I 
118TH CONGRESS 
1ST SESSION H. R. 3346 
To direct the Administrator of the Centers for Medicare & Medicaid Services 
to implement the Perinatal Care Alternative Payment Model Demonstra-
tion Project to test various payment models with respect to maternity 
care provided to pregnant and postpartum individuals, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2023 
Ms. SCHAKOWSKY (for herself, Mr. AGUILAR, Mr. ALLRED, Ms. BARRAGA´N, 
Mrs. BEATTY, Mr. BLUMENAUER, Ms. BLUNT
ROCHESTER, Ms. 
BROWNLEY, Ms. BUDZINSKI, Ms. BUSH, Ms. CARAVEO, Mr. CARBAJAL, 
Mr. CARSON, Mr. CARTER of Louisiana, Mrs. CHERFILUS-MCCORMICK, 
Ms. CLARKE of New York, Mr. CLEAVER, Mr. COHEN, Ms. CRAIG, Ms. 
CROCKETT, Mr. DAVIS of Illinois, Ms. DEAN of Pennsylvania, Ms. 
ESCOBAR, Mr. ESPAILLAT, Mr. EVANS, Mrs. FOUSHEE, Mr. GARAMENDI, 
Ms. GARCIA of Texas, Mr. GARCI´A of Illinois, Mr. GREEN of Texas, Mrs. 
HAYES, Mr. HORSFORD, Mr. HUFFMAN, Mr. IVEY, Mr. JACKSON of Illi-
nois, Ms. JACOBS, Ms. JAYAPAL, Mr. JOHNSON
of Georgia, Ms. 
KAMLAGER-DOVE, Mr. KRISHNAMOORTHI, Ms. KUSTER, Ms. LEE of Cali-
fornia, Mr. LIEU, Ms. LOFGREN, Mrs. MCBATH, Mrs. MCCLELLAN, Ms. 
MCCOLLUM, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG, Mr. MFUME, Mr. 
MORELLE, Mr. MOULTON, Ms. MOORE of Wisconsin, Mr. MRVAN, Mr. 
MULLIN, Mrs. NAPOLITANO, Mr. NEGUSE, Ms. OCASIO-CORTEZ, Mr. 
PAPPAS, Mr. PAYNE, Mr. PHILLIPS, Ms. PORTER, Ms. PRESSLEY, Mr. 
RUPPERSBERGER, Ms. SALINAS, Ms. SCANLON, Mr. SCHIFF, Mr. 
SCHNEIDER, Ms. SCHOLTEN, Mr. DAVID SCOTT of Georgia, Ms. SEWELL, 
Mr. SMITH
of Washington, Mr. SOTO, Ms. SPANBERGER, Ms. 
STANSBURY, Ms. STRICKLAND, Mrs. SYKES, Mr. TAKANO, Ms. TLAIB, 
Ms. TOKUDA, Mr. TONKO, Mrs. TORRES of California, Mrs. TRAHAN, Mr. 
TRONE, Mr. VARGAS, Mr. VEASEY, Ms. VELA´ZQUEZ, Ms. WASSERMAN 
SCHULTZ, Mrs. WATSON COLEMAN, Ms. WEXTON, Ms. WILLIAMS of 
Georgia, Mr. PASCRELL, Ms. DELBENE, and Mr. LYNCH) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce 
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A BILL 
To direct the Administrator of the Centers for Medicare 
& Medicaid Services to implement the Perinatal Care 
Alternative Payment Model Demonstration Project to 
test various payment models with respect to maternity 
care provided to pregnant and postpartum individuals, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Innovative Maternal 
Payment and Coverage To Save Moms Act’’ or the ‘‘IM-
PACT to Save Moms Act’’. 
SEC. 2. PERINATAL CARE ALTERNATIVE PAYMENT MODEL 
DEMONSTRATION PROJECT. 
(a) IN GENERAL.—For the period of fiscal years 
2024 through 2028, the Secretary of Health and Human 
Services (referred to in this section as the ‘‘Secretary’’), 
acting through the Administrator of the Centers for Medi-
care & Medicaid Services, shall establish and implement, 
in accordance with the requirements of this section, a 
demonstration project, to be known as the Perinatal Care 
Alternative Payment Model Demonstration Project (re-
ferred to in this section as the ‘‘Demonstration Project’’), 
for purposes of allowing States to test payment models 
under their State plans under title XIX of the Social Secu-
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(6) relevant health insurance issuers; 
(7) hospitals, health systems, midwifery prac-
tices, freestanding birth centers (as such term is de-
fined in paragraph (3)(B) of section 1905(l) of the 
Social Security Act (42 U.S.C. 1396d(l))), Feder-
ally-qualified health centers (as such term is defined 
in paragraph (2)(B) of such section), and rural 
health clinics (as such term is defined in section 
1861(aa) of such Act (42 U.S.C. 1395x(aa))); 
(8) researchers and policy experts in fields re-
lated to maternity care payment models; and 
(9) any other stakeholders as the Secretary de-
termines appropriate, with a particular focus on 
stakeholders from demographic groups with elevated 
rates of maternal mortality, severe maternal mor-
bidity, maternal health disparities, or other adverse 
perinatal or childbirth outcomes. 
(c) CONSIDERATIONS.—In establishing the Dem-
onstration Project, the Secretary shall consider any alter-
native payment model that— 
(1) is designed to improve maternal health out-
comes for individuals from demographic groups with 
elevated rates of maternal mortality, severe maternal 
morbidity, maternal health disparities, or other ad-
verse perinatal or childbirth outcomes; 
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(2) includes methods for stratifying patients by 
pregnancy risk level and, as appropriate, adjusting 
payments under such model to take into account 
pregnancy risk level, including consideration of the 
appropriate transfer of patients by pregnancy risk 
level; 
(3) establishes evidence-based quality metrics 
for such payments; 
(4) includes consideration of nonhospital birth 
settings such as freestanding birth centers (as so de-
fined); 
(5) includes consideration of social deter-
minants of maternal health; 
(6) includes diverse maternity care teams that 
include— 
(A) maternity care providers, mental and 
behavioral health care providers acting in ac-
cordance with State law, and registered dieti-
tians or nutrition professionals (as such term is 
defined in section 1395x(vv)(2) of title 42, 
United States Code)— 
(i) from racially, ethnically, and pro-
fessionally diverse backgrounds; 
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(ii) with experience practicing in ra-
cially and ethnically diverse communities; 
or 
(iii) who have undergone training on 
implicit bias and racism; and 
(B) perinatal health workers; or 
(7) includes consideration of maternal mental 
health conditions and substance use disorders. 
(d) ELIGIBILITY.—To be eligible to participate in the 
Demonstration Project, a State shall submit an applica-
tion to the Secretary at such time, in such manner, and 
containing such information as the Secretary may require. 
(e) EVALUATION.—The Secretary shall conduct an 
evaluation of the Demonstration Project to determine the 
impact of the Demonstration Project on— 
(1) maternal health outcomes, with data strati-
fied by race, ethnicity, primary language, socio-
economic status, geography, insurance type, and 
other factors as the Secretary determines appro-
priate; 
(2) spending on maternity care by States par-
ticipating in the Demonstration Project; 
(3) to the extent practicable, qualitative and 
quantitative measures of patient experience; and 
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(4) any other areas of assessment that the Sec-
retary determines relevant. 
(f) REPORT.—Not later than one year after the com-
pletion or termination date of the Demonstration Project, 
the Secretary shall submit to the Congress, and make pub-
licly available, a report containing— 
(1) the results of any evaluation conducted 
under subsection (e); and 
(2) a recommendation regarding whether the 
Demonstration Project should be continued after fis-
cal year 2028 and expanded on a national basis. 
(g) DEFINITIONS.—In this section: 
(1) 
ALTERNATIVE
PAYMENT
MODEL.—The 
term ‘‘alternative payment model’’ has the meaning 
given such term in section 1833(z)(3)(C) of the So-
cial Security Act (42 U.S.C. 1395l(z)(3)(C)). 
(2) MATERNAL MORTALITY.—The term ‘‘mater-
nal mortality’’ means a death occurring during or 
within a 1-year period after pregnancy, caused by 
pregnancy-related or childbirth complications, in-
cluding a suicide, overdose, or other death resulting 
from a mental health or substance use disorder at-
tributed to or aggravated by pregnancy-related or 
childbirth complications. 
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(2) MATERNITY
CARE
PROVIDER.—The term 
‘‘maternity care provider’’ means a health care pro-
vider who— 
(A) is a physician, a physician assistant, a 
midwife who meets, at a minimum, the inter-
national definition of a midwife and global 
standards for midwifery education as estab-
lished by the International Confederation of 
Midwives, an advanced practice registered 
nurse, or a lactation consultant certified by the 
International Board of Lactation Consultant 
Examiners; and 
(B) has a focus on maternal or perinatal 
health. 
(3) PERINATAL.—The term ‘‘perinatal’’ means 
the period beginning on the day an individual be-
comes pregnant and ending on the last day of the 
1-year period beginning on the last day of such indi-
vidual’s pregnancy. 
(4) PERINATAL HEALTH WORKER.—The term 
‘‘perinatal health worker’’ means a nonclinical health 
worker focused on maternal or perinatal health, such 
as a doula, community health worker, peer sup-
porter, lactation educator or counselor, nutritionist 
or dietitian, childbirth educator, social worker, home 
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