (relating to comparability) to
the extent necessary to allow selected States to conduct
demonstration projects under this section.
(d) Use of Grant Funds.--A State may use funds from a grant awarded
under this section to connect eligible pregnant or postpartum women to
telehealth services delivered via telehealth that are furnished by--
(1) primary and maternity care providers;
(2) health care specialists;
(3) behavioral health providers; and
(4) other categories of health care providers identified by
the Secretary.
(e) Reports.--
(1) State reports.--Each State that is awarded a grant to
conduct a demonstration project under this section shall submit
the following reports to the Secretary:
(A) Initial report.--An initial report on the first
18 months during which the demonstration project is
conducted, not later than the last day of the 19th
month of the demonstration project, as described in
subparagraph (B).
(B) Final report.--Not later than 6 months after
the date on which the State's demonstration project
ends, a final report that includes the following:
(i) The number of eligible pregnant or
postpartum women served under the demonstration
project.
(ii) The activities and services funded
under the demonstration project, including the
providers that received funds under the
demonstration project.
(iii) Demographic information about the
eligible pregnant or postpartum women served
under the demonstration project, if available.
(iv) A description of the types of models
or programs developed under the demonstration
project.
(v) How such models or programs impacted
access to, and utilization of, telehealth
services by eligible pregnant or postpartum
women, including a description of how such
models or programs addressed racial or ethnic
disparities in access or utilization.
(vi) Qualitative information on beneficiary
experience.
(vii) Challenges faced and lessons learned
by the State in integrating (or increasing the
integration of) telehealth into the delivery
system for furnishing medical assistance to
eligible pregnant or postpartum women in the
areas targeted under the demonstration project.
(2) Reports to congress.--
(A) Initial report.--Not later than 2 years after
the date of enactment of this Act, the Secretary shall
submit a report to Congress summarizing the information
reported by States under paragraph (1)(A).
(B) Final report.--Not later than 5 years after the
date of enactment of this Act, the Secretary shall
submit a report to Congress summarizing the information
reported by States under paragraph (1)(B).
SEC. 10. CMS REPORT ON COVERAGE OF REMOTE PHYSIOLOGIC MONITORING
DEVICES AND IMPACT ON MATERNAL AND CHILD HEALTH OUTCOMES
UNDER MEDICAID.
(a) In General.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall submit to Congress a report
containing information on authorities and State practices for covering
remote physiological monitoring devices, including limitations and
barriers to such coverage and the impact on maternal health outcomes,
and to the extent appropriate, recommendations on how to address such
limitations or barriers related to coverage of remote physiologic
devices under State Medicaid programs, including, but not limited to,
pulse oximeters, blood pressure cuffs, scales, and blood glucose
monitors, with the goal of improving maternal and child health outcomes
for pregnant and postpartum women enrolled in State Medicaid programs.
(b) State Resources.--Not later than 6 months after the submission
of the report required by subsection (a), the Secretary shall update
resources for State Medicaid programs, such as State Medicaid
telehealth toolkits, to be consistent with the recommendations provided
in such report.
SEC. 11. GUIDANCE ON COMMUNITY-BASED MATERNAL HEALTH PROGRAMS.
Not later than 3 years after the date of enactment of this Act, the
Secretary shall issue guidance to State Medicaid programs to support
the use of evidence-based community-based maternal health programs,
including programs that offer group prenatal care, home visiting
services, childbirth and parenting education, peer supports, stillbirth
prevention activities, and substance use disorder and recovery
supports, under such programs, and any other programs as determined by
the Secretary.
SEC. 12. DEVELOPING GUIDANCE ON MATERNAL MORTALITY AND SEVERE MORBIDITY
REDUCTION FOR MATERNAL CARE PROVIDERS RECEIVING PAYMENT
UNDER THE MEDICAID PROGRAM.
(a) In General.--Subject to the availability of appropriations, not
later than 36 months after the date of enactment of this Act, the
Secretary shall, in consultation with the Advisory Committee on
Reducing Maternal Deaths established under subsection (c) and the Task
Force on Maternal Mental Health established under section 1113 of
division FF of the Consolidated Appropriations Act, 2023 (Public Law
117-328), publish on a public website of the Centers for Medicare &
Medicaid Services guidance for States on resources and strategies for
hospitals, freestanding birth centers (as defined in section
1905(l)(3)(B) of the Social Security Act (42 U.S.C. 1396d(l)(3)(B))),
and other maternal care providers as determined by the Secretary for
reducing maternal mortality and severe morbidity in individuals who are
eligible for and receiving medical assistance under Medicaid or CHIP.
(b) Updates.--The Secretary shall, in consultation with the
Advisory Committee on Reducing Maternal Deaths established under
subsection (c) and the Task Force on Maternal Mental Health established
under section 1113 of division FF of the Consolidated Appropriations
Act, 2023 (Public Law 117-328), update the guidance and resources
described in subsection (a) at least once every 3 years.
(c) Consultation With Advisory Committee.--
(1) Establishment.--Subject to the availability of
appropriations, not later than 18 months after the date of
enactment of this Act, the Secretary shall establish an
advisory committee to be known as the ``National Advisory
Committee on Reducing Maternal Deaths'' (referred to in this
section as the ``Advisory Committee'').
(2) Duties.--The Advisory Committee shall provide consensus
advice and guidance to the Secretary on the development and
compilation of the guidance described in subsection (a) (and
any updates to such guidance).
(3) Membership.--
(A) In general.--The Secretary, in consultation
with such other heads of agencies, as the Secretary
deems appropriate and in accordance with this
paragraph, shall appoint not more than 41 members to
the Advisory Committee. In appointing such members, the
Secretary shall ensure that--
(i) the total number of members of the
Advisory Committee is an odd number; and
(ii) the total number of voting members who
are not Federal officials does not exceed the
total number of voting Federal members who are
Federal officials.
(B) Required members.--
(i) Federal officials.--The Advisory
Committee shall include as voting members the
following Federal officials, or their
designees:
(I) The Secretary.
(II) The Administrator of the
Centers for Medicare & Medicaid
Services.
(III) The Director of the Centers
for Disease Control and Prevention.
(IV) The Associate Administrator of
the Maternal and Child Health Bureau of
the Health Resources and Services
Administration.
(V) The Director of the Agency for
Healthcare Research and Quality.
(VI) The National Coordinator for
Health Information Technology.
(VII) The Director of the National
Institutes of Health.
(VIII) The Secretary of Veterans
Affairs.
(IX) The Director of the Indian
Health Service.
(X) The Deputy Assistant Secretary
for Minority Health.
(XI) The Administrator of the
Substance Abuse and Mental Health
Services Administration.
(XII) The Deputy Assistant
Secretary for Women's Health.
(XIII) Such other Federal officials
or their designees as the Secretary
determines appropriate.
(ii) Non-federal officials.--
(I) In general.--The Advisory
Committee shall include the following
as voting members:
(aa) At least 1
representative from a
professional organization
representing hospitals and
health systems.
(bb) At least 1
representative from a medical
professional organization
representing primary care
providers.
(cc) At least 1
representative from a medical
professional organization
representing general
obstetrician-gynecologists.
(dd) At least 1
representative from a medical
professional organization
representing certified nurse-
midwives.
(ee) At least 1
representative from a medical
professional organization
representing other maternal
fetal medicine providers.
(ff) At least 1
representative from a medical
professional organization
representing anesthesiologists.
(gg) At least 1
representative from a medical
professional organization
representing emergency medicine
physicians and urgent care
providers.
(hh) At least 1
representative from a medical
professional organization
representing nurses.
(ii) At least 1
representative from a
professional organization
representing community health
workers.
(jj) At least 1
representative from a
professional organization
representing doulas.
(kk) At least 1
representative from a
professional organization
representing perinatal
psychiatrists.
(ll) At least 1
representative from State-
affiliated programs or existing
collaboratives with
demonstrated expertise or
success in improving maternal
health.
(mm) At least 1 director of
a State Medicaid agency that
has had demonstrated success in
improving maternal health.
(nn) At least 1
representative from an
accrediting organization for
maternal health quality and
safety standards.
(oo) At least 1
representative from a maternal
patient advocacy organization
with lived experience of severe
maternal morbidity.
(pp) At least 1 medical
professional who is an expert
in the treatment of pregnant
women with substance use
disorder.
(II) Requirements.--Each individual
selected to be a member under this
clause shall--
(aa) have expertise in
maternal health;
(bb) not be a Federal
official; and
(cc) have experience
working with populations that
are at higher risk for maternal
mortality or severe morbidity,
such as populations that
experience racial, ethnic, and
geographic health disparities,
pregnant and postpartum women
experiencing a mental health
disorder, or pregnant or
postpartum women with other
comorbidities such as substance
use disorders, hypertension,
thyroid disorders, and sickle
cell disease.
(C) Additional members.--
(i) In general.--In addition to the members
required to be appointed under subparagraph
(B), the Secretary may appoint as non-voting
members to the Advisory Committee such other
individuals with relevant expertise or
experience as the Secretary shall determine
appropriate, which may include, but is not
limited to, individuals described in clause
(ii).
(ii) Suggested additional members.--The
individuals described in this clause are the
following:
(I) Representatives from State
maternal mortality review committees
and perinatal quality collaboratives.
(II) Medical providers who care for
women and infants during pregnancy and
the postpartum period, such as family
practice physicians, cardiologists,
pulmonology critical care specialists,
endocrinologists, pediatricians, and
neonatologists.
(III) Representatives from State
and local public health departments,
including State Medicaid Agencies.
(IV) Subject matter experts in
conducting outreach to women who are
African-American or belong to another
minority group.
(V) Directors of State agencies
responsible for administering a State's
maternal and child health services
program under title V of the Social
Security Act (42 U.S.C. 701 et seq.).
(VI) Experts in medical education
or physician training.
(VII) Representatives from Medicaid
managed care organizations.
(4) Applicability of faca.--Chapter 10 of title 5, United
States Code, shall apply to the committee established under
this subsection.
(d) Contents.--The guidance described in subsection (a) shall
include, with respect to hospitals, freestanding birth centers, and
other maternal care providers, the following:
(1) Best practices regarding evidence-based screening and
clinician education initiatives relating to screening and
treatment protocols for individuals who are at risk of
experiencing complications related to pregnancy, with an
emphasis on individuals with preconditions directly linked to
pregnancy complications and maternal mortality and severe
morbidity, including--
(A) methods to identify individuals who are at risk
of maternal mortality or severe morbidity, including
risk stratification;
(B) evidence-based risk factors associated with
maternal mortality or severe morbidity and racial,
ethnic, and geographic health disparities;
(C) evidence-based strategies to reduce risk
factors associated with maternal mortality or severe
morbidity through services which may be covered under
Medicaid or CHIP, including, but not limited to,
activities by community health workers (as such term is
defined in section 2113 of the Social Security Act (42
U.S.C. 1397mm)) that are funded by a grant awarded
under such section;
(D) resources available to such individuals, such
as nutrition assistance and education, home visitation,
mental health and substance use disorder services,
smoking cessation programs, prenatal care, and other
evidence-based maternal mortality or severe morbidity
reduction programs;
(E) examples of educational materials used by
providers of obstetrics services;
(F) methods for improving community centralized
care, including providing telehealth services or home
visits to increase and facilitate access to and
engagement in prenatal and postpartum care and
collaboration with home health agencies, community
health centers, local public health departments, or
clinics;
(G) guidance on medical record diagnosis codes
linked to maternal mortality and severe morbidity,
including, if applicable, codes related to social risk
factors, and methods for educating clinicians on the
proper use of such codes;
(H) risk appropriate transfer protocols during
pregnancy, childbirth, and the postpartum period; and
(I) any other information related to prevention and
treatment of at-risk individuals determined appropriate
by the Secretary.
(2) Guidance on monitoring programs for individuals who
have been identified as at risk of complications related to
pregnancy.
(3) Best practices for such hospitals, freestanding birth
centers, and providers to make pregnant women aware of the
complications related to pregnancy.
(4) A fact sheet for providing pregnant women who are
receiving care on an outpatient basis with a notice during the
prenatal stage of pregnancy that--
(A) explains the risks associated with pregnancy,
birth, and the postpartum period (including the risks
of hemorrhage, preterm birth, sepsis, eclampsia,
obstructed labor), chronic conditions (including high
blood pressure, diabetes, heart disease, depression,
and obesity) correlated with adverse pregnancy
outcomes, risks associated with advanced maternal age,
and the importance of adhering to a personalized plan
of care;
(B) highlights multimodal and evidence-based
prevention and treatment techniques;
(C) highlights evidence-based programs and
activities to reduce the incidence of stillbirth
(including tracking and awareness of fetal movements,
improvement of birth timing for pregnancies with risk
factors, initiatives that encourage safe sleeping
positions during pregnancy, screening and surveillance
for fetal growth restriction, efforts to achieve
smoking cessation during pregnancy, community-based
programs that provide home visits or other types of
support, and any other research or evidence-based
programming to prevent stillbirths);
(D) provides for a method (through signature or
otherwise) for such an individual, or a person acting
on such individual's behalf, to acknowledge receipt of
such fact sheet;
(E) is worded in an easily understandable manner
and made available in multiple languages and accessible
formats determined appropriate by the Secretary; and
(F) includes any other information determined
appropriate by the Secretary.
(5) A template for a voluntary clinician checklist that
outlines the minimum responsibilities that clinicians, such as
physicians, certified nurse-midwives, emergency room and urgent
care providers, nurses and others, are expected to meet in
order to promote quality and safety in the provision of
obstetric services.
(6) A template for a voluntary checklist that outlines the
minimum responsibilities that hospital leadership responsible
for direct patient care, such as the institution's president,
chief medical officer, chief nursing officer, or other hospital
leadership that directly report to the president or chief
executive officer of the institution, should meet to promote
hospital-wide initiatives that improve quality and safety in
the provision of obstetric services.
(7) Information on multi-stakeholder quality improvement
initiatives, such as the Alliance for Innovation on Maternal
Health, State perinatal quality improvement initiatives, and
other similar initiatives determined appropriate by the
Secretary, including--
(A) information about such improvement initiatives
and how to join;
(B) information about public maternal data
collection centers;
(C) information about quality metrics used and
outcomes achieved by such improvement initiatives;
(D) information about data sharing techniques used
by such improvement initiatives;
(E) information about data sources used by such
improvement initiatives to identify maternal mortality
and severe morbidity risks;
(F) information about interventions used by such
improvement initiatives to mitigate risks of maternal
mortality and severe morbidity;
(G) information about data collection techniques on
race, ethnicity, geography, age, income, and other
demographic information used by such improvement
initiatives; and
(H) any other information determined appropriate by
the Secretary.
(e) Inclusion of Best Practices.--Not later than 18 months after
the date of the publication of the guidance required under subsection
(a), the Secretary shall update such guidance to include best practices
identified by the Secretary for such hospitals, freestanding birth
centers, and providers to track maternal mortality and severe morbidity
trends by clinicians at such hospitals, freestanding birth centers, and
providers including--
(1) ways to establish scoring systems, which may include
quality triggers and safety and quality metrics to score case
and patient outcome metrics, for such clinicians;
(2) methods to identify, educate, and improve such
clinicians who may have higher rates of maternal mortality or
severe morbidity compared to their regional or State peers
(taking into account differences in patient risk for adverse
outcomes, which may include social risk factors);
(3) methods for using such data and tracking to enhance
research efforts focused on maternal health, while also
improving patient outcomes, clinician education and training,
and coordination of care; and
(4) any other information determined appropriate by the
Secretary.
(f) Cultural and Linguistic Appropriateness.--To the extent
practicable, the Secretary should develop the guidance, best practices,
fact sheets, templates, and other materials that are required under
this section in a trauma-informed, culturally and linguistically
appropriate manner.
SEC. 13. PROGRAM RELATED TO REDUCING CESAREAN BIRTHS AND INCREASING
RATES OF VAGINAL BIRTH AFTER CESAREAN.
Section 317K(a) of the Public Health Service Act (42 U.S.C. 247b-
12(a)) is amended--
(1) in paragraph (1)--
(A) by striking ``and to develop or support'' and
inserting ``to develop or support''; and
(B) by inserting ``, and to establish a grant
program, or extend the Alliance for Innovation on
Maternal Health, for the establishment of perinatal
quality collaboratives to reduce cesarean section rates
and increase vaginal birth after cesarean rates''
before the period at the end; and
(2) in paragraph (2), by adding at the end the following:
``(E) The Secretary may establish a competitive
grant program, or extend existing programs, including
the Alliance for Innovation on Maternal Health, for the
establishment or support of perinatal quality
collaboratives, with a focus on maternity care health
professional target areas and other areas with limited
birthing resources, to reduce cesarean birth rates and
increase vaginal birth after cesarean rates, including
through--
``(i) coordination with hospitals, clinical
teams, obstetricians and gynecologists,
birthing centers and community-based maternal
health organizations, public health agencies,
midwives, doulas, patients and families, and
other relevant entities;
``(ii) providing support and training to
hospital and clinical teams for quality
improvement, as appropriate;
``(iii) employing strategies that provide
opportunities for health care professionals and
clinical teams to collaborate across health
care settings and disciplines, including
midwifery care, doula support, the integration
of primary care and mental health, and blended
case payment rates;
``(iv) using data, disaggregated by race
and ethnicity, to provide timely feedback
across hospital and clinical teams, document
baseline cesarean and vaginal birth rates, and
measure progress; and
``(v) promotion of existing evidence on the
best practices for the safe reduction of
primary cesarean births.''.
SEC. 14. COLLECTION OF INFORMATION RELATED TO SOCIAL DETERMINANTS OF
THE HEALTH OF MEDICAID AND CHIP BENEFICIARIES.
(a) Implementation Assessment Report to Congress.--
(1) In general.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall submit a report to
Congress that includes a description of whether and how
information related to the social determinants of health for
individuals eligible for medical assistance under Medicaid or
child health assistance or pregnancy-related assistance under
CHIP may be captured under the data systems for such programs
as in effect on the date such report is submitted, including--
(A) a description of whether and how ICD-10 codes
(or successor codes) may be used to identify social
determinants of health in programs such as Medicaid and
CHIP, and whether other claims file or demographic
information may be employed; and
(B) a description of whether existing data systems
under Medicaid and CHIP could be employed to capture
such information, whether program or system changes
would be required, how privacy and confidentiality as
required under applicable law and regulations would be
maintained, and the resources and timeframes at the
Federal and State levels that would be needed to make
such changes.
(2) Guidance for states.--The Secretary shall issue
detailed guidance for States concurrent with the submission of
the report to Congress under paragraph (1). Such guidance shall
address--
(A) whether and how information related to the
social determinants of health for individuals eligible
for medical assistance under Medicaid or child health
assistance or pregnancy-related assistance under CHIP
could be captured employing existing systems under such
programs; and
(B) implementation considerations for capturing
such information, including whether program or system
changes would be required, whether additional steps
would be needed to maintain privacy and confidentiality
as required under relevant laws and regulations, and
the resources and timeframes at that would be needed to
make such changes.
(3) Stakeholder input.--The Secretary shall develop the
report required under paragraph (1) and the guidance required
under paragraph (2) with the input of relevant stakeholders,
such as State Medicaid directors, Medicaid managed care
organizations, and other relevant Federal agencies such as the
Centers for Disease Control and Prevention, the Health
Resources Services Administration, and the Agency for
Healthcare Research and Quality.
(4) Action plan report.--
(A) In general.--If the Secretary determines in the
report required under paragraph (1) that information
related to the social determinants of health for
individuals eligible for medical assistance under
Medicaid or child health assistance or pregnancy-
related assistance under CHIP cannot be captured under
the data systems for such programs as in effect on the
date such report is submitted, then, not later than 6
months after such date, the Secretary shall submit a
second report to Congress that contains an action plan
for implementing the program or data systems changes
needed in order for such information to be collected
while maintaining privacy and confidentiality as
required under relevant laws and regulations. The
action plan should be prepared so as to be implemented
by the Federal Government and States not later than 2
years after the date on which the report required under
this paragraph is submitted to Congress.
(B) Revised guidance for states.--The Secretary
shall revise and reissue the guidance for States
required under paragraph (2) to take into account the
action plan included in the report submitted to
Congress under subparagraph (A).
(5) Authorization of appropriations.--
(A) Federal costs.--There are authorized to be
appropriated to the Secretary, $40,000,000 for purposes
of preparing the reports required under this subsection
and implementing the collection of information related
to the social determinants of health for individuals
eligible for medical assistance under Medicaid or child
health assistance or pregnancy-related assistance under
CHIP.
(B) State costs.--There are authorized to be
appropriated to the Secretary, $50,000,000 for purposes
of making payments to States in accordance with a
methodology established by the Secretary for State
expenditures attributable to planning for and
implementing the collection of such information in
accordance with subsection (d) of section 1946 of the
Social Security Act (42 U.S.C. 1396w-5) (as added by
subsection (b)).
(b) Application to States.--Section 1946 of the Social Security Act
(42 U.S.C. 1396w-5) is amended by adding at the end the following:
``(d) Collection of Information Related to Social Determinants of
Health.--
``(1) Development of collection methods.--
``(A) In general.--Subject to paragraph (5), the
Secretary, in consultation with the States, shall
develop a method for collecting standardized and
aggregated State-level information related to social
determinants that may factor into the health of
beneficiaries under this title and beneficiaries under
title XXI which the States, notwithstanding section
1902(a)(7) and as a condition for meeting the
requirements of section 1902(a)(6) and section
2107(b)(1), shall use to annually report such
information:
``(i) A model uniform reporting field
through the transformed Medicaid Statistical
Information System (T-MSIS) (or a successor
system) or another appropriate reporting
platform, as approved by the Secretary.
``(ii) A model uniform questionnaire or
survey (which may be included as part of an
existing survey, questionnaire, or form
administered by the Secretary), for purposes of
the State or the Secretary collecting such
information by administering regularly but not
less than annually a questionnaire or survey of
beneficiaries under this title and
beneficiaries under title XXI.
``(iii) A model uniform form to be adapted
for inclusion in the Medicaid and CHIP
Scorecard developed by the Centers for Medicare
& Medicaid Services, for purposes of the
Secretary collecting such information.
``(iv) An alternative method identified by
the Secretary for collecting such information.
``(B) Implementation.--In carrying out the
requirements of subparagraph (A), the Secretary shall--
``(i) for purposes of the method described
in clause (i) of such subparagraph, determine
the appropriate providers and frequency with
which such providers shall complete the
reporting field identified and report the
information to the State;
``(ii) for purposes of the method described
in clause (ii) of such subparagraph, identify
the means and frequency (which shall be no less
frequent than once per year) with which a
questionnaire or survey of beneficiaries is to
be conducted;
``(iii) with respect to any method
described in such subparagraph, issue guidance
for ensuring compliance with applicable laws
regarding beneficiary informed consent,
privacy, and anonymity with respect to the
information collected under such method;
``(iv) with respect to the collection of
information relating to beneficiaries who are
children, issue guidance on the collection of
such information from a parent, legal guardian,
or any other person who is legally authorized
to share such information on behalf of the
child when the direct collection of such
information from children may not otherwise be
feasible or appropriate; and
``(v) regularly evaluate the method under
such subparagraph and the information reported
using such method, and, as needed, make updates
to the method and the information reported.
``(2) Social determinants of health.--The information
collected in accordance with the method made available under
paragraph (1) shall, to the extent practicable, include
standardized definitions for identifying social determinants of
health needs identified in the ICD-10 diagnostic codes Z55
through Z65 (or any such successor diagnostic codes), as
defined by the Healthy People 2020 and related initiatives of
the Office of Disease Prevention and Health Promotion of the
Department of Health and Human Services, or any other
standardized set of definitions for social determinants of
health identified by the Secretary. Such definitions shall
incorporate measures for quantifying the relative severity of
any such social determinant of health need identified in an
individual.
``(3) Federal privacy requirements.--Nothing in this
subsection shall be construed to supersede any Federal privacy
or confidentiality requirement, including the regulations
promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 and section 543 of
the Public Health Service Act and any regulations promulgated
thereunder.
``(4) Application to territories.--
``(A) In general.--To the extent that the Secretary
determines that it is not practicable for a State
specified in subparagraph (B) to report information in
accordance with the method made available under
paragraph (1), this subsection shall not apply with
respect to such State.
``(B) Territories specified.--The States specified
in this subparagraph are Puerto Rico, the Virgin
Islands, Guam, American Samoa, and the Northern Mariana
Islands.
``(5) Application.--
``(A) In general.--Subject to subparagraph (B), the
requirement for a State to collect information in
accordance with the method made available under
paragraph (1) shall not apply to the State before the
date that is 4 years after the date of enactment of
this subsection.
``(B) Alternative date.--If an action plan is
submitted to Congress under section 14(a)(4) of the
Healthy Moms and Babies Act, in lieu of the date
described in subparagraph (A), the requirement for a
State to collect information in accordance with the
method made available under paragraph (1) shall not
apply to the State before the date specified in such
action plan.
``(6) Appropriation.--There is appropriated to the
Secretary for fiscal year 2026 and each fiscal year thereafter
$1,000,000 to carry out the provisions of this section and
subsection (b)(2)(B).''.
(c) Report on Data Analyses.--Section 1946(b)(2) of such Act (42
U.S.C. 1396w-5(b)(2)) is amended--
(1) by striking ``Not later than'' and inserting the
following:
``(A) Initial reports.--Not later than''; and
(2) by adding at the end the following:
``(B) Reports on collection of information related
to social determinants of health.--
``(i) In general.--Not later than 5 years
after the date on which the requirement to
collect information under subsection (d) is
first applicable to States, the Secretary shall
submit to Congress a report that includes
aggregate findings and trends across respective
beneficiary populations for improving the
identification of social determinants of health
for beneficiaries under this title and
beneficiaries under title XXI based on analyses
of the data collected under subsection (d).
``(ii) Interim report.--Not later than 3
years after the date of enactment of this
subparagraph, the Secretary shall submit to
Congress an interim report on progress in
developing, implementing, and utilizing the
method selected by the Secretary under
subsection (d)(1) along with any available,
preliminary information that has been collected
using such method.''.
(d) Conforming Amendment.--Section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end
the following:
``(V) Section 1946 (relating to addressing health
care disparities).''.
SEC. 15. REPORT ON PAYMENT METHODOLOGIES FOR TRANSFERRING PREGNANT
WOMEN BETWEEN FACILITIES BEFORE, DURING, AND AFTER
CHILDBIRTH.
(a) In General.--Subject to the availability of appropriations, not
later than 36 months after the date of enactment of this Act, the
Secretary shall submit to Congress a report on the payment
methodologies under Medicaid for the antepartum, intrapartum, and
postpartum transfer of pregnant women from one health care facility to
another, including any potential disincentives or regulatory barriers
to such transfers.
(b) Consultation.--In developing the report required under
subsection (a), the Secretary shall consult with the advisory committee
established under section 12(c).
SEC. 16. MEDICAID GUIDANCE ON STATE OPTIONS TO ADDRESS SOCIAL
DETERMINANTS OF HEALTH FOR PREGNANT AND POSTPARTUM WOMEN.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, the Secretary shall issue guidance to States and conduct
one or more learning collaboratives to promote cross-state learning
regarding options States may employ to address social determinants of
health, as defined by the Healthy People 2030 and related initiatives
of the Office of Disease Prevention and Health Promotion of the
Department of Health and Human Services, including for pregnant and
postpartum women.
(b) Guidance Requirements.--The guidance required under subsection
(a) shall, at a minimum, describe the authorities that States may
leverage to support addressing the social determinants of health for
pregnant and postpartum women and outline best practices for such
efforts.
(c) Learning Collaborative Requirements.--The learning
collaboratives required under subsection (a) shall, at a minimum,
include opportunities for States and other stakeholders to share
innovative practices and approaches as they are being considered and
developed, share solutions related to challenges that multiple urban
and rural States face, and promote the uptake of approved, effective
interventions addressing social needs and determinants covered by the
Medicaid program.
SEC. 17. PAYMENT ERROR RATE MEASUREMENT (PERM) AUDIT AND IMPROVEMENT
REQUIREMENTS.
(a) Biennial PERM Audit Requirement.--Beginning with fiscal year
2027, the Administrator shall conduct payment error rate measurement
(``PERM'') audits of each State Medicaid program on a biennial basis.
(b) PERM Error Rate Reduction Plan Requirement.--Beginning with
fiscal year 2027, any State with an overall PERM error rate exceeding
15 percent in a PERM audit conducted with respect to the State in the
previous fiscal year shall publish a plan, in coordination with, and
subject to the approval of, the Administrator, for how the State will
reduce its PERM error rate below 15 percent in the current fiscal year.
(c) Notification; Identification of Sources of Improper Payments.--
(1) Notification.--Not later than 6 months after the date
of enactment of this Act, the Administrator shall notify the
contractor conducting PERM audits of the Administrator's intent
to modify contracts to require PERM audits not less than once
every other year in each State.
(2) Identification of sources of improper payments.--The
Administrator shall direct the contractor conducting PERM
audits of State Medicaid programs to identify areas known to be
sources of improper payments under such programs to identify
program areas or components known to be sources of high risk
for improper payments under such programs.
(d) State Medicaid Director Letter.--Not later than 12 months after
the date of enactment of this Act, the Administrator shall issue a
State Medicaid Director letter regarding State requirements under
Federal law and regulations regarding avoiding and responding to
improper payments under State Medicaid programs.
(e) State Improper Payment Mitigation Plans.--
(1) In general.--Not later than January 1, 2026, each State
Medicaid program shall submit to the Administrator a plan,
which shall include specific actions and timeframes for taking
such actions and achieving specified results, for mitigating
improper payments under such program.
(2) Publication of state plans.--The Administrator shall
make State plans submitted under paragraph (1) available to the
public.
(f) Definitions.--In this section:
(1) Administrator.--The term ``Administrator'' means the
Administrator of the Centers for Medicare & Medicaid Services.
(2) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(3) State medicaid program.--The term ``State Medicaid
program'' means a State plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.), and includes any waiver
of such a plan.
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