,,ii #aafth ,,congress #b;d ,session ,s4 #dhfc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,october #bf 7legislative day1 ,october #ai71 #bjbj,mr4 ,portman 7for himself and ,ms4 ,stabenow7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to provide ,states with the option to provide coordinated care through a pregnancy medical home for high-risk pregnant women1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,harnessing ,effective and ,appropriate ,long ,term ,health for ,moms ,on ,medicaid ,act of #bjbj or the ,,health for ,,mom ,act of #bjbj4 #b4 ,state option to provide coordinated care through a pregnancy medical home for high-risk pregnant women ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by inserting after section #aide;,a the following new section3 #aide;,b4 ,state option to provide coordinated care through a pregnancy medical home for high-risk pregnant women 7a7 ,in general ,notwithstanding section #aijb7;a77#a7 7relating to statewideness7 and section #aijb7;a77#aj77;,b7 7relating to comparability71 beginning ,october #a1 #bjbb1 a ,state1 at its option as a ,state plan amendment1 may provide for medical assistance under this title to high-risk pregnant women who choose to-- 7#a7 enroll in a pregnancy medical home under this section by selecting a designated provider1 a team of health care professionals operating with such a provider1 or a health team as the woman's pregnancy medical home for purposes of providing the woman with high-risk pregnancy coordinated care services2 or 7#b7 receive such services from a designated provider1 a team of health care professionals operating with such a provider1 or a health team that has opted to participate in a pregnancy medical home for high-risk pregnant women4 7b7 ,qualification standards ,the ,secretary shall establish standards for qualification as a pregnancy medical home or as a designated provider1 team of health care professionals operating with such a provider1 or a health team eligible for participation in a pregnancy medical home for purposes of this section4 ,such standards shall include requiring designated providers1 teams of health care professionals operating with such providers1 and health teams 7designated a pregnancy medical home7 to demonstrate to the ,state the ability to do the following3 7#a7 ,coordinate prompt care for high-risk pregnant women4 7#b7 ,develop an individualized1 comprehensive1 patient-centered care plan for high-risk pregnant women that accommodates patient preferences4 7#c7 ,work in a culturally and linguistically appropriate manner with the high-risk pregnant woman to develop and incorporate into the woman's care plan1 in a manner consistent with the needs of the woman1 ongoing home care1 community-based primary care1 inpatient care1 social support services1 and local hospital emergency care4 7#d7 ,coordinate access to necessary maternity care services and programs for high-risk pregnant women4 7#e7 ,collect and report information under subsection 7f77#a74 7c7 ,payments 7#a7 ,in general ,a ,state shall provide a designated provider1 a team of health care professionals operating with such a provider1 or a health team with payments for the provision of high-risk pregnancy and postpartum coordinated care services1 to each high-risk pregnant woman that selects such provider1 team of health care professionals1 or health team as the woman's pregnancy medical home or care provider4 ,payments made to a pregnancy medical home or care provider for such services shall be treated as medical assistance for purposes of section #aijc7;a71 except that1 during the first #b fiscal year quarters that the ,state plan amendment is in effect1 the ,federal medical assistance percentage applicable to such payments shall be increased by #ae percentage points1 but in no case may exceed #ij percent4 7#b7 ,methodology 7,a7 ,in general ,the ,state shall specify in the ,state plan amendment the methodology the ,state will use for determining payment for the provision of high-risk pregnancy coordinated care services or treatment during a high-risk pregnancy4 ,such methodology for determining payment-- 7i7 may be based on-- 7,i7 a per-member per-month basis for each high-risk pregnant woman enrolled in the pregnancy medical home2 or 7,,ii7 an alternate model of payment proposed by the ,state and approved by the ,secretary2 7ii7 may be tiered to reflect1 with respect to each high-risk pregnant woman-- 7,i7 the severity of the risks associated with the woman's pregnancy2 and 7,,ii7 the level or amount of time of care coordination required with respect to the woman2 and 7iii7 shall be established consistent with section #aijb7;a77#cj77;,a74 7,b7 ,distribution of financing ,for purposes of a methodology under this section1 the methodology shall identify how any reimbursement or payment as made available under this section to a pregnancy medical home will be equitably shared among respective1 contributing members of the pregnancy medical home or the designated provider1 team of health care professionals with such a provider1 or health team4 7d7 ,coordinating care 7#a7 ,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 7or a waiver of such plan7 to establish procedures in the case of a high-risk pregnant woman that seeks treatment in the emergency department of such hospital for-- 7,a7 providing the woman with information1 including following discharge1 about pregnancy medical homes and opportunities for the woman to access the pregnancy medical home and its associated benefits2 and 7,b7 notifying the pregnancy medical home in which the woman is enrolled1 or the designated provider1 team of health care professionals operating with such a provider1 or health team treating the woman1 of the woman's treatment in the emergency department and of the protocols for the pregnancy medical home1 designated provider1 or team to be involved in the woman's emergency care or post-discharge care4 7#b7 ,education with respect to availability of a pregnancy medical home 7,a7 ,in general ,in order for a ,state plan amendment to be approved under this section1 a ,state shall include in the ,state plan amendment a description of the ,state's process for-- 7i7 educating providers participating in the ,state plan 7or a waiver of such plan7 on the availability of pregnancy medical homes for high-risk pregnant women1 including the process by which such providers can participate in or refer high-risk pregnant women to an approved pregnancy medical home or a designated provider1 team of health care professionals operating such a provider1 or health team2 and 7ii7 educating high-risk pregnant women on the availability of pregnancy medical homes4 7,b7 ,outreach ,the process established by the ,state under subparagraph 7,a7 shall include the participation of entities or other public or private organizations or entities that provide outreach and information on the availability of health care items and services to families of individuals eligible to receive medical assistance under the ,state plan 7or a waiver of such plan74 7#c7 ,mental health coordination ,a ,state with a ,state plan amendment approved under this section shall consult and coordinate1 as appropriate1 with the ,secretary in addressing issues regarding the prevention and treatment of mental health conditions and substance use disorder among high-risk pregnant women4 7#d7 ,social and support services ,a ,state with a ,state plan amendment approved under this section shall consult and coordinate1 as appropriate1 with the ,secretary in establishing means to connect high-risk pregnant women receiving high-risk pregnancy coordinated care services under this section with social and support services1 including services made available under maternal1 infant1 and early childhood home visiting programs established under section #eaa1 and services made available under section #ccj ,h or title ,x of the ,public ,health ,service ,act4 7e7 ,monitoring ,a ,state shall include in the ,state plan amendment-- 7#a7 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 section2 7#b7 a proposal for use of health information technology in providing a pregnancy medical home under this section and improving service delivery and coordination across the care continuum2 and 7#c7 a methodology for tracking prompt and timely access to medically necessary care for high-risk pregnant women from out-of-,state providers4 7f7 ,data collection 7#a7 ,provider reporting requirements ,in order to receive payments from a ,state under subsection 7c71 a pregnancy medical home1 or a designated provider1 a team of health care professionals operating with such a provider1 or a health team1 shall report to the ,state1 at such time and in such form and manner as may be required by the ,state or the ,secretary1 the following information3 7,a7 ,with respect to each such designated provider1 team of health care professionals operating with such a provider1 and health team 7designated as a pregnancy medical home71 the name1 ,national ,provider ,identification number1 address1 and specific health care services offered to be provided to high-risk pregnant women who have selected such provider1 team of health care professionals1 or health team as the women's pregnancy medical home4 7,b7 ,information on all applicable measures for determining the quality of services provided by such provider1 team of health care professionals1 or health team1 including1 to the extent applicable1 maternal health quality measures and measures for centers of excellence for high-risk pregnant women developed under this title4 7,c7 ,such other information as the ,secretary shall specify in guidance4 7#b7 ,state reporting requirements 7,a7 ,comprehensive report ,a ,state with a ,state plan amendment approved under this section shall report to the ,secretary 7and1 upon request1 to the ,medicaid and ,,chip ,payment and ,access ,commission71 at such time1 but at a minimum frequency of every #ab months1 and in such form and manner determined by the ,secretary to be reasonable and minimally burdensome1 the following information3 7i7 ,information described in paragraph 7#a74 7ii7 ,the number of high-risk pregnant women who have enrolled in a pregnancy medical home pursuant to this section4 7iii7 ,the nature1 number1 and prevalence of causes for identified high-risk pregnancies among such women4 7iv7 ,the type of delivery systems and payment models used to provide services to such women under this section4 7v7 ,the number and characteristics of the designated providers1 teams of health care professionals operating with such providers1 and health teams participating in the option established under this section1 including the number and characteristics of out-of-,state providers1 teams of health care professionals operating with such providers1 and health teams who have provided health care items and services to high-risk pregnant women enrolled in a pregnancy medical home pursuant to this section4 7vi7 ,the extent to which such women receive health care items and services under the ,state plan before1 during1 and after the women's enrollment in such a pregnancy medical home4 7vii7 ,quality measures developed specifically with respect to health care items and services provided to high-risk pregnant women4 7viii7 ,where applicable1 mortality data and data for the associated causes of death for high-risk pregnant women enrolled in a pregnancy medical home1 in accordance with subsection 7g74 ,such data shall include deaths that occur while enrolled in a pregnancy medical home and for deaths that occur after the conclusion of participation in a pregnancy medical home but occur up to one year postpartum4 ,for deaths occurring postpartum1 such data shall distinguish between deaths occurring up to #db days postpartum and deaths occurring between #dc days to up to #a year postpartum4 ,where applicable1 data reported under this clause shall be reported alongside comparable data from a ,state's maternal mortality review committee1 as established in accordance with section #cag,k7d7 of the ,public ,health ,service ,act1 for purposes of further identifying and comparing statewide trends in maternal mortality among populations participating in the pregnancy medical home under this section4 7,b7 ,implementation report ,not later than #ah months after a ,state has a ,state plan amendment approved under this section1 the ,state shall submit to the ,secretary1 and make publicly available on the appropriate ,state website1 a report on how the ,state is implementing the option established under this section1 including through any best practices adopted by the ,state4 7g7 ,confidentiality ,a ,state with a ,state plan amendment under this section shall establish confidentiality protections for the purposes of subsection 7f77#b77;,a77viii7 to ensure1 at a minimum1 that there is no disclosure by the ,state of any identifying information about any specific maternal mortality case4 7h7 ,rule of construction ,nothing in this section shall be construed to require-- 7#a7 a high-risk pregnant woman to enroll in a pregnancy medical home under this section2 or 7#b7 a designated provider or health team to act as a pregnancy medical home and provide services in accordance with this section if the provider or health team does not voluntarily agree to act as a pregnancy medical home4 7i7 ,planning grants 7#a7 ,in general ,beginning ,january #a1 #bjba1 the ,secretary may award planning grants to ,states for purposes of developing a payment model for a ,state plan amendment under this section4 ,a planning grant awarded to a ,state under this paragraph shall remain available until expended4 7#b7 ,state contribution ,a ,state awarded a planning grant shall contribute an amount equal to the ,state percentage applicable to the ,state under section #aije7;b7 for each fiscal year for which the grant is awarded4 7#c7 ,limitation ,the total amount of payments made to ,states under this subsection shall not exceed #e1jjj1jjj4 7j7 ,definitions ,in this section3 7#a7 ,designated provider ,the term designated provider means a physician 7including an obstetrician-gynecologist71 hospital1 clinical practice or clinical group practice1 prepaid inpatient health plan or prepaid ambulatory health plan 7as defined by the ,secretary71 rural clinic1 community health center1 community mental health center1 home health agency1 or any other entity or provider that is determined by the ,state and approved by the ,secretary to be qualified to be a pregnancy medical home on the basis of documentation evidencing that the entity has the systems1 expertise1 and infrastructure in place to provide high-risk pregnancy coordinated care services4 ,such term may include providers who are employed by1 or affiliated with1 a hospital4 7#b7 ,pregnancy medical home ,the term pregnancy medical home means a designated provider 7including a provider that operates in coordination with a team of health care professionals7 or a health team that is selected by a high-risk pregnant woman to provide high-risk pregnancy and postpartum coordinated care services4 7#c7 ,health team ,the term health team has the meaning given such term for purposes of section #cejb of ,public ,law #aaa-adh4 7#d7 ,high-risk pregnancy coordinated care services 7,a7 ,in general ,the term high-risk pregnancy coordinated care services means comprehensive and timely high-quality services described in subparagraph 7,b7 that are provided by a designated provider1 a team of health care professionals operating with such a provider1 or a health team 7designated as a pregnancy medical home74 7,b7 ,services described ,the services described in this subparagraph shall include-- 7i7 with respect to a ,state electing to the ,state plan amendment option under this section1 any medical assistance for which payment is available under the ,state plan or under a waiver of such plan2 7ii7 any item or service related to the treatment of a high-risk pregnant woman2 7iii7 comprehensive care management2 7iv7 care coordination1 health promotion1 and providing access to the full range of maternal1 obstetric and gynecologic services1 including services from out-of-,state providers2 7v7 comprehensive transitional care1 including appropriate follow-up1 from inpatient to other settings2 7vi7 patient and family support 7including authorized representatives72 7vii7 referrals to community and social support services1 if relevant2 and 7viii7 use of health information technology to link services1 as feasible and appropriate4 7#e7 ,high-risk pregnant woman 7,a7 ,in general ,the term high-risk pregnant woman means an individual who-- 7i7 is eligible for medical assistance under the ,state plan 7or under a waiver of such plan72 7ii7 is pregnant2 and 7iii7 meets the definition of a high-risk pregnancy under section #aii4b of title #cb1 ,code of ,federal ,regulations 7or any successor regulation74 7,b7 ,continuation of eligibility ,an individual described in subparagraph 7,a7 shall be deemed to be described in such subparagraph through the earlier of-- 7i7 the end of the month in which the individual's eligibility for medical assistance under the ,state plan 7or waiver7 ends2 and 7ii7 the last day of the #a-year period that begins on the last day of the individual's pregnancy4 7#f7 ,team of health care professionals ,the term team of health care professionals means a team of health care professionals 7as described in the ,state plan amendment under this section7 that may-- 7,a7 include-- 7i7 physicians and other professionals1 such as gynecologist-obstetrician1 nurses1 nurse care coordinators1 dietitians1 nutritionists1 social workers1 behavioral health professionals1 physical therapists1 occupational therapists1 or any professionals that assist in prenatal care1 delivery1 or post-partum care determined to be appropriate by the ,state and approved by the ,secretary2 7ii7 an entity or individual who is designated to coordinate such a team2 and 7iii7 community health workers1 interpreters1 and other individuals with culturally appropriate expertise2 and 7,b7 provide care at a facility that is freestanding1 virtual1 or based at a hospital1 community health center1 community mental health center1 rural clinic1 clinical practice or clinical group practice1 academic health center1 or any entity determined to be appropriate by the ,state and approved by the ,secretary4 4