I 
118TH CONGRESS 
1ST SESSION H. R. 4605 
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 HOUSE OF REPRESENTATIVES 
JULY 13, 2023 
Mr. CARTER of Georgia (for himself and Mr. BISHOP of Georgia) 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 subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
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. 
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 
‘‘Healthy Moms and Babies Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
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Sec. 2. Definitions. 
Sec. 3. Mandatory reporting by State Medicaid programs on adult health care 
quality measures of maternal and perinatal health. 
Sec. 4. Medicaid quality improvement initiatives to reduce rates of cesarean sec-
tions; 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 re-
duction 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 be-
tween 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 re-
quirements. 
SEC. 2. DEFINITIONS. 
In this Act: 
(1) CHIP.—The term ‘‘CHIP’’ means the Chil-
dren’s Health Insurance Program established under 
title XXI of the Social Security Act (42 U.S.C. 
1397aa et seq.). 
(2) 
COMPTROLLER
GENERAL.—The 
term 
‘‘Comptroller General’’ means the Comptroller Gen-
eral of the United States. 
(3) GROUP HEALTH PLAN; HEALTH INSURANCE 
ISSUER, ETC.—The terms ‘‘group health plan’’, 
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‘‘health insurance coverage’’, ‘‘health insurance 
issuer’’, ‘‘group health insurance coverage’’, and ‘‘in-
dividual health insurance coverage’’ have the mean-
ings given such terms in section 2791 of the Public 
Health Service Act (42 U.S.C. 300gg–91). 
(4) MEDICAID.—The term ‘‘Medicaid’’ means 
the Medicaid program established under title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.). 
(5) MEDICAID
MANAGED
CARE
ORGANIZA-
TION.—The term ‘‘medicaid managed care organiza-
tion’’ has the meaning given that term in section 
1903(m)(1)(A) of the Social Security Act (42 U.S.C. 
1396b(m)(1)(A)). 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(7) STATE.—The term ‘‘State’’ has the mean-
ing given that term for purposes of titles V, XIX, 
and XXI of the Social Security Act (42 U.S.C. 701 
et seq. 1396 et seq., 1397aa et seq.). 
SEC. 3. MANDATORY REPORTING BY STATE MEDICAID PRO-
GRAMS ON ADULT HEALTH CARE QUALITY 
MEASURES OF MATERNAL AND PERINATAL 
HEALTH. 
Section 1139B of the Social Security Act (42 U.S.C. 
1320b–9b) is amended— 
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(1) in subsection (b)— 
(A) in paragraph (3)(B)— 
(i) in the subparagraph heading, by 
inserting 
‘‘AND
MATERNAL
AND 
PERINATAL HEALTH’’ after ‘‘BEHAVIORAL 
HEALTH’’; 
(ii) by striking ‘‘all behavioral health’’ 
and inserting ‘‘all behavioral health and 
maternal and perinatal health’’; and 
(iii) by inserting ‘‘and of maternal 
and perinatal health care for Medicaid eli-
gible adults’’ after ‘‘Medicaid eligible 
adults’’; and 
(B) in paragraph (5)(C)— 
(i) in the subparagraph heading, by 
inserting 
‘‘AND
MATERNAL
AND 
PERINATAL HEALTH’’ after ‘‘BEHAVIORAL 
HEALTH’’; and 
(ii) by inserting ‘‘and, with respect to 
Medicaid eligible adults, maternal and 
perinatal health measures’’ after ‘‘behav-
ioral health measures’’; and 
(2) in subsection (d)(1)(A), by inserting ‘‘and 
maternal and perinatal health’’ after ‘‘behavioral 
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. 
(a) MEDICAID STATE PLAN AMENDMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) 
is amended— 
(1) in paragraph (86), by striking ‘‘and’’ after 
the semicolon; 
(2) in paragraph (87), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (87) the fol-
lowing: 
‘‘(88) provide that, not later than January 1, 
2025, and annually thereafter through January 1, 
2035, the State shall submit a report to the Sec-
retary, that shall be made publicly available, which 
contains with respect to the preceding calendar 
year— 
‘‘(A) the rate of low-risk cesarean delivery, 
as defined by the Secretary in consultation with 
relevant stakeholders, for pregnant women eligi-
ble for medical assistance under the State plan 
or a waiver of such plan in the State, as com-
pared to the overall rate of cesarean delivery in 
the State; 
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‘‘(B) a description of the State’s quality 
improvement activities to safely reduce the rate 
of low-risk cesarean delivery (as so defined) for 
pregnant women eligible for medical assistance 
under the State plan or a waiver of such plan 
in the State reported under subparagraph (A), 
including initiatives aimed at reducing racial 
and ethnic health disparities, hospital-level 
quality improvement initiatives, taking into ac-
count hospital type and the patient population 
served, and, if applicable, partnerships with 
State 
or 
regional 
perinatal 
quality 
collaboratives; 
‘‘(C) for each report submitted after Janu-
ary 1, 2025, the percentage change (if any) in 
the rate of low-risk cesarean delivery (as so de-
fined) for pregnant women eligible for medical 
assistance under the State plan or a waiver of 
such plan in the State reported under subpara-
graph (A) from the rate reported for the most 
recent previous report; and 
‘‘(D) such other relevant data and infor-
mation as determined by the Secretary, and in 
consultation with relevant stakeholders, such as 
State initiatives and evaluations of quality im-
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provement activities, cesarean delivery rates, 
and health outcomes.’’. 
(b) GAO STUDY REGARDING MEDICAID PAYMENT 
RATES FOR CESAREAN BIRTHS.— 
(1) STUDY.—The Comptroller General shall 
conduct a study regarding payment rates for cesar-
ean births and vaginal births under State Medicaid 
programs. To the extent feasible and data are avail-
able, the study shall include analyses of the fol-
lowing: 
(A) Payment rates for cesarean births and 
vaginal births paid by fee-for-service Medicaid 
programs and by Medicaid programs that con-
tract with Medicaid managed care organizations 
to furnish medical assistance under such pro-
grams. 
(B) What is known about how Medicaid 
payment rates have changed over time. 
(C) What is known about how payment 
rates for cesarean and vaginal births by Med-
icaid programs compare with the payment rates 
for such births by other sources of insurance 
coverage. 
(D) Such other factors related to payment 
rates for cesarean and vaginal births under 
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Medicaid as the Comptroller General deter-
mines appropriate. 
(2) REPORT.—Not later than 18 months after 
the date of enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
(c) GAO STUDY ON RACIAL DISPARITIES IN CESAR-
EAN BIRTHS.— 
(1) IN
GENERAL.—The Comptroller General 
shall conduct a study on racial disparities in the fre-
quency of cesarean births. To the extent feasible and 
data are available, the study shall compare such in-
formation on low- and high-risk cesarean births, dif-
ferences by payer (such as Medicaid and private 
payers), and hospital characteristics (such as loca-
tion or hospital type). Such study may consider 
other factors related to racial disparities in maternal 
health as the Comptroller General deems appro-
priate. 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Comptroller Gen-
eral shall submit to Congress a report containing the 
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results of the study conducted under paragraph (1), 
together with recommendations for such legislation 
and administrative action as the Comptroller Gen-
eral determines appropriate. 
(d) MEDICARE REQUIREMENT FOR HOSPITALS TO 
REPORT DATA ON CESAREAN BIRTHS.— 
(1) REQUIREMENT.—Section 1866(a)(1) of the 
Social Security Act (42 U.S.C. 1395cc(a)(1)) is 
amended— 
(A) by moving the indentation of subpara-
graph (W) 2 ems to the left; 
(B) in subparagraph (X)— 
(i) by moving the indentation 2 ems 
to the left; and 
(ii) by striking ‘‘and’’ at the end; 
(C) in subparagraph (Y), by striking the 
period at the end and inserting ‘‘; and’’; and 
(D) by inserting after subparagraph (Y) 
the following new subparagraph: 
‘‘(Z) in the case of a hospital, to submit, in a 
form and manner, and at a time, specified by the 
Secretary, data on the Nulliparous, Term, Singleton, 
Vertex Cesarean section (NTSV C-section) rate with 
respect to the hospital for the preceding year.’’. 
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(2) INCORPORATION INTO HOSPITAL QUALITY 
REPORTING.—Section 1886(b)(3)(B)(viii) of the So-
cial Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) 
is amended by adding at the end the following new 
subclause: 
‘‘(XIII) Effective for payments beginning with fiscal 
year 2025, in expanding the number of measures under 
subclause (III), the Secretary shall adopt a measure relat-
ing to the Nulliparous, Term, Singleton, Vertex Cesarean 
section (NTSV C-section) rate for hospitals in inpatient 
settings. Not later than 2025, the Secretary shall incor-
porate such measure into the designation of maternity 
care quality hospitals, as described in the final rule enti-
tled ‘Medicare Program; Hospital Inpatient Prospective 
Payment Systems for Acute Care Hospitals and the Long- 
Term Care Hospital Prospective Payment System and 
Policy Changes and Fiscal Year 2023 Rates; Quality Pro-
grams and Medicare Promoting Interoperability Program 
Requirements for Eligible Hospitals and Critical Access 
Hospitals; Costs Incurred for Qualified and Non-Qualified 
Deferred Compensation Plans; and Changes to Hospital 
and Critical Access Hospital Conditions of Participation’ 
(87 Fed. Reg. 48780 (August 10, 2022)).’’. 
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SEC. 5. STATE OPTION TO PROVIDE COORDINATED CARE 
THROUGH A HEALTH HOME FOR PREGNANT 
AND POSTPARTUM WOMEN. 
Title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) is amended by inserting after section 1945A the 
following new section: 
‘‘SEC. 1945B. STATE OPTION TO PROVIDE COORDINATED 
CARE THROUGH A HEALTH HOME FOR PREG-
NANT AND POSTPARTUM WOMEN. 
‘‘(a) STATE OPTION.— 
‘‘(1) IN
GENERAL.—Notwithstanding section 
1902(a)(1) (relating to statewideness) and section 
1902(a)(10)(B) (relating to comparability), begin-
ning April 1, 2026, a State, at its option as a State 
plan amendment, may provide for medical assistance 
under this title to an eligible woman who chooses 
to— 
‘‘(A) enroll in a maternity health home 
under this section by selecting a designated pro-
vider, a team of health care professionals oper-
ating with such a provider, or a health team as 
the woman’s maternity health home for pur-
poses of providing the woman with pregnancy 
and postpartum coordinated care services; or 
‘‘(B) receive such services from a des-
ignated provider, a team of health care profes-
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sionals operating with such a provider, or a 
health team that has voluntarily opted to par-
ticipate in a maternity health home for eligible 
women under this section. 
‘‘(2) ELIGIBLE WOMAN DEFINED.—In this sec-
tion, the term ‘eligible woman’ means an indi-
vidual— 
‘‘(A) who is eligible for medical assistance 
under the State plan (or under a waiver of such 
plan) for all items and services covered under 
the State plan (or waiver) that are not less in 
amount, duration, or scope, or are determined 
by the Secretary to be substantially equivalent, 
to the medical assistance available for an indi-
vidual described in subsection (a)(10)(A)(i); and 
‘‘(B) who— 
‘‘(i) is pregnant; or 
‘‘(ii) had a pregnancy end within the 
last 365 days. 
‘‘(b) QUALIFICATION STANDARDS.—The Secretary 
shall establish standards for qualification as a maternity 
health home or as a designated provider, team of health 
care professionals operating with such a provider, or a 
health team eligible for participation in a maternity health 
home for purposes of this section. In establishing such 
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standards, the Secretary shall consider best practices and 
models of care used by recipients of grants under section 
330P of the Public Health Service Act. Such standards 
shall include requiring designated providers, teams of 
health care professionals operating with such providers, 
and health teams (designated as a maternity health home) 
to demonstrate to the State the ability to do the following: 
‘‘(1) Coordinate prompt care and access to nec-
essary maternity care services, including services 
provided by specialists, and programs for an eligible 
woman during her pregnancy and the 365-day pe-
riod beginning on the last day of her pregnancy. 
‘‘(2) Develop an individualized, comprehensive, 
patient-centered care plan for each eligible woman 
that accommodates patient preferences and, if appli-
cable, reflects adjustments to the payment method-
ology described in subsection (c)(2)(B). 
‘‘(3) Develop and incorporate into each eligible 
woman’s care plan, in a culturally and linguistically 
appropriate manner consistent with the needs of the 
eligible woman, ongoing home care, community- 
based primary care, inpatient care, social support 
services, health-related social needs services, behav-
ioral health services, local hospital emergency care, 
and, in the event of a change in income that would 
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result in the eligible woman losing eligibility for 
medical assistance under the State plan or waiver, 
care management and planning related to a change 
in the eligible woman’s health insurance coverage. 
‘‘(4) Coordinate with pediatric care providers, 
as appropriate. 
‘‘(5) Collect and report information under sub-
section (f)(1). 
‘‘(c) PAYMENTS.— 
‘‘(1) IN GENERAL.—A State shall provide a des-
ignated provider, a team of health care professionals 
operating with such a provider, or a health team 
with payments for the provision of pregnancy and 
postpartum coordinated care services, to each eligi-
ble woman that selects such provider, team of health 
care professionals, or health team as the woman’s 
maternity health home or care provider. Payments 
made to a maternity health home or care provider 
for such services shall be treated as medical assist-
ance for purposes of section 1903(a). 
‘‘(2) METHODOLOGY.—The State shall specify 
in the State plan amendment the methodology the 
State will use for determining payment for the provi-
sion of pregnancy and postpartum coordinated care 
services or treatment during an eligible woman’s 
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pregnancy and the 365-day period beginning on the 
last day of her pregnancy. Such methodology for de-
termining payment— 
‘‘(A) may be based on— 
‘‘(i) a per-member per-month basis for 
each eligible woman enrolled in the mater-
nity health home; 
‘‘(ii) a prospective payment model, in 
the case of payments to Federally qualified 
health centers or a rural health clinics; or 
‘‘(iii) an alternate model of payment 
(which may include a model developed 
under a waiver under section 1115) pro-
posed by the State and approved by the 
Secretary; 
‘‘(B) may be adjusted to reflect, with re-
spect to each eligible woman— 
‘‘(i) the severity of the risks associ-
ated with the woman’s pregnancy; 
‘‘(ii) the severity of the risks associ-
ated with the woman’s postpartum health 
care needs; and 
‘‘(iii) the level or amount of time of 
care coordination required with respect to 
the woman; and 
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‘‘(C) shall be established consistent with 
section 1902(a)(30)(A). 
‘‘(d) COORDINATING CARE.— 
‘‘(1) HOSPITAL NOTIFICATION.—A State with a 
State plan amendment approved under this section 
shall require each hospital that is a participating 
provider under the State plan (or under a waiver of 
such plan) to establish procedures in the case of an 
eligible woman who seeks treatment in the emer-
gency department of such hospital for— 
‘‘(A) providing the woman with culturally 
and linguistically appropriate information on 
the respective treatment models and opportuni-
ties for the woman to access a maternity health 
home and its associated benefits; and 
‘‘(B) notifying the maternity health home 
in which the woman is enrolled, or the des-
ignated provider, team of health care profes-
sionals operating with such a provider, or 
health team treating the woman, of the wom-
an’s treatment in the emergency department 
and of the protocols for the maternity health 
home, designated provider, or team to be in-
volved in the woman’s emergency care or post- 
discharge care. 
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‘‘(2) EDUCATION
WITH
RESPECT
TO
AVAIL-
ABILITY OF A MATERNITY HEALTH HOME.— 
‘‘(A) IN GENERAL.—In order for a State 
plan amendment to be approved under this sec-
tion, a State shall include in the State plan 
amendment a description of the State’s process 
for— 
‘‘(i) educating providers participating 
in the State plan (or a waiver of such 
plan) on the availability of maternity 
health homes for eligible women, including 
the process by which such providers can 
participate in or refer eligible women to an 
approved maternity health home or a des-
ignated provider, team of health care pro-
fessionals operating such a provider, or 
health team; and 
‘‘(ii) educating eligible women, in a 
culturally and linguistically appropriate 
manner, on the availability of maternity 
health homes. 
‘‘(B) OUTREACH.—The process established 
by the State under subparagraph (A) shall in-
clude the participation of entities or other pub-
lic or private organizations or entities that pro-
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vide outreach and information on the avail-
ability of health care items and services to fami-
lies of individuals eligible to receive medical as-
sistance under the State plan (or a waiver of 
such plan). 
‘‘(3) MENTAL
HEALTH
COORDINATION.—A 
State with a State plan amendment approved under 
this section shall consult and coordinate, as appro-
priate, with the Secretary in addressing issues re-
garding the prevention, identification, and treatment 
of mental health conditions and substance use dis-
orders among eligible women. 
‘‘(4) SOCIAL AND SUPPORT SERVICES.—A State 
with a State plan amendment approved under this 
section shall consult and coordinate, as appropriate, 
with the Secretary in establishing means to connect 
eligible women receiving pregnancy and postpartum 
coordinated care services under this section with so-
cial and support services, including services made 
available under maternal, infant, and early childhood 
home visiting programs established under section 
511, and services made available under section 
330H or title X of the Public Health Service Act. 
‘‘(e) MONITORING.—A State shall include in the 
State plan amendment— 
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‘‘(1) a methodology for tracking reductions in 
inpatient days and reductions in the total cost of 
care resulting from improved care coordination and 
management under this section; 
‘‘(2) a proposal for use of health information 
technology in providing an eligible woman with preg-
nancy and postpartum coordinated care services as 
specified under this section and improving service 
delivery and coordination across the care continuum; 
and 
‘‘(3) a methodology for tracking prompt and 
timely access to medically necessary care for eligible 
women from out-of-State providers. 
‘‘(f) DATA COLLECTION.— 
‘‘(1) PROVIDER REPORTING REQUIREMENTS.— 
In order to receive payments from a State under 
subsection (c), a maternity health home, or a des-
ignated provider, a team of health care professionals 
operating with such a provider, or a health team, 
shall report to the State, at such time and in such 
form and manner as may be required by the State, 
including through a health information exchange or 
other public health data sharing entity, the following 
information: 
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‘‘(A) With respect to each such designated 
provider, team of health care professionals oper-
ating with such a provider, and health team 
(designated as a maternity health home), the 
name, National Provider Identification number, 
address, and specific health care services of-
fered to be provided to eligible women who have 
selected such provider, team of health care pro-
fessionals, or health team as the women’s ma-
ternity health home. 
‘‘(B) Information on measures from the 
core sets of child health quality measures and 
adult health quality measures under sections 
1139A and 1139B that are identified by the 
Secretary as being relevant to maternal, 
perinatal, or infant health. 
‘‘(C) Information on all other applicable 
measures for determining the quality of services 
provided by such provider, team of health care 
professionals, or health team. 
‘‘(D) Such other information as the Sec-
retary shall specify in guidance. 
‘‘(2) STATE REPORTING REQUIREMENTS.— 
‘‘(A) COMPREHENSIVE REPORT.—A State 
with a State plan amendment approved under 
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this section shall report to the Secretary (and, 
upon request, to the Medicaid and CHIP Pay-
ment and Access Commission), at such time, 
but at a minimum frequency of every 12 
months, and in such form and manner deter-
mined by the Secretary to be reasonable and 
minimally burdensome, including through a 
health information exchange or other public 
health data sharing entity, the following infor-
mation: 
‘‘(i) Information described in para-
graph (1). 
‘‘(ii) The number and, to the extent 
available and while maintaining all relevant 
protecting privacy and confidentially pro-
tections, disaggregated demographic infor-
mation of eligible women who have enrolled 
in a maternity health home pursuant to 
this section. 
‘‘(iii) The number of maternity health 
homes in the State. 
‘‘(iv) The medical conditions or fac-
tors that contribute to severe maternal 
morbidity among eligible women enrolled in 
maternity health homes in the State. 
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‘‘(v) The extent to which such women 
receive health care items and services 
under the State plan before, during, and 
after the women’s enrollment in such a 
maternity health home. 
‘‘(vi) Where applicable, mortality data 
and data for the associated causes of death 
for eligible women enrolled in a maternity 
health home under this section, in accord-
ance with subsection (g). For deaths occur-
ring postpartum, such data shall distin-
guish between deaths occurring up to 42 
days postpartum and deaths occurring be-
tween 43 days to up to 1 year postpartum. 
Where applicable, data reported under this 
clause shall be reported alongside com-
parable data from a State’s maternal mor-
tality review committee, as established in 
accordance with section 317K(d) of the 
Public Health Service Act, for purposes of 
further identifying and comparing state-
wide trends in maternal mortality among 
populations participating in the maternity 
health home under this section. 
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‘‘(B) 
IMPLEMENTATION
REPORT.—Not 
later than 18 months after a State has a State 
plan amendment approved under this section, 
the State shall submit to the Secretary, and 
make publicly available on the appropriate 
State website, a report on how the State is im-
plementing the option established under this 
section, including through any best practices 
adopted by the State. 
‘‘(g) CONFIDENTIALITY.—A State with a State plan 
amendment under this section shall establish confiden-
tiality protections for the purposes of subsection (f)(2)(A) 
to ensure, at a minimum, that there is no disclosure by 
the State of any identifying information about any specific 
eligible woman enrolled in a maternity health home or any 
maternal mortality case, and that all relevant confiden-
tiality and privacy protections, including the requirements 
under 1902(a)(7)(A), are maintained. 
‘‘(h) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require— 
‘‘(1) an eligible woman to enroll in a maternity 
health home under this section; or 
‘‘(2) a designated provider or health team to 
act as a maternity health home and provide services 
in accordance with this section if the provider or 
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health team does not voluntarily agree to act as a 
maternity health home. 
‘‘(i) PLANNING GRANTS.— 
‘‘(1) IN
GENERAL.—Beginning October 1, 
2025, from the amount appropriated under para-
graph (2), the Secretary shall award planning grants 
to States for purposes of developing and submitting 
a State plan amendment under this section. The 
Secretary shall award a grant to each State that ap-
plies for a grant under this subsection, but the Sec-
retary may determine the amount of the grant based 
on the merits of the application and the goal of the 
State to prioritize health outcomes for eligible 
women. A planning grant awarded to a State under 
this subsection shall remain available until expended. 
‘‘(2) APPROPRIATION.—There are authorized to 
be appropriated to the Secretary $50,000,000 for 
the period of fiscal years 2024 through 2026, for the 
purposes of making grants under this subsection, to 
remain available until expended. 
‘‘(3) LIMITATION.—The total amount of pay-
ments made to States under this subsection shall not 
exceed $50,000,000. 
‘‘(j) ADDITIONAL DEFINITIONS.—In this section: 
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‘‘(1) DESIGNATED PROVIDER.—The term ‘des-
ignated provider’ means a physician (including an 
obstetrician-gynecologist), hospital, clinical practice 
or clinical group practice, a medicaid managed care 
organization, as defined in section 1903(m)(1)(A), a 
prepaid inpatient health plan, as defined in section 
438.2 of title 42, Code of Federal Regulations (or 
any successor regulation), a prepaid ambulatory 
health plan, as defined in such section (or any suc-
cessor regulation), rural clinic, community health 
center, community mental health center, or any 
other entity or provider that is determined by the 
State and approved by the Secretary to be qualified 
to be a maternity health home on the basis of docu-
mentation evidencing that the entity has the sys-
tems, expertise, and infrastructure in place to pro-
vide pregnancy and postpartum coordinated care 
services. Such term may include providers who are 
employed by, or affiliated with, a hospital. 
‘‘(2) MATERNITY
HEALTH
HOME.—The term 
‘maternity health home’ means a designated provider 
(including a provider that operates in coordination 
with a team of health care professionals) or a health 
team is selected by an eligible woman to provide 
pregnancy and postpartum coordinated care services. 
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‘‘(3) HEALTH TEAM.—The term ‘health team’ 
has the meaning given such term for purposes of 
section 3502 of Public Law 111–148. 
‘‘(4) PREGNANCY
AND
POSTPARTUM
COORDI-
NATED CARE SERVICES.— 
‘‘(A) IN GENERAL.—The term ‘pregnancy 
and postpartum coordinated care services’ 
means items and services related to the coordi-
nation of care for comprehensive and timely 
high-quality, culturally and linguistically appro-
priate, services described in subparagraph (B) 
that are provided by a designated provider, a 
team of health care professionals operating with 
such a provider, or a health team (designated 
as a maternity health home). 
‘‘(B) SERVICES DESCRIBED.— 
‘‘(i) IN GENERAL.—The services de-
scribed in this subparagraph shall include 
with respect to a State electing the State 
plan amendment option under this section, 
any medical assistance for items and serv-
ices for which payment is available under 
the State plan or under a waiver of such 
plan. 
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‘‘(ii) OTHER ITEMS AND SERVICES.— 
In addition to medical assistance described 
in clause (i), the services described in this 
subparagraph shall include the following: 
‘‘(I) Any item or service for 
which medical assistance is otherwise 
available under the State plan (or a 
waiver of such plan) related to the 
treatment of a woman during the 
woman’s pregnancy and the 1-year pe-
riod beginning on the last day of her 
pregnancy, including mental health 
and substance use disorder services. 
‘‘(II) Comprehensive care man-
agement. 
‘‘(III) Care coordination (includ-
ing with pediatricians as appropriate), 
health promotion, and providing ac-
cess to the full range of maternal, ob-
stetric, and gynecologic services, in-
cluding services from out-of-State pro-
viders. 
‘‘(IV) Comprehensive transitional 
care, including appropriate follow-up, 
from inpatient to other settings. 
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‘‘(V) Patient and family support 
(including authorized representatives). 
‘‘(VI) Referrals to community 
and social support services, if rel-
evant. 
‘‘(VII) Use of health information 
technology to link services, as feasible 
and appropriate. 
‘‘(5) 
TEAM
OF
HEALTH
CARE
PROFES-
SIONALS.—The term ‘team of health care profes-
sionals’ means a team of health care professionals 
(as described in the State plan amendment under 
this section) that may— 
‘‘(A) include— 
‘‘(i) physicians, including gynecologist- 
obstetricians, pediatricians, and other pro-
fessionals such as physicians assistants, 
advance practice nurses, including certified 
nurse midwives, nurses, nurse care coordi-
nators, 
dietitians, 
nutritionists, 
social 
workers, behavioral health professionals, 
physical counselors, physical therapists, oc-
cupational therapists, or any professionals 
that assist in prenatal care, delivery, or 
postpartum care for which medical assist-
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ance is available under the State plan or a 
waiver of such plan and determined to be 
appropriate by the State and approved by 
the Secretary; 
‘‘(ii) an entity or individual who is 
designated to coordinate such care deliv-
ered by the team; and 
‘‘(iii) when appropriate and if other-
wise eligible to furnish items and services 
that are reimbursable as medical assist-
ance under the State plan or under a waiv-
er of such plan, doulas, community health 
workers, translators and interpreters, and 
other individuals with culturally appro-
priate and trauma-informed expertise; and 
‘‘(B) provide care at a facility that is free-
standing, virtual, or based at a hospital, com-
munity health center, community mental health 
center, rural clinic, clinical practice or clinical 
group practice, academic health center, or any 
entity determined to be appropriate by the 
State and approved by the Secretary.’’. 
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SEC. 6. GUIDANCE ON CARE COORDINATION TO SUPPORT 
MATERNAL HEALTH. 
Not later than 2 years after the date of enactment 
of this Act, the Secretary shall issue guidance for State 
Medicaid programs on improved care coordination, con-
tinuity of care, and clinical integration to support the 
needs of pregnant and postpartum women for services eli-
gible for Medicaid payment. Such guidance shall identify 
best practices for care coordination for such women, both 
with respect to fee-for-service State Medicaid programs 
and State Medicaid programs that contract with Medicaid 
managed care organizations or other specified entities to 
furnish medical assistance for such women, and shall illus-
trate strategies for— 
(1) enhancing primary care and maternity care 
coordination with specialists, including cardiologists, 
specialists in gestational diabetes, dentists, lactation 
specialists, genetic counselors, and behavioral health 
providers; 
(2) integrating behavioral health providers to 
provide screening, assessment, treatment, and refer-
ral for behavioral health needs, including substance 
use disorders, maternal depression, anxiety, intimate 
partner violence, and other trauma; 
(3) integrating into care teams or coordinating 
with nonclinical professionals, including (if licensed 
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or credentialed by a State or State-authorized orga-
nization) doulas, peer support specialists, and com-
munity health workers, and how these services pro-
vided by such professionals may be eligible for Fed-
eral financial participation under Medicaid; 
(4) screening pregnant and postpartum women 
for social needs and coordinating related services 
during the prenatal and postpartum periods to en-
sure social and physical supports are provided for 
such women during such periods and for their chil-
dren; 
(5) supporting women who have had a stillbirth; 
(6) screening for maternal health, behavioral 
health, and social needs during well-child and pedi-
atric care visits; and 
(7) streamlining and reducing duplication in 
care coordination efforts across and among pro-
viders, plans, and other entities for such women. 
SEC. 7. NATIONAL RESKILLING OF THE MATERNITY CARE 
WORKFORCE. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by inserting after sec-
tion 317L–1 the following: 
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‘‘SEC. 317L–2. NATIONAL RESKILLING OF THE MATERNITY 
CARE WORKFORCE. 
‘‘(a) 
ESTABLISHMENT
OF
NATIONAL
EXPERT 
GROUP.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a national expert group to evaluate national 
education on, and practice of, best birthing prac-
tices. 
‘‘(2) MEMBERS.— 
‘‘(A) IN GENERAL.—The group established 
under paragraph (1) shall be composed of such 
members as the Secretary appoints, including— 
‘‘(i) obstetricians and gynecologists, 
family medicine physicians, midwives, and 
nursing leaders; 
‘‘(ii) hospital administrators; 
‘‘(iii) graduate medical education lead-
ers; 
‘‘(iv) doula leaders; 
‘‘(v) individuals with experience in 
community birth settings; 
‘‘(vi) patients; 
‘‘(vii) high-risk birth experts; and 
‘‘(viii) quality improvement leaders. 
‘‘(B) GEOGRAPHIC
DIVERSITY.—In ap-
pointing members under subparagraph (A), the 
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Secretary shall ensure a balance of members 
representing rural areas and members rep-
resenting urban areas. 
‘‘(b) DUTIES.—The group established under sub-
section (a) shall— 
‘‘(1) examine evidence, trends, and differential 
use or access by income, geographic area, and race 
and ethnicity associated with birthing practices that 
include— 
‘‘(A) cesarean sections, repeat cesarean, 
and vaginal birth after cesarean; 
‘‘(B) electronic fetal monitoring and inter-
mittent auscultation; 
‘‘(C) birth positions, including upright po-
sitioning and ambulation; 
‘‘(D) labor with doula support; 
‘‘(E) evaluating indications for cesarean 
delivery, including cervical dilation and duration 
of pushing; 
‘‘(F) operative vaginal deliveries; 
‘‘(G) manual fetal rotation; 
‘‘(H) amnioinfusion and scalp stimulation; 
and 
‘‘(I) cervical ripening methods; 
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‘‘(2) assess the role of the culture of care, ma-
ternity care financing, and health education with re-
spect to the trends under paragraph (1); and 
‘‘(3) identify case studies of the provision of ex-
emplary birthing care. 
‘‘(c) RECOMMENDATIONS.—The group established 
under subsection (a) shall, not later than 1 year after such 
establishment, issue— 
‘‘(1) best practices for— 
‘‘(A) evaluating birthing skills; 
‘‘(B) improving curricula for health profes-
sionals engaged in birthing; and 
‘‘(C) the incorporation of midwives and 
doulas into residency curricula for obstetricians; 
and 
‘‘(2) recommendations for policies and practices 
to improve maternity care overall.’’. 
SEC. 8. MACPAC STUDY ON DOULAS AND COMMUNITY 
HEALTH WORKERS; GUIDANCE ON INCREAS-
ING ACCESS TO DOULA SERVICES UNDER 
MEDICAID. 
(a) MACPAC STUDY ON DOULAS AND COMMUNITY 
HEALTH WORKERS.— 
(1) IN GENERAL.—As part of the first report 
required under section 1900(b)(1) of the Social Se-
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curity Act (42 U.S.C. 1396(b)(1)) after the date 
that is 1 year after the date of enactment of this 
Act, the Medicaid and CHIP Payment and Access 
Commission 
(referred 
to 
in 
this 
section 
as 
‘‘MACPAC’’) shall include with such report a report 
on the coverage of doula services and the role of 
community health workers under State Medicaid 
programs, which shall include the following: 
(A) Information about coverage for doula 
services and community health worker services 
under State Medicaid programs that currently 
provide coverage for such services, including the 
type of doula services offered (such as prenatal, 
labor and delivery, postpartum support, and 
traditional doula services) and information on 
the prevalence of doulas that care for individ-
uals in their own communities. 
(B) An analysis of strategies to facilitate 
the appropriate use of doula services in order to 
provide better care and achieve better maternal 
and infant health outcomes, including strategies 
that States may use to assist with services for 
which Federal financial participation is eligible 
under a State Medicaid plan or a waiver of such 
a plan by recruiting, training, and certifying a 
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diverse doula workforce, particularly from un-
derserved communities, communities of color, 
and communities facing linguistic or cultural 
barriers. 
(C) Provide examples of community health 
worker access in State Medicaid programs and 
strategies employed by States to encourage a 
broad care team to manage Medicaid patients. 
(D) An assessment of the impact of the in-
volvement of doulas and community health 
workers on maternal health outcomes. 
(E) Recommendations, as MACPAC deems 
appropriate, for legislative and administrative 
actions to increase access to services that im-
prove maternal health. 
(2) STAKEHOLDER CONSULTATION.—In devel-
oping the report required under paragraph (1), 
MACPAC shall consult with relevant stakeholders. 
(b) GUIDANCE ON INCREASING ACCESS TO DOULA 
SERVICES UNDER MEDICAID.— 
(1) IN GENERAL.—Not later than 1 year after 
the date that MACPAC publishes the report re-
quired under subsection (a), the Secretary shall 
issue guidance to States on increasing access to 
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doula services under Medicaid. Such guidance shall 
at a minimum include— 
(A) options for States to provide medical 
assistance for doula services under State Med-
icaid programs; 
(B) best practices for ensuring that doulas, 
including community-based doulas, receive reim-
bursement for doula services provided under a 
State Medicaid program, at a level that allows 
doulas to earn a living wage that accounts for 
their time and costs associated with providing 
care and community-based doula program ad-
ministration; and 
(C) best practices for increasing access to 
doula services, including services provided by 
community-based doulas, under State Medicaid 
programs. 
(2) STAKEHOLDER CONSULTATION.—In devel-
oping the report required under paragraph (1), the 
Secretary shall consult with relevant stakeholders. 
(c) RELEVANT STAKEHOLDERS.—For purposes of 
subsections (a)(2) and (b)(2), relevant stakeholders shall 
include— 
(1) States; 
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(2) organizations representing consumers, in-
cluding those that are disproportionately impacted 
by poor maternal health outcomes; 
(3) organizations and individuals representing 
doula services providers and community health work-
ers, including community-based doula programs and 
those who serve underserved communities, commu-
nities of color and communities facing linguistic or 
cultural barriers; and 
(4) organizations representing health care pro-
viders. 
SEC. 9. DEMONSTRATION PROJECTS TO IMPROVE THE DE-
LIVERY 
OF 
MATERNAL 
HEALTH 
CARE 
THROUGH TELEHEALTH. 
(a) IN GENERAL.—Not later than 18 months after 
the date of enactment of this Act, the Secretary shall 
award grants to States to conduct demonstration projects 
under this section that are designed to expand the use of 
telehealth in State Medicaid programs for the delivery of 
health care to eligible pregnant or postpartum women. 
(b) ELIGIBLE PREGNANT OR POSTPARTUM WOMAN 
DEFINED.— 
(1) IN GENERAL.—In this section, the term ‘‘el-
igible pregnant or postpartum woman’’ means a 
woman who is eligible for and receiving medical as-
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sistance under a State Medicaid plan (or waiver of 
such plan) and who is or becomes pregnant. 
(2) POSTPARTUM WOMEN.—Such term includes 
a woman described in paragraph (1) through the 
end of the month in which the 365-day period begin-
ning on the last day of the woman’s pregnancy ends, 
without regard to any change in income of the fam-
ily of which she is a member. 
(c) APPLICATION; SELECTION OF STATES; DURA-
TION.— 
(1) APPLICATION.— 
(A) IN
GENERAL.—To conduct a dem-
onstration project under this section, a State 
shall submit an application to the Secretary at 
such time and in such manner as the Secretary 
shall require. Under the demonstration project, 
a State may include multiple proposed uses of 
grant funds, and propose to focus on multiple 
populations, as otherwise allowable under this 
section, within a single application. 
(B) REQUIRED
INFORMATION.—A State 
application to conduct a demonstration project 
under this section shall include the following: 
(i) The population (such as individ-
uals residing in rural or medically under-
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served areas) that the demonstration 
project will target. 
(ii) A description of how the State 
proposes to use funds awarded under this 
section to conduct the demonstration 
project to integrate or increase the integra-
tion of telehealth into the State Medicaid 
program’s existing delivery system for fur-
nishing medical assistance to and improv-
ing the health care outcomes of eligible 
pregnant or postpartum women. 
(iii) A description of how the State 
will use funds to address racial or ethnic 
disparities in access to maternal health 
services or maternal health outcomes, bar-
riers to care, including in rural or medi-
cally underserved communities, other bar-
riers to using telehealth, such as those ex-
perienced by individuals with disabilities 
and individuals with limited English pro-
ficiency, and as applicable, barriers to the 
use of telehealth in tribal communities. 
(iv) A certification that the applica-
tion meets the requirements of subpara-
graph (C). 
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(v) Such other information as the Sec-
retary shall require. 
(C) CONSULTATION WITH HEALTH CARE 
STAKEHOLDERS.—Prior to the submission of an 
application to conduct a demonstration project 
under this section, a State shall consult with 
health care systems and providers, health plans 
(if relevant), consumer organizations and bene-
ficiary advocates, and community-based organi-
zations or other stakeholders in the area that 
the demonstration project will target to ensure 
that the proposed project addresses the health 
care needs of eligible pregnant or postpartum 
women in such area. 
(2) SELECTION OF STATES AND DURATION OF 
PROJECTS.— 
(A) IN
GENERAL.—The Secretary shall 
award grants to States that apply and meet the 
application requirements to conduct 4-year 
demonstration projects under this section. A 
State may request, and the Secretary shall de-
termine the appropriateness of, an application 
of up to $10,000,000. 
(B) SELECTION OF PROJECTS.—In select-
ing a State to conduct a demonstration project 
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under this section, the Secretary shall ensure 
that the State is aware of the 4-year duration 
of the project and shall determine the State has 
satisfied the application requirements. 
(3) WAIVER
OF
STATEWIDENESS
AND
COM-
PARABILITY
REQUIREMENT.—The Secretary shall 
waive compliance with section 1902(a)(1) of the So-
cial Security Act (42 U.S.C. 1396a(a)(1)) (relating 
to statewideness) and section 1902(a)(10)(B) of 
such Act (42 U.S.C. 1396a(a)(10)(B)) (relating to 
comparability) to the extent necessary to allow se-
lected States to conduct demonstration projects 
under this section. 
(d) USE OF GRANT FUNDS.—A State may use funds 
from a grant awarded under this section to connect eligible 
pregnant or postpartum women to telehealth services de-
livered via telehealth that are furnished by— 
(1) primary and maternity care providers; 
(2) health care specialists; 
(3) behavioral health providers; and 
(4) other categories of health care providers 
identified by the Secretary. 
(e) REPORTS.— 
(1) STATE
REPORTS.—Each State that is 
awarded a grant to conduct a demonstration project 
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under this section shall submit the following reports 
to the Secretary: 
(A) INITIAL REPORT.—An initial report on 
the first 18 months during which the dem-
onstration project is conducted, not later than 
the last day of the 19th month of the dem-
onstration project, as described in subpara-
graph (B). 
(B) FINAL REPORT.— Not later than 6 
months after the date on which the State’s 
demonstration project ends, a final report that 
includes the following: 
(i) The number of eligible pregnant or 
postpartum women served under the dem-
onstration project. 
(ii) The activities and services funded 
under the demonstration project, including 
the providers that received funds under the 
demonstration project. 
(iii) Demographic information about 
the eligible pregnant or postpartum women 
served under the demonstration project, if 
available. 
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(iv) A description of the types of mod-
els or programs developed under the dem-
onstration project. 
(v) How such models or programs im-
pacted access to, and utilization of, tele-
health services by eligible pregnant or 
postpartum women, including a description 
of how such models or programs addressed 
racial or ethnic disparities in access or uti-
lization. 
(vi) Qualitative information on bene-
ficiary experience. 
(vii) Challenges faced and lessons 
learned by the State in integrating (or in-
creasing the integration of) telehealth into 
the delivery system for furnishing medical 
assistance 
to 
eligible 
pregnant 
or 
postpartum women in the areas targeted 
under the demonstration project. 
(2) REPORTS TO CONGRESS.— 
(A) INITIAL
REPORT.—Not later than 2 
years after the date of enactment of this Act, 
the Secretary shall submit a report to Congress 
summarizing the information reported by States 
under paragraph (1)(A). 
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(B) FINAL
REPORT.—Not later than 5 
years after the date of enactment of this Act, 
the Secretary shall submit a report to Congress 
summarizing the information reported by States 
under paragraph (1)(B). 
SEC. 10. CMS REPORT ON COVERAGE OF REMOTE PHYSIO-
LOGIC MONITORING DEVICES AND IMPACT 
ON MATERNAL AND CHILD HEALTH OUT-
COMES UNDER MEDICAID. 
(a) IN GENERAL.—Not later than 18 months after 
the date of enactment of this Act, the Secretary shall sub-
mit to Congress a report containing information on au-
thorities and State practices for covering remote physio-
logical monitoring devices, including limitations and bar-
riers to such coverage and the impact on maternal health 
outcomes, and to the extent appropriate, recommendations 
on how to address such limitations or barriers related to 
coverage of remote physiologic devices under State Med-
icaid programs, including, but not limited to, pulse 
oximeters, blood pressure cuffs, scales, and blood glucose 
monitors, with the goal of improving maternal and child 
health outcomes for pregnant and postpartum women en-
rolled in State Medicaid programs. 
(b) STATE RESOURCES.—Not later than 6 months 
after the submission of the report required by subsection 
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(a), the Secretary shall update resources for State Med-
icaid programs, such as State Medicaid telehealth toolkits, 
to be consistent with the recommendations provided in 
such report. 
SEC. 11. GUIDANCE ON COMMUNITY-BASED MATERNAL 
HEALTH PROGRAMS. 
Not later than 3 years after the date of enactment 
of this Act, the Secretary shall issue guidance to State 
Medicaid programs to support the use of evidence-based 
community-based maternal health programs, including 
programs that offer group prenatal care, home visiting 
services, childbirth and parenting education, peer sup-
ports, stillbirth prevention activities, and substance use 
disorder and recovery supports, under such programs, and 
any other programs as determined by the Secretary. 
SEC. 12. DEVELOPING GUIDANCE ON MATERNAL MOR-
TALITY AND SEVERE MORBIDITY REDUCTION 
FOR MATERNAL CARE PROVIDERS RECEIV-
ING PAYMENT UNDER THE MEDICAID PRO-
GRAM. 
(a) IN GENERAL.—Subject to the availability of ap-
propriations, not later than 36 months after the date of 
enactment of this Act, the Secretary shall, in consultation 
with the Advisory Committee on Reducing Maternal 
Deaths established under subsection (c) and the Task 
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Force on Maternal Mental Health established under sec-
tion 1113 of division FF of the Consolidated Appropria-
tions Act, 2023 (Public Law 117–328), publish on a public 
website of the Centers for Medicare & Medicaid Services 
guidance for States on resources and strategies for hos-
pitals, freestanding birth centers (as defined in section 
1905(l)(3)(B) of the Social Security Act (42 U.S.C. 
1396d(l)(3)(B))), and other maternal care providers as de-
termined by the Secretary for reducing maternal mortality 
and severe morbidity in individuals who are eligible for 
and receiving medical assistance under Medicaid or CHIP. 
(b) UPDATES.—The Secretary shall, in consultation 
with the Advisory Committee on Reducing Maternal 
Deaths established under subsection (c) and the Task 
Force on Maternal Mental Health established under sec-
tion 1113 of division FF of the Consolidated Appropria-
tions Act, 2023 (Public Law 117–328), update the guid-
ance and resources described in subsection (a) at least 
once every 3 years. 
(c) CONSULTATION WITH ADVISORY COMMITTEE.— 
(1) ESTABLISHMENT.—Subject to the avail-
ability of appropriations, not later than 18 months 
after the date of enactment of this Act, the Sec-
retary shall establish an advisory committee to be 
known as the ‘‘National Advisory Committee on Re-
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ducing Maternal Deaths’’ (referred to in this section 
as the ‘‘Advisory Committee’’). 
(2) DUTIES.—The Advisory Committee shall 
provide consensus advice and guidance to the Sec-
retary on the development and compilation of the 
guidance described in subsection (a) (and any up-
dates to such guidance). 
(3) MEMBERSHIP.— 
(A) IN GENERAL.—The Secretary, in con-
sultation with such other heads of agencies, as 
the Secretary deems appropriate and in accord-
ance with this paragraph, shall appoint not 
more than 41 members to the Advisory Com-
mittee. In appointing such members, the Sec-
retary shall ensure that— 
(i) the total number of members of 
the Advisory Committee is an odd number; 
and 
(ii) the total number of voting mem-
bers who are not Federal officials does not 
exceed the total number of voting Federal 
members who are Federal officials. 
(B) REQUIRED MEMBERS.— 
(i) FEDERAL OFFICIALS.—The Advi-
sory Committee shall include as voting 
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members the following Federal officials, or 
their designees: 
(I) The Secretary. 
(II) The Administrator of the 
Centers for Medicare & Medicaid 
Services. 
(III) The Director of the Centers 
for Disease Control and Prevention. 
(IV) The Associate Administrator 
of the Maternal and Child Health Bu-
reau of the Health Resources and 
Services Administration. 
(V) The Director of the Agency 
for Healthcare Research and Quality. 
(VI) The National Coordinator 
for Health Information Technology. 
(VII) The Director of the Na-
tional Institutes of Health. 
(VIII) The Secretary of Veterans 
Affairs. 
(IX) The Director of the Indian 
Health Service. 
(X) The Deputy Assistant Sec-
retary for Minority Health. 
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(XI) The Administrator of the 
Substance Abuse and Mental Health 
Services Administration. 
(XII) The Deputy Assistant Sec-
retary for Women’s Health. 
(XIII) Such other Federal offi-
cials or their designees as the Sec-
retary determines appropriate. 
(ii) NON-FEDERAL OFFICIALS.— 
(I) IN GENERAL.—The Advisory 
Committee shall include the following 
as voting members: 
(aa) At least 1 representa-
tive from a professional organiza-
tion representing hospitals and 
health systems. 
(bb) At least 1 representa-
tive from a medical professional 
organization 
representing 
pri-
mary care providers. 
(cc) At least 1 representa-
tive from a medical professional 
organization representing general 
obstetrician-gynecologists. 
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(dd) At least 1 representa-
tive from a medical professional 
organization 
representing 
cer-
tified nurse-midwives. 
(ee) At least 1 representa-
tive from a medical professional 
organization representing other 
maternal 
fetal 
medicine 
pro-
viders. 
(ff) At least 1 representative 
from a medical professional orga-
nization representing anesthesiol-
ogists. 
(gg) At least 1 representa-
tive from a medical professional 
organization representing emer-
gency medicine physicians and 
urgent care providers. 
(hh) At least 1 representa-
tive from a medical professional 
organization representing nurses. 
(ii) At least 1 representative 
from a professional organization 
representing community health 
workers. 
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(jj) At least 1 representative 
from a professional organization 
representing doulas. 
(kk) At least 1 representa-
tive from a professional organiza-
tion representing perinatal psy-
chiatrists. 
(ll) At least 1 representative 
from State-affiliated programs or 
existing collaboratives with dem-
onstrated expertise or success in 
improving maternal health. 
(mm) At least 1 director of 
a State Medicaid agency that has 
had demonstrated success in im-
proving maternal health. 
(nn) At least 1 representa-
tive from an accrediting organi-
zation for maternal health quality 
and safety standards. 
(oo) At least 1 representa-
tive from a maternal patient ad-
vocacy organization with lived ex-
perience of severe maternal mor-
bidity. 
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(pp) At least 1 medical pro-
fessional who is an expert in the 
treatment of pregnant women 
with substance use disorder. 
(II) REQUIREMENTS.—Each in-
dividual selected to be a member 
under this clause shall— 
(aa) have expertise in mater-
nal health; 
(bb) not be a Federal offi-
cial; and 
(cc) have experience working 
with populations that are at 
higher risk for maternal mor-
tality or severe morbidity, such 
as populations that experience 
racial, ethnic, and geographic 
health disparities, pregnant and 
postpartum women experiencing 
a mental health disorder, or 
pregnant or postpartum women 
with other comorbidities such as 
substance use disorders, hyper-
tension, thyroid disorders, and 
sickle cell disease. 
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(C) ADDITIONAL MEMBERS.— 
(i) IN GENERAL.—In addition to the 
members required to be appointed under 
subparagraph (B), the Secretary may ap-
point as non-voting members to the Advi-
sory Committee such other individuals with 
relevant expertise or experience as the Sec-
retary shall determine appropriate, which 
may include, but is not limited to, individ-
uals described in clause (ii). 
(ii) SUGGESTED
ADDITIONAL
MEM-
BERS.—The individuals described in this 
clause are the following: 
(I) Representatives from State 
maternal mortality review committees 
and perinatal quality collaboratives. 
(II) Medical providers who care 
for women and infants during preg-
nancy and the postpartum period, 
such as family practice physicians, 
cardiologists, 
pulmonology 
critical 
care specialists, endocrinologists, pedi-
atricians, and neonatologists. 
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(III) Representatives from State 
and local public health departments, 
including State Medicaid Agencies. 
(IV) Subject matter experts in 
conducting outreach to women who 
are African American or belong to an-
other minority group. 
(V) Directors of State agencies 
responsible for administering a State’s 
maternal and child health services 
program under title V of the Social 
Security Act (42 U.S.C. 701 et seq.). 
(VI) Experts in medical edu-
cation or physician training. 
(VII) Representatives from Med-
icaid managed care organizations. 
(4) APPLICABILITY OF FACA.—Chapter 10 of 
title 5, United States Code, shall apply to the com-
mittee established under this subsection. 
(d) CONTENTS.—The guidance described in sub-
section (a) shall include, with respect to hospitals, free-
standing birth centers, and other maternal care providers, 
the following: 
(1) Best practices regarding evidence-based 
screening and clinician education initiatives relating 
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to screening and treatment protocols for individuals 
who are at risk of experiencing complications related 
to pregnancy, with an emphasis on individuals with 
preconditions directly linked to pregnancy complica-
tions and maternal mortality and severe morbidity, 
including— 
(A) methods to identify individuals who are 
at risk of maternal mortality or severe mor-
bidity, including risk stratification; 
(B) evidence-based risk factors associated 
with maternal mortality or severe morbidity and 
racial, ethnic, and geographic health disparities; 
(C) evidence-based strategies to reduce risk 
factors associated with maternal mortality or 
severe morbidity through services which may be 
covered under Medicaid or CHIP, including, 
but not limited to, activities by community 
health workers (as such term is defined in sec-
tion 2113 of the Social Security Act (42 U.S.C. 
1397mm)) that are funded by a grant awarded 
under such section; 
(D) resources available to such individuals, 
such as nutrition assistance and education, 
home visitation, mental health and substance 
use disorder services, smoking cessation pro-
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grams, prenatal care, and other evidence-based 
maternal mortality or severe morbidity reduc-
tion programs; 
(E) examples of educational materials used 
by providers of obstetrics services; 
(F) methods for improving community cen-
tralized care, including providing telehealth 
services or home visits to increase and facilitate 
access to and engagement in prenatal and 
postpartum care and collaboration with home 
health agencies, community health centers, local 
public health departments, or clinics; 
(G) guidance on medical record diagnosis 
codes linked to maternal mortality and severe 
morbidity, including, if applicable, codes related 
to social risk factors, and methods for edu-
cating clinicians on the proper use of such 
codes; 
(H) risk appropriate transfer protocols 
during 
pregnancy, 
childbirth, 
and 
the 
postpartum period; and 
(I) any other information related to pre-
vention and treatment of at-risk individuals de-
termined appropriate by the Secretary. 
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(2) Guidance on monitoring programs for indi-
viduals who have been identified as at risk of com-
plications related to pregnancy. 
(3) Best practices for such hospitals, free-
standing birth centers, and providers to make preg-
nant women aware of the complications related to 
pregnancy. 
(4) A fact sheet for providing pregnant women 
who are receiving care on an outpatient basis with 
a notice during the prenatal stage of pregnancy 
that— 
(A) explains the risks associated with preg-
nancy, birth, and the postpartum period (in-
cluding the risks of hemorrhage, preterm birth, 
sepsis, eclampsia, obstructed labor), chronic 
conditions (including high blood pressure, dia-
betes, heart disease, depression, and obesity) 
correlated with adverse pregnancy outcomes, 
risks associated with advanced maternal age, 
and the importance of adhering to a personal-
ized plan of care; 
(B) highlights multimodal and evidence- 
based prevention and treatment techniques; 
(C) highlights evidence-based programs 
and activities to reduce the incidence of still-
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birth (including tracking and awareness of fetal 
movements, improvement of birth timing for 
pregnancies with risk factors, initiatives that 
encourage safe sleeping positions during preg-
nancy, screening and surveillance for fetal 
growth restriction, efforts to achieve smoking 
cessation during pregnancy, community-based 
programs that provide home visits or other 
types of support, and any other research or evi-
dence-based programming to prevent still-
births); 
(D) provides for a method (through signa-
ture or otherwise) for such an individual, or a 
person acting on such individual’s behalf, to ac-
knowledge receipt of such fact sheet; 
(E) is worded in an easily understandable 
manner and made available in multiple lan-
guages and accessible formats determined ap-
propriate by the Secretary; and 
(F) includes any other information deter-
mined appropriate by the Secretary. 
(5) A template for a voluntary clinician check-
list that outlines the minimum responsibilities that 
clinicians, such as physicians, certified nurse-mid-
wives, emergency room and urgent care providers, 
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nurses and others, are expected to meet in order to 
promote quality and safety in the provision of ob-
stetric services. 
(6) A template for a voluntary checklist that 
outlines the minimum responsibilities that hospital 
leadership responsible for direct patient care, such 
as the institution’s president, chief medical officer, 
chief nursing officer, or other hospital leadership 
that directly report to the president or chief execu-
tive officer of the institution, should meet to pro-
mote hospital-wide initiatives that improve quality 
and safety in the provision of obstetric services. 
(7) Information on multi-stakeholder quality 
improvement initiatives, such as the Alliance for In-
novation on Maternal Health, State perinatal quality 
improvement initiatives, and other similar initiatives 
determined appropriate by the Secretary, includ-
ing— 
(A) information about such improvement 
initiatives and how to join; 
(B) information about public maternal 
data collection centers; 
(C) information about quality metrics used 
and outcomes achieved by such improvement 
initiatives; 
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(D) information about data sharing tech-
niques used by such improvement initiatives; 
(E) information about data sources used 
by such improvement initiatives to identify ma-
ternal mortality and severe morbidity risks; 
(F) information about interventions used 
by such improvement initiatives to mitigate 
risks of maternal mortality and severe mor-
bidity; 
(G) information about data collection tech-
niques on race, ethnicity, geography, age, in-
come, and other demographic information used 
by such improvement initiatives; and 
(H) any other information determined ap-
propriate by the Secretary. 
(e) INCLUSION OF BEST PRACTICES.—Not later than 
18 months after the date of the publication of the guid-
ance required under subsection (a), the Secretary shall up-
date such guidance to include best practices identified by 
the Secretary for such hospitals, freestanding birth cen-
ters, and providers to track maternal mortality and severe 
morbidity trends by clinicians at such hospitals, free-
standing birth centers, and providers including— 
(1) ways to establish scoring systems, which 
may include quality triggers and safety and quality 
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metrics to score case and patient outcome metrics, 
for such clinicians; 
(2) methods to identify, educate, and improve 
such clinicians who may have higher rates of mater-
nal mortality or severe morbidity compared to their 
regional or State peers (taking into account dif-
ferences in patient risk for adverse outcomes, which 
may include social risk factors); 
(3) methods for using such data and tracking 
to enhance research efforts focused on maternal 
health, while also improving patient outcomes, clini-
cian education and training, and coordination of 
care; and 
(4) any other information determined appro-
priate by the Secretary. 
(f) CULTURAL
AND
LINGUISTIC
APPROPRIATE-
NESS.—To the extent practicable, the Secretary should de-
velop the guidance, best practices, fact sheets, templates, 
and other materials that are required under this section 
in a trauma-informed, culturally and linguistically appro-
priate manner. 
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SEC. 13. PROGRAM RELATED TO REDUCING CESAREAN 
BIRTHS AND INCREASING RATES OF VAGINAL 
BIRTH AFTER CESAREAN. 
Section 317K(a) of the Public Health Service Act (42 
U.S.C. 247b–12(a)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘and to develop or sup-
port’’ and inserting ‘‘to develop or support’’; 
and 
(B) by inserting ‘‘, and to establish a grant 
program, or extend the Alliance for Innovation 
on Maternal Health, for the establishment of 
perinatal quality collaboratives to reduce cesar-
ean section rates and increase vaginal birth 
after cesarean rates’’ before the period at the 
end; and 
(2) in paragraph (2), by adding at the end the 
following: 
‘‘(E) The Secretary may establish a com-
petitive grant program, or extend existing pro-
grams, including the Alliance for Innovation on 
Maternal Health, for the establishment or sup-
port of perinatal quality collaboratives, with a 
focus on maternity care health professional tar-
get areas and other areas with limited birthing 
resources, to reduce cesarean birth rates and 
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increase vaginal birth after cesarean rates, in-
cluding through— 
‘‘(i) coordination with hospitals, clin-
ical teams, obstetricians and gynecologists, 
birthing centers and community-based ma-
ternal health organizations, public health 
agencies, midwives, doulas, patients and 
families, and other relevant entities; 
‘‘(ii) providing support and training to 
hospital and clinical teams for quality im-
provement, as appropriate; 
‘‘(iii) employing strategies that pro-
vide opportunities for health care profes-
sionals and clinical teams to collaborate 
across health care settings and disciplines, 
including midwifery care, doula support, 
the integration of primary care and mental 
health, and blended case payment rates; 
‘‘(iv) using data, disaggregated by 
race and ethnicity, to provide timely feed-
back across hospital and clinical teams, 
document baseline cesarean and vaginal 
birth rates, and measure progress; and 
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‘‘(v) promotion of existing evidence on 
the best practices for the safe reduction of 
primary cesarean births.’’. 
SEC. 14. COLLECTION OF INFORMATION RELATED TO SO-
CIAL DETERMINANTS OF THE HEALTH OF 
MEDICAID AND CHIP BENEFICIARIES. 
(a) IMPLEMENTATION
ASSESSMENT
REPORT
TO 
CONGRESS.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this Act, the Secretary 
shall submit a report to Congress that includes a de-
scription of whether and how information related to 
the social determinants of health for individuals eli-
gible for medical assistance under Medicaid or child 
health assistance or pregnancy-related assistance 
under CHIP may be captured under the data sys-
tems for such programs as in effect on the date such 
report is submitted, including— 
(A) a description of whether and how ICD- 
10 codes (or successor codes) may be used to 
identify social determinants of health in pro-
grams such as Medicaid and CHIP, and wheth-
er other claims file or demographic information 
may be employed; and 
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(B) a description of whether existing data 
systems under Medicaid and CHIP could be 
employed to capture such information, whether 
program or system changes would be required, 
how privacy and confidentiality as required 
under applicable law and regulations would be 
maintained, and the resources and timeframes 
at the Federal and State levels that would be 
needed to make such changes. 
(2) GUIDANCE
FOR
STATES.—The Secretary 
shall issue detailed guidance for States concurrent 
with the submission of the report to Congress under 
paragraph (1). Such guidance shall address— 
(A) whether and how information related 
to the social determinants of health for individ-
uals eligible for medical assistance under Med-
icaid or child health assistance or pregnancy-re-
lated assistance under CHIP could be captured 
employing existing systems under such pro-
grams; and 
(B) implementation considerations for cap-
turing such information, including whether pro-
gram or system changes would be required, 
whether additional steps would be needed to 
maintain privacy and confidentiality as required 
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under relevant laws and regulations, and the re-
sources and timeframes at that would be needed 
to make such changes. 
(3) STAKEHOLDER INPUT.—The Secretary shall 
develop the report required under paragraph (1) and 
the guidance required under paragraph (2) with the 
input of relevant stakeholders, such as State Med-
icaid directors, Medicaid managed care organiza-
tions, and other relevant Federal agencies such as 
the Centers for Disease Control and Prevention, the 
Health Resources Services Administration, and the 
Agency for Healthcare Research and Quality. 
(4) ACTION PLAN REPORT.— 
(A) IN GENERAL.—If the Secretary deter-
mines in the report required under paragraph 
(1) that information related to the social deter-
minants of health for individuals eligible for 
medical assistance under Medicaid or child 
health assistance or pregnancy-related assist-
ance under CHIP cannot be captured under the 
data systems for such programs as in effect on 
the date such report is submitted, then, not 
later than 6 months after such date, the Sec-
retary shall submit a second report to Congress 
that contains an action plan for implementing 
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the program or data systems changes needed in 
order for such information to be collected while 
maintaining privacy and confidentiality as re-
quired under relevant laws and regulations. The 
action plan should be prepared so as to be im-
plemented by the Federal Government and 
States not later than 2 years after the date on 
which the report required under this paragraph 
is submitted to Congress. 
(B) REVISED
GUIDANCE
FOR
STATES.— 
The Secretary shall revise and reissue the guid-
ance for States required under paragraph (2) to 
take into account the action plan included in 
the report submitted to Congress under sub-
paragraph (A). 
(5) AUTHORIZATION OF APPROPRIATIONS.— 
(A) FEDERAL COSTS.—There are author-
ized to be appropriated to the Secretary, 
$40,000,000 for purposes of preparing the re-
ports required under this subsection and imple-
menting the collection of information related to 
the social determinants of health for individuals 
eligible for medical assistance under Medicaid 
or child health assistance or pregnancy-related 
assistance under CHIP. 
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(B) STATE COSTS.—There are authorized 
to 
be 
appropriated 
to 
the 
Secretary, 
$50,000,000 for purposes of making payments 
to States in accordance with a methodology es-
tablished by the Secretary for State expendi-
tures attributable to planning for and imple-
menting the collection of such information in 
accordance with subsection (d) of section 1946 
of the Social Security Act (42 U.S.C. 1396w– 
5) (as added by subsection (b)). 
(b) APPLICATION TO STATES.—Section 1946 of the 
Social Security Act (42 U.S.C. 1396w–5) is amended by 
adding at the end the following: 
‘‘(d) COLLECTION OF INFORMATION RELATED TO 
SOCIAL DETERMINANTS OF HEALTH.— 
‘‘(1) DEVELOPMENT
OF
COLLECTION
METH-
ODS.— 
‘‘(A) IN GENERAL.—Subject to paragraph 
(5), the Secretary, in consultation with the 
States, shall develop a method for collecting 
standardized and aggregated State-level infor-
mation related to social determinants that may 
factor into the health of beneficiaries under this 
title and beneficiaries under title XXI which the 
States, notwithstanding section 1902(a)(7) and 
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as a condition for meeting the requirements of 
section 1902(a)(6) and section 2107(b)(1), shall 
use to annually report such information: 
‘‘(i) A model uniform reporting field 
through the transformed Medicaid Statis-
tical Information System (T-MSIS) (or a 
successor system) or another appropriate 
reporting platform, as approved by the 
Secretary. 
‘‘(ii) A model uniform questionnaire 
or survey (which may be included as part 
of an existing survey, questionnaire, or 
form administered by the Secretary), for 
purposes of the State or the Secretary col-
lecting such information by administering 
regularly but not less than annually a 
questionnaire or survey of beneficiaries 
under this title and beneficiaries under 
title XXI. 
‘‘(iii) A model uniform form to be 
adapted for inclusion in the Medicaid and 
CHIP Scorecard developed by the Centers 
for Medicare & Medicaid Services, for pur-
poses of the Secretary collecting such in-
formation. 
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‘‘(iv) An alternative method identified 
by the Secretary for collecting such infor-
mation. 
‘‘(B) IMPLEMENTATION.—In carrying out 
the requirements of subparagraph (A), the Sec-
retary shall— 
‘‘(i) for purposes of the method de-
scribed in clause (i) of such subparagraph, 
determine the appropriate providers and 
frequency with which such providers shall 
complete the reporting field identified and 
report the information to the State; 
‘‘(ii) for purposes of the method de-
scribed in clause (ii) of such subparagraph, 
identify the means and frequency (which 
shall be no less frequent than once per 
year) with which a questionnaire or survey 
of beneficiaries is to be conducted; 
‘‘(iii) with respect to any method de-
scribed in such subparagraph, issue guid-
ance for ensuring compliance with applica-
ble laws regarding beneficiary informed 
consent, privacy, and anonymity with re-
spect to the information collected under 
such method; 
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