II 

118TH CONGRESS 

2D SESSION S. 5236 

To amend titles XIX and XXI of the Social Security Act to enhance financial 

support for rural and safety net hospitals providing maternity, labor, 

and delivery services to vulnerable populations, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 25, 2024 

Mr. WYDEN (for himself, Ms. HASSAN, Ms. STABENOW, Ms. CANTWELL, Mr. 

CARPER, Mr. CARDIN, Mr. BROWN, Mr. BENNET, Mr. CASEY, Mr. WARNER, Mr. WHITEHOUSE, Ms. CORTEZ MASTO, Ms. WARREN, Mr. HELMY, 

Ms. DUCKWORTH, Mr. BOOKER, Mr. MERKLEY, and Mrs. MURRAY) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to enhance financial support for rural and safety net 

hospitals providing maternity, labor, and delivery services 

to vulnerable populations, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Keeping Obstetrics Local Act’’. 


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

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—ENHANCING FINANCIAL SUPPORT FOR RURAL AND 

SAFETY NET HOSPITALS THAT PROVIDE OBSTETRIC SERVICES 

Sec. 101. State studies and HHS report on costs of providing maternity, labor, 

and delivery services. 

Sec. 102. Requiring adequate payment rates under Medicaid for maternity, 

labor, and delivery services at eligible hospitals. 

Sec. 103. Increased Federal financial participation for maternity, labor, and delivery services furnished by eligible hospitals. 

Sec. 104. Labor and delivery services anchor payments. 

Sec. 105. Application of adequate payment requirement and increased Federal 

financial participation requirements to CHIP. 

Sec. 106. Disregarding increased and additional payments to hospitals for purposes of other supplemental payments and upper payment limits. 

TITLE II—EXPAND COVERAGE OF MATERNAL HEALTH CARE 

Sec. 201. Requiring 12-month continuous, full benefit coverage for pregnant individuals under Medicaid and CHIP. 

Sec. 202. Health homes for pregnant and postpartum women. 

Sec. 203. Guidance on supporting and improving access to Medicaid and CHIP 

coverage of services provided by doulas and certain maternal 

health professionals. 

Sec. 204. Medicaid and CHIP increased financial support for depression and 

anxiety screening during the perinatal and postpartum periods. 

Sec. 205. Presumptive eligibility for pregnant individuals. 

TITLE III—INVEST IN THE MATERNAL HEALTH CARE 

WORKFORCE 

Sec. 301. Emergency obstetric workforce support. 

Sec. 302. Streamlined screening and enrollment of providers of maternity, 

labor, and delivery services in neighboring States. 

TITLE IV—REQUIRING PUBLIC COMMUNICATION OF OBSTETRICS 

DATA AND UNIT CLOSURES 

Sec. 401. Timely notifications of impending hospital obstetric unit closures. 

Sec. 402. Collection of data relating to hospital labor and delivery services. 


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1 TITLE I—ENHANCING FINAN2 CIAL SUPPORT FOR RURAL 

3 AND SAFETY NET HOSPITALS 

4 THAT PROVIDE OBSTETRIC 

5 SERVICES 

6 SEC. 101. STATE STUDIES AND HHS REPORT ON COSTS OF 

7 PROVIDING MATERNITY, LABOR, AND DELIV8 ERY SERVICES. 

9 (a) STATE STUDY.— 

10 (1) IN GENERAL.—In order to meet the require11 ment of section 1902(a)(6) of the Social Security 

12 Act (42 U.S.C. 1396a(a)(6)), not later than 1 year 

13 after the date of enactment of this Act, and every 

14 5 years thereafter, each State (as such term is de15 fined in section 1101(a)(1) of the Social Security 

16 Act (42 U.S.C. 1301(a)(1)) for purposes of titles 

17 XIX and XXI of such Act) shall conduct a study on 

18 the costs of providing maternity, labor, and delivery 

19 services in hospitals and submit the results of such 

20 study to the Secretary of Health and Human Serv21 ices (referred to in this section as the ‘‘Secretary’’). 

22 (2) CONTENT OF STUDY.—A State study re23 quired under paragraph (1) shall include the fol24 lowing information with respect to maternity, labor, 


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1 and delivery services furnished by hospitals located 

2 in the State: 

3 (A) An estimate of the cost of providing 

4 maternity, labor, and delivery services at hos5 pitals for which more than 50 percent of births 

6 are financed by the Medicaid program or the 

7 Children’s Health Insurance Program, based on 

8 the expenditures a representative sample of 

9 such hospitals incurred for providing such serv10 ices during the 2 most recent years for which 

11 data is available. 

12 (B) An estimate of the full cost of pro13 viding maternity, labor, and delivery services at 

14 independent rural hospitals with less than 300 

15 births per year, based on the expenditures a 

16 representative sample of such hospitals incurred 

17 for providing such services during the 2 most 

18 recent years for which data are available. 

19 (C) An estimate of the cost of providing 

20 maternity services at hospitals that ceased pro21 viding labor and delivery services within the 

22 past 5 years, based on the expenditures a rep23 resentative sample of such hospitals incurred 

24 for providing such services during the 2 most 

25 recent years for which data is available. 


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1 (D) To the extent data allows, an analysis 

2 of the extent to which factors such as geo3 graphic location and community population af4 fect the cost of providing maternity, labor, and 

5 delivery services at hospitals, including the cost 

6 of hospital services that support the provision of 

7 maternity, labor, and delivery services. 

8 (E) The amounts hospitals are paid for 

9 maternity, labor, and delivery services, by geo10 graphic location and hospital size, under Medi11 care, the State Medicaid program, the State 

12 CHIP plan, and private health insurance, in13 cluding, with respect to the State Medicaid pro14 gram, the State CHIP plan, and private health 

15 insurance, payment amounts for such services 

16 under fee-for-service payment arrangements 

17 and under managed care (as applicable). 

18 (F) A comparative payment rate anal19 ysis— 

20 (i) comparing maternity, labor, and 

21 delivery services payment rates under the 

22 State Medicaid fee-for-service program to 

23 payment rates for such services under 

24 Medicare (as described in section 

25 447.203(b)(3) of title 42, Code of Federal 


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1 Regulations), other federally-funded or 

2 State-funded programs (including, to the 

3 extent data is available, Medicaid managed 

4 care rates), and to the payment rates, to 

5 the extent data is available, of private 

6 health insurers within geographic areas of 

7 the State; and 

8 (ii) analyzing different payment meth9 ods for such services, such as the use of 

10 bundled payments, quality incentives, and 

11 low-volume adjustments. 

12 (G) An evaluation of whether each hospital 

13 located in the State that furnishes maternity, 

14 labor, and delivery services is expected to expe15 rience in the next 3 years— 

16 (i) significant changes in particular 

17 expenditures or types of reimbursement for 

18 maternity, labor, and delivery services; or 

19 (ii) any other significant change that 

20 is likely to affect the hospital’s ability to 

21 continue to provide such services. 

22 (3) ASSISTANCE TO SMALL HOSPITALS IN COM23 PILING COST INFORMATION.—There is appropriated 

24 to the Secretary for each fiscal year beginning with 

25 fiscal year 2025, $10,000,000 for the purpose of 


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1 providing grants and technical assistance to small 

2 rural obstetric hospitals to enable such hospitals to 

3 compile detailed information on expenses incurred 

4 for maternity, labor, and delivery services for use in 

5 the State studies required under paragraph (1), to 

6 remain available until expended. 

7 (4) HHS REPORT ON STATE STUDIES.—For 

8 each year in which State studies are required to be 

9 conducted under paragraph (1), the Secretary shall 

10 issue a public report that compiles and details the 

11 results of such studies and includes the information 

12 described in paragraph (2). 

13 (b) HHS REPORT AND PROPOSED LEGISLATION.— 

14 Not later than 2 years after the date of enactment of this 

15 Act, the Secretary shall submit to Congress and make 

16 publicly available a report analyzing the first studies con17 ducted by States under subsection (a)(1) that includes— 

18 (1) recommendations for improving data collec19 tion on the cost of providing maternity, labor, and 

20 delivery services; 

21 (2) guidance to States on the collection of such 

22 data; and 

23 (3) if the Secretary determines it appropriate 

24 based on the findings made by the Secretary in such 

25 report, proposed legislation or administrative action, 


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1 including, to the extent the Secretary determines ap2 propriate, issuance of regulations, to adjust the 

3 amounts paid for maternity, labor, and delivery serv4 ices under Medicare, State Medicaid plans, and 

5 other federally-funded payers, to more accurately 

6 compensate eligible hospitals (as such term is de7 fined in subsection (uu) of section 1902 of the Social 

8 Security Act (42 U.S.C. 1396a), as added by section 

9 102) for the cost of providing such services. 

10 SEC. 102. REQUIRING ADEQUATE PAYMENT RATES UNDER 

11 MEDICAID FOR MATERNITY, LABOR, AND DE12 LIVERY SERVICES AT ELIGIBLE HOSPITALS. 

13 (a) FEE-FOR-SERVICE PAYMENTS.—Section 1902 of 

14 the Social Security Act (42 U.S.C. 1396a) is amended— 

15 (1) in subsection (a)(13)— 

16 (A) by striking ‘‘and’’ at the end of sub17 paragraph (B); 

18 (B) by adding ‘‘and’’ at the end of sub19 paragraph (C); and 

20 (C) by adding at the end the following new 

21 subparagraph: 

22 ‘‘(D) for each fiscal year beginning with 

23 fiscal year 2026, payment for maternity, labor, 

24 and delivery services (as defined in subsection 

25 (uu)) furnished during such fiscal year in an elVerDate Sep 11 2014 07:06 Oct 16, 2024 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S5236.IS S5236

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1 igible hospital (as defined in such subsection) at 

2 a rate that is not less than the minimum pay3 ment rate specified for the fiscal year in para4 graph (4) of such subsection;’’; and 

5 (2) by adding at the end the following new sub6 section: 

7 ‘‘(uu) MATERNITY, LABOR, AND DELIVERY SERV8 ICES AND ELIGIBLE HOSPITALS DEFINED.—For purposes 

9 of subsection (a)(13)(D)— 

10 ‘‘(1) MATERNITY, LABOR, AND DELIVERY SERV11 ICES.— 

12 ‘‘(A) IN GENERAL.—The term ‘maternity, 

13 labor, and delivery services’ means such inpa14 tient hospital services and outpatient hospital 

15 services, including behavioral health services, 

16 that are provided in relation to maternity care 

17 or labor and delivery, identified by appropriate 

18 ICD and CPT codes, as the Secretary shall 

19 specify after consultation with professional or 

20 medical societies with expertise in pregnancy, 

21 childbirth, and postpartum care. 

22 ‘‘(B) SCOPE.—Such term shall not be lim23 ited in application, for any eligible hospital, 

24 only to services that relate to a birth that oc25 curs in the hospital. 


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1 ‘‘(C) RULEMAKING.—Not later than July 

2 1, 2025, the Secretary shall issue an interim 

3 final rule specifying which services shall be con4 sidered maternity, labor, and delivery services 

5 for purposes of this subsection and subsection 

6 (a)(13)(D). 

7 ‘‘(2) ELIGIBLE HOSPITAL.— 

8 ‘‘(A) IN GENERAL.—The term ‘eligible hos9 pital’ means, with respect to a State and fiscal 

10 year— 

11 ‘‘(i) a hospital that is located in a 

12 rural area (as defined by the Federal Of13 fice of Rural Health Policy for the purpose 

14 of rural health grant programs adminis15 tered by such Office); 

16 ‘‘(ii) a critical access hospital (as de17 fined in section 1861(mm)(1)); 

18 ‘‘(iii) a hospital operated by the In19 dian Health Service or an Indian Tribe 

20 under the Indian Self-Determination and 

21 Education Assistance Act; 

22 ‘‘(iv) a hospital for which, in the most 

23 recent 12-month period for which data is 

24 available, at least 50 percent of all births 

25 for which the hospital provided maternity, 


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1 labor, and delivery services during such fis2 cal year were qualifying births; or 

3 ‘‘(v) a hospital that is able to dem4 onstrate, through a process to be deter5 mined by the Secretary, that, for the appli6 cable fiscal year, the hospital projects that 

7 at least 50 percent of all births for which 

8 the hospital will provide maternity, labor, 

9 and delivery services during such fiscal 

10 year will be qualifying births. 

11 ‘‘(B) IDENTIFICATION OF ELIGIBLE HOS12 PITALS.—Each State, subject to the approval of 

13 the Secretary, shall identify the hospitals in the 

14 State that are eligible hospitals with respect to 

15 a fiscal year. 

16 ‘‘(3) QUALIFYING BIRTH.—For purposes of 

17 paragraph (2), the term ‘qualifying birth’ means a 

18 birth for which any maternity, labor, and delivery 

19 services associated with the birth— 

20 ‘‘(A) were paid for under a State plan 

21 under this title (or under a waiver of such a 

22 plan) or under a State child health plan under 

23 title XXI (or under a waiver of such a plan); 

24 ‘‘(B) were paid for under title XVIII; 


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1 ‘‘(C) were provided by the Indian Health 

2 Service or a Native Hawaiian health care sys3 tem (as defined in section 12 of the Native Ha4 waiian Health Care Improvement Act); or 

5 ‘‘(D) were provided to a patient who does 

6 not have minimum essential coverage (as de7 fined in section 5000A(f) of the Internal Rev8 enue Code of 1986) and were not fully paid for 

9 by such patient. 

10 ‘‘(4) MINIMUM PAYMENT RATE SPECIFIED.— 

11 The minimum payment rate specified in this para12 graph is, with respect to an eligible hospital and ma13 ternal, labor, and delivery services— 

14 ‘‘(A) for fiscal year 2026, 150 percent of 

15 the payment rate that would apply for such 

16 services and hospital under title XVIII; and 

17 ‘‘(B) for each period of 5 fiscal years be18 ginning with fiscal years 2027 through 2031, a 

19 payment rate that is determined for such period 

20 by the Secretary to accurately reflect the costs 

21 incurred by eligible hospitals in providing such 

22 services, informed by the results of the most re23 cent State studies submitted to the Secretary 

24 under section 101(a) of the Keeping Obstetrics 

25 Local Act.’’. 


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1 (b) UNDER MEDICAID MANAGED CARE PLANS.— 

2 Section 1932(f) of the Social Security Act (42 U.S.C. 

3 1396u–2(f)) is amended— 

4 (1) in the heading, by inserting ‘‘AND MATER5 NITY, LABOR, AND DELIVERY SERVICES AT ELIGI6 BLE HOSPITALS’’ after ‘‘SERVICES’’; and 

7 (2) by striking ‘‘described in section 

8 1902(a)(13)(C)’’ and inserting ‘‘described in sub9 paragraph (C) of section 1902(a)(13) or maternity, 

10 labor, and delivery services described in subpara11 graph (D) of such section that are furnished by an 

12 eligible hospital (as defined in section 1905(uu))’’. 

13 SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION 

14 FOR MATERNITY, LABOR, AND DELIVERY 

15 SERVICES FURNISHED BY ELIGIBLE HOS16 PITALS. 

17 Section 1905 of the Social Security Act (42 U.S.C. 

18 1396d) is amended— 

19 (1) in subsection (b), by striking ‘‘and (ii)’’ and 

20 inserting ‘‘(ii), and (kk)’’; and 

21 (2) by adding at the end the following new sub22 section: 

23 ‘‘(kk) MATERNITY, LABOR, AND DELIVERY SERV24 ICES.— 


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

2 (b), with respect to State expenditures for medical 

3 assistance for maternity, labor, and delivery services 

4 furnished by an eligible hospital (as such terms are 

5 defined in section 1902(uu)) in a fiscal quarter that 

6 begins on or after October 1, 2025— 

7 ‘‘(A) the Federal medical assistance per8 centage applicable to the enhanced payment 

9 rate amount of such expenditures (as deter10 mined for the State and quarter under para11 graph (2)(A)) shall be equal to 100 percent; 

12 and 

13 ‘‘(B) subject to paragraph (3), the Federal 

14 medical assistance percentage applicable to the 

15 base payment rate amount of such expenditures 

16 (as determined for the State and quarter under 

17 paragraph (2)(B)) shall be equal to the en18 hanced FMAP determined for the State and 

19 quarter under section 2105(b). 

20 ‘‘(2) DETERMINATION OF ENHANCED PAYMENT

21 RATE AMOUNT AND BASE PAYMENT RATE

22 AMOUNT.— 

23 ‘‘(A) ENHANCED PAYMENT RATE

24 AMOUNT.— 


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1 ‘‘(i) IN GENERAL.—For purposes of 

2 paragraph (1)(A), the enhanced payment 

3 rate amount for a State and fiscal quarter 

4 is equal to the amount of State expendi5 tures for medical assistance for maternity, 

6 labor, and delivery services furnished by an 

7 eligible hospital (as such terms are defined 

8 in section 1902(uu)) in such fiscal quarter 

9 that is attributable to the amount by which 

10 the minimum payment rate required under 

11 section 1902(a)(13)(D) (or, by application, 

12 section 1932(f)) exceeds the base payment 

13 rate applicable to such services, as deter14 mined for the State, quarter, and services 

15 under clause (ii). 

16 ‘‘(ii) BASE PAYMENT RATE.—For pur17 poses of clause (i), the base payment rate 

18 determined for a State, a fiscal quarter, 

19 and maternity, labor, and delivery services 

20 (as defined in section 1902(uu)) shall be 

21 equal to— 

22 ‘‘(I) the payment rate applicable 

23 to such services under the State plan 

24 (or under a waiver of such plan) as of 

25 January 1, 2024; increased by 


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1 ‘‘(II) the percentage increase in 

2 the medical care component of the 

3 consumer price index for all urban 

4 consumers from January of 2024 to 

5 the month ending on the day before 

6 the 1st day of such fiscal quarter. 

7 ‘‘(B) BASE PAYMENT RATE AMOUNT.—For 

8 purposes of paragraph (1)(B), the base pay9 ment rate amount for a State and fiscal quarter 

10 is equal to— 

11 ‘‘(i) the total amount of State expend12 itures for medical assistance for maternity, 

13 labor, and delivery services furnished by an 

14 eligible hospital (as such terms are defined 

15 in section 1902(uu)) in such fiscal quarter; 

16 minus 

17 ‘‘(ii) the enhanced payment rate 

18 amount determined for the State and fiscal 

19 quarter under subparagraph (A). 

20 ‘‘(3) APPLICATION OF HIGHER MATCH.—Sub21 paragraph (B) of paragraph (1) shall not apply in 

22 the case of State expenditures described in such sub23 paragraph if the application of such subparagraph 

24 would result in a lower Federal medical assistance 

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1 wise apply without the application of such para2 graph. 

3 ‘‘(4) EXCLUSION OF EXPENDITURES FROM TER4 RITORIAL CAPS.—Any payment made to a territory 

5 for medical assistance that is subject to the Federal 

6 medical assistance percentage specified in paragraph 

7 (1)(A) or the enhanced FMAP referred to in para8 graph (1)(B) shall not be taken into account for 

9 purposes of applying payment limits under sub10 sections (f) and (g) of section 1108.’’. 

11 SEC. 104. LABOR AND DELIVERY SERVICES ANCHOR PAY12 MENTS. 

13 (a) STATE REQUIREMENT.—Section 1902(a)(13)(A) 

14 of the Social Security Act (42 U.S.C. 1396a(a)(13)(A)) 

15 is amended— 

16 (1) in clause (iii), by striking ‘‘and’’ at the end; 

17 (2) in clause (iv), by striking the semicolon at 

18 the end and inserting ‘‘, and’’; and 

19 (3) by adding at the end the following new 

20 clause: 

21 ‘‘(v) in the case of hospitals, such 

22 rates take into account (in a manner con23 sistent with section 1923A) the situation of 

24 low volume obstetric hospitals (as such 

25 term is defined in such section);’’. 


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1 (b) REQUIRING ANCHOR PAYMENTS FOR LOW VOL2 UME OBSTETRIC HOSPITALS.—Title XIX of the Social Se3 curity Act (42 U.S.C. 1396 et seq.) is amended by insert4 ing the following after section 1923: 

5 ‘‘SEC. 1923A. ANCHOR PAYMENTS FOR LABOR AND DELIV6 ERY SERVICES PROVIDED BY LOW VOLUME 

7 OBSTETRIC HOSPITALS. 

8 ‘‘(a) IMPLEMENTATION OF REQUIREMENT.—A State 

9 plan under this title shall not be considered to meet the 

10 requirement of section 1902(a)(13)(A)(v) (insofar as it re11 quires payments to hospitals to take into account the situ12 ation of low volume obstetric hospitals), as of October 1, 

13 2025, unless the State has submitted to the Secretary, by 

14 not later than such date, an amendment to such plan that 

15 provides for an annual anchor payment to such hospitals, 

16 consistent with subsection (c). 

17 ‘‘(b) DEFINITIONS.—In this section: 

18 ‘‘(1) ANTENATAL TRANSFER.—The term 

19 ‘antenatal transfer’ means, with respect to a hos20 pital, a pregnant individual who was expected to re21 ceive labor and delivery services at the hospital but 

22 who is transferred to a different hospital because of 

23 a need for labor and delivery services that are not 

24 available at the transferring hospital. 


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1 ‘‘(2) DELIVERY VOLUME.—The term ‘delivery 

2 volume’ means, with respect to a hospital and a fis3 cal year, the total number of births occurring in, and 

4 antenatal transfers made by, such hospital during 

5 such year. 

6 ‘‘(3) LABOR AND DELIVERY REVENUE

7 FLOOR.—The term ‘labor and delivery revenue floor’ 

8 means, with respect to a low volume obstetric hos9 pital and a fiscal year, the amount equal to the sum 

10 of— 

11 ‘‘(A) the product of— 

12 ‘‘(i) the delivery volume for such hos13 pital and fiscal year; and 

14 ‘‘(ii) the per delivery amount for such 

15 fiscal year; and 

16 ‘‘(B) the standby capacity amount for such 

17 fiscal year. 

18 ‘‘(4) LABOR AND DELIVERY SERVICES.—The 

19 term ‘labor and delivery services’ means such inpa20 tient and outpatient hospital services related to labor 

21 and delivery, including services related to antenatal 

22 transfers, identified by appropriate ICD and CPT 

23 codes, as the Secretary shall specify in consultation 

24 with professional or medical societies with expertise 

25 in this area. 


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1 ‘‘(5) LOW VOLUME OBSTETRIC HOSPITAL.—The 

2 term ‘low volume obstetric hospital’ means, with re3 spect to a hospital and a fiscal year, a hospital— 

4 ‘‘(A) that is an eligible hospital (as defined 

5 in section 1902(uu)(2)); 

6 ‘‘(B) in which the average number of 

7 births for which the hospital provided labor and 

8 delivery services during the preceding 3 fiscal 

9 years is less than 300 births per year; 

10 ‘‘(C) that did not provide labor and deliv11 ery services in the preceding fiscal year, but in 

12 which the average number of births for which 

13 the hospital provided labor and delivery services 

14 during the most recent 3 fiscal years in which 

15 the hospital provided labor and delivery services 

16 is less than 300 births per year; 

17 ‘‘(D) that is not described in subparagraph 

18 (B) or (C) but, in the applicable fiscal year, 

19 provides labor and delivery services for fewer 

20 than 300 births; or 

21 ‘‘(E) that is not described in subpara22 graphs (B) through (D) but is certified by the 

23 State in which the hospital is located as meet24 ing such criteria as the Secretary shall establish 

25 for identifying hospitals that are essential to 


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1 meeting the needs of an underserved popu2 lation, such as serving a population with limited 

3 English proficiency, serving specific racial or 

4 ethnic populations, or other factors. 

5 ‘‘(6) MEDICAID LABOR AND DELIVERY REV6 ENUE FLOOR.—The term ‘Medicaid labor and deliv7 ery revenue floor’ means, with respect to a low vol8 ume obstetric hospital and a fiscal year, the product 

9 of— 

10 ‘‘(A) the labor and delivery revenue floor 

11 for such hospital and fiscal year; and 

12 ‘‘(B) the percentage of the delivery volume 

13 of such hospital in such fiscal year that were 

14 paid for under a State plan under this title (or 

15 under a waiver of such a plan) or under a State 

16 child health plan under title XXI (or under a 

17 waiver of such a plan). 

18 ‘‘(7) PER DELIVERY AMOUNT.— 

19 ‘‘(A) IN GENERAL.—The term ‘per delivery 

20 amount’ means, with respect to a fiscal year, an 

21 amount, as determined under subparagraph 

22 (B), that represents the marginal cost to a low 

23 volume obstetric hospital of a birth or an 

24 antenatal transfer. 


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1 ‘‘(B) DETERMINATION OF PER DELIVERY

2 AMOUNT.— 

3 ‘‘(i) FISCAL YEAR 2027.—For fiscal 

4 year 2027, the per delivery amount shall 

5 be $10,000. 

6 ‘‘(ii) INDEXING.—Subject to clause 

7 (iii), for each fiscal year after fiscal year 

8 2027, the per delivery amount shall be the 

9 amount that applied under this subpara10 graph for the preceding fiscal year in11 creased by the percentage increase in the 

12 medical care component of the consumer 

13 price index for all urban consumers for the 

14 12-month period ending with September of 

15 such preceding fiscal year. 

16 ‘‘(iii) PERIODIC REVISION OF PER DE17 LIVERY AMOUNT.—Not less than once 

18 every 5 fiscal years, the Secretary shall col19 lect and analyze data on the costs of labor 

20 and delivery services at low volume obstet21 ric hospitals and, through rulemaking, 

22 shall establish a new per delivery amount 

23 for purposes of this section to ensure that 

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1 ginal cost to a low volume obstetric hos2 pital of a birth or an antenatal delivery. 

3 ‘‘(8) STANDBY CAPACITY AMOUNT.— 

4 ‘‘(A) IN GENERAL.—The term ‘standby ca5 pacity amount’ means, with respect to a fiscal 

6 year, an amount, as determined under subpara7 graph (B), that represents the minimum level of 

8 expenditures by a low volume obstetric hospital 

9 that is necessary to ensure that adequate per10 sonnel, equipment, and facilities are available at 

11 all times to provide labor and delivery services. 

12 ‘‘(B) DETERMINATION OF STANDBY CA13 PACITY AMOUNT.— 

14 ‘‘(i) FISCAL YEAR 2027.—For fiscal 

15 year 2027, the standby capacity amount 

16 shall be $1,200,000. 

17 ‘‘(ii) INDEXING.—Subject to clause 

18 (iii), for each fiscal year after fiscal year 

19 2027, the standby capacity amount shall 

20 be the amount that applied under this sub21 paragraph for the preceding fiscal year in22 creased by the percentage increase in the 

23 medical care component of the consumer 

24 price index for all urban consumers for the 


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1 12-month period ending with September of 

2 such preceding fiscal year. 

3 ‘‘(iii) PERIODIC REVISION OF STAND4 BY CAPACITY AMOUNT.—Not less than 

5 once every 5 fiscal years, the Secretary 

6 shall collect and analyze data on the costs 

7 of labor and delivery services at low volume 

8 obstetric hospitals and, through rule9 making, shall establish a new standby ca10 pacity amount for purposes of this section 

11 to ensure that such amount accurately re12 flects the minimum level of expenditures by 

13 a low volume obstetric hospital that is nec14 essary to ensure that adequate personnel, 

15 equipment, and facilities are available at 

16 all times to provide labor and delivery serv17 ices. 

18 ‘‘(c) ANCHOR PAYMENT FOR LOW VOLUME OBSTET19 RIC HOSPITALS.—Not later than 3 months after the end 

20 of each fiscal year beginning with fiscal year 2027, each 

21 State shall pay to each low volume obstetric hospital in 

22 the State an amount that is equal to the amount (if any) 

23 by which— 

24 ‘‘(1) the Medicaid labor and delivery revenue 

25 floor for the hospital and fiscal year; exceeds 


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1 ‘‘(2) the total amount of all payments made to 

2 the low volume obstetric hospital under the State 

3 plan under this title (or under a waiver of such plan) 

4 and under the State child health plan under title 

5 XXI (or under a waiver of such plan) (other than 

6 payments under this section) for labor and delivery 

7 services provided by such hospital during such fiscal 

8 year. 

9 ‘‘(d) REQUIREMENTS FOR RECEIPT OF PAYMENTS.— 

10 No anchor payment shall be made to a low volume obstet11 ric hospital under this section for a fiscal year unless the 

12 hospital can satisfy the following requirements: 

13 ‘‘(1) SKILLS MAINTENANCE AND TRAINING AC14 TIVITIES.—The hospital demonstrates to the satis15 faction of the State that the hospital conducts and 

16 completes skills maintenance and training activities, 

17 including continuing education and training to sup18 port maintenance of obstetric skills, that satisfy such 

19 requirements as the Secretary, taking into consider20 ation nationally recognized obstetrics skills, mainte21 nance, and training standards such as standards 

22 published by the American College of Obstetricians 

23 and Gynecologists and the Association of Women’s 

24 Health, Obstetric, and Neonatal Nurses, shall speci25 fy for the purposes of this section. 


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1 ‘‘(2) CONTINUED PROVISION OF LABOR AND

2 DELIVERY SERVICES.— 

3 ‘‘(A) IN GENERAL.—The hospital and the 

4 State enter into a contract under which, in ex5 change for such payment under this section for 

6 a fiscal year, the hospital agrees to continue to 

7 provide labor and delivery services— 

8 ‘‘(i) for the period that begins with 

9 such fiscal year and ends on the last day 

10 of the second fiscal year that follows such 

11 fiscal year; and 

12 ‘‘(ii) at a level that is not less than 

13 the level at which the hospital provided 

14 such services in the fiscal year to which 

15 such payment relates, unless the hospital 

16 can demonstrate that the need for services 

17 in the community has decreased and that 

18 the new level of services will be adequate to 

19 meet that need. 

20 ‘‘(B) RECOVERY OF PAYMENT IN THE

21 EVENT OF BREACH OF CONTRACT BY HOS22 PITAL.—The terms of the contract between a 

23 hospital and a State required under subpara24 graph (A) shall provide that if the hospital does 

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1 quired under the contract throughout the period 

2 described in such subparagraph for any reason 

3 (including in the event of the hospital’s bank4 ruptcy or closure) the State may recover the 

5 full amount of the payment under this section 

6 to which the contract relates and in the event 

7 of the hospital’s bankruptcy, the State shall be 

8 given preferred creditor status for purposes of 

9 the collection of such payment. 

10 ‘‘(3) UTILIZATION OF FUNDS FOR LABOR AND

11 DELIVERY SERVICES.— 

12 ‘‘(A) IN GENERAL.—The hospital and the 

13 State enter into a contract under which, in ex14 change for such payment under this section, the 

15 hospital agrees to utilize funds received under 

16 such payment for the provision of labor and de17 livery services in the community served by the 

18 hospital. 

19 ‘‘(B) RECOVERY OF PAYMENT IN THE

20 EVENT OF BREACH OF CONTRACT BY HOS21 PITAL.—The terms of the contract between a 

22 hospital and a State required under subpara23 graph (A) shall provide that if the hospital does 

24 not utilize payment funds for labor and delivery 

25 services as required under the contract for any 


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1 reason (including in the event of the hospital’s 

2 bankruptcy or closure) the State may recover 

3 the full amount of the payment under this sec4 tion to which the contract relates and in the 

5 event of the hospital’s bankruptcy, the State 

6 shall be given preferred creditor status for pur7 poses of the collection of such payment. 

8 ‘‘(e) TREATMENT OF PAYMENTS; RECOVERY OF PAY9 MENTS.— 

10 ‘‘(1) IN GENERAL.—Payments made by a State 

11 under this section for a fiscal year— 

12 ‘‘(A) shall be in addition to any other pay13 ments made to hospitals for labor and delivery 

14 services under the State plan (or a waiver of 

15 such plan) under this title, under the State 

16 child health assistance plan under title XXI (or 

17 under a waiver of such plan), or under title 

18 XVIII for the fiscal year, including dispropor19 tionate share hospital payments under section 

20 1923 or section 1886(d)(5)(F) and other sup21 plemental payments that are not made under 

22 this section; and 

23 ‘‘(B) shall be treated as medical assistance 

24 for which payment is made under section 

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1 ance percentage applicable to amounts ex2 pended by a State for such payments shall be 

3 equal to the enhanced FMAP determined for 

4 the State and fiscal year under section 2105(b). 

5 ‘‘(2) PAYMENTS RECOVERED BY A STATE.—If a 

6 State recovers any amount of a payment made by a 

7 State under this section (whether pursuant to para8 graph (2)(B) or (3)(B) of subsection (d) or other9 wise), the amount so recovered shall be treated as an 

10 overpayment recovered by the State under section 

11 1903(d).’’. 

12 (c) CONFORMING AMENDMENTS.—Title XIX of the 

13 Social Security Act (42 U.S.C. 1396 et seq.) is amended 

14 as follows: 

15 (1) In section 1903— 

16 (A) in subsection (d)(6)(B)— 

17 (i) by striking ‘‘related to the total 

18 amount’’ and inserting the following: ‘‘re19 lated to— 

20 ‘‘(i) the total amount’’; 

21 (ii) by striking the period at the end 

22 and inserting ‘‘; and’’; and 

23 (iii) by adding at the end the fol24 lowing new clause: 


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1 ‘‘(ii) the total amount of payments made to 

2 individual providers (by provider) under section 

3 1923A during such fiscal year.’’; and 

4 (B) in subsection (bb)(2)(B)— 

5 (i) in the header, by inserting ‘‘AND

6 LOW VOLUME OBSTETRIC HOSPITAL’’ after 

7 ‘‘DSH’’; and 

8 (ii) by inserting ‘‘or a payment made 

9 to a low volume obstetric hospital under 

10 section 1923A’’ before the period. 

11 (2) In section 1905— 

12 (A) in subsection (cc), by striking ‘‘section 

13 1923’’ the second place it appears and inserting 

14 ‘‘section 1923 or 1923A’’; and 

15 (B) in subsection (ii)(2)(A), by inserting 

16 ‘‘or payments to low volume obstetric hospitals 

17 described in section 1923A’’ before the semi18 colon. 

19 SEC. 105. APPLICATION OF ADEQUATE PAYMENT REQUIRE20 MENT AND INCREASED FEDERAL FINANCIAL 

21 PARTICIPATION REQUIREMENTS TO CHIP. 

22 Section 2107(e)(1) of the Social Security Act (42 

23 U.S.C. 1397gg(e)(1)) is amended— 


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1 (1) by redesignating subparagraphs (B) 

2 through (U) as subparagraphs (C) through (V), re3 spectively; and 

4 (2) by inserting after subparagraph (A) the fol5 lowing new subparagraph: 

6 ‘‘(B) Section 1902(a)(13)(D) and section 

7 1905(kk) (relating to the minimum payment 

8 rate required for maternity, labor, and delivery 

9 services furnished by an eligible hospital and 

10 Federal financial participation for State ex11 penditures for such services).’’. 

12 SEC. 106. DISREGARDING INCREASED AND ADDITIONAL 

13 PAYMENTS TO HOSPITALS FOR PURPOSES OF 

14 OTHER SUPPLEMENTAL PAYMENTS AND 

15 UPPER PAYMENT LIMITS. 

16 A hospital’s eligibility for any federally-funded sup17 plemental payment (including a disproportionate share 

18 payment under section 1886(d)(5)(F) or 1923 of the So19 cial Security Act (42 U.S.C. 1395ww(d)(5)(F), 1396r–4)), 

20 the determination of the amount of such payment, and 

21 the application of any Federal limitation on the aggregate 

22 amount of payments that a State may make to the hos23 pital (including any upper payment limitation), shall be 

24 determined without regard to the amount of any increase 

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1 ment made to a hospital that is attributable to the amend2 ments made by this title. 

3 TITLE II—EXPAND COVERAGE 

4 OF MATERNAL HEALTH CARE 

5 SEC. 201. REQUIRING 12-MONTH CONTINUOUS, FULL BEN6 EFIT COVERAGE FOR PREGNANT INDIVID7 UALS UNDER MEDICAID AND CHIP. 

8 (a) MEDICAID.—Section 1902 of the Social Security 

9 Act (42 U.S.C. 1396a) is amended— 

10 (1) in subsection (a)— 

11 (A) in paragraph (10), in the matter fol12 lowing subparagraph (G), by striking ‘‘(VII) the 

13 medical assistance made available to an indi14 vidual described in subsection (l)(1)(A) who is 

15 eligible for medical assistance only because of 

16 subparagraph (A)(i)(IV) or (A)(ii)(IX) shall be 

17 limited to medical assistance for services related 

18 to pregnancy (including prenatal, delivery, 

19 postpartum, and family planning services), 

20 medical assistance for services related to other 

21 conditions which may complicate pregnancy, 

22 and medical assistance for vaccines described in 

23 section 1905(a)(4)(E) and the administration of 

24 such vaccines during the period described in 


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1 such section,’’ and inserting ‘‘(VII) [Re2 pealed],’’; 

3 (B) in paragraph (86), by striking ‘‘and’’ 

4 at the end; 

5 (C) in paragraph (87), by striking the pe6 riod at the end and inserting ‘‘; and’’; and 

7 (D) by inserting after paragraph (87) the 

8 following new paragraph: 

9 ‘‘(88) provide that the State plan is in compli10 ance with subsection (e)(16).’’; and 

11 (2) in subsection (e)(16)— 

12 (A) in subparagraph (A), by striking ‘‘At 

13 the option of the State, the State plan (or waiv14 er of such State plan) may provide’’ and insert15 ing ‘‘A State plan (or waiver of such State 

16 plan) shall provide’’; 

17 (B) in subparagraph (B), in the matter 

18 preceding clause (i), by striking ‘‘by a State 

19 making an election under this paragraph’’ and 

20 inserting ‘‘under a State plan (or a waiver of 

21 such State plan)’’; and 

22 (C) in subparagraph (C)— 

23 (i) by striking ‘‘A State making an 

24 election under this paragraph’’ and insert25 ing ‘‘In the case of a State’’; and 


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1 (ii) by striking ‘‘shall also make the 

2 election’’ and inserting ‘‘the State shall 

3 provide coverage’’. 

4 (b) CHIP.— 

5 (1) IN GENERAL.—Subparagraph (K) of section 

6 2107(e)(1) of the Social Security Act (42 U.S.C. 

7 1397gg(e)(1)), as redesignated by section 105, is 

8 amended to read as follows: 

9 ‘‘(K) Paragraphs (5) and (16) of section 

10 1902(e) (relating to the requirement to provide 

11 medical assistance under the State plan or 

12 waiver consisting of full benefits during preg13 nancy and throughout the 12-month period that 

14 begins on the last day of the individual’s preg15 nancy and ends on the last day of the month 

16 in which such 12-month period ends).’’. 

17 (2) CONFORMING AMENDMENT.—Section 

18 2112(d)(2)(A) of the Social Security Act (42 U.S.C. 

19 1397ll(d)(2)(A)) is amended by striking ‘‘the month 

20 in which the 60-day period’’ and all that follows 

21 through ‘‘pursuant to section 2107(e)(1),’’. 

22 (c) EFFECTIVE DATE.— 

23 (1) IN GENERAL.—Subject to paragraphs (2) 

24 and (3), the amendments made by subsections (a) 

25 and (b) shall take effect on the 1st day of the 1st 


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1 calendar quarter that begins on or after the date 

2 that is 1 year after the date of enactment of this 

3 Act; 

4 (2) EXCEPTION FOR STATE LEGISLATION.—In 

5 the case of a State plan under title XIX of the So6 cial Security Act or a State child health plan under 

7 title XXI of such Act that the Secretary of Health 

8 and Human Services determines requires State legis9 lation in order for the respective plan to meet any 

10 requirement imposed by amendments made by this 

11 subsection, the respective plan shall not be regarded 

12 as failing to comply with the requirements of such 

13 title solely on the basis of its failure to meet such 

14 an additional requirement before the 1st day of the 

15 1st calendar quarter beginning after the close of the 

16 1st regular session of the State legislature that be17 gins after the date of enactment of this Act. For 

18 purposes of the previous sentence, in the case of a 

19 State that has a 2-year legislative session, each year 

20 of the session shall be considered to be a separate 

21 regular session of the State legislature. 

22 (3) STATE OPTION FOR EARLIER EFFECTIVE

23 DATE.—A State may elect to have subsection (e)(16) 

24 of section 1902 of the Social Security Act (42 

25 U.S.C. 1396a) and subparagraph (K) of section 


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1 2107(e)(1) of the Social Security Act (42 U.S.C. 

2 1397gg(e)(1)), as redesignated by section 105 and 

3 amended by subsection (b) of this section, take ef4 fect with respect to the State on the 1st day of any 

5 fiscal quarter that begins before the date described 

6 in paragraph (1) and apply to amounts payable to 

7 the State for expenditures for medical assistance, 

8 child health assistance, or pregnancy-related assist9 ance to pregnant or postpartum individuals fur10 nished on or after such day. 

11 SEC. 202. HEALTH HOMES FOR PREGNANT AND 

12 POSTPARTUM WOMEN. 

13 (a) MEDICAID.—Title XIX of the Social Security Act 

14 (42 U.S.C. 1396 et seq.) is amended by inserting after 

15 section 1945A the following new section: 

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

17 CARE THROUGH A HEALTH HOME FOR PREG18 NANT AND POSTPARTUM INDIVIDUALS. 

19 ‘‘(a) STATE OPTION.— 

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

21 1902(a)(1) (relating to statewideness) and section 

22 1902(a)(10)(B) (relating to comparability), begin23 ning January 1, 2028, a State, at its option as a 

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1 sistance under this title to an eligible individual who 

2 chooses to— 

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

4 under this section by selecting a designated pro5 vider, a team of health care professionals oper6 ating with such a provider, or a health team as 

7 the individual’s maternity health home for pur8 poses of providing the individual with preg9 nancy and postpartum coordinated care serv10 ices; or 

11 ‘‘(B) receive such services from a des12 ignated provider, a team of health care profes13 sionals operating with such a provider, or a 

14 health team that has voluntarily opted to par15 ticipate in a maternity health home for eligible 

16 individuals under this section. 

17 ‘‘(2) ELIGIBLE INDIVIDUAL DEFINED.—In this 

18 section, the term ‘eligible individual’ means an indi19 vidual— 

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

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

22 plan) for all items and services covered under 

23 the State plan (or under a waiver of such plan); 

24 ‘‘(B) who is not enrolled in a health home 

25 under section 1945 or 1945A; and 


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1 ‘‘(C) either— 

2 ‘‘(i) who is pregnant; or 

3 ‘‘(ii) whose pregnancy has ended and 

4 is within the 12-month period that begins 

5 on the last day of the individual’s preg6 nancy and ends on the last day of the 

7 month in which such 12-month period 

8 ends. 

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

10 shall establish standards for qualification as a maternity 

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

12 care professionals operating with such a provider, or a 

13 health team eligible for participation in a maternity health 

14 home for purposes of this section. In establishing such 

15 standards, the Secretary shall consider best practices and 

16 models of care used by recipients of grants under section 

17 330P of the Public Health Service Act. Such standards 

18 shall include requiring a designated provider, a team of 

19 health care professionals operating with such a provider, 

20 and a health team designated as a maternity health home 

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

22 ‘‘(1) Coordinate prompt care and access to nec23 essary maternity care services, including services 

24 provided by specialists, and programs for an eligible 

25 individual during the individual’s pregnancy and the 


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1 365-day period beginning on the last day of such 

2 pregnancy. 

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

4 patient-centered care plan for each eligible individual 

5 that accommodates patient preferences and, if appli6 cable, reflects adjustments to the payment method7 ology described in subsection (c)(2)(B). 

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

9 individual’s care plan, in a culturally and linguis10 tically appropriate manner consistent with the needs 

11 of the eligible individual, ongoing home care, com12 munity-based primary care, inpatient care, social 

13 support services, health-related social needs services, 

14 behavioral health services, local hospital emergency 

15 care, and, in the event of a change in income that 

16 would result in the eligible individual losing eligi17 bility for medical assistance under the State plan (or 

18 under a waiver of such plan), care management and 

19 planning related to a change in the eligible individ20 ual’s health insurance coverage. 

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

22 as appropriate. 

23 ‘‘(5) Collect and report information under sub24 section (f)(1). 

25 ‘‘(c) PAYMENTS.— 


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1 ‘‘(1) IN GENERAL.—A State shall provide a des2 ignated provider, a team of health care professionals 

3 operating with such a provider, or a health team 

4 designated as a maternity health home with pay5 ments for the provision of health home services to 

6 each eligible individual that selects such provider, 

7 team of health care professionals, or health team as 

8 the eligible individual’s health home. Payments made 

9 to a designated provider, a team of health care pro10 fessionals operating with such a provider, or a health 

11 team for such services shall be treated as medical 

12 assistance for purposes of section 1903(a), except 

13 that, during the first 8 fiscal year quarters that the 

14 State plan amendment is in effect, the Federal med15 ical assistance percentage applicable to such pay16 ments shall be equal to 90 percent. 

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

18 in the State plan amendment the methodology the 

19 State will use for determining payment for the provi20 sion of pregnancy and postpartum coordinated care 

21 services or treatment during an eligible individual’s 

22 pregnancy and the 365-day period beginning on the 

23 last day of such pregnancy. Such methodology for 

24 determining payment— 

25 ‘‘(A) may be based on— 


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

2 each eligible individual enrolled in a mater3 nity health home; 

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

5 the case of payments to Federally qualified 

6 health centers or a rural health clinics; or 

7 ‘‘(iii) an alternate model of payment 

8 proposed by the State and approved by the 

9 Secretary; 

10 ‘‘(B) may be adjusted to reflect, with re11 spect to each eligible individual— 

12 ‘‘(i) the severity of the risks associ13 ated with the individual’s pregnancy; 

14 ‘‘(ii) the severity of the risks associ15 ated with the individual’s postpartum 

16 health care needs; and 

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

18 care coordination required with respect to 

19 the individual; and 

20 ‘‘(C) shall be established consistent with 

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

22 ‘‘(d) COORDINATING CARE.— 

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

24 State plan amendment approved under this section 

25 shall require each hospital that is a participating 


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

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

3 eligible individual who seeks treatment in the emer4 gency department of such hospital for— 

5 ‘‘(A) providing the individual with cul6 turally and linguistically appropriate informa7 tion supplied by the State describing the respec8 tive treatment models and opportunities for the 

9 individual to access a maternity health home 

10 and its associated benefits; and 

11 ‘‘(B) notifying the maternity health home 

12 in which the individual is enrolled, or the des13 ignated provider, team of health care profes14 sionals operating with such a provider, or 

15 health team treating the individual, of the indi16 vidual’s treatment in the emergency department 

17 and of the protocols for the maternity health 

18 home, designated provider, or team to be in19 volved in the individual’s emergency care or 

20 post-discharge care. 

21 ‘‘(2) EDUCATION WITH RESPECT TO AVAIL22 ABILITY OF A MATERNITY HEALTH HOME.— 

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

24 plan amendment to be approved under this sec25 tion, a State shall include in the State plan 


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1 amendment a description of the State’s process 

2 for— 

3 ‘‘(i) educating providers participating 

4 in the State plan (or a waiver of such 

5 plan) on the availability of maternity 

6 health homes for eligible individuals, in7 cluding the process by which such pro8 viders can participate in or refer an eligible 

9 individual to an approved maternity health 

10 home or a designated provider, team of 

11 health care professionals operating such a 

12 provider, or health team designated as a 

13 maternity health home; and 

14 ‘‘(ii) educating eligible individuals, in 

15 a culturally and linguistically appropriate 

16 manner, on the availability of maternity 

17 health homes. 

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

19 by the State under subparagraph (A) shall in20 clude the participation of entities or other pub21 lic or private organizations or entities that pro22 vide outreach and information on the avail23 ability of health care items and services to fami24 lies of individuals eligible to receive medical asVerDate Sep 11 2014 01:36 Oct 11, 2024 Jkt 059200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S5236.IS S5236

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1 sistance under the State plan (or a waiver of 

2 such plan). 

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

4 State with a State plan amendment approved under 

5 this section shall consult and coordinate, as appro6 priate, with the Secretary in addressing issues re7 garding the prevention, identification, and treatment 

8 of mental health conditions and substance use dis9 orders among eligible individuals. 

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

11 with a State plan amendment approved under this 

12 section shall consult and coordinate, as appropriate, 

13 with the Secretary in establishing means to connect 

14 eligible individuals receiving pregnancy and 

15 postpartum coordinated care services under this sec16 tion with social and support services, including serv17 ices made available under maternal, infant, and 

18 early childhood home visiting programs established 

19 under section 511 and services made available under 

20 section 330H or title X of the Public Health Service 

21 Act. 

22 ‘‘(5) COORDINATION WITH GRANT PROGRAM

23 FOR INTEGRATED SERVICES FOR PREGNANT AND

24 POSTPARTUM WOMEN.—A State with a State plan 

25 amendment approved under this section shall consult 


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1 and coordinate, as appropriate, with the Secretary 

2 with respect to the provision of medical assistance to 

3 eligible individuals enrolled in a maternity health 

4 home under this section and grantees delivering inte5 grated health care services to pregnant and 

6 postpartum women under section 330P of the Public 

7 Health Service Act (including, if applicable, the 

8 State). 

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

10 State plan amendment— 

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

12 inpatient days and reductions in the total cost of 

13 care resulting from improved care coordination and 

14 management under this section; 

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

16 technology in providing an eligible individual with 

17 pregnancy and postpartum coordinated care services 

18 as specified under this section and improving service 

19 delivery and coordination across the care continuum; 

20 and 

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

22 timely access to medically necessary care for eligible 

23 individuals from out-of-State providers. 

24 ‘‘(f) DATA COLLECTION.— 


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1 ‘‘(1) PROVIDER REPORTING REQUIREMENTS.— 

2 In order to receive payments from a State under 

3 subsection (c), a maternity health home, or a des4 ignated provider, a team of health care professionals 

5 operating with such a provider, or a health team 

6 designated as a maternity health home, shall report 

7 to the State, at such time and in such form and 

8 manner as may be required by the State, including 

9 through a health information exchange or other pub10 lic health data sharing entity, the following informa11 tion: 

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

13 provider, team of health care professionals oper14 ating with such a provider, and health team 

15 designated as a maternity health home, the 

16 name, National Provider Identification number, 

17 address, and specific health care services of18 fered to be provided to any eligible individual 

19 who has selected such provider, team of health 

20 care professionals, or health team as the eligible 

21 individual’s maternity health home. 

22 ‘‘(B) Information on all other applicable 

23 measures for determining the quality of services 

24 provided by such provider, team of health care 

25 professionals, or health team. 


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1 ‘‘(C) Information concerning the factors 

2 described in paragraph (2)(A)(vi) received from 

3 health risk assessments of eligible individuals 

4 conducted and completed by the designated pro5 vider, team of health care professionals oper6 ating with such a provider, or health team des7 ignated as a maternity health home. 

8 ‘‘(D) Such other information as the Sec9 retary shall specify in guidance. 

10 ‘‘(2) STATE REPORTING REQUIREMENTS.— 

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

12 with a State plan amendment approved under 

13 this section shall report to the Secretary (and, 

14 upon request, to the Medicaid and CHIP Pay15 ment and Access Commission), at such time, 

16 but at a minimum annually, and in such form 

17 and manner determined by the Secretary to be 

18 reasonable and minimally burdensome, the fol19 lowing information: 

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

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

23 available and while maintaining all relevant 

24 privacy and confidentially protections, 

25 disaggregated demographic information 


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1 (including information on geography) of el2 igible individuals who have enrolled in a 

3 maternity health home pursuant to this 

4 section. 

5 ‘‘(iii) The number of maternity health 

6 homes in the State designated under this 

7 section. 

8 ‘‘(iv) The medical conditions or fac9 tors that contribute to severe maternal 

10 morbidity among eligible individuals en11 rolled in maternity health homes in the 

12 State. 

13 ‘‘(v) The extent to which such individ14 uals receive health care items and services 

15 under the State plan before, during, and 

16 after an individual’s enrollment in such a 

17 maternity health home. 

18 ‘‘(vi) Where applicable, mortality data 

19 and data for the associated causes of preg20 nancy-related death for eligible individuals 

21 enrolled in a maternity health home under 

22 this section, in accordance with subsection 

23 (g). For deaths occurring postpartum, such 

24 data shall distinguish between deaths oc25 curring up to 42 days postpartum and 


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1 deaths occurring between 43 days to up to 

2 1 year postpartum. Where applicable, data 

3 reported under this clause shall be re4 ported alongside comparable data from a 

5 State’s maternal mortality review com6 mittee, as established in accordance with 

7 section 317K(d) of the Public Health Serv8 ice Act, for purposes of further identifying 

9 and comparing statewide trends in mater10 nal mortality among populations partici11 pating in the maternity health home under 

12 this section. 

13 ‘‘(B) IMPLEMENTATION REPORT.—Not 

14 later than 18 months after a State has a State 

15 plan amendment approved under this section, 

16 the State shall submit to the Secretary, and 

17 make publicly available on the appropriate 

18 State website, a report on how the State is im19 plementing the option established under this 

20 section, including through any best practices 

21 adopted by the State. 

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

23 amendment under this section shall establish confiden24 tiality protections for the purposes of subsection (f)(2)(A) 

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


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1 the State of any identifying information about any specific 

2 eligible individual enrolled in a maternity health home or 

3 any maternal mortality case, and that all relevant con4 fidentiality and privacy protections, including the require5 ments under section 1902(a)(7)(A), are maintained. 

6 ‘‘(h) RULE OF CONSTRUCTION.—Nothing in this sec7 tion shall be construed to require— 

8 ‘‘(1) an eligible individual to enroll in a mater9 nity health home under this section; or 

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

11 act as a maternity health home and provide services 

12 in accordance with this section if the provider or 

13 health team does not voluntarily agree to act as a 

14 maternity health home. 

15 ‘‘(i) PLANNING GRANTS.— 

16 ‘‘(1) IN GENERAL.—Beginning January 1, 

17 2027, from the amount appropriated under para18 graph (2), the Secretary shall award planning grants 

19 to States for purposes of developing and submitting 

20 a State plan amendment under this section. The 

21 Secretary shall award a grant to each State that ap22 plies for a grant under this subsection and meets the 

23 application criteria established by the Secretary, and 

24 the Secretary may determine the amount of the 

25 grant based on the merits of the application and the 


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1 goal of the State to prioritize health outcomes for el2 igible individuals. A planning grant awarded to a 

3 State under this subsection shall remain available 

4 until expended. 

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

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

7 fiscal year 2027, for the purposes of making grants 

8 under this subsection, to remain available until ex9 pended. 

10 ‘‘(3) LIMITATION.—The total amount of pay11 ments made to States under this subsection shall not 

12 exceed $50,000,000. 

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

14 ‘‘(1) DESIGNATED PROVIDER.—The term ‘des15 ignated provider’ means a physician (including an 

16 obstetrician-gynecologist or, if applicable, a certified 

17 nurse midwife, or certified professional midwife who 

18 meets or exceeds the education and training stand19 ards of the International Confederation of Midwives 

20 and who is licensed to practice within the State), a 

21 hospital, clinical practice or clinical group practice, 

22 rural health clinic, community health center, commu23 nity mental health center, or any other entity or pro24 vider that is determined by the State and approved 

25 by the Secretary to be qualified to be a maternity 


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1 health home on the basis of documentation evidenc2 ing that the entity or provider has the systems, ex3 pertise, and infrastructure in place to provide preg4 nancy and postpartum coordinated care services. 

5 Such term may include providers who are employed 

6 by, or affiliated with, a hospital. 

7 ‘‘(2) HEALTH TEAM.—The term ‘health team’ 

8 has the meaning given such term for purposes of 

9 section 3502 of Public Law 111–148. 

10 ‘‘(3) MATERNITY HEALTH HOME.—The term 

11 ‘maternity health home’ means a designated provider 

12 (including a provider that operates in coordination 

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

14 team that is selected by an eligible individual to pro15 vide pregnancy and postpartum coordinated care 

16 services. 

17 ‘‘(4) PREGNANCY AND POSTPARTUM COORDI18 NATED CARE SERVICES.— 

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

20 and postpartum coordinated care services’ 

21 means items and services related to the coordi22 nation of care for comprehensive and timely 

23 high-quality, culturally and linguistically appro24 priate, services described in subparagraph (B) 

25 that are provided by a designated provider, a 


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1 team of health care professionals operating with 

2 such a provider, or a health team designated as 

3 a maternity health home. 

4 ‘‘(B) SERVICES DESCRIBED.— 

5 ‘‘(i) IN GENERAL.—The services de6 scribed in this subparagraph shall include 

7 with respect to a State electing the State 

8 plan amendment option under this section, 

9 any medical assistance for items and serv10 ices for which payment is available under 

11 the State plan or under a waiver of such 

12 plan. 

13 ‘‘(ii) OTHER ITEMS AND SERVICES.— 

14 In addition to medical assistance described 

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

16 subparagraph shall include the following: 

17 ‘‘(I) Any item or service for 

18 which medical assistance is otherwise 

19 available under the State plan (or a 

20 waiver of such plan) related to the 

21 treatment of an individual during the 

22 individual’s pregnancy and the 1-year 

23 period beginning on the last day of 

24 such pregnancy, including mental 


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1 health and substance use disorder 

2 services. 

3 ‘‘(II) Comprehensive care man4 agement. 

5 ‘‘(III) Care coordination (includ6 ing with pediatricians as appropriate), 

7 health promotion, and providing ac8 cess to the full range of maternal, ob9 stetric, and gynecologic services, in10 cluding services from out-of-State pro11 viders. 

12 ‘‘(IV) Comprehensive transitional 

13 care, including appropriate follow-up, 

14 from inpatient to other settings. 

15 ‘‘(V) Patient and family support 

16 (including authorized representatives). 

17 ‘‘(VI) Referrals to community 

18 and social support services, if rel19 evant. 

20 ‘‘(VII) Use of health information 

21 technology to link services, as feasible 

22 and appropriate. 

23 ‘‘(5) TEAM OF HEALTH CARE PROFES24 SIONALS.—The term ‘team of health care profes25 sionals’ means a team of health care professionals 


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1 (as described in the State plan amendment under 

2 this section) that may— 

3 ‘‘(A) include— 

4 ‘‘(i) physicians, including gynecologist5 obstetricians, certified nurse midwives, or 

6 certified professional midwives who meet or 

7 exceed the education and training stand8 ards of the International Confederation of 

9 Midwives and who are licensed to practice 

10 within the State, family physicians, pri11 mary care physicians, pediatricians, and 

12 other professionals such as physicians as13 sistants, advance practice nurses, nurses, 

14 nurse care coordinators, dietitians, nutri15 tionists, social workers, behavioral health 

16 professionals, physical counselors, physical 

17 therapists, occupational therapists, or any 

18 professionals that assist in prenatal care, 

19 delivery, or postpartum care for which 

20 medical assistance is available under the 

21 State plan or a waiver of such plan and de22 termined to be appropriate by the State 

23 and approved by the Secretary; 


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

2 designated to coordinate such care deliv3 ered by the team; and 

4 ‘‘(iii) when appropriate and if other5 wise eligible to furnish items and services 

6 that are reimbursable as medical assist7 ance under the State plan or under a waiv8 er of such plan, doulas, community health 

9 workers, translators and interpreters, and 

10 other individuals with culturally appro11 priate and trauma-informed expertise; and 

12 ‘‘(B) provide care at a facility that is free13 standing, virtual, or based at a hospital, com14 munity health center, community mental health 

15 center, rural health clinic, clinical practice or 

16 clinical group practice, academic health center, 

17 or any entity determined to be appropriate by 

18 the State and approved by the Secretary.’’. 

19 (b) APPLICABILITY TO CHIP.—Section 2107(e)(1) of 

20 the Social Security Act (42 U.S.C. 1397gg(e)(1)), as 

21 amended by section 105, is amended by adding at the end 

22 the following new subparagraph: 

23 ‘‘(W) Section 1945B (relating to optional 

24 health homes for pregnant and postpartum in25 dividuals).’’. 


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1 SEC. 203. GUIDANCE ON SUPPORTING AND IMPROVING AC2 CESS TO MEDICAID AND CHIP COVERAGE OF 

3 SERVICES PROVIDED BY DOULAS AND CER4 TAIN MATERNAL HEALTH PROFESSIONALS. 

5 Not later than 1 year after the date of the enactment 

6 of this Act, the Secretary of Health and Human Services 

7 shall issue and publish guidance for States concerning op8 tions for supporting and improving access to coverage and 

9 payment under a State plan under title XIX of the Social 

10 Security Act (42 U.S.C. 1396 et seq.) or under a waiver 

11 of such plan, and under a State child health plan under 

12 title XXI of such Act (42 U.S.C. 1397aa et seq.) or under 

13 a waiver of such plan, for services provided by doulas, cer14 tified nurse midwives, certified midwives, or certified pro15 fessional midwives, who meet or exceed the education and 

16 training standards of the International Confederation of 

17 Midwives and who are licensed to practice within the State 

18 and certain maternal health professionals (specified by the 

19 Secretary)— 

20 (1) in rural areas; 

21 (2) across a continuum of care; and 

22 (3) among varied provider settings and payment 

23 and care models, including managed care. 


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1 SEC. 204. MEDICAID AND CHIP INCREASED FINANCIAL SUP2 PORT FOR DEPRESSION AND ANXIETY 

3 SCREENING DURING THE PERINATAL AND 

4 POSTPARTUM PERIODS. 

5 (a) MEDICAID.—Section 1905 of the Social Security 

6 Act (42 U.S.C. 1396d), as amended by section 103, is fur7 ther amended— 

8 (1) in the first sentence of subsection (b), by 

9 striking ‘‘subsection (a)(4)(D)’’ and inserting ‘‘sub10 sections (a)(4)(D) and (ll)’’; and 

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

12 ‘‘(ll) INCREASED FMAP FOR DEPRESSION AND ANX13 IETY SCREENING DURING THE PERINATAL AND

14 POSTPARTUM PERIODS.— 

15 ‘‘(1) IN GENERAL.—For purposes of clause (5) 

16 of the first sentence of subsection (b), services de17 scribed in this subsection are screening services pro18 vided to an individual who is eligible for such assist19 ance on the basis of being pregnant that include at 

20 a minimum— 

21 ‘‘(A) during the perinatal period, at least 

22 1 screening for depression and anxiety symp23 toms using a standardized, validated tool; and 

24 ‘‘(B) during the postpartum period, a full 

25 assessment of mood and emotional well-being, 

26 including screening for postpartum depression 


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1 and anxiety, using a standardized, validated 

2 tool. 

3 ‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 

4 The additional amount paid to a territory for ex5 penditures for medical assistance for services de6 scribed in paragraph (1) as a result of the applica7 tion of clause (5) of the first sentence of subsection 

8 (b) shall not be taken into account for purposes of 

9 applying payment limits under subsections (f) and 

10 (g) of section 1108.’’. 

11 (b) CHIP.—Section 2105(c) of the Social Security 

12 Act (42 U.S.C. 1397ee(c)) is amended by adding at the 

13 end the following new paragraph: 

14 ‘‘(13) ENHANCED PAYMENT FOR DEPRESSION

15 AND ANXIETY SCREENING DURING THE PERINATAL

16 AND POSTPARTUM PERIODS.—Notwithstanding sub17 section (b), the enhanced FMAP with respect to 

18 payments under subsection (a) for expenditures 

19 under the State child health plan (or a waiver of 

20 such plan) shall be increased by 1 percentage point 

21 with respect to expenditures for services described in 

22 section 1905(ll)(1) that are provided under the plan 

23 (or waiver) to an individual who is eligible for such 

24 assistance on the basis of being pregnant (including 

25 pregnancy-related assistance provided to a targeted 


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1 low-income pregnant woman (as defined in section 

2 2112(d)), pregnancy-related assistance provided to 

3 an individual who is eligible for such assistance 

4 through application of section 1903(v)(4)(A)(i) 

5 under section 2107(e)(1), or any other assistance 

6 under the plan (or waiver) provided to an individual 

7 who is eligible for such assistance on the basis of 

8 being pregnant) and during the 12-month period 

9 that begins on the last day of the individual’s preg10 nancy and ends on the last day of the month in 

11 which such 12-month period ends (including any 

12 such assistance provided during the month in which 

13 such period ends).’’. 

14 (c) EFFECTIVE DATE.—The amendments made by 

15 this section shall take effect on the first day of the first 

16 fiscal quarter that begins on or after the date that is 1 

17 year after the date of enactment of this section. 

18 SEC. 205. PRESUMPTIVE ELIGIBILITY FOR PREGNANT INDI19 VIDUALS. 

20 (a) IN GENERAL.— 

21 (1) REQUIREMENT.—Section 1920(a) of the So22 cial Security Act (42 U.S.C. 1396r–1(a)) is amended 

23 by striking ‘‘may provide’’ and inserting ‘‘shall pro24 vide’’. 


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1 (2) APPLICATION.—Section 1920 of the Social 

2 Security Act (42 U.S.C. 1396r–1) is amended by 

3 adding at the end the following new subsection: 

4 ‘‘(f) APPLICATION.—A State shall provide to a preg5 nant woman a presumptive eligibility period in accordance 

6 with this section without regard to whether the individual 

7 would otherwise qualify for a presumptive eligibility period 

8 the State has elected to provide under section 1920A, 

9 1920B, or 1920C.’’. 

10 (b) CONFORMING AMENDMENTS.— 

11 (1) Section 1902(a)(47) of the Social Security 

12 Act (42 U.S.C. 1396a(a)(47)) is amended to read as 

13 follows: 

14 ‘‘(47) provide— 

15 ‘‘(A)(i) for making ambulatory prenatal 

16 care available to pregnant women during a pre17 sumptive eligibility period in accordance with 

18 section 1920; and 

19 ‘‘(ii) at the option of the State— 

20 ‘‘(I) for making medical assistance for 

21 items and services described in subsection 

22 (a) of section 1920A available to children 

23 during a presumptive eligibility period in 

24 accordance with such section; 


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1 ‘‘(II) for making medical assistance 

2 available to individuals described in sub3 section (a) of section 1920B during a pre4 sumptive eligibility period in accordance 

5 with such section; and 

6 ‘‘(III) for making medical assistance 

7 available to individuals described in sub8 section (a) of section 1920C during a pre9 sumptive eligibility period in accordance 

10 with such section; and 

11 ‘‘(B) that any hospital that is a partici12 pating provider under the State plan may elect 

13 to be a qualified entity for purposes of deter14 mining, on the basis of preliminary information, 

15 whether any individual is eligible for medical as16 sistance under the State plan or under a waiver 

17 of the plan for purposes of providing the indi18 vidual with medical assistance during a pre19 sumptive eligibility period, in the same manner, 

20 and subject to the same requirements, as apply 

21 with respect to populations described in section 

22 1920, 1920A, 1920B, or 1920C (without re23 gard to whether the State has elected to provide 

24 for a presumptive eligibility period under secVerDate Sep 11 2014 01:36 Oct 11, 2024 Jkt 059200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\S5236.IS S5236

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1 tions 1920A, 1920B, or 1920C), subject to 

2 such guidance as the Secretary shall establish;’’. 

3 (2) Section 1920(e) of the Social Security Act 

4 (42 U.S.C. 1396r–1(e)) is amended— 

5 (A) by striking ‘‘If the State has elected 

6 the option to provide a presumptive eligibility 

7 period under this section or section 1920A, 

8 the’’ and inserting ‘‘The’’; and 

9 (B) by striking ‘‘1920A, subject to’’ and 

10 inserting ‘‘1920A (if the State has elected the 

11 option), subject to’’. 

12 (3) Section 2107(e)(1)(R) of the Social Security 

13 Act (42 U.S.C. 1397gg(e)(1)(R)) is amended by in14 serting ‘‘1920 (relating to presumptive eligibility for 

15 pregnant women and section’’ before ‘‘1920A’’. 

16 (4) Section 2112(c) of the Social Security Act 

17 (42 U.S.C. 1397ll(c)) is amended— 

18 (A) in the heading, by striking ‘‘OPTION

19 TO PROVIDE’’; and 

20 (B) by striking ‘‘may elect’’ and inserting 

21 ‘‘shall elect’’. 


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1 TITLE III—INVEST IN THE MA2 TERNAL HEALTH CARE 

3 WORKFORCE 

4 SEC. 301. EMERGENCY OBSTETRIC WORKFORCE SUPPORT. 

5 (a) IN GENERAL.—Section 203A of the Public 

6 Health Service Act (42 U.S.C. 204a) is amended— 

7 (1) in subsection (a)— 

8 (A) in paragraph (1), in the matter pre9 ceding subparagraph (A), by inserting ‘‘and ur10 gent maternal health care needs’’ after ‘‘public 

11 health care needs’’; 

12 (B) in paragraph (3), by inserting ‘‘or ur13 gent maternal health care need’’ after ‘‘public 

14 health care need’’; 

15 (C) in paragraph (5)— 

16 (i) in subparagraph (C), by striking 

17 ‘‘or’’ at the end; 

18 (ii) in subparagraph (D), by striking 

19 the period at the end and inserting ‘‘; or’’; 

20 and 

21 (iii) by adding at the end the fol22 lowing: 

23 ‘‘(E) any urgent need, not rising to the 

24 level of an emergency described in subpara25 graph (D), that, in the judgment of the SecVerDate Sep 11 2014 01:36 Oct 11, 2024 Jkt 059200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S5236.IS S5236

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1 retary, if not addressed, could result in an 

2 emergency that would be appropriate for the 

3 deployment of the Commissioned Corps.’’; and 

4 (D) by adding at the end the following: 

5 ‘‘(6) URGENT MATERNAL HEALTH CARE

6 NEED.— 

7 ‘‘(A) IN GENERAL.—For purposes of this 

8 section and section 214, the term ‘urgent ma9 ternal health care need’, with respect to an 

10 area, means a maternal health care need, as de11 termined by the Secretary, in consultation with 

12 the Attorney General, arising as a result of the 

13 closure or imminent closure of a hospital or 

14 other health care facility in such area, or the 

15 loss of workers employed by such hospital or 

16 health care facility who are trained to provide 

17 maternal health care services. 

18 ‘‘(B) CONSIDERATIONS.—In determining 

19 whether there is an urgent maternal health care 

20 need for purposes of subparagraph (A) with re21 spect to an area, the Secretary shall consider 

22 whether such closure, imminent closure, or loss 

23 of workers has impacted access by individuals 

24 in such area to a full range of maternal health 

25 care services, including prenatal services, labor 


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1 and delivery services, postnatal services, mater2 nal and postpartum mental health services, be3 havioral health services, and reproductive health 

4 services.’’; 

5 (2) in subsection (b)— 

6 (A) in paragraph (1), by inserting ‘‘or ur7 gent maternal health care needs’’ after ‘‘public 

8 health care needs’’; and 

9 (B) in each of paragraphs (2) and (4)(B), 

10 by inserting ‘‘or urgent maternal health care 

11 need’’ after ‘‘public health care need’’; and 

12 (3) in subsection (c), by inserting ‘‘or urgent 

13 maternal health care need’’ after ‘‘public health care 

14 need’’. 

15 (b) DETAIL OF PERSONNEL.—Section 214 of the 

16 Public Health Service Act (42 U.S.C. 215) is amended— 

17 (1) by redesignating subsection (e) as sub18 section (f); 

19 (2) by inserting after subsection (d) the fol20 lowing: 

21 ‘‘(e)(1) Upon the request of an eligible entity with 

22 respect to a hospital or other health care facility the clo23 sure, imminent closure, or loss of workers of which led 

24 to an urgent maternal health care need in an area, per25 sonnel may be detailed by the Secretary for the purpose 


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1 of assisting such eligible entity in work related to such 

2 urgent maternal health care need. 

3 ‘‘(2)(A) Personnel detailed under paragraph (1) shall 

4 be paid from applicable appropriations of the Service. 

5 ‘‘(B) In the case of detail of personnel under para6 graph (1) to be paid from applicable Service appropria7 tions, the Secretary may condition such detail on an agree8 ment by the eligible entity concerned that such eligible en9 tity concerned shall reimburse the United States for a por10 tion of the amount of such payments made by the Service. 

11 ‘‘(C) The services of personnel while detailed pursu12 ant to this subsection shall be considered as having been 

13 performed in the Service for purposes of the computation 

14 of basic pay, promotion, retirement, compensation for in15 jury or death, and the benefits provided by section 212. 

16 ‘‘(3) The Secretary may condition a detail of per17 sonnel under paragraph (1) on an agreement by the eligi18 ble entity concerned that such eligible entity concerned 

19 shall— 

20 ‘‘(A) in the case of an imminent closure or a 

21 loss of workers, as determined by the Secretary— 

22 ‘‘(i) maintain the maternal health care 

23 services in the applicable area to the maximum 

24 extent practicable, including by hiring temVerDate Sep 11 2014 01:36 Oct 11, 2024 Jkt 059200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S5236.IS S5236

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1 porary workers, until the date on which the per2 sonnel are detailed to such area; and 

3 ‘‘(ii) submit to the Secretary a plan for 

4 hiring and retaining health practitioners in the 

5 short- and long-term, both during periods in 

6 which personnel are detailed to such applicable 

7 area and periods in which personnel are not de8 tailed to such applicable area; 

9 ‘‘(B) in the case of a closure, submit to the Sec10 retary a plan for working with, as applicable, State 

11 and local agencies and local stakeholders to transi12 tion patients to alternate sources of safe maternal 

13 health care services; and 

14 ‘‘(C) commit to an assessment by the Secretary 

15 of the workplace practices of such eligible entity con16 cerned, if applicable. 

17 ‘‘(4) In this subsection— 

18 ‘‘(A) the term ‘eligible entity’ means— 

19 ‘‘(i) a State; 

20 ‘‘(ii) a political subdivision of a State; or 

21 ‘‘(iii) a Tribal, nonprofit, or other health 

22 care entity; and 

23 ‘‘(B) the term ‘personnel’ means an employee 

24 or officer of the Commissioned Corps.’’; and 


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1 (3) in subsection (f) (as so redesignated), by in2 serting ‘‘or an urgent maternal health care need’’ 

3 before the period at the end. 

4 (c) FUNDING FOR COMMISSIONED CORPS OF THE

5 PUBLIC HEALTH SERVICE.—Section 203 of the Public 

6 Health Service Act (42 U.S.C. 204) is amended by adding 

7 at the end the following: 

8 ‘‘(e) OPERATIONS OF THE COMMISSIONED CORPS OF

9 THE PUBLIC HEALTH SERVICE.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall carry 

11 out duties and responsibilities relating to the oper12 ations of the Commissioned Corps of the Service, in13 cluding the following: 

14 ‘‘(A) Enhance the processes and systems 

15 of the Service’s Headquarters operations. 

16 ‘‘(B) Maximize the force management, re17 quired training opportunities (as determined by 

18 the Secretary under section 203A(a)(1)), oper19 ational capacity, and mission readiness of the 

20 Regular Corps, the Ready Reserve Corps, and 

21 the Public Health Emergency Response Strike 

22 Teams, a subcomponent of the Regular Corps. 

23 ‘‘(C) Recruit and retain qualified profes24 sionals suited to serving underserved and vul25 nerable communities by— 


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1 ‘‘(i) improving onboarding timelines, 

2 providing officer placements to align with 

3 mission needs, ensuring adequate officer 

4 morale and wellness resources, and 

5 incentivizing recruiters and recruits; and 

6 ‘‘(ii) expanding training opportunities, 

7 including training of personnel to deliver 

8 maternal health care services, providing 

9 credentialing support for high demand skill 

10 sets, and enriching leadership and research 

11 potential. 

12 ‘‘(D) Improve deployment processes and 

13 prepare mission teams to execute routine and 

14 emergent public health events. 

15 ‘‘(E) Establish a legislative liaison office to 

16 carry out legislative affairs functions under the 

17 direction of the Secretary. 

18 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—In 

19 addition to amounts otherwise authorized to be ap20 propriated for the Commissioned Corps of the Serv21 ice, there is authorized to be appropriated to the 

22 Secretary to carry out paragraph (1) $150,000,000 

23 for fiscal year 2026 and each fiscal year there24 after.’’. 


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1 SEC. 302. STREAMLINED SCREENING AND ENROLLMENT OF 

2 PROVIDERS OF MATERNITY, LABOR, AND DE3 LIVERY SERVICES IN NEIGHBORING STATES. 

4 (a) APPLICATION TO MEDICAID.—Section 1902(kk) 

5 of the Social Security Act (42 U.S.C. 1396a(kk)) is 

6 amended by adding at the end the following new para7 graph: 

8 ‘‘(10) STREAMLINED ENROLLMENT PROCESS

9 FOR ELIGIBLE OUT-OF-STATE PROVIDERS OF MA10 TERNITY, LABOR, AND DELIVERY SERVICES.— 

11 ‘‘(A) IN GENERAL.—The State adopts and 

12 implements a process that enables an eligible 

13 out-of-State provider to enroll as a provider in 

14 the State plan without imposing any screening 

15 requirements that are in addition to the re16 quirements imposed on in-State providers. An 

17 eligible out-of-State provider that enrolls in the 

18 State plan through such process shall be so en19 rolled for a 5-year period (unless the provider 

20 is terminated or excluded from participation 

21 during such period) and may revalidate such 

22 enrollment through such process for subsequent 

23 5-year periods. 

24 ‘‘(B) ELIGIBLE OUT-OF-STATE PRO25 VIDER.—In this paragraph, the term ‘eligible 


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1 out-of-State provider’ means, with respect to a 

2 State, a provider— 

3 ‘‘(i) that furnishes maternity, labor, 

4 and delivery services (as defined in sub5 section (uu)(1)), or provides orders or re6 ferrals for such services, for which pay7 ment is available under the State plan of 

8 the State; 

9 ‘‘(ii) that is located in a neighboring 

10 State (as defined by the Secretary); 

11 ‘‘(iii) with respect to which the Sec12 retary has determined there is a limited 

13 risk of fraud, waste, or abuse for purposes 

14 of determining the level of screening to be 

15 conducted under section 1866(j)(2)(B); 

16 ‘‘(iv) that has been screened under 

17 such section 1866(j)(2)(B) for purposes of 

18 enrolling in the Medicare program under 

19 title XVIII or the State plan of the State 

20 in which such provider is located; and 

21 ‘‘(v) that has not been excluded from 

22 participation in the Medicare program 

23 under such title or the Medicaid program 

24 under this title.’’. 

25 (b) CONFORMING AMENDMENTS.— 


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1 (1) Section 1902(a)(77) of the Social Security 

2 Act (42 U.S.C. 1396a(a)(77)) is amended by insert3 ing ‘‘enrollment,’’ after ‘‘screening,’’. 

4 (2) Section 1902(kk) of such Act (42 U.S.C. 

5 1396a(kk)), as amended by subsection (a), is further 

6 amended— 

7 (A) in the subsection heading, by inserting 

8 ‘‘ENROLLMENT,’’ after ‘‘SCREENING,’’; and 

9 (B) in paragraph (9), by striking ‘‘Noth10 ing’’ and inserting ‘‘Except as provided in para11 graph (10), nothing’’. 

12 (c) APPLICATION TO CHIP.—Section 2107(e)(1)(G) 

13 of such Act (42 U.S.C. 1397gg(e)(1)(G)) is amended by 

14 inserting ‘‘enrollment,’’ after ‘‘screening,’’. 

15 (d) GUIDANCE ON SCREENING AND ENROLLING OUT16 OF-STATE PROVIDERS OF MATERNITY, LABOR, AND DE17 LIVERY SERVICES.—Not later than January 1, 2027, the 

18 Secretary of Health and Human Services shall issue (and 

19 update as the Secretary determines necessary) guidance 

20 to State Medicaid and CHIP directors on best practices 

21 for screening and enrolling out-of-State providers of ma22 ternity, labor, and delivery services in accordance with 

23 paragraph (10) of section 1902(kk) of the Social Security 

24 Act (42 U.S.C. 1396a(kk)) and section 2107(e)(1)(G) of 

25 such Act (42 U.S.C. 1397gg(e)(1)(G)) (as added and 


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1 amended by this section) and including best practices for 

2 screening and enrolling out-of-State providers in managed 

3 care plans. 

4 (e) EFFECTIVE DATE.—The amendments made by 

5 this section take effect on January 1, 2027. 

6 TITLE IV—REQUIRING PUBLIC 

7 COMMUNICATION OF OBSTET8 RICS DATA AND UNIT CLO9 SURES 

10 SEC. 401. TIMELY NOTIFICATIONS OF IMPENDING HOS11 PITAL OBSTETRIC UNIT CLOSURES. 

12 (a) IN GENERAL.—Section 1866(a)(1) of the Social 

13 Security Act (42 U.S.C. 1395cc(a)(1)) is amended— 

14 (1) in subparagraph (X), by striking ‘‘and’’ at 

15 the end; 

16 (2) in subparagraph (Y)(ii)(V), by striking the 

17 period and inserting ‘‘, and’’; and 

18 (3) by inserting after subparagraph (Y) the fol19 lowing new subparagraph: 

20 ‘‘(Z) beginning 180 days after the date of 

21 the enactment of this subparagraph, in the case 

22 of a hospital, not less than 180 days prior to 

23 the closure of any obstetric unit of the hospital, 

24 to submit to the Secretary, any relevant local 


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1 and State agencies, and the community a notifi2 cation, which shall include— 

3 ‘‘(i) a report analyzing the impact the 

4 closure will have on the community, includ5 ing data on any adverse outcomes and in6 crease in costs relating to obstetric services 

7 for such community; 

8 ‘‘(ii) steps the hospital will take to 

9 identify other health care providers that 

10 can alleviate any service gaps as a result of 

11 the closure; 

12 ‘‘(iii) the cause of the closure of such 

13 obstetric unit; 

14 ‘‘(iv) data regarding historic transpor15 tation costs related to obstetric services in 

16 such community; and 

17 ‘‘(v) any additional information as 

18 may be required by the Secretary.’’. 

19 (b) STATE REQUIREMENT TO POST REPORTS.—Sec20 tion 1902(a) of the Social Security Act (42 U.S.C. 

21 1396a(a)), as amended by section 201(a)(1), is further 

22 amended— 

23 (1) in paragraph (87), by striking ‘‘and’’ at the 

24 end; 


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1 (2) in paragraph (88), by striking the period at 

2 the end and inserting ‘‘; and’’; and 

3 (3) by inserting after paragraph (88) the fol4 lowing new paragraph: 

5 ‘‘(89) provide that the State will make publicly 

6 available, on the website of any relevant State agen7 cy, any report received by the State from a hospital 

8 pursuant to section 1866(a)(1)(Z)(i).’’; and 

9 SEC. 402. COLLECTION OF DATA RELATING TO HOSPITAL 

10 LABOR AND DELIVERY SERVICES. 

11 Section 1866(a)(1) of the Social Security Act (42 

12 U.S.C. 1395cc(a)(1)), as amended by section 401, is 

13 amended— 

14 (1) in subparagraph (Y)(ii)(V), by striking 

15 ‘‘and’’ at the end; 

16 (2) in subparagraph (Z), by striking the period 

17 and inserting ‘‘, and’’; and 

18 (3) by adding at the end the following new sub19 paragraph: 

20 ‘‘(AA) in the case of a hospital, to include 

21 in cost reports submitted under this title for 

22 cost reporting periods beginning on or after 

23 July 1, 2025— 

24 ‘‘(i) the number of births that oc25 curred at such hospital during the cost reVerDate Sep 11 2014 01:36 Oct 11, 2024 Jkt 059200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\S5236.IS S5236

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1 porting period, delineated by the number 

2 of cesarean births and vaginal births; 

3 ‘‘(ii) the number of antenatal and 

4 postpartum transfers from the hospital to 

5 other hospitals; 

6 ‘‘(iii) data on the number and charac7 teristics of the staff providing labor and 

8 delivery services at such hospital; 

9 ‘‘(iv) the expenses the hospital in10 curred for providing labor and delivery 

11 services at such hospital, including nursing 

12 care, anesthesia, and operating room serv13 ices; 

14 ‘‘(v) the amount the hospital spent for 

15 on-call coverage for labor and delivery 

16 services by physicians and midwives; and 

17 ‘‘(vi) the amount and sources of rev18 enue received by such hospital for labor 

19 and delivery services, including payments 

20 received for— 

21 ‘‘(I) items and services furnished 

22 to individuals eligible for coverage 

23 under a State plan under title XIX 

24 (or a waiver of such a plan); 


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1 ‘‘(II) items and services fur2 nished to individuals with other forms 

3 of health insurance or third-party cov4 erage; and 

5 ‘‘(III) items and services fur6 nished to individuals without health 

7 insurance or other source of third8 party coverage.’’. 

Æ 


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