```

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 5015 Introduced in Senate (IS)]

<DOC>

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.

    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 
                            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.

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 
              CAESAREAN SECTIONS.

    (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, 2024, and 
        annually thereafter through January 1, 2034, 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, 
                2024, 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 Caesarean Births.--
            (1) Study.--The Comptroller General shall conduct a study 
        regarding caesarean births under State Medicaid programs. The 
        study shall include analyses of the following:
                    (A) Changes in Medicaid payment rates for caesarean 
                births and vaginal births over time, disaggregated by 
                rates paid by fee-for-service Medicaid programs and by 
                Medicaid programs that contract with medicaid managed 
                care organizations and other specified entities to 
                furnish medical assistance under such programs.
                    (B) The frequency of primary and repeat caesarean 
                births, as well as vaginal births after a caesarean, 
                under Medicaid programs and a comparison of such 
                frequency with the frequency of such births when paid 
                for under a group health plan or by a health insurance 
                issuer offering group or individual health insurance 
                coverage. To the extent feasible, this information 
                should be disaggregated according to race and 
                ethnicity.
                    (C) Comparisons of payment rates for caesarean and 
                vaginal births under Medicaid programs with the payment 
                rates for such births under a group health plan or by a 
                health insurance issuer offering group or individual 
                health insurance coverage.
                    (D) Such other factors related to payment rates for 
                caesarean 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 Caesarean Births.--
            (1) In general.--The Comptroller General shall conduct a 
        study on racial disparities in the frequency of low- and high-
        risk caesarean births across hospitals of different settings 
        (rural, urban, and suburban), volumes, and types (such as 
        teaching, private, public, and not-for-profit) in a selection 
        of 10 States. The study shall compare such information with 
        respect to Medicaid and private payers and compare total 
        charges, if feasible. The study shall also investigate, to the 
        extent practicable, the day of the week and time of day that 
        such births occur at a subset of hospitals in the selected 
        States. 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.

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, 2025, 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. 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, 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 all applicable measures for 
                determining the quality of services provided by such 
                provider, team of health care professionals, or health 
                team.
                    ``(C) Such other information as the Secretary shall 
                specify in guidance.
            ``(2) State reporting requirements.--
                    ``(A) Comprehensive report.--A State with a State 
                plan amendment approved under this section shall report 
                to the Secretary (and, upon request, to the Medicaid 
                and CHIP Payment and Access Commission), at such time, 
                but at a minimum frequency of every 12 months, and in 
                such form and manner determined by the Secretary to be 
                reasonable and minimally burdensome, including through 
                a health information exchange or other public health 
                data sharing entity, the following information:
                            ``(i) Information described in paragraph 
                        (1).
                            ``(ii) The number and, to the extent 
                        available and while maintaining all relevant 
                        protecting privacy and confidentially 
                        protections, disaggregated demographic 
                        information of eligible women who have enrolled 
                        in a maternity health home pursuant to this 
                        section.
                            ``(iii) The number of maternity health 
                        homes in the State.
                            ``(iv) The medical 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, 2024, 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 2023 through 2025, 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. MACPAC STUDY ON DOULAS AND COMMUNITY HEALTH WORKERS.

    (a) 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:
            (1) 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.
            (2) 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.
            (3) 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.
            (4) An assessment of the impact of the involvement of 
        doulas and community health workers on maternal health 
        outcomes.
            (5) Recommendations, as MACPAC deems appropriate, for 
        legislative and administrative actions to increase access to 
        services that improve maternal health.
    (b) Stakeholder Consultation.--In developing the report required 
under subsection (a), MACPAC shall consult with relevant stakeholders, 
including--
            (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. 8. 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. 9. 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. 10. 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. 11. 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 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 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.
                                    (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.--The Federal Advisory Committee 
        Act (5 U.S.C. App.) 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, pre-natal 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. 12. 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 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 13(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 2023 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:
                    ``(U) Section 1946 (relating to addressing health 
                care disparities).''.

SEC. 13. 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. 14. MEDICAID GUIDANCE ON STATE OPTIONS TO ADDRESS SOCIAL 
              DETERMINANTS OF HEALTH FOR PREGNANT AND POSTPARTUM WOMEN.

    Not later than 1 year after the date of enactment of this Act, the 
Secretary shall issue guidance to States 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. Such guidance 
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.

SEC. 15. PAYMENT ERROR RATE MEASUREMENT (PERM) AUDIT AND IMPROVEMENT 
              REQUIREMENTS.

    (a) Biennial PERM Audit Requirement.--Beginning with fiscal year 
2024, 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 2025, 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, 2023, 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.
                                 <all>
```