retary shall provide grants to States to enter into arrange-
ments with eligible entities to implement or expand a ma-
ternity care home model for eligible individuals. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means an entity or organization that provides 
medically accurate, comprehensive maternity services 
to individuals who are eligible for medical assistance 
under a State plan under this title or a waiver of 
such a plan, and may include: 
‘‘(A) A freestanding birth center. 
‘‘(B) An entity or organization receiving 
assistance under section 330 of the Public 
Health Service Act. 
‘‘(C) A federally qualified health center. 
‘‘(D) A rural health clinic. 
‘‘(E) A health facility operated by an In-
dian tribe or tribal organization (as those terms 
are defined in section 4 of the Indian Health 
Care Improvement Act). 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means a pregnant individual or a for-
merly pregnant individual during the 1-year period 
beginning on the last day of the pregnancy, or such 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
longer period beginning on such day as a State may 
elect, who is— 
‘‘(A) enrolled in a State plan under this 
title, a waiver of such a plan, or a State child 
health plan under title XXI; and 
‘‘(B) a patient of an eligible entity which 
has entered into an arrangement with a State 
under subsection (g). 
‘‘(c) GOALS
OF DEMONSTRATION PROJECT.—The 
goals of the demonstration project are the following: 
‘‘(1) To improve— 
‘‘(A) maternity and infant care outcomes; 
‘‘(B) birth equity; 
‘‘(C) health equity for— 
‘‘(i) Black, Indigenous, and other peo-
ple of color; 
‘‘(ii) lesbian, gay, bisexual, transgen-
der, queer, non-binary, and gender noncon-
firming individuals; 
‘‘(iii) people who live in regions with 
limited or no access to obstetric care; 
‘‘(iv) people with disabilities; and 
‘‘(v) other underserved populations; 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(D) communication by and between ma-
ternity, infant care, and social services pro-
viders; 
‘‘(E) integration of perinatal support serv-
ices, including community health workers, 
doulas, social workers, public health nurses, 
peer lactation counselors, lactation consultants, 
childbirth educators, peer mental health work-
ers, and others, into health care entities and or-
ganizations; 
‘‘(F) care coordination between maternity, 
infant care, oral health services, and social serv-
ices providers within the community; 
‘‘(G) the quality and safety of maternity 
and infant care; 
‘‘(H) the experience of individuals receiv-
ing respectful maternity care, including by in-
creasing the ability of an individual to develop 
and follow their own birthing plans; and 
‘‘(I) access to adequate prenatal and 
postpartum care, including— 
‘‘(i) prenatal care that is initiated in 
a timely manner; 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(ii) not fewer than 5 post-pregnancy 
visits to a maternity care provider for 
postpartum care and support; 
‘‘(iii) interpregnancy care; and 
‘‘(iv) support and treatment for 
perinatal mood and anxiety disorders. 
‘‘(2) To provide coordinated, evidence-based, re-
spectful, culturally and linguistically appropriate, 
and person-centered maternity care management. 
‘‘(3) To decrease— 
‘‘(A) preventable and severe maternal mor-
bidity and maternal mortality; 
‘‘(B) overall health care spending; 
‘‘(C) unnecessary emergency department 
visits; 
‘‘(D) disparities in maternal and infant 
care outcomes, including racial, economic, dis-
ability, gender-based, and geographical dispari-
ties; 
‘‘(E) racial, gender, economic, and other 
discrimination among among health care profes-
sionals; 
‘‘(F) racism, discrimination, disrespect, 
trauma, and abuse in maternity care settings; 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(G) the rate of cesarean deliveries for 
low-risk pregnancies; 
‘‘(H) the rate of preterm births and in-
fants born with low birth weight; 
‘‘(I) the rate of avoidable maternal and 
newborn hospitalizations and admissions to in-
tensive care units; and 
‘‘(J) the rate of perinatal mood and anx-
iety disorders. 
‘‘(d) CONSULTATION.—In designing and imple-
menting the demonstration project the Secretary shall 
consult with stakeholders, including— 
‘‘(1) States; 
‘‘(2) organizations representing relevant health 
care professionals, including oral health services pro-
fessionals; 
‘‘(3) organizations, particularly reproductive 
justice and birth justice organizations led by people 
of color, that represent consumers of maternal 
health care, including consumers of maternal health 
care who are disproportionately impacted by poor 
maternal health outcomes; 
‘‘(4) representatives with experience imple-
menting other maternity care home models, includ-
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
ing representatives from the Center for Medicare 
and Medicaid Innovation; 
‘‘(5) community-based health care professionals, 
including doulas, lactation consultants, and other 
stakeholders; 
‘‘(6) experts in promoting health equity and 
combating racial bias in health care settings; and 
‘‘(7) Black, Indigenous, and other maternal 
health care consumers of color who have experienced 
severe maternal morbidity. 
‘‘(e) APPLICATION AND SELECTION OF STATES.— 
‘‘(1) IN GENERAL.—A State seeking to partici-
pate in the demonstration project shall submit an 
application to the Secretary at such time and in 
such manner as the Secretary shall require. 
‘‘(2) SELECTION OF STATES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
select at least 10 States to participate in the 
demonstration project. 
‘‘(B) SELECTION REQUIREMENTS.—In se-
lecting States to participate in the demonstra-
tion project, the Secretary shall— 
‘‘(i) ensure that there is geographic 
and regional diversity in the areas in which 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
activities will be carried out under the 
project; 
‘‘(ii) ensure that States with signifi-
cant disparities in maternal and infant 
health outcomes, including severe maternal 
morbidity, and other disparities based on 
race, income, or access to maternity care, 
are included; and 
‘‘(iii) ensure that at least 1 territory 
is included. 
‘‘(f) GRANTS.— 
‘‘(1) IN
GENERAL.—From amounts appro-
priated under subsection (l), the Secretary shall 
award 1 grant for each year of the demonstration 
project to each State that is selected to participate 
in the demonstration project. 
‘‘(2) USE OF GRANT FUNDS.—A State may use 
funds received under this section to— 
‘‘(A) award grants or make payments to 
eligible entities as part of an arrangement de-
scribed in subsection (g)(2); 
‘‘(B) provide financial incentives to health 
care professionals, including community-based 
health care workers and community-based 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
doulas, who participate in the State’s maternity 
care home model; 
‘‘(C) provide adequate training for health 
care professionals, including community-based 
health care workers, doulas, and care coordina-
tors, who participate in the State’s maternity 
care home model, which may include training 
for cultural humility and antiracism, racial bias, 
health equity, reproductive and birth justice, 
trauma-informed care, home visiting skills, and 
respectful communication and listening skills, 
particularly in regards to maternal health; 
‘‘(D) pay for personnel and administrative 
expenses associated with designing, imple-
menting, and operating the State’s maternity 
care home model; 
‘‘(E) pay for items and services that are 
furnished under the State’s maternity care 
home model and for which payment is otherwise 
unavailable under this title; 
‘‘(F) pay for services and materials to en-
sure culturally and linguistically appropriate 
communication, including— 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(i) language services such as inter-
preters and translation of written mate-
rials; and 
‘‘(ii) development of culturally and lin-
guistically appropriate materials; and aux-
iliary aids and services; and 
‘‘(G) pay for other costs related to the 
State’s maternity care home model, as deter-
mined by the Secretary. 
‘‘(3) GRANT
FOR
NATIONAL
INDEPENDENT 
EVALUATOR.— 
‘‘(A) IN
GENERAL.—From the amounts 
appropriated under subsection (l), prior to 
awarding any grants under paragraph (1), the 
Secretary shall enter into a contract with a na-
tional external entity to create a single, uniform 
process to— 
‘‘(i) ensure that States that receive 
grants under paragraph (1) comply with 
the requirements of this section; and 
‘‘(ii) evaluate the outcomes of the 
demonstration project in each participating 
State. 
‘‘(B) ANNUAL REPORT.—The contract de-
scribed in subparagraph (A) shall require the 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
national external entity to submit to the Sec-
retary— 
‘‘(i) a yearly evaluation report for 
each year of the demonstration project; 
and 
‘‘(ii) a final impact report after the 
demonstration project has concluded. 
‘‘(C) SECRETARY’S AUTHORITY.—Nothing 
in this paragraph shall prevent the Secretary 
from making a determination that a State is 
not in compliance with the requirements of this 
section without the national external entity 
making such a determination. 
‘‘(g) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 
‘‘(1) IN GENERAL.—As a condition of receiving 
a grant under this section, a State shall enter into 
an arrangement with one or more eligible entities 
that meets the requirements of paragraph (2). 
‘‘(2) ARRANGEMENTS
WITH
ELIGIBLE
ENTI-
TIES.—Under an arrangement between a State and 
an eligible entity under this subsection, the eligible 
entity shall perform the following functions, with re-
spect to eligible individuals enrolled with the entity 
under the State’s maternity care home model— 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(A) provide culturally and linguistically 
appropriate congruent care, which may include 
prenatal care, family planning services, medical 
care, mental and behavioral care, postpartum 
care, and oral health services to such eligible in-
dividuals through a team of health care profes-
sionals, which may include obstetrician-gyne-
cologists, maternal-fetal medicine specialists, 
family physicians, primary care providers, oral 
health providers, physician assistants, advanced 
practice registered nurses such as nurse practi-
tioners and certified nurse midwives, certified 
midwives, certified professional midwives, phys-
ical therapists, social workers, traditional and 
community-based doulas, lactation consultants, 
childbirth educators, community health workers, 
peer mental health supporters, and other health 
care professionals; 
‘‘(B) conduct a risk assessment of each 
such eligible individual to determine if their 
pregnancy is high or low risk, and establish a 
tailored pregnancy care plan, which takes into 
consideration the individual’s own preferences 
and pregnancy care and birthing plans and de-
termines the appropriate support services to re-
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
duce the individual’s medical, social, and envi-
ronmental risk factors, for each such eligible in-
dividual based on the results of such risk as-
sessment; 
‘‘(C) assign each such eligible individual to 
a culturally and linguistically appropriate care 
coordinator, which may be a nurse, social work-
er, traditional or community-based doula, com-
munity health worker, midwife, or other health 
care provider, who is responsible for ensuring 
that such eligible individual receives the nec-
essary medical care and connections to essential 
support services; 
‘‘(D) provide, or arrange for the provision 
of, essential support services, such as services 
that address— 
‘‘(i) food access, nutrition, and exer-
cise; 
‘‘(ii) smoking cessation; 
‘‘(iii) substance use disorder and ad-
diction treatment; 
‘‘(iv) anxiety, depression, trauma, and 
other mental and behavioral health issues; 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(v) breast feeding, chestfeeding, or 
other infant feeding options supports, initi-
ation, continuation, and duration; 
‘‘(vi) stable, affordable, safe, and 
healthy housing; 
‘‘(vii) transportation; 
‘‘(viii) intimate partner violence; 
‘‘(ix) community and police violence; 
‘‘(x) home visiting services; 
‘‘(xi) childbirth and newborn care edu-
cation; 
‘‘(xii) oral health education; 
‘‘(xiii) continuous labor support; 
‘‘(xiv) group prenatal care; 
‘‘(xv) family planning and contracep-
tive care and supplies; and 
‘‘(xvi) affordable child care; 
‘‘(E) as appropriate, facilitate connections 
to a usual primary care provider, which may be 
a reproductive health care provider; 
‘‘(F) refer to guidelines and opinions of 
medical associations when determining whether 
an elective delivery should be performed on an 
eligible individual before 39 weeks of gestation; 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(G) provide such eligible individual with 
evidence-based and culturally and linguistically 
appropriate education and resources to identify 
potential warning signs of pregnancy and 
postpartum complications and when and how to 
obtain medical attention; 
‘‘(H) provide, or arrange for the provision 
of, culturally and linguistically appropriate 
pregnancy and postpartum health services, in-
cluding family planning counseling and services, 
to eligible individuals; 
‘‘(I) track and report postpartum health 
and birth outcomes of such eligible individuals 
and their children; 
‘‘(J) ensure that care is person-centered, 
culturally and linguistically appropriate, and 
patient-led, including by engaging eligible indi-
viduals in their own care, including through 
communication and education; and 
‘‘(K) ensure adequate training for appro-
priately serving the population of individuals el-
igible for medical assistance under the State 
plan or waiver of such plan, including through 
reproductive justice, birth justice, birth equity, 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
and anti-racist frameworks, home visiting skills, 
and knowledge of social services. 
‘‘(h) TERM
OF DEMONSTRATION PROJECT.—The 
Secretary shall conduct the demonstration project for a 
period of 5 years. 
‘‘(i) WAIVER AUTHORITY.—To the extent that the 
Secretary determines necessary in order to carry out the 
demonstration project, the Secretary may waive section 
1902(a)(1) (relating to statewideness) and section 
1902(a)(10)(B) (relating to comparability). 
‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 
establish a process to provide technical assistance to 
States that are awarded grants under this section and to 
eligible entities and other providers participating in a 
State maternity care home model funded by such a grant. 
‘‘(k) REPORT.— 
‘‘(1) IN GENERAL.—Not later than 18 months 
after the date of the enactment of this section and 
annually thereafter for each year of the demonstra-
tion project term, the Secretary shall submit a re-
port to Congress on the results of the demonstration 
project. 
‘‘(2) FINAL REPORT.—As part of the final re-
port required under paragraph (1), the Secretary 
shall include— 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(A) the results of the final report of the 
national external entity required under sub-
section (f)(3)(B)(ii); and 
‘‘(B) recommendations on whether the 
model studied in the demonstration project 
should be continued or more widely adopted, in-
cluding by private health plans. 
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary, for 
each of fiscal years 2024 through 2031, such sums as may 
be necessary to carry out this section.’’. 
SEC. 4. REAPPLICATION OF MEDICARE PAYMENT RATE 
FLOOR TO PRIMARY CARE SERVICES FUR-
NISHED UNDER MEDICAID AND INCLUSION 
OF ADDITIONAL PROVIDERS. 
(a) REAPPLICATION
OF PAYMENT FLOOR; ADDI-
TIONAL PROVIDERS.— 
(1) IN GENERAL.—Section 1902(a)(13) of the 
Social Security Act (42 U.S.C. 1396a(a)(13)) is 
amended— 
(A) in subparagraph (B), by striking ‘‘; 
and’’ and inserting a semicolon; 
(B) in subparagraph (C), by striking the 
semicolon and inserting ‘‘; and’’; and 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) payment for primary care services (as 
defined in subsection (jj)(1)) furnished in the 
period that begins on the first day of the first 
month that begins after the date of enactment 
of the Maximizing Outcomes for Moms through 
Medicaid Improvement and Enhancement of 
Services Act by a provider described in sub-
section (jj)(2)— 
‘‘(i) at a rate that is not less than 100 
percent of the payment rate that applies to 
such services and the provider of such 
services under part B of title XVIII (or, if 
greater, the payment rate that would be 
applicable under such part if the conver-
sion factor under section 1848(d) for the 
year were the conversion factor under such 
section for 2009); 
‘‘(ii) in the case of items and services 
that are not items and services provided 
under such part, at a rate to be established 
by the Secretary; and 
‘‘(iii) in the case of items and services 
that are furnished in rural areas (as de-
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB
fined in section 1886(d)(2)(D)), health 
professional shortage areas (as defined in 
section 332(a)(1)(A) of the Public Health 
Service Act (42 U.S.C. 254e(a)(1)(A))), or 
medically underserved areas (according to 
a designation under section 330(b)(3)(A) 
of the Public Health Service Act (42 
U.S.C. 254b(b)(3)(A))), at the rate other-
wise applicable to such items or services 
under clause (i) or (ii) increased, at the 
Secretary’s discretion, by not more than 25 
percent;’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1902(a)(13)(C) of the Social 
Security Act (42 U.S.C. 1396a(a)(13)(C)) is 
amended by striking ‘‘subsection (jj)’’ and in-
serting ‘‘subsection (jj)(1)’’. 
(B) Section 1905(dd) of the Social Secu-
rity Act (42 U.S.C. 1396d(dd)) is amended— 
(i) by striking ‘‘Notwithstanding’’ and 
inserting the following: 
‘‘(1) IN GENERAL.—Notwithstanding’’; 
(ii) 
by 
striking 
‘‘section 
1902(a)(13)(C)’’ and inserting ‘‘subpara-
graph (C) of section 1902(a)(13)’’; 
VerDate Sep 11 2014 
21:23 Nov 05, 2023
Jkt 049200
PO 00000
Frm 00032
Fmt 6652
Sfmt 6201
E:\BILLS\H6004.IH
H6004
pbinns on DSKJLVW7X2PROD with $$_JOB