II 

118TH CONGRESS 

1ST SESSION S. 948 

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 

MARCH 22, 2023 

Mr. GRASSLEY (for himself and Ms. HASSAN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to improve maternal health coverage under Medicaid and 

CHIP, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Healthy Moms and Babies Act’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

Sec. 3. Mandatory reporting by State Medicaid programs on adult health care 

quality measures of maternal and perinatal health. 


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Sec. 4. Medicaid quality improvement initiatives to reduce rates of cesarean sections; Medicare requirement for hospitals to report on data on 

cesarean births. 

Sec. 5. State option to provide coordinated care through a health home for 

pregnant and postpartum women. 

Sec. 6. Guidance on care coordination to support maternal health. 

Sec. 7. National reskilling of the maternity care workforce. 

Sec. 8. MACPAC study on doulas and community health workers; guidance on 

increasing access to doula services under Medicaid. 

Sec. 9. Demonstration projects to improve the delivery of maternal health care 

through telehealth. 

Sec. 10. CMS report on coverage of remote physiologic monitoring devices and 

impact on maternal and child health outcomes under Medicaid. 

Sec. 11. Guidance on community-based maternal health programs. 

Sec. 12. Developing guidance on maternal mortality and severe morbidity reduction for maternal care providers receiving payment under 

the Medicaid program. 

Sec. 13. Program related to reducing cesarean births and increasing rates of 

vaginal birth after cesarean. 

Sec. 14. Collection of information related to social determinants of the health 

of Medicaid and CHIP beneficiaries. 

Sec. 15. Report on payment methodologies for transferring pregnant women between facilities before, during, and after childbirth. 

Sec. 16. Medicaid guidance on State options to address social determinants of 

health for pregnant and postpartum women. 

Sec. 17. Payment error rate measurement (PERM) audit and improvement requirements. 

1 SEC. 2. DEFINITIONS. 

2 In this Act: 

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

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

6 1397aa et seq.). 

7 (2) COMPTROLLER GENERAL.—The term 

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

10 (3) GROUP HEALTH PLAN; HEALTH INSURANCE

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

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

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1 dividual health insurance coverage’’ have the mean2 ings given such terms in section 2791 of the Public 

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

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

5 the Medicaid program established under title XIX of 

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

7 (5) MEDICAID MANAGED CARE ORGANIZA8 TION.—The term ‘‘medicaid managed care organiza9 tion’’ has the meaning given that term in section 

10 1903(m)(1)(A) of the Social Security Act (42 U.S.C. 

11 1396b(m)(1)(A)). 

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

13 the Secretary of Health and Human Services. 

14 (7) STATE.—The term ‘‘State’’ has the mean15 ing given that term for purposes of titles V, XIX, 

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

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

18 SEC. 3. MANDATORY REPORTING BY STATE MEDICAID PRO19 GRAMS ON ADULT HEALTH CARE QUALITY 

20 MEASURES OF MATERNAL AND PERINATAL 

21 HEALTH. 

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

23 1320b–9b) is amended— 

24 (1) in subsection (b)— 

25 (A) in paragraph (3)(B)— 


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1 (i) in the subparagraph heading, by 

2 inserting ‘‘AND MATERNAL AND

3 PERINATAL HEALTH’’ after ‘‘BEHAVIORAL

4 HEALTH’’; 

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

6 and inserting ‘‘all behavioral health and 

7 maternal and perinatal health’’; and 

8 (iii) by inserting ‘‘and of maternal 

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

11 adults’’; and 

12 (B) in paragraph (5)(C)— 

13 (i) in the subparagraph heading, by 

14 inserting ‘‘AND MATERNAL AND

15 PERINATAL HEALTH’’ after ‘‘BEHAVIORAL

16 HEALTH’’; and 

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

18 Medicaid eligible adults, maternal and 

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

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

22 maternal and perinatal health’’ after ‘‘behavioral 

23 health’’. 


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1 SEC. 4. MEDICAID QUALITY IMPROVEMENT INITIATIVES TO 

2 REDUCE RATES OF CESAREAN SECTIONS; 

3 MEDICARE REQUIREMENT FOR HOSPITALS 

4 TO REPORT ON DATA ON CESAREAN BIRTHS. 

5 (a) MEDICAID STATE PLAN AMENDMENT.—Section 

6 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) 

7 is amended— 

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

9 the semicolon; 

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

11 the end and inserting ‘‘; and’’; and 

12 (3) by inserting after paragraph (87) the fol13 lowing: 

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

15 2025, and annually thereafter through January 1, 

16 2035, the State shall submit a report to the Sec17 retary, that shall be made publicly available, which 

18 contains with respect to the preceding calendar 

19 year— 

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

21 as defined by the Secretary in consultation with 

22 relevant stakeholders, for pregnant women eligi23 ble for medical assistance under the State plan 

24 or a waiver of such plan in the State, as com25 pared to the overall rate of cesarean delivery in 

26 the State; 


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

2 improvement activities to safely reduce the rate 

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

4 pregnant women eligible for medical assistance 

5 under the State plan or a waiver of such plan 

6 in the State reported under subparagraph (A), 

7 including initiatives aimed at reducing racial 

8 and ethnic health disparities, hospital-level 

9 quality improvement initiatives, taking into ac10 count hospital type and the patient population 

11 served, and, if applicable, partnerships with 

12 State or regional perinatal quality 

13 collaboratives; 

14 ‘‘(C) for each report submitted after Janu15 ary 1, 2025, the percentage change (if any) in 

16 the rate of low-risk cesarean delivery (as so de17 fined) for pregnant women eligible for medical 

18 assistance under the State plan or a waiver of 

19 such plan in the State reported under subpara20 graph (A) from the rate reported for the most 

21 recent previous report; and 

22 ‘‘(D) such other relevant data and infor23 mation as determined by the Secretary, and in 

24 consultation with relevant stakeholders, such as 

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1 provement activities, cesarean delivery rates, 

2 and health outcomes.’’. 

3 (b) GAO STUDY REGARDING MEDICAID PAYMENT

4 RATES CESAREAN BIRTHS.— 

5 (1) STUDY.—The Comptroller General shall 

6 conduct a study regarding payment rates for cesar7 ean births and vaginal births under State Medicaid 

8 programs. To the extent feasible and data are avail9 able, the study shall include analyses of the fol10 lowing: 

11 (A) Payment rates for cesarean births and 

12 vaginal births paid by fee-for-service Medicaid 

13 programs and by Medicaid programs that con14 tract with Medicaid managed care organizations 

15 to furnish medical assistance under such pro16 grams; 

17 (B) What is known about how Medicaid 

18 payment rates have changed over time; 

19 (C) What is known about how payment 

20 rates for cesarean and vaginal births by Med21 icaid programs compare with the payment rates 

22 for such births by other sources of insurance 

23 coverage; 

24 (D) Such other factors related to payment 

25 rates for cesarean and vaginal births under 


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1 Medicaid as the Comptroller General deter2 mines appropriate. 

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

4 the date of enactment of this Act, the Comptroller 

5 General shall submit to Congress a report containing 

6 the results of the study conducted under paragraph 

7 (1), together with recommendations for such legisla8 tion and administrative action as the Comptroller 

9 General determines appropriate. 

10 (c) GAO STUDY ON RACIAL DISPARITIES IN CESAR11 EAN BIRTHS.— 

12 (1) IN GENERAL.—The Comptroller General 

13 shall conduct a study on racial disparities in the fre14 quency of cesarean births. To the extent feasible and 

15 data are available, the study shall compare such in16 formation on low- and high-risk cesarean births, dif17 ferences by payer (such as Medicaid and private 

18 payers), and hospital characteristics (such as loca19 tion or hospital type). Such study may consider 

20 other factors related to racial disparities in maternal 

21 health as the Comptroller General deems appro22 priate. 

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

24 date of enactment of this Act, the Comptroller Gen25 eral shall submit to Congress a report containing the 


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

2 together with recommendations for such legislation 

3 and administrative action as the Comptroller Gen4 eral determines appropriate. 

5 (d) MEDICARE REQUIREMENT FOR HOSPITALS TO

6 REPORT DATA ON CESAREAN BIRTHS.— 

7 (1) REQUIREMENT.—Section 1866(a)(1) of the 

8 Social Security Act (42 U.S.C. 1395cc(a)(1)) is 

9 amended— 

10 (A) by moving the indentation of subpara11 graph (W) 2 ems to the left; 

12 (B) in subparagraph (X)— 

13 (i) by moving the indentation 2 ems 

14 to the left; and 

15 (ii) by striking ‘‘and’’ at the end; 

16 (C) in subparagraph (Y), by striking the 

17 period at the end and inserting ‘‘; and’’; and 

18 (D) by inserting after subparagraph (Y) 

19 the following new subparagraph: 

20 ‘‘(Z) in the case of a hospital, to submit, in a 

21 form and manner, and at a time, specified by the 

22 Secretary, data on the Nulliparous, Term, Singleton, 

23 Vertex Cesarean section (NTSV C-section) rate with 

24 respect to the hospital for the preceding year.’’. 


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1 (2) INCORPORATION INTO HOSPITAL QUALITY

2 REPORTING.—Section 1886(b)(3)(B)(viii) of the So3 cial Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) 

4 is amended by adding at the end the following new 

5 subclause: 

6 ‘‘(XIII) Effective for payments beginning with fiscal 

7 year 2025, in expanding the number of measures under 

8 subclause (III), the Secretary shall adopt a measure relat9 ing to the Nulliparous, Term, Singleton, Vertex Cesarean 

10 section (NTSV C-section) rate for hospitals in inpatient 

11 settings. Not later than 2025, the Secretary shall incor12 porate such measure into the designation of maternity 

13 care quality hospitals, as described in the final rule enti14 tled ‘Medicare Program; Hospital Inpatient Prospective 

15 Payment Systems for Acute Care Hospitals and the Long 

16 Term Care Hospital Prospective Payment System and 

17 Policy Changes and Fiscal Year 2023 Rates; Quality Pro18 grams and Medicare Promoting Interoperability Program 

19 Requirements for Eligible Hospitals and Critical Access 

20 Hospitals; Costs Incurred for Qualified and Non-Qualified 

21 Deferred Compensation Plans; and Changes to Hospital 

22 and Critical Access Hospital Conditions of Participation’ 

23 (87 Fed. Reg. 48780 (August 10, 2022)).’’. 


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1 SEC. 5. STATE OPTION TO PROVIDE COORDINATED CARE 

2 THROUGH A HEALTH HOME FOR PREGNANT 

3 AND POSTPARTUM WOMEN. 

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

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

6 following new section: 

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

8 CARE THROUGH A HEALTH HOME FOR PREG9 NANT AND POSTPARTUM WOMEN. 

10 ‘‘(a) STATE OPTION.— 

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

12 1902(a)(1) (relating to statewideness) and section 

13 1902(a)(10)(B) (relating to comparability), begin14 ning April 1, 2026, a State, at its option as a State 

15 plan amendment, may provide for medical assistance 

16 under this title to an eligible woman who chooses 

17 to— 

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

19 under this section by selecting a designated pro20 vider, a team of health care professionals oper21 ating with such a provider, or a health team as 

22 the woman’s maternity health home for pur23 poses of providing the woman with pregnancy 

24 and postpartum coordinated care services; or 

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1 sionals operating with such a provider, or a 

2 health team that has voluntarily opted to par3 ticipate in a maternity health home for eligible 

4 women under this section. 

5 ‘‘(2) ELIGIBLE WOMAN DEFINED.—In this sec6 tion, the term ‘eligible woman’ means an indi7 vidual— 

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

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

10 plan) for all items and services covered under 

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

12 amount, duration, or scope, or are determined 

13 by the Secretary to be substantially equivalent, 

14 to the medical assistance available for an indi15 vidual described in subsection (a)(10)(A)(i); and 

16 ‘‘(B) who— 

17 ‘‘(i) is pregnant; or 

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

19 last 365 days. 

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

21 shall establish standards for qualification as a maternity 

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

23 care professionals operating with such a provider, or a 

24 health team eligible for participation in a maternity health 

25 home for purposes of this section. In establishing such 


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1 standards, the Secretary shall consider best practices and 

2 models of care used by recipients of grants under section 

3 330P of the Public Health Service Act. Such standards 

4 shall include requiring designated providers, teams of 

5 health care professionals operating with such providers, 

6 and health teams (designated as a maternity health home) 

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

8 ‘‘(1) Coordinate prompt care and access to nec9 essary maternity care services, including services 

10 provided by specialists, and programs for an eligible 

11 woman during her pregnancy and the 365-day pe12 riod beginning on the last day of her pregnancy. 

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

14 patient-centered care plan for each eligible woman 

15 that accommodates patient preferences and, if appli16 cable, reflects adjustments to the payment method17 ology described in subsection (c)(2)(B). 

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

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

20 appropriate manner consistent with the needs of the 

21 eligible woman, ongoing home care, community22 based primary care, inpatient care, social support 

23 services, health-related social needs services, behav24 ioral health services, local hospital emergency care, 

25 and, in the event of a change in income that would 


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1 result in the eligible woman losing eligibility for 

2 medical assistance under the State plan or waiver, 

3 care management and planning related to a change 

4 in the eligible woman’s health insurance coverage. 

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

6 as appropriate. 

7 ‘‘(5) Collect and report information under sub8 section (f)(1). 

9 ‘‘(c) PAYMENTS.— 

10 ‘‘(1) IN GENERAL.—A State shall provide a des11 ignated provider, a team of health care professionals 

12 operating with such a provider, or a health team 

13 with payments for the provision of pregnancy and 

14 postpartum coordinated care services, to each eligi15 ble woman that selects such provider, team of health 

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

17 maternity health home or care provider. Payments 

18 made to a maternity health home or care provider 

19 for such services shall be treated as medical assist20 ance for purposes of section 1903(a). 

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

22 in the State plan amendment the methodology the 

23 State will use for determining payment for the provi24 sion of pregnancy and postpartum coordinated care 

25 services or treatment during an eligible woman’s 


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1 pregnancy and the 365-day period beginning on the 

2 last day of her pregnancy. Such methodology for de3 termining payment— 

4 ‘‘(A) may be based on— 

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

6 each eligible woman enrolled in the mater7 nity health home; 

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

9 the case of payments to Federally qualified 

10 health centers or a rural health clinics; or 

11 ‘‘(iii) an alternate model of payment 

12 (which may include a model developed 

13 under a waiver under section 1115) pro14 posed by the State and approved by the 

15 Secretary; 

16 ‘‘(B) may be adjusted to reflect, with re17 spect to each eligible woman— 

18 ‘‘(i) the severity of the risks associ19 ated with the woman’s pregnancy; 

20 ‘‘(ii) the severity of the risks associ21 ated with the woman’s postpartum health 

22 care needs; and 

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

24 care coordination required with respect to 

25 the woman; and 


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1 ‘‘(C) shall be established consistent with 

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

3 ‘‘(d) COORDINATING CARE.— 

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

5 State plan amendment approved under this section 

6 shall require each hospital that is a participating 

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

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

9 eligible woman who seeks treatment in the emer10 gency department of such hospital for— 

11 ‘‘(A) providing the woman with culturally 

12 and linguistically appropriate information on 

13 the respective treatment models and opportuni14 ties for the woman to access a maternity health 

15 home and its associated benefits; and 

16 ‘‘(B) notifying the maternity health home 

17 in which the woman is enrolled, or the des18 ignated provider, team of health care profes19 sionals operating with such a provider, or 

20 health team treating the woman, of the wom21 an’s treatment in the emergency department 

22 and of the protocols for the maternity health 

23 home, designated provider, or team to be in24 volved in the woman’s emergency care or post25 discharge care. 


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1 ‘‘(2) EDUCATION WITH RESPECT TO AVAIL2 ABILITY OF A MATERNITY HEALTH HOME.— 

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

4 plan amendment to be approved under this sec5 tion, a State shall include in the State plan 

6 amendment a description of the State’s process 

7 for— 

8 ‘‘(i) educating providers participating 

9 in the State plan (or a waiver of such 

10 plan) on the availability of maternity 

11 health homes for eligible women, including 

12 the process by which such providers can 

13 participate in or refer eligible women to an 

14 approved maternity health home or a des15 ignated provider, team of health care pro16 fessionals operating such a provider, or 

17 health team; and 

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

19 culturally and linguistically appropriate 

20 manner, on the availability of maternity 

21 health homes. 

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

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1 vide outreach and information on the avail2 ability of health care items and services to fami3 lies of individuals eligible to receive medical as4 sistance under the State plan (or a waiver of 

5 such plan). 

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

7 State with a State plan amendment approved under 

8 this section shall consult and coordinate, as appro9 priate, with the Secretary in addressing issues re10 garding the prevention, identification, and treatment 

11 of mental health conditions and substance use dis12 orders among eligible women. 

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

14 with a State plan amendment approved under this 

15 section shall consult and coordinate, as appropriate, 

16 with the Secretary in establishing means to connect 

17 eligible women receiving pregnancy and postpartum 

18 coordinated care services under this section with so19 cial and support services, including services made 

20 available under maternal, infant, and early childhood 

21 home visiting programs established under section 

22 511, and services made available under section 

23 330H or title X of the Public Health Service Act. 

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

25 State plan amendment— 


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

2 inpatient days and reductions in the total cost of 

3 care resulting from improved care coordination and 

4 management under this section; 

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

6 technology in providing an eligible woman with preg7 nancy and postpartum coordinated care services as 

8 specified under this section and improving service 

9 delivery and coordination across the care continuum; 

10 and 

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

12 timely access to medically necessary care for eligible 

13 women from out-of-State providers. 

14 ‘‘(f) DATA COLLECTION.— 

15 ‘‘(1) PROVIDER REPORTING REQUIREMENTS.— 

16 In order to receive payments from a State under 

17 subsection (c), a maternity health home, or a des18 ignated provider, a team of health care professionals 

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

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

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

22 including through a health information exchange or 

23 other public health data sharing entity, the following 

24 information: 


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

2 provider, team of health care professionals oper3 ating with such a provider, and health team 

4 (designated as a maternity health home), the 

5 name, National Provider Identification number, 

6 address, and specific health care services of7 fered to be provided to eligible women who have 

8 selected such provider, team of health care pro9 fessionals, or health team as the women’s ma10 ternity health home. 

11 ‘‘(B) Information on measures from the 

12 core sets of child health quality measures and 

13 adult health quality measures under sections 

14 1139A and 1139B that are identified by the 

15 Secretary as being relevant to maternal, 

16 perinatal, or infant health. 

17 ‘‘(C) Information on all other applicable 

18 measures for determining the quality of services 

19 provided by such provider, team of health care 

20 professionals, or health team. 

21 ‘‘(D) Such other information as the Sec22 retary shall specify in guidance. 

23 ‘‘(2) STATE REPORTING REQUIREMENTS.— 

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

25 with a State plan amendment approved under 


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1 this section shall report to the Secretary (and, 

2 upon request, to the Medicaid and CHIP Pay3 ment and Access Commission), at such time, 

4 but at a minimum frequency of every 12 

5 months, and in such form and manner deter6 mined by the Secretary to be reasonable and 

7 minimally burdensome, including through a 

8 health information exchange or other public 

9 health data sharing entity, the following infor10 mation: 

11 ‘‘(i) Information described in para12 graph (1). 

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

14 available and while maintaining all relevant 

15 protecting privacy and confidentially pro16 tections, disaggregated demographic infor17 mation of eligible women who have enrolled 

18 in a maternity health home pursuant to 

19 this section. 

20 ‘‘(iii) The number of maternity health 

21 homes in the State. 

22 ‘‘(iv) The medical conditions or fac23 tors that contribute to severe maternal 

24 morbidity among eligible women enrolled in 

25 maternity health homes in the State. 


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

2 receive health care items and services 

3 under the State plan before, during, and 

4 after the women’s enrollment in such a 

5 maternity health home. 

6 ‘‘(vi) Where applicable, mortality data 

7 and data for the associated causes of death 

8 for eligible women enrolled in a maternity 

9 health home under this section, in accord10 ance with subsection (g). For deaths occur11 ring postpartum, such data shall distin12 guish between deaths occurring up to 42 

13 days postpartum and deaths occurring be14 tween 43 days to up to 1 year postpartum. 

15 Where applicable, data reported under this 

16 clause shall be reported alongside com17 parable data from a State’s maternal mor18 tality review committee, as established in 

19 accordance with section 317K(d) of the 

20 Public Health Service Act, for purposes of 

21 further identifying and comparing state22 wide trends in maternal mortality among 

23 populations participating in the maternity 

24 health home under this section. 


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1 ‘‘(B) IMPLEMENTATION REPORT.—Not 

2 later than 18 months after a State has a State 

3 plan amendment approved under this section, 

4 the State shall submit to the Secretary, and 

5 make publicly available on the appropriate 

6 State website, a report on how the State is im7 plementing the option established under this 

8 section, including through any best practices 

9 adopted by the State. 

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

11 amendment under this section shall establish confiden12 tiality protections for the purposes of subsection (f)(2)(A) 

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

14 the State of any identifying information about any specific 

15 eligible woman enrolled in a maternity health home or any 

16 maternal mortality case, and that all relevant confiden17 tiality and privacy protections, including the requirements 

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

19 ‘‘(h) RULE OF CONSTRUCTION.—Nothing in this sec20 tion shall be construed to require— 

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

22 health home under this section; or 

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

24 act as a maternity health home and provide services 

25 in accordance with this section if the provider or 


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1 health team does not voluntarily agree to act as a 

2 maternity health home. 

3 ‘‘(i) PLANNING GRANTS.— 

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

5 2025, from the amount appropriated under para6 graph (2), the Secretary shall award planning grants 

7 to States for purposes of developing and submitting 

8 a State plan amendment under this section. The 

9 Secretary shall award a grant to each State that ap10 plies for a grant under this subsection, but the Sec11 retary may determine the amount of the grant based 

12 on the merits of the application and the goal of the 

13 State to prioritize health outcomes for eligible 

14 women. A planning grant awarded to a State under 

15 this subsection shall remain available until expended. 

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

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

18 the period of fiscal years 2024 through 2026, for the 

19 purposes of making grants under this subsection, to 

20 remain available until expended. 

21 ‘‘(3) LIMITATION.—The total amount of pay22 ments made to States under this subsection shall not 

23 exceed $50,000,000. 

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


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1 ‘‘(1) DESIGNATED PROVIDER.—The term ‘des2 ignated provider’ means a physician (including an 

3 obstetrician-gynecologist), hospital, clinical practice 

4 or clinical group practice, a medicaid managed care 

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

6 prepaid inpatient health plan, as defined in section 

7 438.2 of title 42, Code of Federal Regulations (or 

8 any successor regulation), a prepaid ambulatory 

9 health plan, as defined in such section (or any suc10 cessor regulation), rural clinic, community health 

11 center, community mental health center, or any 

12 other entity or provider that is determined by the 

13 State and approved by the Secretary to be qualified 

14 to be a maternity health home on the basis of docu15 mentation evidencing that the entity has the sys16 tems, expertise, and infrastructure in place to pro17 vide pregnancy and postpartum coordinated care 

18 services. Such term may include providers who are 

19 employed by, or affiliated with, a hospital. 

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

21 ‘maternity health home’ means a designated provider 

22 (including a provider that operates in coordination 

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

24 team is selected by an eligible woman to provide 

25 pregnancy and postpartum coordinated care services. 


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

2 has the meaning given such term for purposes of 

3 section 3502 of Public Law 111–148. 

4 ‘‘(4) PREGNANCY AND POSTPARTUM COORDI5 NATED CARE SERVICES.— 

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

7 and postpartum coordinated care services’ 

8 means items and services related to the coordi9 nation of care for comprehensive and timely 

10 high-quality, culturally and linguistically appro11 priate, services described in subparagraph (B) 

12 that are provided by a designated provider, a 

13 team of health care professionals operating with 

14 such a provider, or a health team (designated 

15 as a maternity health home). 

16 ‘‘(B) SERVICES DESCRIBED.— 

17 ‘‘(i) IN GENERAL.—The services de18 scribed in this subparagraph shall include 

19 with respect to a State electing the State 

20 plan amendment option under this section, 

21 any medical assistance for items and serv22 ices for which payment is available under 

23 the State plan or under a waiver of such 

24 plan. 


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1 ‘‘(ii) OTHER ITEMS AND SERVICES.— 

2 In addition to medical assistance described 

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

4 subparagraph shall include the following: 

5 ‘‘(I) Any item or service for 

6 which medical assistance is otherwise 

7 available under the State plan (or a 

8 waiver of such plan) related to the 

9 treatment of a woman during the 

10 woman’s pregnancy and the 1-year pe11 riod beginning on the last day of her 

12 pregnancy, including mental health 

13 and substance use disorder services. 

14 ‘‘(II) Comprehensive care man15 agement. 

16 ‘‘(III) Care coordination (includ17 ing with pediatricians as appropriate), 

18 health promotion, and providing ac19 cess to the full range of maternal, ob20 stetric, and gynecologic services, in21 cluding services from out-of-State pro22 viders. 

23 ‘‘(IV) Comprehensive transitional 

24 care, including appropriate follow-up, 

25 from inpatient to other settings. 


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1 ‘‘(V) Patient and family support 

2 (including authorized representatives). 

3 ‘‘(VI) Referrals to community 

4 and social support services, if rel5 evant. 

6 ‘‘(VII) Use of health information 

7 technology to link services, as feasible 

8 and appropriate. 

9 ‘‘(5) TEAM OF HEALTH CARE PROFES10 SIONALS.—The term ‘team of health care profes11 sionals’ means a team of health care professionals 

12 (as described in the State plan amendment under 

13 this section) that may— 

14 ‘‘(A) include— 

15 ‘‘(i) physicians, including gynecologist16 obstetricians, pediatricians, and other pro17 fessionals such as physicians assistants, 

18 advance practice nurses, including certified 

19 nurse midwives, nurses, nurse care coordi20 nators, dietitians, nutritionists, social 

21 workers, behavioral health professionals, 

22 physical counselors, physical therapists, oc23 cupational therapists, or any professionals 

24 that assist in prenatal care, delivery, or 

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1 ance is available under the State plan or a 

2 waiver of such plan and determined to be 

3 appropriate by the State and approved by 

4 the Secretary; 

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

6 designated to coordinate such care deliv7 ered by the team; and 

8 ‘‘(iii) when appropriate and if other9 wise eligible to furnish items and services 

10 that are reimbursable as medical assist11 ance under the State plan or under a waiv12 er of such plan, doulas, community health 

13 workers, translators and interpreters, and 

14 other individuals with culturally appro15 priate and trauma-informed expertise; and 

16 ‘‘(B) provide care at a facility that is free17 standing, virtual, or based at a hospital, com18 munity health center, community mental health 

19 center, rural clinic, clinical practice or clinical 

20 group practice, academic health center, or any 

21 entity determined to be appropriate by the 

22 State and approved by the Secretary.’’. 


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1 SEC. 6. GUIDANCE ON CARE COORDINATION TO SUPPORT 

2 MATERNAL HEALTH. 

3 Not later than 2 years after the date of enactment 

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

5 Medicaid programs on improved care coordination, con6 tinuity of care, and clinical integration to support the 

7 needs of pregnant and postpartum women for services eli8 gible for Medicaid payment. Such guidance shall identify 

9 best practices for care coordination for such women, both 

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

11 and State Medicaid programs that contract with Medicaid 

12 managed care organizations or other specified entities to 

13 furnish medical assistance for such women, and shall illus14 trate strategies for— 

15 (1) enhancing primary care and maternity care 

16 coordination with specialists, including cardiologists, 

17 specialists in gestational diabetes, dentists, lactation 

18 specialists, genetic counselors, and behavioral health 

19 providers; 

20 (2) integrating behavioral health providers to 

21 provide screening, assessment, treatment, and refer22 ral for behavioral health needs, including substance 

23 use disorders, maternal depression, anxiety, intimate 

24 partner violence, and other trauma; 

25 (3) integrating into care teams or coordinating 

26 with nonclinical professionals, including (if licensed 


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1 or credentialed by a State or State-authorized orga2 nization) doulas, peer support specialists, and com3 munity health workers, and how these services pro4 vided by such professionals may be eligible for Fed5 eral financial participation under Medicaid; 

6 (4) screening pregnant and postpartum women 

7 for social needs and coordinating related services 

8 during the prenatal and postpartum periods to en9 sure social and physical supports are provided for 

10 such women during such periods and for their chil11 dren; 

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

13 (6) screening for maternal health, behavioral 

14 health, and social needs during well-child and pedi15 atric care visits; and 

16 (7) streamlining and reducing duplication in 

17 care coordination efforts across and among pro18 viders, plans, and other entities for such women. 

19 SEC. 7. NATIONAL RESKILLING OF THE MATERNITY CARE 

20 WORKFORCE. 

21 Part B of title III of the Public Health Service Act 

22 (42 U.S.C. 243 et seq.) is amended by inserting after sec23 tion 317L–1 the following: 


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1 ‘‘SEC. 317L–2. NATIONAL RESKILLING OF THE MATERNITY 

2 CARE WORKFORCE. 

3 ‘‘(a) ESTABLISHMENT OF NATIONAL EXPERT

4 GROUP.— 

5 ‘‘(1) IN GENERAL.—The Secretary shall estab6 lish a national expert group to evaluate national 

7 education on, and practice of, best birthing prac8 tices. 

9 ‘‘(2) MEMBERS.— 

10 ‘‘(A) IN GENERAL.—The group established 

11 under paragraph (1) shall be composed of such 

12 members as the Secretary appoints, including— 

13 ‘‘(i) obstetricians and gynecologists, 

14 family medicine physicians, midwifes, and 

15 nursing leaders; 

16 ‘‘(ii) hospital administrators; 

17 ‘‘(iii) graduate medical education lead18 ers; 

19 ‘‘(iv) doula leaders; 

20 ‘‘(v) individuals with experience in 

21 community birth settings; 

22 ‘‘(vi) patients; 

23 ‘‘(vii) high-risk birth experts; and 

24 ‘‘(viii) quality improvement leaders. 

25 ‘‘(B) GEOGRAPHIC DIVERSITY.—In ap26 pointing members under subparagraph (A), the 


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1 Secretary shall ensure a balance of members 

2 representing rural areas and members rep3 resenting urban areas. 

4 ‘‘(b) DUTIES.—The group established under sub5 section (a) shall— 

6 ‘‘(1) examine evidence, trends, and differential 

7 use or access by income, geographic area, and race 

8 and ethnicity associated with birthing practices that 

9 include— 

10 ‘‘(A) cesarean sections, repeat cesarean, 

11 and vaginal birth after cesarean; 

12 ‘‘(B) electronic fetal monitoring and inter13 mittent auscultation; 

14 ‘‘(C) birth positions, including upright po15 sitioning and ambulation; 

16 ‘‘(D) labor with doula support; 

17 ‘‘(E) evaluating indications for cesarean 

18 delivery, including cervical dilation and duration 

19 of pushing; 

20 ‘‘(F) operative vaginal deliveries; 

21 ‘‘(G) manual fetal rotation; 

22 ‘‘(H) amnioinfusion and scalp stimulation; 

23 and 

24 ‘‘(I) cervical ripening methods; 


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1 ‘‘(2) assess the role of the culture of care, ma2 ternity care financing, and health education with re3 spect to the trends under paragraph (1); and 

4 ‘‘(3) identify case studies of the provision of ex5 emplary birthing care. 

6 ‘‘(c) RECOMMENDATIONS.—The group established 

7 under subsection (a) shall, not later than 1 year after such 

8 establishment, issue— 

9 ‘‘(1) best practices for— 

10 ‘‘(A) evaluating birthing skills; 

11 ‘‘(B) improving curricula for health profes12 sionals engaged in birthing; and 

13 ‘‘(C) the incorporation of midwives and 

14 doulas into residency curricula for obstetricians; 

15 and 

16 ‘‘(2) recommendations for policies and practices 

17 to improve maternity care overall.’’. 

18 SEC. 8. MACPAC STUDY ON DOULAS AND COMMUNITY 

19 HEALTH WORKERS; GUIDANCE ON INCREAS20 ING ACCESS TO DOULA SERVICES UNDER 

21 MEDICAID. 

22 (a) MACPAC STUDY ON DOULAS AND COMMUNITY

23 HEALTH WORKERS.— 

24 (1) IN GENERAL.—As part of the first report 

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1 curity Act (42 U.S.C. 1396(b)(1)) after the date 

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

3 Act, the Medicaid and CHIP Payment and Access 

4 Commission (referred to in this section as 

5 ‘‘MACPAC’’) shall include with such report a report 

6 on the coverage of doula services and the role of 

7 community health workers under State Medicaid 

8 programs, which shall include the following: 

9 (A) Information about coverage for doula 

10 services and community health worker services 

11 under State Medicaid programs that currently 

12 provide coverage for such services, including the 

13 type of doula services offered (such as prenatal, 

14 labor and delivery, postpartum support, and 

15 traditional doula services) and information on 

16 the prevalence of doulas that care for individ17 uals in their own communities. 

18 (B) An analysis of strategies to facilitate 

19 the appropriate use of doula services in order to 

20 provide better care and achieve better maternal 

21 and infant health outcomes, including strategies 

22 that States may use to assist with services for 

23 which Federal financial participation is eligible 

24 under a State Medicaid plan or a waiver of such 

25 a plan by recruiting, training, and certifying a 


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1 diverse doula workforce, particularly from un2 derserved communities, communities of color, 

3 and communities facing linguistic or cultural 

4 barriers. 

5 (C) Provide examples of community health 

6 worker access in State Medicaid programs and 

7 strategies employed by States to encourage a 

8 broad care team to manage Medicaid patients. 

9 (D) An assessment of the impact of the in10 volvement of doulas and community health 

11 workers on maternal health outcomes. 

12 (E) Recommendations, as MACPAC deems 

13 appropriate, for legislative and administrative 

14 actions to increase access to services that im15 prove maternal health. 

16 (2) STAKEHOLDER CONSULTATION.—In devel17 oping the report required under paragraph (1), 

18 MACPAC shall consult with relevant stakeholders. 

19 (b) GUIDANCE ON INCREASING ACCESS TO DOULA

20 SERVICES UNDER MEDICAID.— 

21 (1) IN GENERAL.—Not later than 1 year after 

22 the date that MACPAC publishes the report re23 quired under subsection (a), the Secretary shall 

24 issue guidance to States on increasing access to 


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1 doula services under Medicaid. Such guidance shall 

2 at a minimum include— 

3 (A) options for States to provide medical 

4 assistance for doula services under State Med5 icaid programs; 

6 (B) best practices for ensuring that doulas, 

7 including community-based doulas, receive reim8 bursement for doula services provided under a 

9 State Medicaid program, at a level that allows 

10 doulas to earn a living wage that accounts for 

11 their time and costs associated with providing 

12 care and community-based doula program ad13 ministration; and 

14 (C) best practices for increasing access to 

15 doula services, including services provided by 

16 community-based doulas, under State Medicaid 

17 programs. 

18 (2) STAKEHOLDER CONSULTATION.—In devel19 oping the report required under paragraph (1), the 

20 Secretary shall consult with relevant stakeholders. 

21 (c) RELEVANT STAKEHOLDERS.—For purposes of 

22 subsections (a)(2) and (b)(2), relevant stakeholders shall 

23 include— 

24 (1) States; 


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1 (2) organizations representing consumers, in2 cluding those that are disproportionately impacted 

3 by poor maternal health outcomes; 

4 (3) organizations and individuals representing 

5 doula services providers and community health work6 ers, including community-based doula programs and 

7 those who serve underserved communities, commu8 nities of color and communities facing linguistic or 

9 cultural barriers; and 

10 (4) organizations representing health care pro11 viders. 

12 SEC. 9. DEMONSTRATION PROJECTS TO IMPROVE THE DE13 LIVERY OF MATERNAL HEALTH CARE 

14 THROUGH TELEHEALTH. 

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

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

17 award grants to States to conduct demonstration projects 

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

19 telehealth in State Medicaid programs for the delivery of 

20 health care to eligible pregnant or postpartum women. 

21 (b) ELIGIBLE PREGNANT OR POSTPARTUM WOMAN

22 DEFINED.— 

23 (1) IN GENERAL.—In this section, the term ‘‘el24 igible pregnant or postpartum woman’’ means a 

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1 sistance under a State Medicaid plan (or waiver of 

2 such plan) and who is or becomes pregnant. 

3 (2) POSTPARTUM WOMEN.—Such term includes 

4 a woman described in paragraph (1) through the 

5 end of the month in which the 365-day period begin6 ning on the last day of the woman’s pregnancy ends, 

7 without regard to any change in income of the fam8 ily of which she is a member. 

9 (c) APPLICATION; SELECTION OF STATES; DURA10 TION.— 

11 (1) APPLICATION.— 

12 (A) IN GENERAL.—To conduct a dem13 onstration project under this section, a State 

14 shall submit an application to the Secretary at 

15 such time and in such manner as the Secretary 

16 shall require. Under the demonstration project, 

17 a State may include multiple proposed uses of 

18 grant funds, and propose to focus on multiple 

19 populations, as otherwise allowable under this 

20 section, within a single application. 

21 (B) REQUIRED INFORMATION.—A State 

22 application to conduct a demonstration project 

23 under this section shall include the following: 

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1 served areas) that the demonstration 

2 project will target. 

3 (ii) A description of how the State 

4 proposes to use funds awarded under this 

5 section to conduct the demonstration 

6 project to integrate or increase the integra7 tion of telehealth into the State Medicaid 

8 program’s existing delivery system for fur9 nishing medical assistance to and improv10 ing the health care outcomes of eligible 

11 pregnant or postpartum women. 

12 (iii) A description of how the State 

13 will use funds to address racial or ethnic 

14 disparities in access to maternal health 

15 services or maternal health outcomes, bar16 riers to care, including in rural or medi17 cally underserved communities, other bar18 riers to using telehealth, such as those ex19 perienced by individuals with disabilities 

20 and individuals with limited English pro21 ficiency, and as applicable, barriers to the 

22 use of telehealth in tribal communities. 

23 (iv) A certification that the applica24 tion meets the requirements of subpara25 graph (C). 


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1 (v) Such other information as the Sec2 retary shall require. 

3 (C) CONSULTATION WITH HEALTH CARE

4 STAKEHOLDERS.—Prior to the submission of an 

5 application to conduct a demonstration project 

6 under this section, a State shall consult with 

7 health care systems and providers, health plans 

8 (if relevant), consumer organizations and bene9 ficiary advocates, and community-based organi10 zations or other stakeholders in the area that 

11 the demonstration project will target to ensure 

12 that the proposed project addresses the health 

13 care needs of eligible pregnant or postpartum 

14 women in such area. 

15 (2) SELECTION OF STATES AND DURATION OF

16 PROJECTS.— 

17 (A) IN GENERAL.—The Secretary shall 

18 award grants to States that apply and meet the 

19 application requirements to conduct 4-year 

20 demonstration projects under this section. A 

21 State may request, and the Secretary shall de22 termine the appropriateness of, an application 

23 of up to $10,000,000. 

24 (B) SELECTION OF PROJECTS.—In select25 ing a State to conduct a demonstration project 


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1 under this section, the Secretary shall ensure 

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

3 of the project and shall determine the State has 

4 satisfied the application requirements. 

5 (3) WAIVER OF STATEWIDENESS AND COM6 PARABILITY REQUIREMENT.—The Secretary shall 

7 waive compliance with section 1902(a)(1) of the So8 cial Security Act (42 U.S.C. 1396a(a)(1)) (relating 

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

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

11 comparability) to the extent necessary to allow se12 lected States to conduct demonstration projects 

13 under this section. 

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

15 from a grant awarded under this section to connect eligible 

16 pregnant or postpartum women to telehealth services de17 livered via telehealth that are furnished by— 

18 (1) primary and maternity care providers; 

19 (2) health care specialists; 

20 (3) behavioral health providers; and 

21 (4) other categories of health care providers 

22 identified by the Secretary. 

23 (e) REPORTS.— 

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

25 awarded a grant to conduct a demonstration project 


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1 under this section shall submit the following reports 

2 to the Secretary: 

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

4 the first 18 months during which the dem5 onstration project is conducted, not later than 

6 the last day of the 19th month of the dem7 onstration project, as described in subpara8 graph (B). 

9 (B) FINAL REPORT.— Not later than 6 

10 months after the date on which the State’s 

11 demonstration project ends, a final report that 

12 includes the following: 

13 (i) The number of eligible pregnant or 

14 postpartum women served under the dem15 onstration project. 

16 (ii) The activities and services funded 

17 under the demonstration project, including 

18 the providers that received funds under the 

19 demonstration project. 

20 (iii) Demographic information about 

21 the eligible pregnant or postpartum women 

22 served under the demonstration project, if 

23 available. 


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1 (iv) A description of the types of mod2 els or programs developed under the dem3 onstration project. 

4 (v) How such models or programs im5 pacted access to, and utilization of, tele6 health services by eligible pregnant or 

7 postpartum women, including a description 

8 of how such models or programs addressed 

9 racial or ethnic disparities in access or uti10 lization. 

11 (vi) Qualitative information on bene12 ficiary experience. 

13 (vii) Challenges faced and lessons 

14 learned by the State in integrating (or in15 creasing the integration of) telehealth into 

16 the delivery system for furnishing medical 

17 assistance to eligible pregnant or 

18 postpartum women in the areas targeted 

19 under the demonstration project. 

20 (2) REPORTS TO CONGRESS.— 

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

22 years after the date of enactment of this Act, 

23 the Secretary shall submit a report to Congress 

24 summarizing the information reported by States 

25 under paragraph (1)(A). 


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1 (B) FINAL REPORT.—Not later than 5 

2 years after the date of enactment of this Act, 

3 the Secretary shall submit a report to Congress 

4 summarizing the information reported by States 

5 under paragraph (1)(B). 

6 SEC. 10. CMS REPORT ON COVERAGE OF REMOTE PHYSIO7 LOGIC MONITORING DEVICES AND IMPACT 

8 ON MATERNAL AND CHILD HEALTH OUT9 COMES UNDER MEDICAID. 

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

11 the date of enactment of this Act, the Secretary shall sub12 mit to Congress a report containing information on au13 thorities and State practices for covering remote physio14 logical monitoring devices, including limitations and bar15 riers to such coverage and the impact on maternal health 

16 outcomes, and to the extent appropriate, recommendations 

17 on how to address such limitations or barriers related to 

18 coverage of remote physiologic devices under State Med19 icaid programs, including, but not limited to, pulse 

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

21 monitors, with the goal of improving maternal and child 

22 health outcomes for pregnant and postpartum women en23 rolled in State Medicaid programs. 

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

25 after the submission of the report required by subsection 


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1 (a), the Secretary shall update resources for State Med2 icaid programs, such as State Medicaid telehealth toolkits, 

3 to be consistent with the recommendations provided in 

4 such report. 

5 SEC. 11. GUIDANCE ON COMMUNITY-BASED MATERNAL 

6 HEALTH PROGRAMS. 

7 Not later than 3 years after the date of enactment 

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

9 Medicaid programs to support the use of evidence-based 

10 community-based maternal health programs, including 

11 programs that offer group prenatal care, home visiting 

12 services, childbirth and parenting education, peer sup13 ports, stillbirth prevention activities, and substance use 

14 disorder and recovery supports, under such programs, and 

15 any other programs as determined by the Secretary. 

16 SEC. 12. DEVELOPING GUIDANCE ON MATERNAL MOR17 TALITY AND SEVERE MORBIDITY REDUCTION 

18 FOR MATERNAL CARE PROVIDERS RECEIV19 ING PAYMENT UNDER THE MEDICAID PRO20 GRAM. 

21 (a) IN GENERAL.—Subject to the availability of ap22 propriations, not later than 36 months after the date of 

23 enactment of this Act, the Secretary shall, in consultation 

24 with the Advisory Committee on Reducing Maternal 

25 Deaths established under subsection (c) and the Task 


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1 Force on Maternal Mental Health established under sec2 tion 1113 of division FF of the Consolidated Appropria3 tions Act, 2023 (Public Law 117–328), publish on a public 

4 website of the Centers for Medicare & Medicaid Services 

5 guidance for States on resources and strategies for hos6 pitals, freestanding birth centers (as defined in section 

7 1905(l)(3)(B) of the Social Security Act (42 U.S.C. 

8 1396d(l)(3)(B))), and other maternal care providers as de9 termined by the Secretary for reducing maternal mortality 

10 and severe morbidity in individuals who are eligible for 

11 and receiving medical assistance under Medicaid or CHIP. 

12 (b) UPDATES.—The Secretary shall, in consultation 

13 with the Advisory Committee on Reducing Maternal 

14 Deaths established under subsection (c) and the Task 

15 Force on Maternal Mental Health established under sec16 tion 1113 of division FF of the Consolidated Appropria17 tions Act, 2023 (Public Law 117–328), update the guid18 ance and resources described in subsection (a) at least 

19 once every 3 years. 

20 (c) CONSULTATION WITH ADVISORY COMMITTEE.— 

21 (1) ESTABLISHMENT.—Subject to the avail22 ability of appropriations, not later than 18 months 

23 after the date of enactment of this Act, the Sec24 retary shall establish an advisory committee to be 

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1 ducing Maternal Deaths’’ (referred to in this section 

2 as the ‘‘Advisory Committee’’). 

3 (2) DUTIES.—The Advisory Committee shall 

4 provide consensus advice and guidance to the Sec5 retary on the development and compilation of the 

6 guidance described in subsection (a) (and any up7 dates to such guidance). 

8 (3) MEMBERSHIP.— 

9 (A) IN GENERAL.—The Secretary, in con10 sultation with such other heads of agencies, as 

11 the Secretary deems appropriate and in accord12 ance with this paragraph, shall appoint not 

13 more than 41 members to the Advisory Com14 mittee. In appointing such members, the Sec15 retary shall ensure that— 

16 (i) the total number of members of 

17 the Advisory Committee is an odd number; 

18 and 

19 (ii) the total number of voting mem20 bers who are not Federal officials does not 

21 exceed the total number of voting Federal 

22 members who are Federal officials. 

23 (B) REQUIRED MEMBERS.— 

24 (i) FEDERAL OFFICIALS.—The Advi25 sory Committee shall include as voting 


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1 members the following Federal officials, or 

2 their designees: 

3 (I) The Secretary. 

4 (II) The Administrator of the 

5 Centers for Medicare & Medicaid 

6 Services. 

7 (III) The Director of the Centers 

8 for Disease Control and Prevention. 

9 (IV) The Associate Administrator 

10 of the Maternal and Child Health Bu11 reau of the Health Resources and 

12 Services Administration. 

13 (V) The Director of the Agency 

14 for Healthcare Research and Quality. 

15 (VI) The National Coordinator 

16 for Health Information Technology. 

17 (VII) The Director of the Na18 tional Institutes of Health. 

19 (VIII) The Secretary of Veterans 

20 Affairs. 

21 (IX) The Director of the Indian 

22 Health Service. 

23 (X) The Deputy Assistant Sec24 retary for Minority Health. 


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1 (XI) The Administrator of the 

2 Substance Abuse and Mental Health 

3 Services Administration. 

4 (XII) The Deputy Assistant Sec5 retary for Women’s Health. 

6 (XIII) Such other Federal offi7 cials or their designees as the Sec8 retary determines appropriate. 

9 (ii) NON-FEDERAL OFFICIALS.— 

10 (I) IN GENERAL.—The Advisory 

11 Committee shall include the following 

12 as voting members: 

13 (aa) At least 1 representa14 tive from a professional organiza15 tion representing hospitals and 

16 health systems. 

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

19 organization representing pri20 mary care providers. 

21 (cc) At least 1 representa22 tive from a medical professional 

23 organization representing general 

24 obstetrician-gynecologists. 


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

3 organization representing cer4 tified nurse-midwives. 

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

7 organization representing other 

8 maternal fetal medicine pro9 viders. 

10 (ff) At least 1 representative 

11 from a medical professional orga12 nization representing anesthesiol13 ogists. 

14 (gg) At least 1 representa15 tive from a medical professional 

16 organization representing emer17 gency medicine physicians and 

18 urgent care providers. 

19 (hh) At least 1 representa20 tive from a medical professional 

21 organization representing nurses. 

22 (ii) At least 1 representative 

23 from a professional organization 

24 representing community health 

25 workers. 


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1 (jj) At least 1 representative 

2 from a professional organization 

3 representing doulas. 

4 (kk) At least 1 representa5 tive from a professional organiza6 tion representing perinatal psy7 chiatrists. 

8 (ll) At least 1 representative 

9 from State-affiliated programs or 

10 existing collaboratives with dem11 onstrated expertise or success in 

12 improving maternal health. 

13 (mm) At least 1 director of 

14 a State Medicaid agency that has 

15 had demonstrated success in im16 proving maternal health. 

17 (nn) At least 1 representa18 tive from an accrediting organi19 zation for maternal health quality 

20 and safety standards. 

21 (oo) At least 1 representa22 tive from a maternal patient ad23 vocacy organization with lived ex24 perience of severe maternal mor25 bidity. 


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1 (pp) At least 1 medical pro2 fessional who is an expert in the 

3 treatment of pregnant women 

4 with substance use disorder. 

5 (II) REQUIREMENTS.—Each in6 dividual selected to be a member 

7 under this clause shall— 

8 (aa) have expertise in mater9 nal health; 

10 (bb) not be a Federal offi11 cial; and 

12 (cc) have experience working 

13 with populations that are at 

14 higher risk for maternal mor15 tality or severe morbidity, such 

16 as populations that experience 

17 racial, ethnic, and geographic 

18 health disparities, pregnant and 

19 postpartum women experiencing 

20 a mental health disorder, or 

21 pregnant or postpartum women 

22 with other comorbidities such as 

23 substance use disorders, hyper24 tension, thyroid disorders, and 

25 sickle cell disease. 


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1 (C) ADDITIONAL MEMBERS.— 

2 (i) IN GENERAL.—In addition to the 

3 members required to be appointed under 

4 subparagraph (B), the Secretary may ap5 point as non-voting members to the Advi6 sory Committee such other individuals with 

7 relevant expertise or experience as the Sec8 retary shall determine appropriate, which 

9 may include, but is not limited to, individ10 uals described in clause (ii). 

11 (ii) SUGGESTED ADDITIONAL MEM12 BERS.—The individuals described in this 

13 clause are the following: 

14 (I) Representatives from State 

15 maternal mortality review committees 

16 and perinatal quality collaboratives. 

17 (II) Medical providers who care 

18 for women and infants during preg19 nancy and the postpartum period, 

20 such as family practice physicians, 

21 cardiologists, pulmonology critical 

22 care specialists, endocrinologists, pedi23 atricians, and neonatologists. 


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1 (III) Representatives from State 

2 and local public health departments, 

3 including State Medicaid Agencies. 

4 (IV) Subject matter experts in 

5 conducting outreach to women who 

6 are African American or belong to an7 other minority group. 

8 (V) Directors of State agencies 

9 responsible for administering a State’s 

10 maternal and child health services 

11 program under title V of the Social 

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

13 (VI) Experts in medical edu14 cation or physician training. 

15 (VII) Representatives from Med16 icaid managed care organizations. 

17 (4) APPLICABILITY OF FACA.—Chapter 10 of 

18 title 5, United States Code, shall apply to the com19 mittee established under this subsection. 

20 (d) CONTENTS.—The guidance described in sub21 section (a) shall include, with respect to hospitals, free22 standing birth centers, and other maternal care providers, 

23 the following: 

24 (1) Best practices regarding evidence-based 

25 screening and clinician education initiatives relating 


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1 to screening and treatment protocols for individuals 

2 who are at risk of experiencing complications related 

3 to pregnancy, with an emphasis on individuals with 

4 preconditions directly linked to pregnancy complica5 tions and maternal mortality and severe morbidity, 

6 including— 

7 (A) methods to identify individuals who are 

8 at risk of maternal mortality or severe mor9 bidity, including risk stratification; 

10 (B) evidence-based risk factors associated 

11 with maternal mortality or severe morbidity and 

12 racial, ethnic, and geographic health disparities; 

13 (C) evidence-based strategies to reduce risk 

14 factors associated with maternal mortality or 

15 severe morbidity through services which may be 

16 covered under Medicaid or CHIP, including, 

17 but not limited to, activities by community 

18 health workers (as such term is defined in sec19 tion 2113 of the Social Security Act (42 U.S.C. 

20 1397mm)) that are funded by a grant awarded 

21 under such section; 

22 (D) resources available to such individuals, 

23 such as nutrition assistance and education, 

24 home visitation, mental health and substance 

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1 grams, pre-natal care, and other evidence-based 

2 maternal mortality or severe morbidity reduc3 tion programs; 

4 (E) examples of educational materials used 

5 by providers of obstetrics services; 

6 (F) methods for improving community cen7 tralized care, including providing telehealth 

8 services or home visits to increase and facilitate 

9 access to and engagement in prenatal and 

10 postpartum care and collaboration with home 

11 health agencies, community health centers, local 

12 public health departments, or clinics; 

13 (G) guidance on medical record diagnosis 

14 codes linked to maternal mortality and severe 

15 morbidity, including, if applicable, codes related 

16 to social risk factors, and methods for edu17 cating clinicians on the proper use of such 

18 codes; 

19 (H) risk appropriate transfer protocols 

20 during pregnancy, childbirth, and the 

21 postpartum period; and 

22 (I) any other information related to pre23 vention and treatment of at-risk individuals de24 termined appropriate by the Secretary. 


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1 (2) Guidance on monitoring programs for indi2 viduals who have been identified as at risk of com3 plications related to pregnancy. 

4 (3) Best practices for such hospitals, free5 standing birth centers, and providers to make preg6 nant women aware of the complications related to 

7 pregnancy. 

8 (4) A fact sheet for providing pregnant women 

9 who are receiving care on an outpatient basis with 

10 a notice during the prenatal stage of pregnancy 

11 that— 

12 (A) explains the risks associated with preg13 nancy, birth, and the postpartum period (in14 cluding the risks of hemorrhage, preterm birth, 

15 sepsis, eclampsia, obstructed labor), chronic 

16 conditions (including high blood pressure, dia17 betes, heart disease, depression, and obesity) 

18 correlated with adverse pregnancy outcomes, 

19 risks associated with advanced maternal age, 

20 and the importance of adhering to a personal21 ized plan of care; 

22 (B) highlights multimodal and evidence23 based prevention and treatment techniques; 

24 (C) highlights evidence-based programs 

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1 birth (including tracking and awareness of fetal 

2 movements, improvement of birth timing for 

3 pregnancies with risk factors, initiatives that 

4 encourage safe sleeping positions during preg5 nancy, screening and surveillance for fetal 

6 growth restriction, efforts to achieve smoking 

7 cessation during pregnancy, community-based 

8 programs that provide home visits or other 

9 types of support, and any other research or evi10 dence-based programming to prevent still11 births); 

12 (D) provides for a method (through signa13 ture or otherwise) for such an individual, or a 

14 person acting on such individual’s behalf, to ac15 knowledge receipt of such fact sheet; 

16 (E) is worded in an easily understandable 

17 manner and made available in multiple lan18 guages and accessible formats determined ap19 propriate by the Secretary; and 

20 (F) includes any other information deter21 mined appropriate by the Secretary. 

22 (5) A template for a voluntary clinician check23 list that outlines the minimum responsibilities that 

24 clinicians, such as physicians, certified nurse-mid25 wives, emergency room and urgent care providers, 


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

2 promote quality and safety in the provision of ob3 stetric services. 

4 (6) A template for a voluntary checklist that 

5 outlines the minimum responsibilities that hospital 

6 leadership responsible for direct patient care, such 

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

8 chief nursing officer, or other hospital leadership 

9 that directly report to the president or chief execu10 tive officer of the institution, should meet to pro11 mote hospital-wide initiatives that improve quality 

12 and safety in the provision of obstetric services. 

13 (7) Information on multi-stakeholder quality 

14 improvement initiatives, such as the Alliance for In15 novation on Maternal Health, State perinatal quality 

16 improvement initiatives, and other similar initiatives 

17 determined appropriate by the Secretary, includ18 ing— 

19 (A) information about such improvement 

20 initiatives and how to join; 

21 (B) information about public maternal 

22 data collection centers; 

23 (C) information about quality metrics used 

24 and outcomes achieved by such improvement 

25 initiatives; 


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1 (D) information about data sharing tech2 niques used by such improvement initiatives; 

3 (E) information about data sources used 

4 by such improvement initiatives to identify ma5 ternal mortality and severe morbidity risks; 

6 (F) information about interventions used 

7 by such improvement initiatives to mitigate 

8 risks of maternal mortality and severe mor9 bidity; 

10 (G) information about data collection tech11 niques on race, ethnicity, geography, age, in12 come, and other demographic information used 

13 by such improvement initiatives; and 

14 (H) any other information determined ap15 propriate by the Secretary. 

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

17 18 months after the date of the publication of the guid18 ance required under subsection (a), the Secretary shall up19 date such guidance to include best practices identified by 

20 the Secretary for such hospitals, freestanding birth cen21 ters, and providers to track maternal mortality and severe 

22 morbidity trends by clinicians at such hospitals, free23 standing birth centers, and providers including— 

24 (1) ways to establish scoring systems, which 

25 may include quality triggers and safety and quality 


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1 metrics to score case and patient outcome metrics, 

2 for such clinicians; 

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

4 such clinicians who may have higher rates of mater5 nal mortality or severe morbidity compared to their 

6 regional or State peers (taking into account dif7 ferences in patient risk for adverse outcomes, which 

8 may include social risk factors); 

9 (3) methods for using such data and tracking 

10 to enhance research efforts focused on maternal 

11 health, while also improving patient outcomes, clini12 cian education and training, and coordination of 

13 care; and 

14 (4) any other information determined appro15 priate by the Secretary. 

16 (f) CULTURAL AND LINGUISTIC APPROPRIATE17 NESS.—To the extent practicable, the Secretary should de18 velop the guidance, best practices, fact sheets, templates, 

19 and other materials that are required under this section 

20 in a trauma-informed, culturally and linguistically appro21 priate manner. 


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1 SEC. 13. PROGRAM RELATED TO REDUCING CESAREAN 

2 BIRTHS AND INCREASING RATES OF VAGINAL 

3 BIRTH AFTER CESAREAN. 

4 Section 317K(a) of the Public Health Service Act (42 

5 U.S.C. 247b–12(a)) is amended— 

6 (1) in paragraph (1)— 

7 (A) by striking ‘‘and to develop or sup8 port’’ and inserting ‘‘to develop or support’’; 

9 and 

10 (B) by inserting ‘‘, and to establish a grant 

11 program, or extend the Alliance for Innovation 

12 on Maternal Health, for the establishment of 

13 perinatal quality collaboratives to reduce cesar14 ean section rates and increase vaginal birth 

15 after cesarean rates’’ before the period at the 

16 end; and 

17 (2) in paragraph (2), by adding at the end the 

18 following: 

19 ‘‘(E) The Secretary may establish a com20 petitive grant program, or extend existing pro21 grams, including the Alliance for Innovation on 

22 Maternal Health, for the establishment or sup23 port of perinatal quality collaboratives, with a 

24 focus on maternity care health professional tar25 get areas and other areas with limited birthing 

26 resources, to reduce cesarean birth rates and 


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1 increase vaginal birth after cesarean rates, in2 cluding through— 

3 ‘‘(i) coordination with hospitals, clin4 ical teams, obstetricians and gynecologists, 

5 birthing centers and community-based ma6 ternal health organizations, public health 

7 agencies, midwives, doulas, patients and 

8 families, and other relevant entities; 

9 ‘‘(ii) providing support and training to 

10 hospital and clinical teams for quality im11 provement, as appropriate; 

12 ‘‘(iii) employing strategies that pro13 vide opportunities for health care profes14 sionals and clinical teams to collaborate 

15 across health care settings and disciplines, 

16 including midwifery care, doula support, 

17 the integration of primary care and mental 

18 health, and blended case payment rates; 

19 ‘‘(iv) using data, disaggregated by 

20 race and ethnicity, to provide timely feed21 back across hospital and clinical teams, 

22 document baseline cesarean and vaginal 

23 birth rates, and measure progress; and 


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1 ‘‘(v) promotion of existing evidence on 

2 the best practices for the safe reduction of 

3 primary cesarean births.’’. 

4 SEC. 14. COLLECTION OF INFORMATION RELATED TO SO5 CIAL DETERMINANTS OF THE HEALTH OF 

6 MEDICAID AND CHIP BENEFICIARIES. 

7 (a) IMPLEMENTATION ASSESSMENT REPORT TO

8 CONGRESS.— 

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

10 the date of enactment of this Act, the Secretary 

11 shall submit a report to Congress that includes a de12 scription of whether and how information related to 

13 the social determinants of health for individuals eli14 gible for medical assistance under Medicaid or child 

15 health assistance or pregnancy-related assistance 

16 under CHIP may be captured under the data sys17 tems for such programs as in effect on the date such 

18 report is submitted, including— 

19 (A) a description of whether and how ICD20 10 codes (or successor codes) may be used to 

21 identify social determinants of health in pro22 grams such as Medicaid and CHIP, and wheth23 er other claims file or demographic information 

24 may be employed; and 


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1 (B) a description of whether existing data 

2 systems under Medicaid and CHIP could be 

3 employed to capture such information, whether 

4 program or system changes would be required, 

5 how privacy and confidentiality as required 

6 under applicable law and regulations would be 

7 maintained, and the resources and timeframes 

8 at the Federal and State levels that would be 

9 needed to make such changes. 

10 (2) GUIDANCE FOR STATES.—The Secretary 

11 shall issue detailed guidance for States concurrent 

12 with the submission of the report to Congress under 

13 paragraph (1). Such guidance shall address— 

14 (A) whether and how information related 

15 to the social determinants of health for individ16 uals eligible for medical assistance under Med17 icaid or child health assistance or pregnancy-re18 lated assistance under CHIP could be captured 

19 employing existing systems under such pro20 grams; and 

21 (B) implementation considerations for cap22 turing such information, including whether pro23 gram or system changes would be required, 

24 whether additional steps would be needed to 

25 maintain privacy and confidentiality as required 


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1 under relevant laws and regulations, and the re2 sources and timeframes at that would be needed 

3 to make such changes. 

4 (3) STAKEHOLDER INPUT.—The Secretary shall 

5 develop the report required under paragraph (1) and 

6 the guidance required under paragraph (2) with the 

7 input of relevant stakeholders, such as State Med8 icaid directors, Medicaid managed care organiza9 tions, and other relevant Federal agencies such as 

10 the Centers for Disease Control and Prevention, the 

11 Health Resources Services Administration, and the 

12 Agency for Healthcare Research and Quality. 

13 (4) ACTION PLAN REPORT.— 

14 (A) IN GENERAL.—If the Secretary deter15 mines in the report required under paragraph 

16 (1) that information related to the social deter17 minants of health for individuals eligible for 

18 medical assistance under Medicaid or child 

19 health assistance or pregnancy-related assist20 ance under CHIP cannot be captured under the 

21 data systems for such programs as in effect on 

22 the date such report is submitted, then, not 

23 later than 6 months after such date, the Sec24 retary shall submit a second report to Congress 

25 that contains an action plan for implementing 


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1 the program or data systems changes needed in 

2 order for such information to be collected while 

3 maintaining privacy and confidentiality as re4 quired under relevant laws and regulations. The 

5 action plan should be prepared so as to be im6 plemented by the Federal Government and 

7 States not later than 2 years after the date on 

8 which the report required under this paragraph 

9 is submitted to Congress. 

10 (B) REVISED GUIDANCE FOR STATES.— 

11 The Secretary shall revise and reissue the guid12 ance for States required under paragraph (2) to 

13 take into account the action plan included in 

14 the report submitted to Congress under sub15 paragraph (A). 

16 (5) AUTHORIZATION OF APPROPRIATIONS.— 

17 (A) FEDERAL COSTS.—There are author18 ized to be appropriated to the Secretary, 

19 $40,000,000 for purposes of preparing the re20 ports required under this subsection and imple21 menting the collection of information related to 

22 the social determinants of health for individuals 

23 eligible for medical assistance under Medicaid 

24 or child health assistance or pregnancy-related 

25 assistance under CHIP. 


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1 (B) STATE COSTS.—There are authorized 

2 to be appropriated to the Secretary, 

3 $50,000,000 for purposes of making payments 

4 to States in accordance with a methodology es5 tablished by the Secretary for State expendi6 tures attributable to planning for and imple7 menting the collection of such information in 

8 accordance with subsection (d) of section 1946 

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

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

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

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

13 adding at the end the following: 

14 ‘‘(d) COLLECTION OF INFORMATION RELATED TO

15 SOCIAL DETERMINANTS OF HEALTH.— 

16 ‘‘(1) DEVELOPMENT OF COLLECTION METH17 ODS.— 

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

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

20 States, shall develop a method for collecting 

21 standardized and aggregated State-level infor22 mation related to social determinants that may 

23 factor into the health of beneficiaries under this 

24 title and beneficiaries under title XXI which the 

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


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1 as a condition for meeting the requirements of 

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

3 use to annually report such information: 

4 ‘‘(i) A model uniform reporting field 

5 through the transformed Medicaid Statis6 tical Information System (T-MSIS) (or a 

7 successor system) or another appropriate 

8 reporting platform, as approved by the 

9 Secretary. 

10 ‘‘(ii) A model uniform questionnaire 

11 or survey (which may be included as part 

12 of an existing survey, questionnaire, or 

13 form administered by the Secretary), for 

14 purposes of the State or the Secretary col15 lecting such information by administering 

16 regularly but not less than annually a 

17 questionnaire or survey of beneficiaries 

18 under this title and beneficiaries under 

19 title XXI. 

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

21 adapted for inclusion in the Medicaid and 

22 CHIP Scorecard developed by the Centers 

23 for Medicare & Medicaid Services, for pur24 poses of the Secretary collecting such in25 formation. 


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1 ‘‘(iv) An alternative method identified 

2 by the Secretary for collecting such infor3 mation. 

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

5 the requirements of subparagraph (A), the Sec6 retary shall— 

7 ‘‘(i) for purposes of the method de8 scribed in clause (i) of such subparagraph, 

9 determine the appropriate providers and 

10 frequency with which such providers shall 

11 complete the reporting field identified and 

12 report the information to the State; 

13 ‘‘(ii) for purposes of the method de14 scribed in clause (ii) of such subparagraph, 

15 identify the means and frequency (which 

16 shall be no less frequent than once per 

17 year) with which a questionnaire or survey 

18 of beneficiaries is to be conducted; 

19 ‘‘(iii) with respect to any method de20 scribed in such subparagraph, issue guid21 ance for ensuring compliance with applica22 ble laws regarding beneficiary informed 

23 consent, privacy, and anonymity with re24 spect to the information collected under 

25 such method; 


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

2 information relating to beneficiaries who 

3 are children, issue guidance on the collec4 tion of such information from a parent, 

5 legal guardian, or any other person who is 

6 legally authorized to share such informa7 tion on behalf of the child when the direct 

8 collection of such information from chil9 dren may not otherwise be feasible or ap10 propriate; and 

11 ‘‘(v) regularly evaluate the method 

12 under such subparagraph and the informa13 tion reported using such method, and, as 

14 needed, make updates to the method and 

15 the information reported. 

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

17 information collected in accordance with the method 

18 made available under paragraph (1) shall, to the ex19 tent practicable, include standardized definitions for 

20 identifying social determinants of health needs iden21 tified in the ICD–10 diagnostic codes Z55 through 

22 Z65 (or any such successor diagnostic codes), as de23 fined by the Healthy People 2020 and related initia24 tives of the Office of Disease Prevention and Health 

25 Promotion of the Department of Health and Human 


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1 Services, or any other standardized set of definitions 

2 for social determinants of health identified by the 

3 Secretary. Such definitions shall incorporate meas4 ures for quantifying the relative severity of any such 

5 social determinant of health need identified in an in6 dividual. 

7 ‘‘(3) FEDERAL PRIVACY REQUIREMENTS.— 

8 Nothing in this subsection shall be construed to su9 persede any Federal privacy or confidentiality re10 quirement, including the regulations promulgated 

11 under section 264(c) of the Health Insurance Port12 ability and Accountability Act of 1996 and section 

13 543 of the Public Health Service Act and any regu14 lations promulgated thereunder. 

15 ‘‘(4) APPLICATION TO TERRITORIES.— 

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

17 Secretary determines that it is not practicable 

18 for a State specified in subparagraph (B) to re19 port information in accordance with the method 

20 made available under paragraph (1), this sub21 section shall not apply with respect to such 

22 State. 

23 ‘‘(B) TERRITORIES SPECIFIED.—The 

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1 to Rico, the Virgin Islands, Guam, American 

2 Samoa, and the Northern Mariana Islands. 

3 ‘‘(5) APPLICATION.— 

4 ‘‘(A) IN GENERAL.—Subject to subpara5 graph (B), the requirement for a State to col6 lect information in accordance with the method 

7 made available under paragraph (1) shall not 

8 apply to the State before the date that is 4 

9 years after the date of enactment of this sub10 section. 

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

12 plan is submitted to Congress under section 

13 14(a)(4) of the Healthy Moms and Babies Act, 

14 in lieu of the date described in subparagraph 

15 (A), the requirement for a State to collect infor16 mation in accordance with the method made 

17 available under paragraph (1) shall not apply to 

18 the State before the date specified in such ac19 tion plan. 

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

21 to the Secretary for fiscal year 2024 and each fiscal 

22 year thereafter $1,000,000 to carry out the provi23 sions of this section and subsection (b)(2)(B).’’. 


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1 (c) REPORT ON DATA ANALYSES.—Section 

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

3 amended— 

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

5 the following: 

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

7 and 

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

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

11 OF HEALTH.— 

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

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

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

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

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

22 under title XXI based on analyses of the 

23 data collected under subsection (d). 

24 ‘‘(ii) INTERIM REPORT.—Not later 

25 than 3 years after the date of enactment 


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1 of this subparagraph, the Secretary shall 

2 submit to Congress an interim report on 

3 progress in developing, implementing, and 

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

6 any available, preliminary information that 

7 has been collected using such method.’’. 

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

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

10 amended by adding at the end the following: 

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

12 health care disparities).’’. 

13 SEC. 15. REPORT ON PAYMENT METHODOLOGIES FOR 

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

16 AFTER CHILDBIRTH. 

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

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

22 transfer of pregnant women from one health care facility 

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


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

3 with the advisory committee established under section 

4 12(c). 

5 SEC. 16. MEDICAID GUIDANCE ON STATE OPTIONS TO AD6 DRESS SOCIAL DETERMINANTS OF HEALTH 

7 FOR PREGNANT AND POSTPARTUM WOMEN. 

8 (a) IN GENERAL.—Not later than 2 years after the 

9 date of enactment of this Act, the Secretary shall issue 

10 guidance to States and conduct one or more learning 

11 collaboratives to promote cross-state learning regarding 

12 options States may employ to address social determinants 

13 of health, as defined by the Healthy People 2030 and re14 lated initiatives of the Office of Disease Prevention and 

15 Health Promotion of the Department of Health and 

16 Human Services, including for pregnant and postpartum 

17 women. 

18 (b) GUIDANCE REQUIREMENTS.—The guidance re19 quired under subsection (a) shall, at a minimum, describe 

20 the authorities that States may leverage to support ad21 dressing the social determinants of health for pregnant 

22 and postpartum women and outline best practices for such 

23 efforts. 

24 (c) LEARNING COLLABORATIVE REQUIREMENTS.— 

25 The learning collaboratives required under subsection (a) 


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1 shall, at a minimum, include opportunities for States and 

2 other stakeholders to share innovative practices and ap3 proaches as they are being considered and developed, 

4 share solutions related to challenges that multiple urban 

5 and rural States face, and promote the uptake of ap6 proved, effective interventions addressing social needs and 

7 determinants covered by the Medicaid program. 

8 SEC. 17. PAYMENT ERROR RATE MEASUREMENT (PERM) 

9 AUDIT AND IMPROVEMENT REQUIREMENTS. 

10 (a) BIENNIAL PERM AUDIT REQUIREMENT.—Be11 ginning with fiscal year 2025, the Administrator shall con12 duct payment error rate measurement (‘‘PERM’’) audits 

13 of each State Medicaid program on a biennial basis. 

14 (b) PERM ERROR RATE REDUCTION PLAN RE15 QUIREMENT.—Beginning with fiscal year 2025, any State 

16 with an overall PERM error rate exceeding 15 percent in 

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

18 previous fiscal year shall publish a plan, in coordination 

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

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

21 15 percent in the current fiscal year. 

22 (c) NOTIFICATION; IDENTIFICATION OF SOURCES OF

23 IMPROPER PAYMENTS.— 

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

25 after the date of enactment of this Act, the AdminisVerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948

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1 trator shall notify the contractor conducting PERM 

2 audits of the Administrator’s intent to modify con3 tracts to require PERM audits not less than once 

4 every other year in each State. 

5 (2) IDENTIFICATION OF SOURCES OF IMPROPER

6 PAYMENTS.—The Administrator shall direct the con7 tractor conducting PERM audits of State Medicaid 

8 programs to identify areas known to be sources of 

9 improper payments under such programs to identify 

10 program areas or components known to be sources 

11 of high risk for improper payments under such pro12 grams. 

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

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

15 the Administrator shall issue a State Medicaid Director 

16 letter regarding State requirements under Federal law and 

17 regulations regarding avoiding and responding to im18 proper payments under State Medicaid programs. 

19 (e) STATE IMPROPER PAYMENT MITIGATION

20 PLANS.— 

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

22 2024, each State Medicaid program shall submit to 

23 the Administrator a plan, which shall include spe24 cific actions and timeframes for taking such actions 


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1 and achieving specified results, for mitigating im2 proper payments under such program. 

3 (2) PUBLICATION OF STATE PLANS.—The Ad4 ministrator shall make State plans submitted under 

5 paragraph (1) available to the public. 

6 (f) DEFINITIONS.—In this section: 

7 (1) ADMINISTRATOR.—The term ‘‘Adminis8 trator’’ means the Administrator of the Centers for 

9 Medicare & Medicaid Services. 

10 (2) STATE.—The term ‘‘State’’ has the mean11 ing given such term for purposes of title XIX of the 

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

13 (3) STATE MEDICAID PROGRAM.—The term 

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

15 under title XIX of the Social Security Act (42 

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

17 such a plan. 

Æ 


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