,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #eahi  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #bj1         
#bjai,ms4 ,cl>k ( ,massa*usetts 7=      
h]self & ,mr4 ,c>t] ( ,georgia7         
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce  ,a  
,,bill  ,to require ! ,secret>y ( ,heal?
 & ,human ,s]vices to e/abli% a ,m$icaid
 demon/ration program to develop &      
advance innovative paym5t models =      
free/&+ bir? c5t] s]vices = wom5 ) a    
l[-risk pregnancy1 & = o!r purposes4    
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,bir? ,access ,b5efit+ ,improv$       
,ess5tial ,facility ,s]vices ,act or !  
,,babies ,act4  #b4 ,m$icaid            
demon/ration program to improve free/&+ 
bir? c5t] s]vices ,section #aijc ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7 is am5d$ by add+ at ! end !    
foll[+3  7bb7 ,demon/ration program ,to 
improve free/&+ bir? c5t] s]vices  7#a7 
,au?ority ,! ,secret>y %all e/abli% a   
demon/ration program = ! purpose (      

id5tify+ ways to improve access to1 & ! 
quality & scope (1 free/&+ bir? c5t]    
s]vices = wom5 ) a l[-risk pregnancy4   
7#b7 ,deadl9es = c5t]s p>ticipation     
crit]ia1 prospective paym5t sy/em2      
plann+ grants  7,a7 ,p>ticipation &     
prospective paym5t sy/em deadl9e ,n lat]
 ?an "o ye> aft] ! date ( ! enactm5t (  
?is subsection1 ! ,secret>y %all d !    
foll[+3  7i7 ,publication ( p>ticipation
 crit]ia = free/&+ bir? c5t]s  7,i7 ,9  
g5]al ,publi% crit]ia = a free/&+ bir?  
c5t] to be c]tifi$ by a ,/ate = purposes
 ( p>ticipat+ 9 a ,/ate demon/ration    
program conduct$ "u ?is subsection4     
7,,ii7 ,requirem5ts ,! crit]ia requir$  
to be publi%$ "u subclause 7,i7 %all    
include ! foll[+3 7aa7 ,accr$itation ,a 
free/&+ bir? c5t] mu/ h a curr5t        
accr$itation cr$5tial f an approv$      
nationally recogniz$ bir? c5t]          
accr$itation body1 z det]m9$ by !       
,secret>y4  7bb7 ,lic5sure & o!r        
requirem5ts ,a free/&+ bir? c5t] %all-- 
7,,aa7 be lic5s$1 or o!rwise approv$1 by

 ! ,/ate to provide pr5atal1 labor &    
deliv]y1 po/p>tum1 newborn c>e1 & o!r   
ambulatory s]vices t are includ$ 9 !    
,/ate ,m$icaid program2 & 7,,bb7 comply 
) su* o!r requirem5ts relat+ to ! heal? 
& safety ( individuals :o receive       
s]vices furni%$ by ! facility z ! ,/ate 
%all e/abli%4  7cc7 ,c>e coord9ation ,a 
free/&+ bir? c5t] %all be able to meet  
c>e coord9ation requirem5ts1 includ+    
requirem5ts to coord9ate c>e across     
sett+s & provid]s to ensure seamless    
transitions = pati5ts across ! full     
spectrum ( heal? s]vices1 & engage 9    
consultation = high] level mat]nity c>e 
s]vices1 non-mat]nity c>e s]vices1 &    
behavioral heal? ne$s1 & :i* may include
 plans = consultation1 collaboration &  
ref]ral1 & arrangem5ts ) ! foll[+3      
7,,aa7 ,f$]ally-qualifi$ heal? c5t]s 7& 
z applicable1 rural heal? cl9ics7 to    
provide ,f$]ally-qualifi$ heal? c5t]    
s]vices 7& z applicable1 rural heal?    
cl9ic s]vices7 to ! ext5t su* s]vices   
are n provid$ directly ?r\gh ! bir?     

c5t]4 7,,bb7 ,o!r outpati5t cl9ics1     
includ+ lic5s$ midwif]y & physician     
practices4 7,,cc7 ,inpati5t acute c>e   
facilities ) ob/etrical c>e units4  7dd7
 ,scope ( ,s]vices ,z det]m9$ by !      
,secret>y1 a free/&+ bir? c5t] mu/ be   
able to provide p]ip>tum c>e = wom5 ) a 
l[-risk pregnancy & = newborns1 consi/5t
 ) evid5ce-bas$ guidel9es4  7ee7        
,capabilities ,a free/&+ bir? c5t] %all 
h ! foll[+3 7,,aa7 ,! capability &      
equipm5t to provide pr5atal1 labor &    
deliv]y1 po/p>tum1 & newborn c>e = wom5 
) a l[-risk pregnancy1 read9ess at all  
times to initiate em]g5cy proc$ures to  
meet unexpect$ ne$s ( su* wom5 & (      
newborns )9 ! c5t]1 includ+ at lea/ #b  
qualifi$ /aff on-site at e bir?1 & !    
ability to facilitate transport to an   
acute c>e hospital ) an ob/etrical c>e  
unit :5 necess>y4 7,,bb7 ,an e/abli%$   
transf] plan ) a receiv+ hospital ) an  
ob/etrical c>e unit ) policies &        
proc$ures = timely transport4 7,,cc7    
,m$ical consultation available f a      

lic5s$ bo>d-c]tifi$ physician ) admitt+ 
privileges 9 ob/etrics at a ne>by       
hospital4 7,,dd7 ,data collection1      
/orage1 & retrieval1 includ+ data on    
intrap>tum & po/p>tum mat]nal & newborn 
transf] rates & hospital admissions4    
7,,ee7 ,! ability to initiate & docum5t 
quality improvem5t programs z requir$ by
 accr$itation t include ef=ts to        
maximize pati5t safety1 su* z safety    
*eckli/s1 validat$ tra9+ & compet5cy (  
/aff1 & em]g5cy prep>$ness & drills4    
,no?+ 9 subitem 7,,aa7 %all be con/ru$ z
 affect+ ! ,/ate plan requirem5t        
specifi$ "u section #dca4ec ( title #db1
 ,code ( ,f$]al ,regulations1 or any    
successor regulation 7relat+ to         
assurance ( transportation74  7ff7      
,heal? c>e provid]s ,a free/&+ bir? c5t]
 mu/ employ or h c>e deliv]y arrangem5ts
 ) bo? ( ! foll[+3 7,,aa7 ,a physician  
or physicians lic5s$ to practice )9 !   
,/ate or jurisdiction ( ! bir? c5t]4    
7,,bb7 ,a midwife or midwives t meet or 
exce$ ! education & tra9+ /&>ds ( !     

,int]national ,conf$]ation ( ,midwives &
 :o are lic5s$ to practice )9 !         
jurisdiction ( ! bir? c5t]4  7gg7       
,non-duplication ,9 c>ry+ out ?is       
subsection1 ! ,secret>y %all1 to !      
greate/ ext5t practicable1 prev5t !     
duplication ( s]vices cov]$ "u ?is      
subsection ) s]vices o!rwise cov]$ "u ! 
,/ate plan "u ?is title & prev5t paym5t 
"u a demon/ration program "u p>agraph   
7#c7 = s]vices = :i* paym5t is o!rwise  
made "u ! ,/ate plan "u ?is title4  7ii7
 ,guidance on developm5t ( prospective  
paym5t sy/em = te/+ "u ,/ate            
demon/ration programs  7,i7 ,9 g5]al ,! 
,secret>y %all issue guidance = ,/ates  
p>ticipat+ 9 a demon/ration program     
conduct$ "u p>agraph 7#c7 to e/abli% a  
prospective paym5t sy/em t %all only    
apply to free/&+ bir? c5t] s]vices t    
meet ! crit]ia e/abli%$ "u clause 7i7   
furni%$ by a free/&+ bir? c5t]          
p>ticipat+ 9 su* demon/ration program4  
7,,ii7 ,requirem5ts ,! guidance issu$ by
 ! ,secret>y "u subclause 7,i7 %all1 to 

! greate/ ext5t practicable1 provide =--
  7aa7 p>tial facility paym5t bas$ on   
units 9 ! case t a pregnant woman is    
admitt$ 9 labor & !n ne$s to be         
transf]r$ to ! hospital 9 labor be=e !  
bir? ( ! baby2  7bb7 facility paym5t =  
obs]vation %ort /ays to rule out labor  
or = !rapeutic re/2  7cc7 ensur+ paym5t 
= ! newborn & "m z two facility paym5t  
compon5ts2  7dd7 ensur+ paym5t = nitr\s 
oxide & hydro!rapy supplies co/s = pa9  
relief2  7ee7 ensur+ paym5t = all       
pr(essional s]vices ( heal? pr(essionals
 involv$ 9 ! deliv]y ( c>e 9 a bir? c5t]
 :i* may include #c or m (fice visits2  
obs]vation & triage2 newborn exam & c>e2
 & multiple po/p>tum1 "m1 & baby visits1
 z ne$$2  7ff7 ensur+ paym5t = p>tial   
pr5atal & po/p>tum c>e episodes or =    
pr5atal c>e only ) plann$ deliv]y 9 !   
hospital & cli5t return+ = po/p>tum c>e 
9 ! bir? c5t]2 &  7gg7 paym5t = s]vices 
provid$ )9-- 7,,aa7 9 ! case ( a        
pregnant woman1 ! p]iod t comm5ces ^u ! 
confirmation ( pregnancy :5 ! woman is  

accept$ into c>e at ! free/&+ bir? c5t]1
 cont9ues ?r\gh pr5atal c>e1 labor &    
deliv]y1 & ends #fj days po/p>tum1      
inclusive ( at lea/ #b po/p>tum c>e     
visits2 & 7,,bb7 9 ! case ( a newborn1 a
 p]iod t cont9ues ?r\gh ! fir/ #bh days 
( life4  7,b7 ,plann+ grants  7i7 ,9    
g5]al ,n lat] ?an #ah mon?s aft] ! date 
( ! enactm5t ( ?is subsection1 !        
,secret>y %all aw>d plann+ grants to    
,/ates = ! purpose ( develop+ proposals 
to conduct a demon/ration program       
describ$ 9 p>agraph 7#c74  7ii7 ,use (  
funds ,a ,/ate aw>d$ a plann+ grant "u  
?is subp>agraph %all use ! funds aw>d$  
"u su* grant to--  7,i7 solicit input ) 
respect to ! developm5t ( ! demon/ration
 program f pati5ts1 provid]s 7includ+   
c]tifi$ nurse-midwives & physicians7 &  
o!r /akehold]s2  7,,ii7 secure          
p>ticipation ( free/&+ bir? c5t]s t meet
 ! crit]ia e/abli%$ "u subp>agraph      
7,a77i71 includ+ by provid+ support =   
su* c5t]s to meet t crit]ia 9 ord] to   
maximize ! numb] ( free/&+ bir? c5t]s   

p>ticipat+ 9 ! demon/ration program2 &  
7,,iii7 9 accordance ) ! guidance issu$ 
"u subp>agraph 7,a77ii71 e/abli% a      
prospective paym5t sy/em :i* ,/ates mu/ 
use = mak+ paym5ts to free/&+ bir? c5t]s
 p>ticipat+ 9 ! demon/ration program4   
7#c7 ,/ate demon/ration programs  7,a7  
,9 g5]al ,n lat] ?an #bd mon?s aft] !   
date ( ! enactm5t ( ?is subsection1 f   
among ! ,/ates aw>d$ a plann+ grant "u  
p>agraph 7#b77;,b71 ! ,secret>y %all    
select n m ?an #f su* ,/ates to conduct 
demon/ration programs t meet !          
requirem5ts ( ?is p>agraph4  7,b7       
,application requirem5ts  7i7 ,9 g5]al  
,! ,secret>y %all solicit applications  
to conduct a demon/ration program "u ?is
 subsection f ,/ates aw>d$ plann+ grants
 "u p>agraph 7#b77;,b74  7ii7 ,requir$  
in=mation ,a ,/ate application to       
conduct a demon/ration program "u ?is   
p>agraph %all include ! foll[+3  7,i7 ,a
 description ( ! t>get ,m$icaid         
population to be s]v$ "u ! demon/ration 
program4  7,,ii7 ,a li/ ( ! p>ticipat+  

free/&+ bir? c5t]s 9 ! ,/ate4  7,,iii7  
,v]ification t ea* p>ticipat+ free/&+   
bir? c5t] meets ! p>ticipation crit]ia  
e/abli%$ 9 p>agraph 7#b77;,a77i74       
7,,iv7 ,a description ( ! scope ( !     
free/&+ bir? c5t] s]vices available "u !
 ,/ate ,m$icaid program = wom5 ) a      
l[-risk pregnancy t w be paid = "u !    
prospective paym5t sy/em te/$ 9 !       
demon/ration program4  7,v7 ,v]ification
 t ! ,/ate has agre$ to pay = su*       
s]vices at ! rate e/abli%$ "u !         
prospective paym5t sy/em4  7,,vi7 ,an   
assurance t ! ,/ate w require free/&+   
bir? c5t]s to submit to ! ,/ate1 & t !  
,/ate w submit to ! ,secret>y1 su*      
in=mation & data z ! ,/ate or ,secret>y 
may require relat+ to ! demon/ration    
program or an episode ( c>e = su* a     
pregnant woman or newborn4  7,,vii7 ,su*
 o!r in=mation z ! ,secret>y may require
 relat+ to ! demon/ration program1      
includ+ ) respect to det]m9+ ! s\ndness 
( ! propos$ prospective paym5t sy/em4   
7,c7 ,l5g? ( demon/ration programs ,a   

,/ate select$ to conduct a demon/ration 
program "u ?is p>agraph %all conduct !  
program = a #d-ye> p]iod4  7,d7         
,requirem5ts = select+ demon/ration     
programs ,9 select+ ,/ates to conduct   
demon/ration programs "u ?is p>agraph1 !
 ,secret>y %all-- 7i7 ensure ,/ates meet
 ! crit]ia describ$ 9 p>agraph          
7#b77;,a77i77,,ii72  7ii7 ensure t !    
,/ates repres5t a div]se selection (    
geographic areas1 includ+ rural &       
und]s]v$ areas2 &  7iii7 give pref]5ce  
to ,/ates t demon/rate ! pot5tial to    
exp& ! availability ( & access to       
mat]nity c>e s]vices 9 a demon/ration   
area & increase ! quality ( s]vices     
provid$ by free/&+ bir? c5t]s )\t       
increas+ net ,f$]al sp5d+4  7,e7 ,paym5t
 = s]vices provid$ by free/&+ bir? c5t]s
  7i7 ,9 g5]al ,am\nts exp5d$ by a ,/ate
 to conduct a demon/ration program "u   
?is p>agraph %all be treat$ z m$ical    
assi/ance = purposes ( subsection 7a7 ( 
?is section4 ,"u a demon/ration program 
conduct$ "u ?is p>agraph by a ,/ate1    

paym5ts %all be made by ! ,/ate =       
free/&+ bir? c5t] s]vices t meet !      
crit]ia e/abli%$ "u p>agraph            
7#b77;,a77i7 furni%$ by a free/&+ bir?  
c5t] 9 accordance ) ! prospective paym5t
 sy/em = su* s]vices e/abli%$ pursuant  
to ! guidance issu$ "u p>agraph         
7#b77;,a77ii74  7ii7 ,limitations       
,paym5ts %all be made "u ?is subp>agraph
 to a ,/ate only = free/&+ bir? c5t]    
s]vices t are--  7,i7 describ$ 9 !      
demon/ration program application        
submitt$ by ! ,/ate & approv$ by !      
,secret>y2 &  7,,ii7 provid$ to an      
individual :o is eligible = m$ical      
assi/ance "u ! ,/ate ,m$icaid program4  
7iii7 ,prohibit$ paym5ts ,unless includ$
 z "p ( a paym5t provid$ "u a           
prospective paym5t sy/em e/abli%$ by a  
,/ate = ! demon/ration program pursuant 
to ! guidance issu$ "u p>agraph         
7#b77;,a7ii71 no paym5t %all be made "u 
?is subp>agraph = inpati5t c>e or o!r   
non-ambulatory s]vices1 z det]m9$ by !  
,secret>y4  7,f7 ,waiv] ( /atewid5ess   

requirem5t ,! ,secret>y %all waive      
section #aijb7;a77#a7 7relat+ to        
/atewid5ess7 z may be necess>y = a ,/ate
 to conduct a demon/ration program 9    
accordance ) ! requirem5ts ( ?is        
p>agraph4  7,g7 ,annual reports  7i7 ,9 
g5]al ,n lat] ?an #b ye>s aft] ! date on
 :i* ! fir/ ,/ate is select$ to conduct 
a demon/ration program "u ?is p>agraph1 
& annually !reaft]1 bas$ on in=mation & 
data submitt$ by ,/ates 9 accordance ) !
 assurance provid$ "u subp>agraph       
7,b77ii77,,vi71 ! ,secret>y %all submit 
to ,congress an annual report on all    
,/ate demon/ration programs conduct$ "u 
?is p>agraph4 ,ea* su* report %all      
include ) respect to ea* su* ,/ate      
demon/ration program--  7,i7 an         
assessm5t ( cl9ical outcomes = mat]nity 
s]vices provid$ by free/&+ bir? c5t]s   
p>ticipat+ 9 ! demon/ration program     
comp>$ to outcomes = l[-risk pregnancy  
,m$icaid pati5ts 9 comp>able demographic
 & geographic areas1 includ+ ) respect  
to ! numb] ( bir?s & data on intrap>tum 

& po/p>tum mat]nal & newborn transf]    
rates & hospital admissions2 &  7,,ii7  
an assessm5t ( ! impact ( all ! ,/ate   
demon/ration programs conduct$ "u ?is   
p>agraph on ! ,f$]al & ,/ate co/s relat+
 to provid+ free/&+ bir? c5t] s]vices = 
wom5 ) a l[-risk pregnancy 7includ+ )   
respect to ! provision ( inpati5t1      
em]g5cy1 & ambulatory s]vices7 & newborn
 c>e1 comp>$ to ! ,f$]al & ,/ate co/s   
relat$ to ! provision ( free/&+ bir?    
c5t] s]vices by free/&+ bir? c5t]s      
outside ( su* demon/ration programs4    
7ii7 ,recomm5dations ,n lat] ?an ! end (
 ! ?ird ye> ( ! demon/ration program    
e/abli%$ "u ?is subsection1 ! ,secret>y 
%all submit to ,congress recomm5dations 
conc]n+ :e!r ! demon/ration programs "u 
?is p>agraph %\ld be cont9u$1 exp&$1    
modifi$1 or t]m9at$4  7#d7 ,fund+  7,a7 
,9 g5]al ,out ( any funds 9 ! ,treasury 
n o!rwise appropriat$1 !re is           
appropriat$ to ! ,secret>y--  7i7 =     
purposes ( c>ry+ out p>agraph 7#b77;,b71
 #b1jjj1jjj2 &  7ii7 = purposes ( c>ry+ 

out ! demon/ration programs "u p>agraph 
7#c71 #be1jjj1jjj4  7,b7 ,availability  
,funds appropriat$ "u subp>agraph 7,a7  
%all rema9 available until exp5d$4  7#e7
 ,def9itions ,9 ?is subsection3  7,a7   
,free/&+ bir? c5t] s]vices ,! t]m       
free/&+ bir? c5t] s]vices has ! mean+   
giv5 t t]m "u section #aije7l77#c77;,a7 
& includes su* o!r s]vices z ! ,secret>y
 %all det]m9e = purposes ( !            
demon/ration programs conduct$ "u       
p>agraph 7#c74  7,b7 ,l[-risk pregnancy 
,! t]m l[-risk pregnancy means an       
uncomplicat$ s+leton t]m pregnancy ) a  
v]tex pres5tation ) an expect$          
uncomplicat$ bir?4  4