II 

117TH CONGRESS 

2D SESSION S. 5015 

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 

SEPTEMBER 29, 2022 

Mr. GRASSLEY 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Healthy Moms and Babies Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 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. 


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Sec. 4. Medicaid quality improvement initiatives to reduce rates of caesarean 

sections. 

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. MACPAC study on doulas and community health workers. 

Sec. 8. Demonstration projects to improve the delivery of maternal health care 

through telehealth. 

Sec. 9. CMS report on coverage of remote physiologic monitoring devices and 

impact on maternal and child health outcomes under Medicaid. 

Sec. 10. Guidance on community-based maternal health programs. 

Sec. 11. Developing guidance on maternal mortality and severe morbidity reduction for maternal care providers receiving payment under 

the Medicaid program. 

Sec. 12. Collection of information related to social determinants of the health 

of Medicaid and CHIP beneficiaries. 

Sec. 13. Report on payment methodologies for transferring pregnant women between facilities before, during, and after childbirth. 

Sec. 14. Medicaid guidance on State options to address social determinants of 

health for pregnant and postpartum women. 

Sec. 15. Payment error rate measurement (PERM) audit and improvement requirements. 

1 SEC. 2. DEFINITIONS. 

2 In this Act: 

3 (1) CHIP.—The term ‘‘CHIP’’ means the Chil4 dren’s Health Insurance Program established under 

5 title XXI of the Social Security Act (42 U.S.C. 

6 1397aa et seq.). 

7 (2) COMPTROLLER GENERAL.—The term 

8 ‘‘Comptroller General’’ means the Comptroller Gen9 eral of the United States. 

10 (3) GROUP HEALTH PLAN; HEALTH INSURANCE

11 ISSUER, ETC.—The terms ‘‘group health plan’’, 

12 ‘‘health insurance coverage’’, ‘‘health insurance 

13 issuer’’, ‘‘group health insurance coverage’’, and ‘‘in14 dividual health insurance coverage’’ have the meanVerDate Sep 11 2014 02:11 Oct 15, 2022 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S5015.IS S5015

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1 ings given such terms in section 2791 of the Public 

2 Health Service Act (42 U.S.C. 300gg–91). 

3 (4) MEDICAID.—The term ‘‘Medicaid’’ means 

4 the Medicaid program established under title XIX of 

5 the Social Security Act (42 U.S.C. 1396 et seq.). 

6 (5) MEDICAID MANAGED CARE ORGANIZA7 TION.—The term ‘‘medicaid managed care organiza8 tion’’ has the meaning given that term in section 

9 1903(m)(1)(A) of the Social Security Act (42 U.S.C. 

10 1396b(m)(1)(A)). 

11 (6) SECRETARY.—The term ‘‘Secretary’’ means 

12 the Secretary of Health and Human Services. 

13 (7) STATE.—The term ‘‘State’’ has the mean14 ing given that term for purposes of titles V, XIX, 

15 and XXI of the Social Security Act (42 U.S.C. 701 

16 et seq. 1396 et seq., 1397aa et seq.). 

17 SEC. 3. MANDATORY REPORTING BY STATE MEDICAID PRO18 GRAMS ON ADULT HEALTH CARE QUALITY 

19 MEASURES OF MATERNAL AND PERINATAL 

20 HEALTH. 

21 Section 1139B of the Social Security Act (42 U.S.C. 

22 1320b–9b) is amended— 

23 (1) in subsection (b)— 

24 (A) in paragraph (3)(B)— 


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1 (i) in the subparagraph heading, by 

2 inserting ‘‘AND MATERNAL AND

3 PERINATAL HEALTH’’ after ‘‘BEHAVIORAL

4 HEALTH’’; 

5 (ii) by striking ‘‘all behavioral health’’ 

6 and inserting ‘‘all behavioral health and 

7 maternal and perinatal health’’; and 

8 (iii) by inserting ‘‘and of maternal 

9 and perinatal health care for Medicaid eli10 gible adults’’ after ‘‘Medicaid eligible 

11 adults’’; and 

12 (B) in paragraph (5)(C)— 

13 (i) in the subparagraph heading, by 

14 inserting ‘‘AND MATERNAL AND

15 PERINATAL HEALTH’’ after ‘‘BEHAVIORAL

16 HEALTH’’; and 

17 (ii) by inserting ‘‘and, with respect to 

18 Medicaid eligible adults, maternal and 

19 perinatal health measures’’ after ‘‘behav20 ioral health measures’’; and 

21 (2) in subsection (d)(1)(A), by inserting ‘‘and 

22 maternal and perinatal health’’ after ‘‘behavioral 

23 health’’. 


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1 SEC. 4. MEDICAID QUALITY IMPROVEMENT INITIATIVES TO 

2 REDUCE RATES OF CAESAREAN SECTIONS. 

3 (a) MEDICAID STATE PLAN AMENDMENT.—Section 

4 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) 

5 is amended— 

6 (1) in paragraph (86), by striking ‘‘and’’ after 

7 the semicolon; 

8 (2) in paragraph (87), by striking the period at 

9 the end and inserting ‘‘; and’’; and 

10 (3) by inserting after paragraph (87) the fol11 lowing: 

12 ‘‘(88) provide that, not later than January 1, 

13 2024, and annually thereafter through January 1, 

14 2034, the State shall submit a report to the Sec15 retary, that shall be made publicly available, which 

16 contains with respect to the preceding calendar 

17 year— 

18 ‘‘(A) the rate of low-risk cesarean delivery, 

19 as defined by the Secretary in consultation with 

20 relevant stakeholders, for pregnant women eligi21 ble for medical assistance under the State plan 

22 or a waiver of such plan in the State, as com23 pared to the overall rate of cesarean delivery in 

24 the State; 

25 ‘‘(B) a description of the State’s quality 

26 improvement activities to safely reduce the rate 


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1 of low-risk cesarean delivery (as so defined) for 

2 pregnant women eligible for medical assistance 

3 under the State plan or a waiver of such plan 

4 in the State reported under subparagraph (A), 

5 including initiatives aimed at reducing racial 

6 and ethnic health disparities, hospital-level 

7 quality improvement initiatives, taking into ac8 count hospital type and the patient population 

9 served, and, if applicable, partnerships with 

10 State or regional perinatal quality 

11 collaboratives; 

12 ‘‘(C) for each report submitted after Janu13 ary 1, 2024, the percentage change (if any) in 

14 the rate of low-risk cesarean delivery (as so de15 fined) for pregnant women eligible for medical 

16 assistance under the State plan or a waiver of 

17 such plan in the State reported under subpara18 graph (A) from the rate reported for the most 

19 recent previous report; and 

20 ‘‘(D) such other relevant data and infor21 mation as determined by the Secretary, and in 

22 consultation with relevant stakeholders, such as 

23 State initiatives and evaluations of quality im24 provement activities, cesarean delivery rates, 

25 and health outcomes.’’. 


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1 (b) GAO STUDY REGARDING MEDICAID CAESAREAN

2 BIRTHS.— 

3 (1) STUDY.—The Comptroller General shall 

4 conduct a study regarding caesarean births under 

5 State Medicaid programs. The study shall include 

6 analyses of the following: 

7 (A) Changes in Medicaid payment rates for 

8 caesarean births and vaginal births over time, 

9 disaggregated by rates paid by fee-for-service 

10 Medicaid programs and by Medicaid programs 

11 that contract with medicaid managed care orga12 nizations and other specified entities to furnish 

13 medical assistance under such programs. 

14 (B) The frequency of primary and repeat 

15 caesarean births, as well as vaginal births after 

16 a caesarean, under Medicaid programs and a 

17 comparison of such frequency with the fre18 quency of such births when paid for under a 

19 group health plan or by a health insurance 

20 issuer offering group or individual health insur21 ance coverage. To the extent feasible, this infor22 mation should be disaggregated according to 

23 race and ethnicity. 

24 (C) Comparisons of payment rates for cae25 sarean and vaginal births under Medicaid proVerDate Sep 11 2014 02:11 Oct 15, 2022 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S5015.IS S5015

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1 grams with the payment rates for such births 

2 under a group health plan or by a health insur3 ance issuer offering group or individual health 

4 insurance coverage. 

5 (D) Such other factors related to payment 

6 rates for caesarean and vaginal births under 

7 Medicaid as the Comptroller General deter8 mines appropriate. 

9 (2) REPORT.—Not later than 18 months after 

10 the date of enactment of this Act, the Comptroller 

11 General shall submit to Congress a report containing 

12 the results of the study conducted under paragraph 

13 (1), together with recommendations for such legisla14 tion and administrative action as the Comptroller 

15 General determines appropriate. 

16 (c) GAO STUDY ON RACIAL DISPARITIES IN CAE17 SAREAN BIRTHS.— 

18 (1) IN GENERAL.—The Comptroller General 

19 shall conduct a study on racial disparities in the fre20 quency of low- and high-risk caesarean births across 

21 hospitals of different settings (rural, urban, and sub22 urban), volumes, and types (such as teaching, pri23 vate, public, and not-for-profit) in a selection of 10 

24 States. The study shall compare such information 

25 with respect to Medicaid and private payers and 


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1 compare total charges, if feasible. The study shall 

2 also investigate, to the extent practicable, the day of 

3 the week and time of day that such births occur at 

4 a subset of hospitals in the selected States. Such 

5 study may consider other factors related to racial 

6 disparities in maternal health as the Comptroller 

7 General deems appropriate. 

8 (2) REPORT.—Not later than 2 years after the 

9 date of enactment of this Act, the Comptroller Gen10 eral shall submit to Congress a report containing the 

11 results of the study conducted under paragraph (1), 

12 together with recommendations for such legislation 

13 and administrative action as the Comptroller Gen14 eral determines appropriate. 

15 SEC. 5. STATE OPTION TO PROVIDE COORDINATED CARE 

16 THROUGH A HEALTH HOME FOR PREGNANT 

17 AND POSTPARTUM WOMEN. 

18 Title XIX of the Social Security Act (42 U.S.C. 1396 

19 et seq.) is amended by inserting after section 1945A the 

20 following new section: 

21 ‘‘SEC. 1945B. STATE OPTION TO PROVIDE COORDINATED 

22 CARE THROUGH A HEALTH HOME FOR PREG23 NANT AND POSTPARTUM WOMEN. 

24 ‘‘(a) STATE OPTION.— 


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1 ‘‘(1) IN GENERAL.—Notwithstanding section 

2 1902(a)(1) (relating to statewideness) and section 

3 1902(a)(10)(B) (relating to comparability), begin4 ning April 1, 2025, a State, at its option as a State 

5 plan amendment, may provide for medical assistance 

6 under this title to an eligible woman who chooses 

7 to— 

8 ‘‘(A) enroll in a maternity health home 

9 under this section by selecting a designated pro10 vider, a team of health care professionals oper11 ating with such a provider, or a health team as 

12 the woman’s maternity health home for pur13 poses of providing the woman with pregnancy 

14 and postpartum coordinated care services; or 

15 ‘‘(B) receive such services from a des16 ignated provider, a team of health care profes17 sionals operating with such a provider, or a 

18 health team that has voluntarily opted to par19 ticipate in a maternity health home for eligible 

20 women under this section. 

21 ‘‘(2) ELIGIBLE WOMAN DEFINED.—In this sec22 tion, the term ‘eligible woman’ means an indi23 vidual— 

24 ‘‘(A) who is eligible for medical assistance 

25 under the State plan (or under a waiver of such 


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1 plan) for all items and services covered under 

2 the State plan (or waiver) that are not less in 

3 amount, duration, or scope, or are determined 

4 by the Secretary to be substantially equivalent, 

5 to the medical assistance available for an indi6 vidual described in subsection (a)(10)(A)(i); and 

7 ‘‘(B) who— 

8 ‘‘(i) is pregnant; or 

9 ‘‘(ii) had a pregnancy end within the 

10 last 365 days. 

11 ‘‘(b) QUALIFICATION STANDARDS.—The Secretary 

12 shall establish standards for qualification as a maternity 

13 health home or as a designated provider, team of health 

14 care professionals operating with such a provider, or a 

15 health team eligible for participation in a maternity health 

16 home for purposes of this section. Such standards shall 

17 include requiring designated providers, teams of health 

18 care professionals operating with such providers, and 

19 health teams (designated as a maternity health home) to 

20 demonstrate to the State the ability to do the following: 

21 ‘‘(1) Coordinate prompt care and access to nec22 essary maternity care services, including services 

23 provided by specialists, and programs for an eligible 

24 woman during her pregnancy and the 365-day pe25 riod beginning on the last day of her pregnancy. 


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1 ‘‘(2) Develop an individualized, comprehensive, 

2 patient-centered care plan for each eligible woman 

3 that accommodates patient preferences and, if appli4 cable, reflects adjustments to the payment method5 ology described in subsection (c)(2)(B). 

6 ‘‘(3) Develop and incorporate into each eligible 

7 woman’s care plan, in a culturally and linguistically 

8 appropriate manner consistent with the needs of the 

9 eligible woman, ongoing home care, community10 based primary care, inpatient care, social support 

11 services, behavioral health services, local hospital 

12 emergency care, and, in the event of a change in in13 come that would result in the eligible woman losing 

14 eligibility for medical assistance under the State 

15 plan or waiver, care management and planning re16 lated to a change in the eligible woman’s health in17 surance coverage. 

18 ‘‘(4) Coordinate with pediatric care providers, 

19 as appropriate. 

20 ‘‘(5) Collect and report information under sub21 section (f)(1). 

22 ‘‘(c) PAYMENTS.— 

23 ‘‘(1) IN GENERAL.—A State shall provide a des24 ignated provider, a team of health care professionals 

25 operating with such a provider, or a health team 


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1 with payments for the provision of pregnancy and 

2 postpartum coordinated care services, to each eligi3 ble woman that selects such provider, team of health 

4 care professionals, or health team as the woman’s 

5 maternity health home or care provider. Payments 

6 made to a maternity health home or care provider 

7 for such services shall be treated as medical assist8 ance for purposes of section 1903(a). 

9 ‘‘(2) METHODOLOGY.—The State shall specify 

10 in the State plan amendment the methodology the 

11 State will use for determining payment for the provi12 sion of pregnancy and postpartum coordinated care 

13 services or treatment during an eligible woman’s 

14 pregnancy and the 365-day period beginning on the 

15 last day of her pregnancy. Such methodology for de16 termining payment— 

17 ‘‘(A) may be based on— 

18 ‘‘(i) a per-member per-month basis for 

19 each eligible woman enrolled in the mater20 nity health home; 

21 ‘‘(ii) a prospective payment model, in 

22 the case of payments to Federally qualified 

23 health centers or a rural health clinics; or 

24 ‘‘(iii) an alternate model of payment 

25 (which may include a model developed 


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1 under a waiver under section 1115) pro2 posed by the State and approved by the 

3 Secretary; 

4 ‘‘(B) may be adjusted to reflect, with re5 spect to each eligible woman— 

6 ‘‘(i) the severity of the risks associ7 ated with the woman’s pregnancy; 

8 ‘‘(ii) the severity of the risks associ9 ated with the woman’s postpartum health 

10 care needs; and 

11 ‘‘(iii) the level or amount of time of 

12 care coordination required with respect to 

13 the woman; and 

14 ‘‘(C) shall be established consistent with 

15 section 1902(a)(30)(A). 

16 ‘‘(d) COORDINATING CARE.— 

17 ‘‘(1) HOSPITAL NOTIFICATION.—A State with a 

18 State plan amendment approved under this section 

19 shall require each hospital that is a participating 

20 provider under the State plan (or under a waiver of 

21 such plan) to establish procedures in the case of an 

22 eligible woman who seeks treatment in the emer23 gency department of such hospital for— 

24 ‘‘(A) providing the woman with culturally 

25 and linguistically appropriate information on 


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1 the respective treatment models and opportuni2 ties for the woman to access a maternity health 

3 home and its associated benefits; and 

4 ‘‘(B) notifying the maternity health home 

5 in which the woman is enrolled, or the des6 ignated provider, team of health care profes7 sionals operating with such a provider, or 

8 health team treating the woman, of the wom9 an’s treatment in the emergency department 

10 and of the protocols for the maternity health 

11 home, designated provider, or team to be in12 volved in the woman’s emergency care or post13 discharge care. 

14 ‘‘(2) EDUCATION WITH RESPECT TO AVAIL15 ABILITY OF A MATERNITY HEALTH HOME.— 

16 ‘‘(A) IN GENERAL.—In order for a State 

17 plan amendment to be approved under this sec18 tion, a State shall include in the State plan 

19 amendment a description of the State’s process 

20 for— 

21 ‘‘(i) educating providers participating 

22 in the State plan (or a waiver of such 

23 plan) on the availability of maternity 

24 health homes for eligible women, including 

25 the process by which such providers can 


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1 participate in or refer eligible women to an 

2 approved maternity health home or a des3 ignated provider, team of health care pro4 fessionals operating such a provider, or 

5 health team; and 

6 ‘‘(ii) educating eligible women, in a 

7 culturally and linguistically appropriate 

8 manner, on the availability of maternity 

9 health homes. 

10 ‘‘(B) OUTREACH.—The process established 

11 by the State under subparagraph (A) shall in12 clude the participation of entities or other pub13 lic or private organizations or entities that pro14 vide outreach and information on the avail15 ability of health care items and services to fami16 lies of individuals eligible to receive medical as17 sistance under the State plan (or a waiver of 

18 such plan). 

19 ‘‘(3) MENTAL HEALTH COORDINATION.—A 

20 State with a State plan amendment approved under 

21 this section shall consult and coordinate, as appro22 priate, with the Secretary in addressing issues re23 garding the prevention, identification, and treatment 

24 of mental health conditions and substance use dis25 orders among eligible women. 


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1 ‘‘(4) SOCIAL AND SUPPORT SERVICES.—A State 

2 with a State plan amendment approved under this 

3 section shall consult and coordinate, as appropriate, 

4 with the Secretary in establishing means to connect 

5 eligible women receiving pregnancy and postpartum 

6 coordinated care services under this section with so7 cial and support services, including services made 

8 available under maternal, infant, and early childhood 

9 home visiting programs established under section 

10 511, and services made available under section 

11 330H or title X of the Public Health Service Act. 

12 ‘‘(e) MONITORING.—A State shall include in the 

13 State plan amendment— 

14 ‘‘(1) a methodology for tracking reductions in 

15 inpatient days and reductions in the total cost of 

16 care resulting from improved care coordination and 

17 management under this section; 

18 ‘‘(2) a proposal for use of health information 

19 technology in providing an eligible woman with preg20 nancy and postpartum coordinated care services as 

21 specified under this section and improving service 

22 delivery and coordination across the care continuum; 

23 and 


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1 ‘‘(3) a methodology for tracking prompt and 

2 timely access to medically necessary care for eligible 

3 women from out-of-State providers. 

4 ‘‘(f) DATA COLLECTION.— 

5 ‘‘(1) PROVIDER REPORTING REQUIREMENTS.— 

6 In order to receive payments from a State under 

7 subsection (c), a maternity health home, or a des8 ignated provider, a team of health care professionals 

9 operating with such a provider, or a health team, 

10 shall report to the State, at such time and in such 

11 form and manner as may be required by the State, 

12 including through a health information exchange or 

13 other public health data sharing entity, the following 

14 information: 

15 ‘‘(A) With respect to each such designated 

16 provider, team of health care professionals oper17 ating with such a provider, and health team 

18 (designated as a maternity health home), the 

19 name, National Provider Identification number, 

20 address, and specific health care services of21 fered to be provided to eligible women who have 

22 selected such provider, team of health care pro23 fessionals, or health team as the women’s ma24 ternity health home. 


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1 ‘‘(B) Information on all applicable meas2 ures for determining the quality of services pro3 vided by such provider, team of health care pro4 fessionals, or health team. 

5 ‘‘(C) Such other information as the Sec6 retary shall specify in guidance. 

7 ‘‘(2) STATE REPORTING REQUIREMENTS.— 

8 ‘‘(A) COMPREHENSIVE REPORT.—A State 

9 with a State plan amendment approved under 

10 this section shall report to the Secretary (and, 

11 upon request, to the Medicaid and CHIP Pay12 ment and Access Commission), at such time, 

13 but at a minimum frequency of every 12 

14 months, and in such form and manner deter15 mined by the Secretary to be reasonable and 

16 minimally burdensome, including through a 

17 health information exchange or other public 

18 health data sharing entity, the following infor19 mation: 

20 ‘‘(i) Information described in para21 graph (1). 

22 ‘‘(ii) The number and, to the extent 

23 available and while maintaining all relevant 

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1 mation of eligible women who have enrolled 

2 in a maternity health home pursuant to 

3 this section. 

4 ‘‘(iii) The number of maternity health 

5 homes in the State. 

6 ‘‘(iv) The medical conditions or fac7 tors that contribute to severe maternal 

8 morbidity among eligible women enrolled in 

9 maternity health homes in the State. 

10 ‘‘(v) The extent to which such women 

11 receive health care items and services 

12 under the State plan before, during, and 

13 after the women’s enrollment in such a 

14 maternity health home. 

15 ‘‘(vi) Where applicable, mortality data 

16 and data for the associated causes of death 

17 for eligible women enrolled in a maternity 

18 health home under this section, in accord19 ance with subsection (g). For deaths occur20 ring postpartum, such data shall distin21 guish between deaths occurring up to 42 

22 days postpartum and deaths occurring be23 tween 43 days to up to 1 year postpartum. 

24 Where applicable, data reported under this 

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1 parable data from a State’s maternal mor2 tality review committee, as established in 

3 accordance with section 317K(d) of the 

4 Public Health Service Act, for purposes of 

5 further identifying and comparing state6 wide trends in maternal mortality among 

7 populations participating in the maternity 

8 health home under this section. 

9 ‘‘(B) IMPLEMENTATION REPORT.—Not 

10 later than 18 months after a State has a State 

11 plan amendment approved under this section, 

12 the State shall submit to the Secretary, and 

13 make publicly available on the appropriate 

14 State website, a report on how the State is im15 plementing the option established under this 

16 section, including through any best practices 

17 adopted by the State. 

18 ‘‘(g) CONFIDENTIALITY.—A State with a State plan 

19 amendment under this section shall establish confiden20 tiality protections for the purposes of subsection (f)(2)(A) 

21 to ensure, at a minimum, that there is no disclosure by 

22 the State of any identifying information about any specific 

23 eligible woman enrolled in a maternity health home or any 

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1 tiality and privacy protections, including the requirements 

2 under 1902(a)(7)(A), are maintained. 

3 ‘‘(h) RULE OF CONSTRUCTION.—Nothing in this sec4 tion shall be construed to require— 

5 ‘‘(1) an eligible woman to enroll in a maternity 

6 health home under this section; or 

7 ‘‘(2) a designated provider or health team to 

8 act as a maternity health home and provide services 

9 in accordance with this section if the provider or 

10 health team does not voluntarily agree to act as a 

11 maternity health home. 

12 ‘‘(i) PLANNING GRANTS.— 

13 ‘‘(1) IN GENERAL.—Beginning October 1, 

14 2024, from the amount appropriated under para15 graph (2), the Secretary shall award planning grants 

16 to States for purposes of developing and submitting 

17 a State plan amendment under this section. The 

18 Secretary shall award a grant to each State that ap19 plies for a grant under this subsection, but the Sec20 retary may determine the amount of the grant based 

21 on the merits of the application and the goal of the 

22 State to prioritize health outcomes for eligible 

23 women. A planning grant awarded to a State under 

24 this subsection shall remain available until expended. 


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1 ‘‘(2) APPROPRIATION.—There are authorized to 

2 be appropriated to the Secretary $50,000,000 for 

3 the period of fiscal years 2023 through 2025, for the 

4 purposes of making grants under this subsection, to 

5 remain available until expended. 

6 ‘‘(3) LIMITATION.—The total amount of pay7 ments made to States under this subsection shall not 

8 exceed $50,000,000. 

9 ‘‘(j) ADDITIONAL DEFINITIONS.—In this section: 

10 ‘‘(1) DESIGNATED PROVIDER.—The term ‘des11 ignated provider’ means a physician (including an 

12 obstetrician-gynecologist), hospital, clinical practice 

13 or clinical group practice, a medicaid managed care 

14 organization, as defined in section 1903(m)(1)(A), a 

15 prepaid inpatient health plan, as defined in section 

16 438.2 of title 42, Code of Federal Regulations (or 

17 any successor regulation), a prepaid ambulatory 

18 health plan, as defined in such section (or any suc19 cessor regulation), rural clinic, community health 

20 center, community mental health center, or any 

21 other entity or provider that is determined by the 

22 State and approved by the Secretary to be qualified 

23 to be a maternity health home on the basis of docu24 mentation evidencing that the entity has the sys25 tems, expertise, and infrastructure in place to proVerDate Sep 11 2014 02:11 Oct 15, 2022 Jkt 039200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S5015.IS S5015

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1 vide pregnancy and postpartum coordinated care 

2 services. Such term may include providers who are 

3 employed by, or affiliated with, a hospital. 

4 ‘‘(2) MATERNITY HEALTH HOME.—The term 

5 ‘maternity health home’ means a designated provider 

6 (including a provider that operates in coordination 

7 with a team of health care professionals) or a health 

8 team is selected by an eligible woman to provide 

9 pregnancy and postpartum coordinated care services. 

10 ‘‘(3) HEALTH TEAM.—The term ‘health team’ 

11 has the meaning given such term for purposes of 

12 section 3502 of Public Law 111–148. 

13 ‘‘(4) PREGNANCY AND POSTPARTUM COORDI14 NATED CARE SERVICES.— 

15 ‘‘(A) IN GENERAL.—The term ‘pregnancy 

16 and postpartum coordinated care services’ 

17 means items and services related to the coordi18 nation of care for comprehensive and timely 

19 high-quality, culturally and linguistically appro20 priate, services described in subparagraph (B) 

21 that are provided by a designated provider, a 

22 team of health care professionals operating with 

23 such a provider, or a health team (designated 

24 as a maternity health home). 

25 ‘‘(B) SERVICES DESCRIBED.— 


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1 ‘‘(i) IN GENERAL.—The services de2 scribed in this subparagraph shall include 

3 with respect to a State electing the State 

4 plan amendment option under this section, 

5 any medical assistance for items and serv6 ices for which payment is available under 

7 the State plan or under a waiver of such 

8 plan. 

9 ‘‘(ii) OTHER ITEMS AND SERVICES.— 

10 In addition to medical assistance described 

11 in clause (i), the services described in this 

12 subparagraph shall include the following: 

13 ‘‘(I) Any item or service for 

14 which medical assistance is otherwise 

15 available under the State plan (or a 

16 waiver of such plan) related to the 

17 treatment of a woman during the 

18 woman’s pregnancy and the 1-year pe19 riod beginning on the last day of her 

20 pregnancy, including mental health 

21 and substance use disorder services. 

22 ‘‘(II) Comprehensive care man23 agement. 

24 ‘‘(III) Care coordination (includ25 ing with pediatricians as appropriate), 


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1 health promotion, and providing ac2 cess to the full range of maternal, ob3 stetric, and gynecologic services, in4 cluding services from out-of-State pro5 viders. 

6 ‘‘(IV) Comprehensive transitional 

7 care, including appropriate follow-up, 

8 from inpatient to other settings. 

9 ‘‘(V) Patient and family support 

10 (including authorized representatives). 

11 ‘‘(VI) Referrals to community 

12 and social support services, if rel13 evant. 

14 ‘‘(VII) Use of health information 

15 technology to link services, as feasible 

16 and appropriate. 

17 ‘‘(5) TEAM OF HEALTH CARE PROFES18 SIONALS.—The term ‘team of health care profes19 sionals’ means a team of health care professionals 

20 (as described in the State plan amendment under 

21 this section) that may— 

22 ‘‘(A) include— 

23 ‘‘(i) physicians, including gynecologist24 obstetricians, pediatricians, and other pro25 fessionals such as physicians assistants, 


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1 advance practice nurses, including certified 

2 nurse midwives, nurses, nurse care coordi3 nators, dietitians, nutritionists, social 

4 workers, behavioral health professionals, 

5 physical counselors, physical therapists, oc6 cupational therapists, or any professionals 

7 that assist in prenatal care, delivery, or 

8 postpartum care for which medical assist9 ance is available under the State plan or a 

10 waiver of such plan and determined to be 

11 appropriate by the State and approved by 

12 the Secretary; 

13 ‘‘(ii) an entity or individual who is 

14 designated to coordinate such care deliv15 ered by the team; and 

16 ‘‘(iii) when appropriate and if other17 wise eligible to furnish items and services 

18 that are reimbursable as medical assist19 ance under the State plan or under a waiv20 er of such plan, doulas, community health 

21 workers, translators and interpreters, and 

22 other individuals with culturally appro23 priate and trauma-informed expertise; and 

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1 munity health center, community mental health 

2 center, rural clinic, clinical practice or clinical 

3 group practice, academic health center, or any 

4 entity determined to be appropriate by the 

5 State and approved by the Secretary.’’. 

6 SEC. 6. GUIDANCE ON CARE COORDINATION TO SUPPORT 

7 MATERNAL HEALTH. 

8 Not later than 2 years after the date of enactment 

9 of this Act, the Secretary shall issue guidance for State 

10 Medicaid programs on improved care coordination, con11 tinuity of care, and clinical integration to support the 

12 needs of pregnant and postpartum women for services eli13 gible for Medicaid payment. Such guidance shall identify 

14 best practices for care coordination for such women, both 

15 with respect to fee-for-service State Medicaid programs 

16 and State Medicaid programs that contract with medicaid 

17 managed care organizations or other specified entities to 

18 furnish medical assistance for such women, and shall illus19 trate strategies for— 

20 (1) enhancing primary care and maternity care 

21 coordination with specialists, including cardiologists, 

22 specialists in gestational diabetes, dentists, lactation 

23 specialists, genetic counselors, and behavioral health 

24 providers; 


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1 (2) integrating behavioral health providers to 

2 provide screening, assessment, treatment, and refer3 ral for behavioral health needs, including substance 

4 use disorders, maternal depression, anxiety, intimate 

5 partner violence, and other trauma; 

6 (3) integrating into care teams or coordinating 

7 with nonclinical professionals, including (if licensed 

8 or credentialed by a State or State-authorized orga9 nization) doulas, peer support specialists, and com10 munity health workers, and how these services pro11 vided by such professionals may be eligible for Fed12 eral financial participation under Medicaid; 

13 (4) screening pregnant and postpartum women 

14 for social needs and coordinating related services 

15 during the prenatal and postpartum periods to en16 sure social and physical supports are provided for 

17 such women during such periods and for their chil18 dren; 

19 (5) supporting women who have had a stillbirth; 

20 (6) screening for maternal health, behavioral 

21 health, and social needs during well-child and pedi22 atric care visits; and 

23 (7) streamlining and reducing duplication in 

24 care coordination efforts across and among pro25 viders, plans, and other entities for such women. 


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1 SEC. 7. MACPAC STUDY ON DOULAS AND COMMUNITY 

2 HEALTH WORKERS. 

3 (a) IN GENERAL.—As part of the first report re4 quired under section 1900(b)(1) of the Social Security Act 

5 (42 U.S.C. 1396(b)(1)) after the date that is 1 year after 

6 the date of enactment of this Act, the Medicaid and CHIP 

7 Payment and Access Commission (referred to in this sec8 tion as ‘‘MACPAC’’) shall include with such report a re9 port on the coverage of doula services and the role of com10 munity health workers under State Medicaid programs, 

11 which shall include the following: 

12 (1) Information about coverage for doula serv13 ices and community health worker services under 

14 State Medicaid programs that currently provide cov15 erage for such services, including the type of doula 

16 services offered (such as prenatal, labor and deliv17 ery, postpartum support, and traditional doula serv18 ices) and information on the prevalence of doulas 

19 that care for individuals in their own communities. 

20 (2) An analysis of strategies to facilitate the ap21 propriate use of doula services in order to provide 

22 better care and achieve better maternal and infant 

23 health outcomes, including strategies that States 

24 may use to assist with services for which Federal fi25 nancial participation is eligible under a State Med26 icaid plan or a waiver of such a plan by recruiting, 


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1 training, and certifying a diverse doula workforce, 

2 particularly from underserved communities, commu3 nities of color, and communities facing linguistic or 

4 cultural barriers. 

5 (3) Provide examples of community health 

6 worker access in State Medicaid programs and strat7 egies employed by States to encourage a broad care 

8 team to manage Medicaid patients. 

9 (4) An assessment of the impact of the involve10 ment of doulas and community health workers on 

11 maternal health outcomes. 

12 (5) Recommendations, as MACPAC deems ap13 propriate, for legislative and administrative actions 

14 to increase access to services that improve maternal 

15 health. 

16 (b) STAKEHOLDER CONSULTATION.—In developing 

17 the report required under subsection (a), MACPAC shall 

18 consult with relevant stakeholders, including— 

19 (1) States; 

20 (2) organizations representing consumers, in21 cluding those that are disproportionately impacted 

22 by poor maternal health outcomes; 

23 (3) organizations and individuals representing 

24 doula services providers and community health work25 ers, including community-based doula programs and 


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1 those who serve underserved communities, commu2 nities of color and communities facing linguistic or 

3 cultural barriers; and 

4 (4) organizations representing health care pro5 viders. 

6 SEC. 8. DEMONSTRATION PROJECTS TO IMPROVE THE DE7 LIVERY OF MATERNAL HEALTH CARE 

8 THROUGH TELEHEALTH. 

9 (a) IN GENERAL.—Not later than 18 months after 

10 the date of enactment of this Act, the Secretary shall 

11 award grants to States to conduct demonstration projects 

12 under this section that are designed to expand the use of 

13 telehealth in State Medicaid programs for the delivery of 

14 health care to eligible pregnant or postpartum women. 

15 (b) ELIGIBLE PREGNANT OR POSTPARTUM WOMAN

16 DEFINED.— 

17 (1) IN GENERAL.—In this section, the term ‘‘el18 igible pregnant or postpartum woman’’ means a 

19 woman who is eligible for and receiving medical as20 sistance under a State Medicaid plan (or waiver of 

21 such plan) and who is or becomes pregnant. 

22 (2) POSTPARTUM WOMEN.—Such term includes 

23 a woman described in paragraph (1) through the 

24 end of the month in which the 365-day period begin25 ning on the last day of the woman’s pregnancy ends, 


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1 without regard to any change in income of the fam2 ily of which she is a member. 

3 (c) APPLICATION; SELECTION OF STATES; DURA4 TION.— 

5 (1) APPLICATION.— 

6 (A) IN GENERAL.—To conduct a dem7 onstration project under this section, a State 

8 shall submit an application to the Secretary at 

9 such time and in such manner as the Secretary 

10 shall require. Under the demonstration project, 

11 a State may include multiple proposed uses of 

12 grant funds, and propose to focus on multiple 

13 populations, as otherwise allowable under this 

14 section, within a single application. 

15 (B) REQUIRED INFORMATION.—A State 

16 application to conduct a demonstration project 

17 under this section shall include the following: 

18 (i) The population (such as individ19 uals residing in rural or medically under20 served areas) that the demonstration 

21 project will target. 

22 (ii) A description of how the State 

23 proposes to use funds awarded under this 

24 section to conduct the demonstration 

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1 tion of telehealth into the State Medicaid 

2 program’s existing delivery system for fur3 nishing medical assistance to and improv4 ing the health care outcomes of eligible 

5 pregnant or postpartum women. 

6 (iii) A description of how the State 

7 will use funds to address racial or ethnic 

8 disparities in access to maternal health 

9 services or maternal health outcomes, bar10 riers to care, including in rural or medi11 cally underserved communities, other bar12 riers to using telehealth, such as those ex13 perienced by individuals with disabilities 

14 and individuals with limited English pro15 ficiency, and as applicable, barriers to the 

16 use of telehealth in tribal communities. 

17 (iv) A certification that the applica18 tion meets the requirements of subpara19 graph (C). 

20 (v) Such other information as the Sec21 retary shall require. 

22 (C) CONSULTATION WITH HEALTH CARE

23 STAKEHOLDERS.—Prior to the submission of an 

24 application to conduct a demonstration project 

25 under this section, a State shall consult with 


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1 health care systems and providers, health plans 

2 (if relevant), consumer organizations and bene3 ficiary advocates, and community-based organi4 zations or other stakeholders in the area that 

5 the demonstration project will target to ensure 

6 that the proposed project addresses the health 

7 care needs of eligible pregnant or postpartum 

8 women in such area. 

9 (2) SELECTION OF STATES AND DURATION OF

10 PROJECTS.— 

11 (A) IN GENERAL.—The Secretary shall 

12 award grants to States that apply and meet the 

13 application requirements to conduct 4-year 

14 demonstration projects under this section. A 

15 State may request, and the Secretary shall de16 termine the appropriateness of, an application 

17 of up to $10,000,000. 

18 (B) SELECTION OF PROJECTS.—In select19 ing a State to conduct a demonstration project 

20 under this section, the Secretary shall ensure 

21 that the State is aware of the 4-year duration 

22 of the project and shall determine the State has 

23 satisfied the application requirements. 

24 (3) WAIVER OF STATEWIDENESS AND COM25 PARABILITY REQUIREMENT.—The Secretary shall 


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1 waive compliance with section 1902(a)(1) of the So2 cial Security Act (42 U.S.C. 1396a(a)(1)) (relating 

3 to statewideness) and section 1902(a)(10)(B) of 

4 such Act (42 U.S.C. 1396a(a)(10)(B)) (relating to 

5 comparability) to the extent necessary to allow se6 lected States to conduct demonstration projects 

7 under this section. 

8 (d) USE OF GRANT FUNDS.—A State may use funds 

9 from a grant awarded under this section to connect eligible 

10 pregnant or postpartum women to telehealth services de11 livered via telehealth that are furnished by— 

12 (1) primary and maternity care providers; 

13 (2) health care specialists; 

14 (3) behavioral health providers; and 

15 (4) other categories of health care providers 

16 identified by the Secretary. 

17 (e) REPORTS.— 

18 (1) STATE REPORTS.—Each State that is 

19 awarded a grant to conduct a demonstration project 

20 under this section shall submit the following reports 

21 to the Secretary: 

22 (A) INITIAL REPORT.—An initial report on 

23 the first 18 months during which the dem24 onstration project is conducted, not later than 

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1 onstration project, as described in subpara2 graph (B). 

3 (B) FINAL REPORT.—Not later than 6 

4 months after the date on which the State’s 

5 demonstration project ends, a final report that 

6 includes the following: 

7 (i) The number of eligible pregnant or 

8 postpartum women served under the dem9 onstration project. 

10 (ii) The activities and services funded 

11 under the demonstration project, including 

12 the providers that received funds under the 

13 demonstration project. 

14 (iii) Demographic information about 

15 the eligible pregnant or postpartum women 

16 served under the demonstration project, if 

17 available. 

18 (iv) A description of the types of mod19 els or programs developed under the dem20 onstration project. 

21 (v) How such models or programs im22 pacted access to, and utilization of, tele23 health services by eligible pregnant or 

24 postpartum women, including a description 

25 of how such models or programs addressed 


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1 racial or ethnic disparities in access or uti2 lization. 

3 (vi) Qualitative information on bene4 ficiary experience. 

5 (vii) Challenges faced and lessons 

6 learned by the State in integrating (or in7 creasing the integration of) telehealth into 

8 the delivery system for furnishing medical 

9 assistance to eligible pregnant or 

10 postpartum women in the areas targeted 

11 under the demonstration project. 

12 (2) REPORTS TO CONGRESS.— 

13 (A) INITIAL REPORT.—Not later than 2 

14 years after the date of enactment of this Act, 

15 the Secretary shall submit a report to Congress 

16 summarizing the information reported by States 

17 under paragraph (1)(A). 

18 (B) FINAL REPORT.—Not later than 5 

19 years after the date of enactment of this Act, 

20 the Secretary shall submit a report to Congress 

21 summarizing the information reported by States 

22 under paragraph (1)(B). 


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1 SEC. 9. CMS REPORT ON COVERAGE OF REMOTE PHYSIO2 LOGIC MONITORING DEVICES AND IMPACT 

3 ON MATERNAL AND CHILD HEALTH OUT4 COMES UNDER MEDICAID. 

5 (a) IN GENERAL.—Not later than 18 months after 

6 the date of enactment of this Act, the Secretary shall sub7 mit to Congress a report containing information on au8 thorities and State practices for covering remote physio9 logical monitoring devices, including limitations and bar10 riers to such coverage and the impact on maternal health 

11 outcomes, and to the extent appropriate, recommendations 

12 on how to address such limitations or barriers related to 

13 coverage of remote physiologic devices under State Med14 icaid programs, including, but not limited to, pulse 

15 oximeters, blood pressure cuffs, scales, and blood glucose 

16 monitors, with the goal of improving maternal and child 

17 health outcomes for pregnant and postpartum women en18 rolled in State Medicaid programs. 

19 (b) STATE RESOURCES.—Not later than 6 months 

20 after the submission of the report required by subsection 

21 (a), the Secretary shall update resources for State Med22 icaid programs, such as State Medicaid telehealth toolkits, 

23 to be consistent with the recommendations provided in 

24 such report. 


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1 SEC. 10. GUIDANCE ON COMMUNITY-BASED MATERNAL 

2 HEALTH PROGRAMS. 

3 Not later than 3 years after the date of enactment 

4 of this Act, the Secretary shall issue guidance to State 

5 Medicaid programs to support the use of evidence-based 

6 community-based maternal health programs, including 

7 programs that offer group prenatal care, home visiting 

8 services, childbirth and parenting education, peer sup9 ports, stillbirth prevention activities, and substance use 

10 disorder and recovery supports, under such programs, and 

11 any other programs as determined by the Secretary. 

12 SEC. 11. DEVELOPING GUIDANCE ON MATERNAL MOR13 TALITY AND SEVERE MORBIDITY REDUCTION 

14 FOR MATERNAL CARE PROVIDERS RECEIV15 ING PAYMENT UNDER THE MEDICAID PRO16 GRAM. 

17 (a) IN GENERAL.—Subject to the availability of ap18 propriations, not later than 36 months after the date of 

19 enactment of this Act, the Secretary shall publish on a 

20 public website of the Centers for Medicare & Medicaid 

21 Services guidance for States on resources and strategies 

22 for hospitals, freestanding birth centers (as defined in sec23 tion 1905(l)(3)(B) of the Social Security Act (42 U.S.C. 

24 1396d(l)(3)(B))), and other maternal care providers as de25 termined by the Secretary for reducing maternal mortality 


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1 and severe morbidity in individuals who are eligible for 

2 and receiving medical assistance under Medicaid or CHIP. 

3 (b) UPDATES.—The Secretary shall update the guid4 ance and resources described in subsection (a) at least 

5 once every 3 years. 

6 (c) CONSULTATION WITH ADVISORY COMMITTEE.— 

7 (1) ESTABLISHMENT.—Subject to the avail8 ability of appropriations, not later than 18 months 

9 after the date of enactment of this Act, the Sec10 retary shall establish an advisory committee to be 

11 known as the ‘‘National Advisory Committee on Re12 ducing Maternal Deaths’’ (referred to in this section 

13 as the ‘‘Advisory Committee’’). 

14 (2) DUTIES.—The Advisory Committee shall 

15 provide consensus advice and guidance to the Sec16 retary on the development and compilation of the 

17 guidance described in subsection (a) (and any up18 dates to such guidance). 

19 (3) MEMBERSHIP.— 

20 (A) IN GENERAL.—The Secretary, in con21 sultation with such other heads of agencies, as 

22 the Secretary deems appropriate and in accord23 ance with this paragraph, shall appoint not 

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1 mittee. In appointing such members, the Sec2 retary shall ensure that— 

3 (i) the total number of members of 

4 the Advisory Committee is an odd number; 

5 and 

6 (ii) the total number of voting mem7 bers who are not Federal officials does not 

8 exceed the total number of voting Federal 

9 members who are Federal officials. 

10 (B) REQUIRED MEMBERS.— 

11 (i) FEDERAL OFFICIALS.—The Advi12 sory Committee shall include as voting 

13 members the following Federal officials, or 

14 their designees: 

15 (I) The Secretary. 

16 (II) The Administrator of the 

17 Centers for Medicare & Medicaid 

18 Services. 

19 (III) The Director of the Centers 

20 for Disease Control and Prevention. 

21 (IV) The Associate Administrator 

22 of the Maternal and Child Health Bu23 reau of the Health Resources and 

24 Services Administration. 


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1 (V) The Director of the Agency 

2 for Healthcare Research and Quality. 

3 (VI) The National Coordinator 

4 for Health Information Technology. 

5 (VII) The Director of the Na6 tional Institutes of Health. 

7 (VIII) The Secretary of Veterans 

8 Affairs. 

9 (IX) The Director of the Indian 

10 Health Service. 

11 (X) The Deputy Assistant Sec12 retary for Minority Health. 

13 (XI) The Administrator of the 

14 Substance Abuse and Mental Health 

15 Services Administration. 

16 (XII) The Deputy Assistant Sec17 retary for Women’s Health. 

18 (XIII) Such other Federal offi19 cials or their designees as the Sec20 retary determines appropriate. 

21 (ii) NON-FEDERAL OFFICIALS.— 

22 (I) IN GENERAL.—The Advisory 

23 Committee shall include the following 

24 as voting members: 


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1 (aa) At least 1 representa2 tive from a professional organiza3 tion representing hospitals and 

4 health systems. 

5 (bb) At least 1 representa6 tive from a medical professional 

7 organization representing pri8 mary care providers. 

9 (cc) At least 1 representa10 tive from a medical professional 

11 organization representing general 

12 obstetrician-gynecologists. 

13 (dd) At least 1 representa14 tive from a medical professional 

15 organization representing cer16 tified nurse-midwives. 

17 (ee) At least 1 representa18 tive from a medical professional 

19 organization representing other 

20 maternal fetal medicine pro21 viders. 

22 (ff) At least 1 representative 

23 from a medical professional orga24 nization representing anesthesiol25 ogists. 


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1 (gg) At least 1 representa2 tive from a medical professional 

3 organization representing emer4 gency medicine physicians and 

5 urgent care providers. 

6 (hh) At least 1 representa7 tive from a medical professional 

8 organization representing nurses. 

9 (ii) At least 1 representative 

10 from a professional organization 

11 representing community health 

12 workers. 

13 (jj) At least 1 representative 

14 from a professional organization 

15 representing doulas. 

16 (kk) At least 1 representa17 tive from a professional organiza18 tion representing perinatal psy19 chiatrists. 

20 (ll) At least 1 representative 

21 from State-affiliated programs or 

22 existing collaboratives with dem23 onstrated expertise or success in 

24 improving maternal health. 


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1 (mm) At least 1 director of 

2 a State Medicaid agency that has 

3 had demonstrated success in im4 proving maternal health. 

5 (nn) At least 1 representa6 tive from an accrediting organi7 zation for maternal health quality 

8 and safety standards. 

9 (oo) At least 1 representa10 tive from a maternal patient ad11 vocacy organization with lived ex12 perience of severe maternal mor13 bidity. 

14 (II) REQUIREMENTS.—Each in15 dividual selected to be a member 

16 under this clause shall— 

17 (aa) have expertise in mater18 nal health; 

19 (bb) not be a Federal offi20 cial; and 

21 (cc) have experience working 

22 with populations that are at 

23 higher risk for maternal mor24 tality or severe morbidity, such 

25 as populations that experience 


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1 racial, ethnic, and geographic 

2 health disparities, pregnant and 

3 postpartum women experiencing 

4 a mental health disorder, or 

5 pregnant or postpartum women 

6 with other comorbidities such as 

7 substance use disorders, hyper8 tension, thyroid disorders, and 

9 sickle cell disease. 

10 (C) ADDITIONAL MEMBERS.— 

11 (i) IN GENERAL.—In addition to the 

12 members required to be appointed under 

13 subparagraph (B), the Secretary may ap14 point as non-voting members to the Advi15 sory Committee such other individuals with 

16 relevant expertise or experience as the Sec17 retary shall determine appropriate, which 

18 may include, but is not limited to, individ19 uals described in clause (ii). 

20 (ii) SUGGESTED ADDITIONAL MEM21 BERS.—The individuals described in this 

22 clause are the following: 

23 (I) Representatives from State 

24 maternal mortality review committees 

25 and perinatal quality collaboratives. 


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1 (II) Medical providers who care 

2 for women and infants during preg3 nancy and the postpartum period, 

4 such as family practice physicians, 

5 cardiologists, pulmonology critical 

6 care specialists, endocrinologists, pedi7 atricians, and neonatologists. 

8 (III) Representatives from State 

9 and local public health departments, 

10 including State Medicaid Agencies. 

11 (IV) Subject matter experts in 

12 conducting outreach to women who 

13 are African American or belong to an14 other minority group. 

15 (V) Directors of State agencies 

16 responsible for administering a State’s 

17 maternal and child health services 

18 program under title V of the Social 

19 Security Act (42 U.S.C. 701 et seq.). 

20 (VI) Experts in medical edu21 cation or physician training. 

22 (VII) Representatives from med23 icaid managed care organizations. 


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1 (4) APPLICABILITY OF FACA.—The Federal Ad2 visory Committee Act (5 U.S.C. App.) shall apply to 

3 the committee established under this subsection. 

4 (d) CONTENTS.—The guidance described in sub5 section (a) shall include, with respect to hospitals, free6 standing birth centers, and other maternal care providers, 

7 the following: 

8 (1) Best practices regarding evidence-based 

9 screening and clinician education initiatives relating 

10 to screening and treatment protocols for individuals 

11 who are at risk of experiencing complications related 

12 to pregnancy, with an emphasis on individuals with 

13 preconditions directly linked to pregnancy complica14 tions and maternal mortality and severe morbidity, 

15 including— 

16 (A) methods to identify individuals who are 

17 at risk of maternal mortality or severe mor18 bidity, including risk stratification; 

19 (B) evidence-based risk factors associated 

20 with maternal mortality or severe morbidity and 

21 racial, ethnic, and geographic health disparities; 

22 (C) evidence-based strategies to reduce risk 

23 factors associated with maternal mortality or 

24 severe morbidity through services which may be 

25 covered under Medicaid or CHIP, including, 


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1 but not limited to, activities by community 

2 health workers (as such term is defined in sec3 tion 2113 of the Social Security Act (42 U.S.C. 

4 1397mm)) that are funded by a grant awarded 

5 under such section; 

6 (D) resources available to such individuals, 

7 such as nutrition assistance and education, 

8 home visitation, mental health and substance 

9 use disorder services, smoking cessation pro10 grams, pre-natal care, and other evidence-based 

11 maternal mortality or severe morbidity reduc12 tion programs; 

13 (E) examples of educational materials used 

14 by providers of obstetrics services; 

15 (F) methods for improving community cen16 tralized care, including providing telehealth 

17 services or home visits to increase and facilitate 

18 access to and engagement in prenatal and 

19 postpartum care and collaboration with home 

20 health agencies, community health centers, local 

21 public health departments, or clinics; 

22 (G) guidance on medical record diagnosis 

23 codes linked to maternal mortality and severe 

24 morbidity, including, if applicable, codes related 

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1 cating clinicians on the proper use of such 

2 codes; 

3 (H) risk appropriate transfer protocols 

4 during pregnancy, childbirth, and the 

5 postpartum period; and 

6 (I) any other information related to pre7 vention and treatment of at-risk individuals de8 termined appropriate by the Secretary. 

9 (2) Guidance on monitoring programs for indi10 viduals who have been identified as at risk of com11 plications related to pregnancy. 

12 (3) Best practices for such hospitals, free13 standing birth centers, and providers to make preg14 nant women aware of the complications related to 

15 pregnancy. 

16 (4) A fact sheet for providing pregnant women 

17 who are receiving care on an outpatient basis with 

18 a notice during the prenatal stage of pregnancy 

19 that— 

20 (A) explains the risks associated with preg21 nancy, birth, and the postpartum period (in22 cluding the risks of hemorrhage, preterm birth, 

23 sepsis, eclampsia, obstructed labor), chronic 

24 conditions (including high blood pressure, dia25 betes, heart disease, depression, and obesity) 


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1 correlated with adverse pregnancy outcomes, 

2 risks associated with advanced maternal age, 

3 and the importance of adhering to a personal4 ized plan of care; 

5 (B) highlights multimodal and evidence6 based prevention and treatment techniques; 

7 (C) highlights evidence-based programs 

8 and activities to reduce the incidence of still9 birth (including tracking and awareness of fetal 

10 movements, improvement of birth timing for 

11 pregnancies with risk factors, initiatives that 

12 encourage safe sleeping positions during preg13 nancy, screening and surveillance for fetal 

14 growth restriction, efforts to achieve smoking 

15 cessation during pregnancy, community-based 

16 programs that provide home visits or other 

17 types of support, and any other research or evi18 dence-based programming to prevent still19 births); 

20 (D) provides for a method (through signa21 ture or otherwise) for such an individual, or a 

22 person acting on such individual’s behalf, to ac23 knowledge receipt of such fact sheet; 

24 (E) is worded in an easily understandable 

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1 guages and accessible formats determined ap2 propriate by the Secretary; and 

3 (F) includes any other information deter4 mined appropriate by the Secretary. 

5 (5) A template for a voluntary clinician check6 list that outlines the minimum responsibilities that 

7 clinicians, such as physicians, certified nurse-mid8 wives, emergency room and urgent care providers, 

9 nurses and others, are expected to meet in order to 

10 promote quality and safety in the provision of ob11 stetric services. 

12 (6) A template for a voluntary checklist that 

13 outlines the minimum responsibilities that hospital 

14 leadership responsible for direct patient care, such 

15 as the institution’s president, chief medical officer, 

16 chief nursing officer, or other hospital leadership 

17 that directly report to the president or chief execu18 tive officer of the institution, should meet to pro19 mote hospital-wide initiatives that improve quality 

20 and safety in the provision of obstetric services. 

21 (7) Information on multi-stakeholder quality 

22 improvement initiatives, such as the Alliance for In23 novation on Maternal Health, State perinatal quality 

24 improvement initiatives, and other similar initiatives 


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1 determined appropriate by the Secretary, includ2 ing— 

3 (A) information about such improvement 

4 initiatives and how to join; 

5 (B) information about public maternal 

6 data collection centers; 

7 (C) information about quality metrics used 

8 and outcomes achieved by such improvement 

9 initiatives; 

10 (D) information about data sharing tech11 niques used by such improvement initiatives; 

12 (E) information about data sources used 

13 by such improvement initiatives to identify ma14 ternal mortality and severe morbidity risks; 

15 (F) information about interventions used 

16 by such improvement initiatives to mitigate 

17 risks of maternal mortality and severe mor18 bidity; 

19 (G) information about data collection tech20 niques on race, ethnicity, geography, age, in21 come, and other demographic information used 

22 by such improvement initiatives; and 

23 (H) any other information determined ap24 propriate by the Secretary. 


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1 (e) INCLUSION OF BEST PRACTICES.—Not later than 

2 18 months after the date of the publication of the guid3 ance required under subsection (a), the Secretary shall up4 date such guidance to include best practices identified by 

5 the Secretary for such hospitals, freestanding birth cen6 ters, and providers to track maternal mortality and severe 

7 morbidity trends by clinicians at such hospitals, free8 standing birth centers, and providers including— 

9 (1) ways to establish scoring systems, which 

10 may include quality triggers and safety and quality 

11 metrics to score case and patient outcome metrics, 

12 for such clinicians; 

13 (2) methods to identify, educate, and improve 

14 such clinicians who may have higher rates of mater15 nal mortality or severe morbidity compared to their 

16 regional or State peers (taking into account dif17 ferences in patient risk for adverse outcomes, which 

18 may include social risk factors); 

19 (3) methods for using such data and tracking 

20 to enhance research efforts focused on maternal 

21 health, while also improving patient outcomes, clini22 cian education and training, and coordination of 

23 care; and 

24 (4) any other information determined appro25 priate by the Secretary. 


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1 (f) CULTURAL AND LINGUISTIC APPROPRIATE2 NESS.—To the extent practicable, the Secretary should de3 velop the guidance, best practices, fact sheets, templates, 

4 and other materials that are required under this section 

5 in a trauma-informed, culturally and linguistically appro6 priate manner. 

7 SEC. 12. COLLECTION OF INFORMATION RELATED TO SO8 CIAL DETERMINANTS OF THE HEALTH OF 

9 MEDICAID AND CHIP BENEFICIARIES. 

10 (a) IMPLEMENTATION ASSESSMENT REPORT TO

11 CONGRESS.— 

12 (1) IN GENERAL.—Not later than 2 years after 

13 the date of enactment of this Act, the Secretary 

14 shall submit a report to Congress that includes a de15 scription of whether and how information related to 

16 the social determinants of health for individuals eli17 gible for medical assistance under Medicaid or child 

18 health assistance or pregnancy-related assistance 

19 under CHIP may be captured under the data sys20 tems for such programs as in effect on the date such 

21 report is submitted, including— 

22 (A) a description of whether and how 

23 ICD–10 codes (or successor codes) may be used 

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1 er other claims file or demographic information 

2 may be employed; and 

3 (B) a description of whether existing data 

4 systems under Medicaid and CHIP could be 

5 employed to capture such information, whether 

6 program or system changes would be required, 

7 how privacy and confidentiality as required 

8 under applicable law and regulations would be 

9 maintained, and the resources and timeframes 

10 at the Federal and State levels that would be 

11 needed to make such changes. 

12 (2) GUIDANCE FOR STATES.—The Secretary 

13 shall issue detailed guidance for States concurrent 

14 with the submission of the report to Congress under 

15 paragraph (1). Such guidance shall address— 

16 (A) whether and how information related 

17 to the social determinants of health for individ18 uals eligible for medical assistance under Med19 icaid or child health assistance or pregnancy-re20 lated assistance under CHIP could be captured 

21 employing existing systems under such pro22 grams; and 

23 (B) implementation considerations for cap24 turing such information, including whether pro25 gram or system changes would be required, 


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1 whether additional steps would be needed to 

2 maintain privacy and confidentiality as required 

3 under relevant laws and regulations, and the re4 sources and timeframes at that would be needed 

5 to make such changes. 

6 (3) STAKEHOLDER INPUT.—The Secretary shall 

7 develop the report required under paragraph (1) and 

8 the guidance required under paragraph (2) with the 

9 input of relevant stakeholders, such as State Med10 icaid directors, medicaid managed care organiza11 tions, and other relevant Federal agencies such as 

12 the Centers for Disease Control and Prevention, the 

13 Health Resources Services Administration, and the 

14 Agency for Healthcare Research and Quality. 

15 (4) ACTION PLAN REPORT.— 

16 (A) IN GENERAL.—If the Secretary deter17 mines in the report required under paragraph 

18 (1) that information related to the social deter19 minants of health for individuals eligible for 

20 medical assistance under Medicaid or child 

21 health assistance or pregnancy-related assist22 ance under CHIP cannot be captured under the 

23 data systems for such programs as in effect on 

24 the date such report is submitted, then, not 

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1 retary shall submit a second report to Congress 

2 that contains an action plan for implementing 

3 the program or data systems changes needed in 

4 order for such information to be collected while 

5 maintaining privacy and confidentiality as re6 quired under relevant laws and regulations. The 

7 action plan should be prepared so as to be im8 plemented by the Federal Government and 

9 States not later than 2 years after the date on 

10 which the report required under this paragraph 

11 is submitted is submitted to Congress. 

12 (B) REVISED GUIDANCE FOR STATES.— 

13 The Secretary shall revise and reissue the guid14 ance for States required under paragraph (2) to 

15 take into account the action plan included in 

16 the report submitted to Congress under sub17 paragraph (A). 

18 (5) AUTHORIZATION OF APPROPRIATIONS.— 

19 (A) FEDERAL COSTS.—There are author20 ized to be appropriated to the Secretary, 

21 $40,000,000 for purposes of preparing the re22 ports required under this subsection and imple23 menting the collection of information related to 

24 the social determinants of health for individuals 

25 eligible for medical assistance under Medicaid 


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1 or child health assistance or pregnancy-related 

2 assistance under CHIP. 

3 (B) STATE COSTS.—There are authorized 

4 to be appropriated to the Secretary, 

5 $50,000,000 for purposes of making payments 

6 to States in accordance with a methodology es7 tablished by the Secretary for State expendi8 tures attributable to planning for and imple9 menting the collection of such information in 

10 accordance with subsection (d) of section 1946 

11 of the Social Security Act (42 U.S.C. 1396w– 

12 5) (as added by subsection (b)). 

13 (b) APPLICATION TO STATES.—Section 1946 of the 

14 Social Security Act (42 U.S.C. 1396w–5) is amended by 

15 adding at the end the following: 

16 ‘‘(d) COLLECTION OF INFORMATION RELATED TO

17 SOCIAL DETERMINANTS OF HEALTH.— 

18 ‘‘(1) DEVELOPMENT OF COLLECTION METH19 ODS.— 

20 ‘‘(A) IN GENERAL.—Subject to paragraph 

21 (5), the Secretary, in consultation with the 

22 States, shall develop a method for collecting 

23 standardized and aggregated State-level infor24 mation related to social determinants that may 

25 factor into the health of beneficiaries under this 


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1 title and beneficiaries under title XXI which the 

2 States, notwithstanding section 1902(a)(7) and 

3 as a condition for meeting the requirements of 

4 section 1902(a)(6) and section 2107(b)(1), shall 

5 use to annually report such information: 

6 ‘‘(i) A model uniform reporting field 

7 through the transformed Medicaid Statis8 tical Information System (T–MSIS) (or a 

9 successor system) or another appropriate 

10 reporting platform, as approved by the 

11 Secretary. 

12 ‘‘(ii) A model uniform questionnaire 

13 or survey (which may be included as part 

14 of an existing survey, questionnaire, or 

15 form administered by the Secretary), for 

16 purposes of the State or the Secretary col17 lecting such information by administering 

18 regularly but not less than annually a 

19 questionnaire or survey of beneficiaries 

20 under this title and beneficiaries under 

21 title XXI. 

22 ‘‘(iii) A model uniform form to be 

23 adapted for inclusion in the Medicaid and 

24 CHIP Scorecard developed by the Centers 

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1 poses of the Secretary collecting such in2 formation. 

3 ‘‘(iv) An alternative method identified 

4 by the Secretary for collecting such infor5 mation. 

6 ‘‘(B) IMPLEMENTATION.—In carrying out 

7 the requirements of subparagraph (A), the Sec8 retary shall— 

9 ‘‘(i) for purposes of the method de10 scribed in clause (i) of such subparagraph, 

11 determine the appropriate providers and 

12 frequency with which such providers shall 

13 complete the reporting field identified and 

14 report the information to the State; 

15 ‘‘(ii) for purposes of the method de16 scribed in clause (ii) of such subparagraph, 

17 identify the means and frequency (which 

18 shall be no less frequent than once per 

19 year) with which a questionnaire or survey 

20 of beneficiaries is to be conducted; 

21 ‘‘(iii) with respect to any method de22 scribed in such subparagraph, issue guid23 ance for ensuring compliance with applica24 ble laws regarding beneficiary informed 

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1 spect to the information collected under 

2 such method; 

3 ‘‘(iv) with respect to the collection of 

4 information relating to beneficiaries who 

5 are children, issue guidance on the collec6 tion of such information from a parent, 

7 legal guardian, or any other person who is 

8 legally authorized to share such informa9 tion on behalf of the child when the direct 

10 collection of such information from chil11 dren may not otherwise be feasible or ap12 propriate; and 

13 ‘‘(v) regularly evaluate the method 

14 under such subparagraph and the informa15 tion reported using such method, and, as 

16 needed, make updates to the method and 

17 the information reported. 

18 ‘‘(2) SOCIAL DETERMINANTS OF HEALTH.—The 

19 information collected in accordance with the method 

20 made available under paragraph (1) shall, to the ex21 tent practicable, include standardized definitions for 

22 identifying social determinants of health needs iden23 tified in the ICD–10 diagnostic codes Z55 through 

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1 tives of the Office of Disease Prevention and Health 

2 Promotion of the Department of Health and Human 

3 Services, or any other standardized set of definitions 

4 for social determinants of health identified by the 

5 Secretary. Such definitions shall incorporate meas6 ures for quantifying the relative severity of any such 

7 social determinant of health need identified in an in8 dividual. 

9 ‘‘(3) FEDERAL PRIVACY REQUIREMENTS.— 

10 Nothing in this subsection shall be construed to su11 persede any Federal privacy or confidentiality re12 quirement, including the regulations promulgated 

13 under section 264(c) of the Health Insurance Port14 ability and Accountability Act of 1996 and section 

15 543 of the Public Health Service Act and any regu16 lations promulgated thereunder. 

17 ‘‘(4) APPLICATION TO TERRITORIES.— 

18 ‘‘(A) IN GENERAL.—To the extent that the 

19 Secretary determines that it is not practicable 

20 for a State specified in subparagraph (B) to re21 port information in accordance with the method 

22 made available under paragraph (1), this sub23 section shall not apply with respect to such 

24 State. 


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1 ‘‘(B) TERRITORIES SPECIFIED.—The 

2 States specified in this subparagraph are Puer3 to Rico, the Virgin Islands, Guam, American 

4 Samoa, and the Northern Mariana Islands. 

5 ‘‘(5) APPLICATION.— 

6 ‘‘(A) IN GENERAL.—Subject to subpara7 graph (B), the requirement for a State to col8 lect information in accordance with the method 

9 made available under paragraph (1) shall not 

10 apply to the State before the date that is 4 

11 years after the date of enactment of this sub12 section. 

13 ‘‘(B) ALTERNATIVE DATE.—If an action 

14 plan is submitted to Congress under section 

15 13(a)(4) of the Healthy Moms and Babies Act, 

16 in lieu of the date described in subparagraph 

17 (A), the requirement for a State to collect infor18 mation in accordance with the method made 

19 available under paragraph (1) shall not apply to 

20 the State before the date specified in such ac21 tion plan. 

22 ‘‘(6) APPROPRIATION.—There is appropriated 

23 to the Secretary for fiscal year 2023 and each fiscal 

24 year thereafter $1,000,000 to carry out the provi25 sions of this section and subsection (b)(2)(B).’’. 


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1 (c) REPORT ON DATA ANALYSES.—Section 

2 1946(b)(2) of such Act (42 U.S.C. 1396w–5(b)(2)) is 

3 amended— 

4 (1) by striking ‘‘Not later than’’ and inserting 

5 the following: 

6 ‘‘(A) INITIAL REPORTS.—Not later than’’; 

7 and 

8 (2) by adding at the end the following: 

9 ‘‘(B) REPORTS ON COLLECTION OF INFOR10 MATION RELATED TO SOCIAL DETERMINANTS

11 OF HEALTH.— 

12 ‘‘(i) IN GENERAL.—Not later than 5 

13 years after the date on which the require14 ment to collect information under sub15 section (d) is first applicable to States, the 

16 Secretary shall submit to Congress a re17 port that includes aggregate findings and 

18 trends across respective beneficiary popu19 lations for improving the identification of 

20 social determinants of health for bene21 ficiaries under this title and beneficiaries 

22 under title XXI based on analyses of the 

23 data collected under subsection (d). 

24 ‘‘(ii) INTERIM REPORT.—Not later 

25 than 3 years after the date of enactment 


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1 of this subparagraph, the Secretary shall 

2 submit to Congress an interim report on 

3 progress in developing, implementing, and 

4 utilizing the method selected by the Sec5 retary under subsection (d)(1) along with 

6 any available, preliminary information that 

7 has been collected using such method.’’. 

8 (d) CONFORMING AMENDMENT.—Section 2107(e)(1) 

9 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

10 amended by adding at the end the following: 

11 ‘‘(U) Section 1946 (relating to addressing 

12 health care disparities).’’. 

13 SEC. 13. REPORT ON PAYMENT METHODOLOGIES FOR 

14 TRANSFERRING PREGNANT WOMEN BE15 TWEEN FACILITIES BEFORE, DURING, AND 

16 AFTER CHILDBIRTH. 

17 (a) IN GENERAL.—Subject to the availability of ap18 propriations, not later than 36 months after the date of 

19 enactment of this Act, the Secretary shall submit to Con20 gress a report on the payment methodologies under Med21 icaid for the antepartum, intrapartum, and postpartum 

22 transfer of pregnant women from one health care facility 

23 to another, including any potential disincentives or regu24 latory barriers to such transfers. 


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1 (b) CONSULTATION.—In developing the report re2 quired under subsection (a), the Secretary shall consult 

3 with the advisory committee established under section 

4 12(c). 

5 SEC. 14. MEDICAID GUIDANCE ON STATE OPTIONS TO AD6 DRESS SOCIAL DETERMINANTS OF HEALTH 

7 FOR PREGNANT AND POSTPARTUM WOMEN. 

8 Not later than 1 year after the date of enactment 

9 of this Act, the Secretary shall issue guidance to States 

10 regarding options States may employ to address social de11 terminants of health, as defined by the Healthy People 

12 2030 and related initiatives of the Office of Disease Pre13 vention and Health Promotion of the Department of 

14 Health and Human Services, including for pregnant and 

15 postpartum women. Such guidance shall, at a minimum, 

16 describe the authorities that States may leverage to sup17 port addressing the social determinants of health for preg18 nant and postpartum women and outline best practices for 

19 such efforts. 

20 SEC. 15. PAYMENT ERROR RATE MEASUREMENT (PERM) 

21 AUDIT AND IMPROVEMENT REQUIREMENTS. 

22 (a) BIENNIAL PERM AUDIT REQUIREMENT.—Be23 ginning with fiscal year 2024, the Administrator shall con24 duct payment error rate measurement (‘‘PERM’’) audits 

25 of each State Medicaid program on a biennial basis. 


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1 (b) PERM ERROR RATE REDUCTION PLAN RE2 QUIREMENT.—Beginning with fiscal year 2025, any State 

3 with an overall PERM error rate exceeding 15 percent in 

4 a PERM audit conducted with respect to the State in the 

5 previous fiscal year shall publish a plan, in coordination 

6 with, and subject to the approval of, the Administrator, 

7 for how the State will reduce its PERM error rate below 

8 15 percent in the current fiscal year. 

9 (c) NOTIFICATION; IDENTIFICATION OF SOURCES OF

10 IMPROPER PAYMENTS.— 

11 (1) NOTIFICATION.—Not later than 6 months 

12 after the date of enactment of this Act, the Adminis13 trator shall notify the contractor conducting PERM 

14 audits of the Administrator’s intent to modify con15 tracts to require PERM audits not less than once 

16 every other year in each State. 

17 (2) IDENTIFICATION OF SOURCES OF IMPROPER

18 PAYMENTS.—The Administrator shall direct the con19 tractor conducting PERM audits of State Medicaid 

20 programs to identify areas known to be sources of 

21 improper payments under such programs to identify 

22 program areas or components known to be sources 

23 of high risk for improper payments under such pro24 grams. 


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1 (d) STATE MEDICAID DIRECTOR LETTER.—Not later 

2 than 12 months after the date of enactment of this Act, 

3 the Administrator shall issue a State Medicaid Director 

4 letter regarding State requirements under Federal law and 

5 regulations regarding avoiding and responding to im6 proper payments under State Medicaid programs. 

7 (e) STATE IMPROPER PAYMENT MITIGATION

8 PLANS.— 

9 (1) IN GENERAL.—Not later than January 1, 

10 2023, each State Medicaid program shall submit to 

11 the Administrator a plan, which shall include spe12 cific actions and timeframes for taking such actions 

13 and achieving specified results, for mitigating im14 proper payments under such program. 

15 (2) PUBLICATION OF STATE PLANS.—The Ad16 ministrator shall make State plans submitted under 

17 paragraph (1) available to the public. 

18 (f) DEFINITIONS.—In this section: 

19 (1) ADMINISTRATOR.—The term ‘‘Adminis20 trator’’ means the Administrator of the Centers for 

21 Medicare & Medicaid Services. 

22 (2) STATE.—The term ‘‘State’’ has the mean23 ing given such term for purposes of title XIX of the 

24 Social Security Act (42 U.S.C. 1396 et seq.). 


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1 (3) STATE MEDICAID PROGRAM.—The term 

2 ‘‘State Medicaid program’’ means a State plan 

3 under title XIX of the Social Security Act (42 

4 U.S.C. 1396 et seq.), and includes any waiver of 

5 such a plan. 

Æ 


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