I 
119TH CONGRESS 
1ST SESSION H. R. 3942 
To amend titles XIX and XXI of the Social Security Act to enhance financial 
support for rural and safety net hospitals providing maternity, labor, 
and delivery services to vulnerable populations, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 12, 2025 
Ms. BONAMICI (for herself and Ms. KELLY of Illinois) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on Ways and Means, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to enhance financial support for rural and safety net 
hospitals providing maternity, labor, and delivery services 
to vulnerable populations, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Keeping Obstetrics Local Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
TITLE I—ENHANCING FINANCIAL SUPPORT FOR RURAL AND 
SAFETY NET HOSPITALS THAT PROVIDE OBSTETRIC SERVICES 
Sec. 101. State studies and HHS report on costs of providing maternity, labor, 
and delivery services. 
Sec. 102. Requiring adequate payment rates under Medicaid for maternity, 
labor, and delivery services at eligible hospitals. 
Sec. 103. Increased Federal financial participation for maternity, labor, and de-
livery services furnished by eligible hospitals. 
Sec. 104. Labor and delivery services anchor payments. 
Sec. 105. Application of adequate payment requirement and increased Federal 
financial participation requirements to CHIP. 
Sec. 106. Disregarding increased and additional payments to hospitals for pur-
poses of other supplemental payments and upper payment lim-
its. 
TITLE II—EXPAND COVERAGE OF MATERNAL HEALTH CARE 
Sec. 201. Requiring 12-month continuous, full benefit coverage for pregnant in-
dividuals under Medicaid and CHIP. 
Sec. 202. Health homes for pregnant and postpartum women. 
Sec. 203. Guidance on supporting and improving access to Medicaid and CHIP 
coverage of services provided by doulas and certain maternal 
health professionals. 
Sec. 204. Medicaid and CHIP increased financial support for depression and 
anxiety screening during the perinatal and postpartum periods. 
Sec. 205. Presumptive eligibility for pregnant individuals. 
TITLE III—INVEST IN THE MATERNAL HEALTH CARE 
WORKFORCE 
Sec. 301. Emergency obstetric workforce support. 
Sec. 302. Streamlined screening and enrollment of providers of maternity, 
labor, and delivery services in neighboring States. 
TITLE IV—REQUIRING PUBLIC COMMUNICATION OF OBSTETRICS 
DATA AND UNIT CLOSURES 
Sec. 401. Timely notifications of impending hospital obstetric unit closures. 
Sec. 402. Collection of data relating to hospital labor and delivery services. 
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TITLE 
I—ENHANCING 
FINAN-
CIAL SUPPORT FOR RURAL 
AND SAFETY NET HOSPITALS 
THAT 
PROVIDE 
OBSTETRIC 
SERVICES 
SEC. 101. STATE STUDIES AND HHS REPORT ON COSTS OF 
PROVIDING MATERNITY, LABOR, AND DELIV-
ERY SERVICES. 
(a) STATE STUDY.— 
(1) IN GENERAL.—Not later than 24 months 
after the date of enactment of this Act, and every 
5 years thereafter, each State (as such term is de-
fined in section 1101(a)(1) of the Social Security 
Act (42 U.S.C. 1301(a)(1)) for purposes of titles 
XIX and XXI of such Act) shall conduct a study on 
the costs of providing maternity, labor, and delivery 
services in applicable hospitals (as defined in para-
graph (3)) and submit the results of such study to 
the Secretary of Health and Human Services (re-
ferred to in this section as the ‘‘Secretary’’). 
(2) CONTENT OF STUDY.—A State study re-
quired under paragraph (1) shall include the fol-
lowing information (to the extent practicable) with 
respect to maternity, labor, and delivery services fur-
nished by applicable hospitals located in the State: 
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State-funded programs (including, to the 
extent data is available, Medicaid managed 
care rates), and to the payment rates for 
such services, to the extent data is avail-
able, of private health insurers within geo-
graphic areas of the State; and 
(ii) analyzing different payment meth-
ods for such services, such as the use of 
bundled payments, quality incentives, and 
low-volume adjustments. 
(F) An evaluation, using such methodology 
and parameters established by the Secretary, of 
whether each hospital located in the State that 
furnishes maternity, labor, and delivery services 
is expected to experience in the next 3 years 
significant changes in particular expenditures 
or types of reimbursement for maternity, labor, 
and delivery services. 
(3) APPLICABLE
HOSPITAL
DEFINED.—For 
purposes of this subsection, the term ‘‘applicable 
hospital’’ means any hospital located in a State that 
meets either of the following criteria: 
(A) The hospital provides labor and deliv-
ery services and more than 50 percent of the 
hospital’s births (in the most recent year for 
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which such data is available) are financed by 
the Medicaid program or CHIP. 
(B) The hospital— 
(i) is located in a rural area (as de-
fined by the Federal Office of Rural 
Health Policy for the purpose of rural 
health grant programs administered by 
such Office); 
(ii) based on the most recent 2 years 
of data available (as determined by the 
Secretary), furnished services for less than 
an average of 300 births per year; and 
(iii) provides labor and delivery serv-
ices. 
(4) ASSISTANCE TO SMALL HOSPITALS IN COM-
PILING
COST
INFORMATION.—There are appro-
priated to the Secretary for fiscal year 2026, 
$10,000,000 for the purpose of providing grants and 
technical assistance to a hospital described in para-
graph (3)(B) to enable such hospital to compile de-
tailed information for use in the State studies re-
quired under paragraph (1), to remain available 
until expended. 
(5) HHS REPORT
ON
STATE
STUDIES.—For 
each year in which a State is required to conduct a 
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study under paragraph (1), the Secretary shall issue, 
not later than 12 months after the date on which 
the State submits to the Secretary the data de-
scribed in such paragraph, a publicly available re-
port that compiles and details the results of such 
study and includes the information described in 
paragraph (2). 
(b) HHS REPORT ON NATIONAL DATA COLLECTION 
FINDINGS.—Not later than 3 years after the date of en-
actment of this Act, the Secretary shall submit to Con-
gress, and make publicly available, a report analyzing the 
first studies conducted by States under subsection (a)(1), 
including recommendations for improving data collection 
on the cost of providing maternity, labor, and delivery 
services. 
(c) IMPLEMENTATION FUNDING.—In addition to the 
amount appropriated under subsection (a)(4), there are 
appropriated, out of any funds in the Treasury not other-
wise obligated, $3,000,000 for fiscal year 2026, to remain 
available until expended, to the Secretary of Health and 
Human Services for purposes of implementing this sec-
tion. 
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SEC. 102. REQUIRING ADEQUATE PAYMENT RATES UNDER 
MEDICAID FOR MATERNITY, LABOR, AND DE-
LIVERY SERVICES AT ELIGIBLE HOSPITALS. 
(a) FEE-FOR-SERVICE PAYMENTS.—Section 1902 of 
the Social Security Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)(13)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (B); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (C); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) for each fiscal year beginning with 
fiscal year 2027, payment for maternity, labor, 
and delivery services (as defined in subsection 
(uu)) furnished during such fiscal year in an el-
igible hospital (as defined in such subsection) at 
a rate that is not less than the minimum pay-
ment rate specified for the fiscal year in para-
graph (4) of such subsection;’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(uu) MATERNITY, LABOR, AND DELIVERY SERV-
ICES AND ELIGIBLE HOSPITALS DEFINED.—For purposes 
of subsection (a)(13)(D)— 
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‘‘(1) MATERNITY, LABOR, AND DELIVERY SERV-
ICES.— 
‘‘(A) IN GENERAL.—The term ‘maternity, 
labor, and delivery services’ means such inpa-
tient hospital services and outpatient hospital 
services, including behavioral health services, 
that are provided in relation to maternity care 
or labor and delivery, identified by appropriate 
ICD and CPT codes, as the Secretary shall 
specify after consultation with professional or 
medical societies with expertise in pregnancy, 
childbirth, and postpartum care. 
‘‘(B) SCOPE.—Such term shall not be lim-
ited in application, for any eligible hospital, 
only to services that relate to a birth that oc-
curs in the hospital. 
‘‘(C) RULEMAKING.—Not later than July 
1, 2026, the Secretary shall issue an interim 
final rule specifying which services shall be con-
sidered maternity, labor, and delivery services 
for purposes of this subsection and subsection 
(a)(13)(D). 
‘‘(2) ELIGIBLE HOSPITAL.— 
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‘‘(A) IN GENERAL.—The term ‘eligible hos-
pital’ means, with respect to a State and fiscal 
year— 
‘‘(i) a hospital that is located in a 
rural area (as defined by the Federal Of-
fice of Rural Health Policy for the purpose 
of rural health grant programs adminis-
tered by such Office); 
‘‘(ii) a critical access hospital (as de-
fined in section 1861(mm)(1)); 
‘‘(iii) a hospital operated by the In-
dian Health Service or an Indian Tribe 
under the Indian Self-Determination and 
Education Assistance Act; 
‘‘(iv) a hospital for which, in the most 
recent 12-month period for which data is 
available, at least 50 percent of all births 
for which the hospital provided maternity, 
labor, and delivery services during such fis-
cal year were qualifying births; or 
‘‘(v) a hospital that is able to dem-
onstrate, through a process to be deter-
mined by the Secretary, that, for the appli-
cable fiscal year, the hospital projects that 
at least 50 percent of all births for which 
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the hospital will provide maternity, labor, 
and delivery services during such fiscal 
year will be qualifying births. 
‘‘(B) IDENTIFICATION OF ELIGIBLE HOS-
PITALS.—Each State, subject to the approval of 
the Secretary, shall identify the hospitals in the 
State that are eligible hospitals with respect to 
a fiscal year. 
‘‘(3) QUALIFYING
BIRTH.—For purposes of 
paragraph (2), the term ‘qualifying birth’ means a 
birth for which any maternity, labor, and delivery 
services associated with the birth— 
‘‘(A) were paid for under a State plan 
under this title (or under a waiver of such a 
plan) or under a State child health plan under 
title XXI (or under a waiver of such a plan); 
‘‘(B) were paid for under title XVIII; 
‘‘(C) were provided by the Indian Health 
Service or a Native Hawaiian health care sys-
tem (as defined in section 12 of the Native Ha-
waiian Health Care Improvement Act); or 
‘‘(D) were provided to a patient who does 
not have minimum essential coverage (as de-
fined in section 5000A(f) of the Internal Rev-
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enue Code of 1986) and were not fully paid for 
by such patient. 
‘‘(4) MINIMUM
PAYMENT
RATE
SPECIFIED.— 
The minimum payment rate specified in this para-
graph is, with respect to an eligible hospital and ma-
ternal, labor, and delivery services— 
‘‘(A) for fiscal year 2027, 150 percent of 
the payment rate that would apply for such 
services and hospital under title XVIII; and 
‘‘(B) for each period of 5 fiscal years be-
ginning with fiscal years 2028 through 2032, a 
payment rate that is determined for such period 
by the Secretary to accurately reflect the costs 
incurred by eligible hospitals in providing such 
services, informed by the results of the most re-
cent State studies submitted to the Secretary 
under section 101(a) of the Keeping Obstetrics 
Local Act.’’. 
(b) UNDER MEDICAID MANAGED CARE PLANS.— 
Section 1932(f) of the Social Security Act (42 U.S.C. 
1396u–2(f)) is amended— 
(1) in the heading, by inserting ‘‘AND MATER-
NITY, LABOR, AND DELIVERY SERVICES AT ELIGI-
BLE HOSPITALS’’ after ‘‘SERVICES’’; and 
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(2) 
by 
striking 
‘‘described 
in 
section 
1902(a)(13)(C)’’ and inserting ‘‘described in sub-
paragraph (C) of section 1902(a)(13) or maternity, 
labor, and delivery services described in subpara-
graph (D) of such section that are furnished by an 
eligible hospital (as defined in section 1905(uu))’’. 
SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION 
FOR MATERNITY, LABOR, AND DELIVERY 
SERVICES FURNISHED BY ELIGIBLE HOS-
PITALS. 
Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended— 
(1) in subsection (b), by striking ‘‘and (ii)’’ and 
inserting ‘‘(ii), and (kk)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(kk) MATERNITY, LABOR, AND DELIVERY SERV-
ICES.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), with respect to State expenditures for medical 
assistance for maternity, labor, and delivery services 
furnished by an eligible hospital (as such terms are 
defined in section 1902(uu)) in a fiscal quarter that 
begins on or after October 1, 2026— 
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‘‘(A) the Federal medical assistance per-
centage applicable to the enhanced payment 
rate amount of such expenditures (as deter-
mined for the State and quarter under para-
graph (2)(A)) shall be equal to 100 percent; 
and 
‘‘(B) subject to paragraph (3), the Federal 
medical assistance percentage applicable to the 
base payment rate amount of such expenditures 
(as determined for the State and quarter under 
paragraph (2)(B)) shall be equal to the en-
hanced FMAP determined for the State and 
quarter under section 2105(b). 
‘‘(2) DETERMINATION OF ENHANCED PAYMENT 
RATE
AMOUNT
AND
BASE
PAYMENT
RATE 
AMOUNT.— 
‘‘(A) 
ENHANCED
PAYMENT
RATE 
AMOUNT.— 
‘‘(i) IN
GENERAL.—For purposes of 
paragraph (1)(A), the enhanced payment 
rate amount for a State and fiscal quarter 
is equal to the amount of State expendi-
tures for medical assistance for maternity, 
labor, and delivery services furnished by an 
eligible hospital (as such terms are defined 
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in section 1902(uu)) in such fiscal quarter 
that is attributable to the amount by which 
the minimum payment rate required under 
section 1902(a)(13)(D) (or, by application, 
section 1932(f)) exceeds the base payment 
rate applicable to such services, as deter-
mined for the State, quarter, and services 
under clause (ii). 
‘‘(ii) BASE PAYMENT RATE.—For pur-
poses of clause (i), the base payment rate 
determined for a State, a fiscal quarter, 
and maternity, labor, and delivery services 
(as defined in section 1902(uu)) shall be 
equal to— 
‘‘(I) the payment rate applicable 
to such services under the State plan 
(or under a waiver of such plan) as of 
January 1, 2025; increased by 
‘‘(II) the percentage increase in 
the medical care component of the 
consumer price index for all urban 
consumers from January of 2025 to 
the month ending on the day before 
the 1st day of such fiscal quarter. 
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‘‘(B) BASE PAYMENT RATE AMOUNT.—For 
purposes of paragraph (1)(B), the base pay-
ment rate amount for a State and fiscal quarter 
is equal to— 
‘‘(i) the total amount of State expend-
itures for medical assistance for maternity, 
labor, and delivery services furnished by an 
eligible hospital (as such terms are defined 
in section 1902(uu)) in such fiscal quarter; 
minus 
‘‘(ii) the enhanced payment rate 
amount determined for the State and fiscal 
quarter under subparagraph (A). 
‘‘(3) APPLICATION OF HIGHER MATCH.—Sub-
paragraph (B) of paragraph (1) shall not apply in 
the case of State expenditures described in such sub-
paragraph if the application of such subparagraph 
would result in a lower Federal medical assistance 
percentage for such expenditures than would other-
wise apply without the application of such para-
graph. 
‘‘(4) EXCLUSION OF EXPENDITURES FROM TER-
RITORIAL CAPS.—Any payment made to a territory 
for medical assistance that is subject to the Federal 
medical assistance percentage specified in paragraph 
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(1)(A) or the enhanced FMAP referred to in para-
graph (1)(B) shall not be taken into account for 
purposes of applying payment limits under sub-
sections (f) and (g) of section 1108.’’. 
SEC. 104. LABOR AND DELIVERY SERVICES ANCHOR PAY-
MENTS. 
(a) STATE REQUIREMENT.—Section 1902(a)(13)(A) 
of the Social Security Act (42 U.S.C. 1396a(a)(13)(A)) 
is amended— 
(1) in clause (iii), by striking ‘‘and’’ at the end; 
(2) in clause (iv), by striking the semicolon at 
the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(v) in the case of hospitals, such 
rates take into account (in a manner con-
sistent with section 1923A) the situation of 
low volume obstetric hospitals (as such 
term is defined in such section);’’. 
(b) REQUIRING ANCHOR PAYMENTS FOR LOW VOL-
UME OBSTETRIC HOSPITALS.—Title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) is amended by insert-
ing the following after section 1923: 
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‘‘SEC. 1923A. ANCHOR PAYMENTS FOR LABOR AND DELIV-
ERY SERVICES PROVIDED BY LOW VOLUME 
OBSTETRIC HOSPITALS. 
‘‘(a) IMPLEMENTATION OF REQUIREMENT.—A State 
plan under this title shall not be considered to meet the 
requirement of section 1902(a)(13)(A)(v) (insofar as it re-
quires payments to hospitals to take into account the situ-
ation of low volume obstetric hospitals), as of October 1, 
2026, unless the State has submitted to the Secretary, by 
not later than such date, an amendment to such plan that 
provides for an annual anchor payment to such hospitals, 
consistent with subsection (c). 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) 
ANTENATAL
TRANSFER.—The 
term 
‘antenatal transfer’ means, with respect to a hos-
pital, a pregnant individual who was expected to re-
ceive labor and delivery services at the hospital but 
who is transferred to a different hospital because of 
a need for labor and delivery services that are not 
available at the transferring hospital. 
‘‘(2) DELIVERY VOLUME.—The term ‘delivery 
volume’ means, with respect to a hospital and a fis-
cal year, the total number of births occurring in, and 
antenatal transfers made by, such hospital during 
such year. 
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‘‘(3) 
LABOR
AND
DELIVERY
REVENUE 
FLOOR.—The term ‘labor and delivery revenue floor’ 
means, with respect to a low volume obstetric hos-
pital and a fiscal year, the amount equal to the sum 
of— 
‘‘(A) the product of— 
‘‘(i) the delivery volume for such hos-
pital and fiscal year; and 
‘‘(ii) the per delivery amount for such 
fiscal year; and 
‘‘(B) the standby capacity amount for such 
fiscal year. 
‘‘(4) LABOR
AND
DELIVERY
SERVICES.—The 
term ‘labor and delivery services’ means such inpa-
tient and outpatient hospital services related to labor 
and delivery, including services related to antenatal 
transfers, identified by appropriate ICD and CPT 
codes, as the Secretary shall specify in consultation 
with professional or medical societies with expertise 
in this area. 
‘‘(5) LOW VOLUME OBSTETRIC HOSPITAL.—The 
term ‘low volume obstetric hospital’ means, with re-
spect to a hospital and a fiscal year, a hospital— 
‘‘(A) that is an eligible hospital (as defined 
in section 1902(uu)(2)); 
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‘‘(B) in which the average number of 
births for which the hospital provided labor and 
delivery services during the preceding 3 fiscal 
years is less than 300 births per year; 
‘‘(C) that did not provide labor and deliv-
ery services in the preceding fiscal year, but in 
which the average number of births for which 
the hospital provided labor and delivery services 
during the most recent 3 fiscal years in which 
the hospital provided labor and delivery services 
is less than 300 births per year; 
‘‘(D) that is not described in subpara-
graphs (B) or (C) but, in the applicable fiscal 
year, provides labor and delivery services for 
fewer than 300 births; or 
‘‘(E) that is not described in subpara-
graphs (B) through (D) but is certified by the 
State in which the hospital is located as meet-
ing such criteria as the Secretary shall establish 
for identifying hospitals that are essential to 
meeting the needs of an underserved popu-
lation, such as serving a population with limited 
English proficiency, serving specific racial or 
ethnic populations, or other factors. 
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‘‘(6) MEDICAID
LABOR
AND
DELIVERY
REV-
ENUE FLOOR.—The term ‘Medicaid labor and deliv-
ery revenue floor’ means, with respect to a low vol-
ume obstetric hospital and a fiscal year, the product 
of— 
‘‘(A) the labor and delivery revenue floor 
for such hospital and fiscal year; and 
‘‘(B) the percentage of the delivery volume 
of such hospital in such fiscal year that were 
paid for under a State plan under this title (or 
under a waiver of such a plan) or under a State 
child health plan under title XXI (or under a 
waiver of such a plan). 
‘‘(7) PER DELIVERY AMOUNT.— 
‘‘(A) IN GENERAL.—The term ‘per delivery 
amount’ means, with respect to a fiscal year, an 
amount, as determined under subparagraph 
(B), that represents the marginal cost to a low 
volume obstetric hospital of a birth or an 
antenatal transfer. 
‘‘(B) DETERMINATION OF PER DELIVERY 
AMOUNT.— 
‘‘(i) FISCAL
YEAR
2028.—For fiscal 
year 2028, the per delivery amount shall 
be $10,000. 
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‘‘(ii) INDEXING.—Subject to clause 
(iii), for each fiscal year after fiscal year 
2028, the per delivery amount shall be the 
amount that applied under this subpara-
graph for the preceding fiscal year in-
creased by the percentage increase in the 
medical care component of the consumer 
price index for all urban consumers for the 
12-month period ending with September of 
such preceding fiscal year. 
‘‘(iii) PERIODIC REVISION OF PER DE-
LIVERY
AMOUNT.—Not less than once 
every 5 fiscal years, the Secretary shall col-
lect and analyze data on the costs of labor 
and delivery services at low volume obstet-
ric hospitals and, through rulemaking, 
shall establish a new per delivery amount 
for purposes of this section to ensure that 
such amount accurately reflects the mar-
ginal cost to a low volume obstetric hos-
pital of a birth or an antenatal delivery. 
‘‘(8) STANDBY CAPACITY AMOUNT.— 
‘‘(A) IN GENERAL.—The term ‘standby ca-
pacity amount’ means, with respect to a fiscal 
year, an amount, as determined under subpara-
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graph (B), that represents the minimum level of 
expenditures by a low volume obstetric hospital 
that is necessary to ensure that adequate per-
sonnel, equipment, and facilities are available at 
all times to provide labor and delivery services. 
‘‘(B) DETERMINATION
OF
STANDBY
CA-
PACITY AMOUNT.— 
‘‘(i) FISCAL
YEAR
2028.—For fiscal 
year 2028, the standby capacity amount 
shall be $1,200,000. 
‘‘(ii) INDEXING.—Subject to clause 
(iii), for each fiscal year after fiscal year 
2028, the standby capacity amount shall 
be the amount that applied under this sub-
paragraph for the preceding fiscal year in-
creased by the percentage increase in the 
medical care component of the consumer 
price index for all urban consumers for the 
12-month period ending with September of 
such preceding fiscal year. 
‘‘(iii) PERIODIC REVISION OF STAND-
BY
CAPACITY
AMOUNT.—Not less than 
once every 5 fiscal years, the Secretary 
shall collect and analyze data on the costs 
of labor and delivery services at low volume 
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obstetric hospitals and, through rule-
making, shall establish a new standby ca-
pacity amount for purposes of this section 
to ensure that such amount accurately re-
flects the minimum level of expenditures by 
a low volume obstetric hospital that is nec-
essary to ensure that adequate personnel, 
equipment, and facilities are available at 
all times to provide labor and delivery serv-
ices. 
‘‘(c) ANCHOR PAYMENT FOR LOW VOLUME OBSTET-
RIC HOSPITALS.—Not later than 3 months after the end 
of each fiscal year beginning with fiscal year 2028, each 
State shall pay to each low volume obstetric hospital in 
the State an amount that is equal to the amount (if any) 
by which— 
‘‘(1) the Medicaid labor and delivery revenue 
floor for the hospital and fiscal year; exceeds 
‘‘(2) the total amount of all payments made to 
the low volume obstetric hospital under the State 
plan under this title (or under a waiver of such plan) 
and under the State child health plan under title 
XXI (or under a waiver of such plan) (other than 
payments under this section) for labor and delivery 
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services provided by such hospital during such fiscal 
year. 
‘‘(d) REQUIREMENTS FOR RECEIPT OF PAYMENTS.— 
No anchor payment shall be made to a low volume obstet-
ric hospital under this section for a fiscal year unless the 
hospital can satisfy the following requirements: 
‘‘(1) SKILLS MAINTENANCE AND TRAINING AC-
TIVITIES.—The hospital demonstrates to the satis-
faction of the State that the hospital conducts and 
completes skills maintenance and training activities, 
including continuing education and training to sup-
port maintenance of obstetric skills, that satisfy such 
requirements as the Secretary, taking into consider-
ation nationally recognized obstetrics skills, mainte-
nance, and training standards such as standards 
published by the American College of Obstetricians 
and Gynecologists and the Association of Women’s 
Health, Obstetric, and Neonatal Nurses, shall speci-
fy for the purposes of this section. 
‘‘(2) CONTINUED
PROVISION
OF
LABOR
AND 
DELIVERY SERVICES.— 
‘‘(A) IN GENERAL.—The hospital and the 
State enter into a contract under which, in ex-
change for such payment under this section for 
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a fiscal year, the hospital agrees to continue to 
provide labor and delivery services— 
‘‘(i) for the period that begins with 
such fiscal year and ends on the last day 
of the second fiscal year that follows such 
fiscal year; and 
‘‘(ii) at a level that is not less than 
the level at which the hospital provided 
such services in the fiscal year to which 
such payment relates, unless the hospital 
can demonstrate that the need for services 
in the community has decreased and that 
the new level of services will be adequate to 
meet that need. 
‘‘(B) RECOVERY
OF
PAYMENT
IN
THE 
EVENT
OF
BREACH
OF
CONTRACT
BY
HOS-
PITAL.—The terms of the contract between a 
hospital and a State required under subpara-
graph (A) shall provide that if the hospital does 
not provide labor and delivery services as re-
quired under the contract throughout the period 
described in such subparagraph for any reason 
(including in the event of the hospital’s bank-
ruptcy or closure) the State may recover the 
full amount of the payment under this section 
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to which the contract relates and in the event 
of the hospital’s bankruptcy, the State shall be 
given preferred creditor status for purposes of 
the collection of such payment. 
‘‘(3) UTILIZATION OF FUNDS FOR LABOR AND 
DELIVERY SERVICES.— 
‘‘(A) IN GENERAL.—The hospital and the 
State enter into a contract under which, in ex-
change for such payment under this section, the 
hospital agrees to utilize funds received under 
such payment for the provision of labor and de-
livery services in the community served by the 
hospital. 
‘‘(B) RECOVERY
OF
PAYMENT
IN
THE 
EVENT
OF
BREACH
OF
CONTRACT
BY
HOS-
PITAL.—The terms of the contract between a 
hospital and a State required under subpara-
graph (A) shall provide that if the hospital does 
not utilize payment funds for labor and delivery 
services as required under the contract for any 
reason (including in the event of the hospital’s 
bankruptcy or closure) the State may recover 
the full amount of the payment under this sec-
tion to which the contract relates and in the 
event of the hospital’s bankruptcy, the State 
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shall be given preferred creditor status for pur-
poses of the collection of such payment. 
‘‘(e) TREATMENT OF PAYMENTS; RECOVERY OF PAY-
MENTS.— 
‘‘(1) IN GENERAL.—Payments made by a State 
under this section for a fiscal year— 
‘‘(A) shall be in addition to any other pay-
ments made to hospitals for labor and delivery 
services under the State plan (or a waiver of 
such plan) under this title, under the State 
child health assistance plan under title XXI (or 
under a waiver of such plan), or under title 
XVIII for the fiscal year, including dispropor-
tionate share hospital payments under section 
1923 or section 1886(d)(5)(F) and other sup-
plemental payments that are not made under 
this section; and 
‘‘(B) shall be treated as medical assistance 
for which payment is made under section 
1903(a), except that the Federal medical assist-
ance percentage applicable to amounts ex-
pended by a State for such payments shall be 
equal to the enhanced FMAP determined for 
the State and fiscal year under section 2105(b). 
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‘‘(2) PAYMENTS RECOVERED BY A STATE.—If a 
State recovers any amount of a payment made by a 
State under this section (whether pursuant to para-
graphs (2)(B) or (3)(B) of subsection (d) or other-
wise), the amount so recovered shall be treated as an 
overpayment recovered by the State under section 
1903(d).’’. 
(c) CONFORMING AMENDMENTS.—Title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.) is amended 
as follows: 
(1) In section 1903— 
(A) in subsection (d)(6)(B)— 
(i) by striking ‘‘related to the total 
amount’’ and inserting the following: ‘‘re-
lated to— 
‘‘(i) the total amount’’; 
(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(ii) the total amount of payments made to 
individual providers (by provider) under section 
1923A during such fiscal year.’’; and 
(B) in subsection (bb)(2)(B)— 
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(i) in the header, by inserting ‘‘AND 
LOW VOLUME OBSTETRIC HOSPITAL’’ after 
‘‘DSH’’; and 
(ii) by inserting ‘‘or a payment made 
to a low volume obstetric hospital under 
section 1923A’’ before the period. 
(2) In section 1905— 
(A) in subsection (cc), by striking ‘‘section 
1923’’ the second place it appears and inserting 
‘‘section 1923 or 1923A’’; and 
(B) in subsection (ii)(2)(A), by inserting 
‘‘or payments to low volume obstetric hospitals 
described in section 1923A’’ before the semi-
colon. 
SEC. 105. APPLICATION OF ADEQUATE PAYMENT REQUIRE-
MENT AND INCREASED FEDERAL FINANCIAL 
PARTICIPATION REQUIREMENTS TO CHIP. 
Section 2107(e)(1) of the Social Security Act (42 
U.S.C. 1397gg(e)(1)) is amended— 
(1) 
by 
redesignating 
subparagraphs 
(B) 
through (U) as subparagraphs (C) through (V), re-
spectively; and 
(2) by inserting after subparagraph (A) the fol-
lowing new subparagraph: 
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‘‘(B) Section 1902(a)(13)(D) and section 
1905(kk) (relating to the minimum payment 
rate required for maternity, labor, and delivery 
services furnished by an eligible hospital and 
Federal financial participation for State ex-
penditures for such services).’’. 
SEC. 106. DISREGARDING INCREASED AND ADDITIONAL 
PAYMENTS TO HOSPITALS FOR PURPOSES OF 
OTHER 
SUPPLEMENTAL 
PAYMENTS 
AND 
UPPER PAYMENT LIMITS. 
A hospital’s eligibility for any Federally-funded sup-
plemental payment (including a disproportionate share 
payment under section 1886(d)(5)(F) or 1923 of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(F), 1396r–4)), 
the determination of the amount of such payment, and 
the application of any Federal limitation on the aggregate 
amount of payments that a State may make to the hos-
pital (including any upper payment limitation), shall be 
determined without regard to the amount of any increase 
to a payment received by a hospital or any additional pay-
ment made to a hospital that is attributable to the amend-
ments made by this title. 
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TITLE II—EXPAND COVERAGE 
OF MATERNAL HEALTH CARE 
SEC. 201. REQUIRING 12-MONTH CONTINUOUS, FULL BEN-
EFIT COVERAGE FOR PREGNANT INDIVID-
UALS UNDER MEDICAID AND CHIP. 
(a) MEDICAID.—Section 1902 of the Social Security 
Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)— 
(A) in paragraph (10), in the matter fol-
lowing subparagraph (G), by striking ‘‘(VII) the 
medical assistance made available to an indi-
vidual described in subsection (l)(1)(A) who is 
eligible for medical assistance only because of 
subparagraph (A)(i)(IV) or (A)(ii)(IX) shall be 
limited to medical assistance for services related 
to pregnancy (including prenatal, delivery, 
postpartum, and family planning services), 
medical assistance for services related to other 
conditions which may complicate pregnancy, 
and medical assistance for vaccines described in 
section 1905(a)(4)(E) and the administration of 
such vaccines during the period described in 
such section,’’ and inserting ‘‘(VII) [Re-
pealed],’’; 
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(B) in paragraph (86), by striking ‘‘and’’ 
at the end; 
(C) in paragraph (87), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(D) by inserting after paragraph (87) the 
following new paragraph: 
‘‘(88) provide that the State plan is in compli-
ance with subsection (e)(16).’’; and 
(2) in subsection (e)(16)— 
(A) in subparagraph (A), by striking ‘‘At 
the option of the State, the State plan (or waiv-
er of such State plan) may provide’’ and insert-
ing ‘‘A State plan (or waiver of such State 
plan) shall provide’’; 
(B) in subparagraph (B), in the matter 
preceding clause (i), by striking ‘‘by a State 
making an election under this paragraph’’ and 
inserting ‘‘under a State plan (or a waiver of 
such State plan)’’; and 
(C) in subparagraph (C)— 
(i) by striking ‘‘A State making an 
election under this paragraph’’ and insert-
ing ‘‘In the case of a State’’; and 
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