,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #dhfc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,octob] #bf            
7legislative day1 ,octob] #ai71         
#bjbj,mr4 ,portman 7= himself & ,ms4    
,/ab5[7 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to provide  
,/ates ) ! option to provide coord9at$  
c>e ?r\gh a pregnancy m$ical home =     
high-risk pregnant wom51 & = o!r        
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,h>ness+ ,effective &      
,appropriate ,long ,t]m ,heal? = ,moms  
,on ,m$icaid ,act ( #bjbj or ! ,,heal? =
 ,,mom ,act ( #bjbj4  #b4 ,/ate option  
to provide coord9at$ c>e ?r\gh a        
pregnancy m$ical home = high-risk       
pregnant wom5 ,title ,,xix ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is am5d$ by ins]t+ aft] section   
#aide;,a ! foll[+ new section3          
#aide;,b4 ,/ate option to provide       
coord9at$ c>e ?r\gh a pregnancy m$ical  

home = high-risk pregnant wom5  7a7 ,9  
g5]al ,not)/&+ section #aijb7;a77#a7    
7relat+ to /atewid5ess7 & section       
#aijb7;a77#aj77;,b7 7relat+ to          
comp>ability71 beg9n+ ,octob] #a1 #bjbb1
 a ,/ate1 at its option z a ,/ate plan  
am5dm5t1 may provide = m$ical assi/ance 
"u ?is title to high-risk pregnant wom5 
:o *oose to-- 7#a7 enroll 9 a pregnancy 
m$ical home "u ?is section by select+ a 
designat$ provid]1 a team ( heal? c>e   
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team z ! woman's pregnancy      
m$ical home = purposes ( provid+ ! woman
 ) high-risk pregnancy coord9at$ c>e    
s]vices2 or  7#b7 receive su* s]vices f 
a designat$ provid]1 a team ( heal? c>e 
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team t has opt$ to p>ticipate 9 
a pregnancy m$ical home = high-risk     
pregnant wom54  7b7 ,qualification /&>ds
 ,! ,secret>y %all e/abli% /&>ds =      
qualification z a pregnancy m$ical home 
or z a designat$ provid]1 team ( heal?  
c>e pr(essionals op]at+ ) su* a provid]1

 or a heal? team eligible = p>ticipation
 9 a pregnancy m$ical home = purposes ( 
?is section4 ,su* /&>ds %all include    
requir+ designat$ provid]s1 teams (     
heal? c>e pr(essionals op]at+ ) su*     
provid]s1 & heal? teams 7designat$ a    
pregnancy m$ical home7 to demon/rate to 
! ,/ate ! ability to d ! foll[+3 7#a7   
,coord9ate prompt c>e = high-risk       
pregnant wom54  7#b7 ,develop an        
individualiz$1 compreh5sive1            
pati5t-c5t]$ c>e plan = high-risk       
pregnant wom5 t accommodates pati5t     
pref]5ces4  7#c7 ,"w 9 a culturally &   
l+ui/ically appropriate mann] ) !       
high-risk pregnant woman to develop &   
incorporate into ! woman's c>e plan1 9 a
 mann] consi/5t ) ! ne$s ( ! woman1     
ongo+ home c>e1 community-bas$ prim>y   
c>e1 inpati5t c>e1 social support       
s]vices1 & local hospital em]g5cy c>e4  
7#d7 ,coord9ate access to necess>y      
mat]nity c>e s]vices & programs =       
high-risk pregnant wom54  7#e7 ,collect 
& report in=mation "u subsection        

7f77#a74  7c7 ,paym5ts  7#a7 ,9 g5]al ,a
 ,/ate %all provide a designat$ provid]1
 a team ( heal? c>e pr(essionals op]at+ 
) su* a provid]1 or a heal? team )      
paym5ts = ! provision ( high-risk       
pregnancy & po/p>tum coord9at$ c>e      
s]vices1 to ea* high-risk pregnant woman
 t selects su* provid]1 team ( heal? c>e
 pr(essionals1 or heal? team z ! woman's
 pregnancy m$ical home or c>e provid]4  
,paym5ts made to a pregnancy m$ical home
 or c>e provid] = su* s]vices %all be   
treat$ z m$ical assi/ance = purposes (  
section #aijc7;a71 except t1 dur+ ! fir/
 #b fiscal ye> qu>t]s t ! ,/ate plan    
am5dm5t is 9 effect1 ! ,f$]al m$ical    
assi/ance p]c5tage applicable to su*    
paym5ts %all be increas$ by #ae p]c5tage
 po9ts1 b 9 no case may exce$ #ij p]c5t4
  7#b7 ,me?odology  7,a7 ,9 g5]al ,!    
,/ate %all specify 9 ! ,/ate plan       
am5dm5t ! me?odology ! ,/ate w use =    
det]m9+ paym5t = ! provision ( high-risk
 pregnancy coord9at$ c>e s]vices or     
treatm5t dur+ a high-risk pregnancy4    

,su* me?odology = det]m9+ paym5t-- 7i7  
may be bas$ on-- 7,i7 a p]-memb] p]-mon?
 basis = ea* high-risk pregnant woman   
enroll$ 9 ! pregnancy m$ical home2 or   
7,,ii7 an alt]nate model ( paym5t       
propos$ by ! ,/ate & approv$ by !       
,secret>y2  7ii7 may be ti]$ to reflect1
 ) respect to ea* high-risk pregnant    
woman-- 7,i7 ! sev]ity ( ! risks        
associat$ ) ! woman's pregnancy2 &      
7,,ii7 ! level or am\nt ( "t ( c>e      
coord9ation requir$ ) respect to !      
woman2 &  7iii7 %all be e/abli%$        
consi/5t ) section #aijb7;a77#cj77;,a74 
7,b7 ,di/ribution ( f9anc+ ,= purposes (
 a me?odology "u ?is section1 !         
me?odology %all id5tify h[ any          
reimbursem5t or paym5t z made available 
"u ?is section to a pregnancy m$ical    
home w be equitably %>$ among           
respective1 contribut+ memb]s ( !       
pregnancy m$ical home or ! designat$    
provid]1 team ( heal? c>e pr(essionals )
 su* a provid]1 or heal? team4  7d7     
,coord9at+ c>e  7#a7 ,hospital          

notification ,a ,/ate ) a ,/ate plan    
am5dm5t approv$ "u ?is section %all     
require ea* hospital t is a p>ticipat+  
provid] "u ! ,/ate plan 7or a waiv] (   
su* plan7 to e/abli% proc$ures 9 ! case 
( a high-risk pregnant woman t seeks    
treatm5t 9 ! em]g5cy dep>tm5t ( su*     
hospital =-- 7,a7 provid+ ! woman )     
in=mation1 includ+ foll[+ dis*>ge1 ab\t 
pregnancy m$ical homes & opportunities =
 ! woman to access ! pregnancy m$ical   
home & its associat$ b5efits2 &  7,b7   
notify+ ! pregnancy m$ical home 9 :i* ! 
woman is enroll$1 or ! designat$        
provid]1 team ( heal? c>e pr(essionals  
op]at+ ) su* a provid]1 or heal? team   
treat+ ! woman1 ( ! woman's treatm5t 9 !
 em]g5cy dep>tm5t & ( ! protocols = !   
pregnancy m$ical home1 designat$        
provid]1 or team to be involv$ 9 !      
woman's em]g5cy c>e or po/-dis*>ge c>e4 
7#b7 ,education ) respect to            
availability ( a pregnancy m$ical home  
7,a7 ,9 g5]al ,9 ord] = a ,/ate plan    
am5dm5t to be approv$ "u ?is section1 a 

,/ate %all include 9 ! ,/ate plan       
am5dm5t a description ( ! ,/ate's       
process =-- 7i7 educat+ provid]s        
p>ticipat+ 9 ! ,/ate plan 7or a waiv] ( 
su* plan7 on ! availability ( pregnancy 
m$ical homes = high-risk pregnant wom51 
includ+ ! process by :i* su* provid]s c 
p>ticipate 9 or ref] high-risk pregnant 
wom5 to an approv$ pregnancy m$ical home
 or a designat$ provid]1 team ( heal?   
c>e pr(essionals op]at+ su* a provid]1  
or heal? team2 &  7ii7 educat+ high-risk
 pregnant wom5 on ! availability (      
pregnancy m$ical homes4  7,b7 ,outrea*  
,! process e/abli%$ by ! ,/ate "u       
subp>agraph 7,a7 %all include !         
p>ticipation ( entities or o!r public or
 private organizations or entities t    
provide outrea* & in=mation on !        
availability ( heal? c>e items & s]vices
 to families ( individuals eligible to  
receive m$ical assi/ance "u ! ,/ate plan
 7or a waiv] ( su* plan74  7#c7 ,m5tal  
heal? coord9ation ,a ,/ate ) a ,/ate    
plan am5dm5t approv$ "u ?is section %all

 consult & coord9ate1 z appropriate1 ) !
 ,secret>y 9 address+ issues reg>d+ !   
prev5tion & treatm5t ( m5tal heal?      
conditions & sub/ance use disord] among 
high-risk pregnant wom54  7#d7 ,social &
 support s]vices ,a ,/ate ) a ,/ate plan
 am5dm5t approv$ "u ?is section %all    
consult & coord9ate1 z appropriate1 ) ! 
,secret>y 9 e/abli%+ means to connect   
high-risk pregnant wom5 receiv+         
high-risk pregnancy coord9at$ c>e       
s]vices "u ?is section ) social &       
support s]vices1 includ+ s]vices made   
available "u mat]nal1 infant1 & e>ly    
*ildhood home visit+ programs e/abli%$  
"u section #eaa1 & s]vices made         
available "u section #ccj ,h or title ,x
 ( ! ,public ,heal? ,s]vice ,act4  7e7  
,monitor+ ,a ,/ate %all include 9 !     
,/ate plan am5dm5t-- 7#a7 a me?odology =
 track+ r$uctions 9 inpati5t days &     
r$uctions 9 ! total co/ ( c>e result+ f 
improv$ c>e coord9ation & managem5t "u  
?is section2  7#b7 a proposal = use (   
heal? in=mation te*nology 9 provid+ a   

pregnancy m$ical home "u ?is section &  
improv+ s]vice deliv]y & coord9ation    
across ! c>e cont9uum2 &  7#c7 a        
me?odology = track+ prompt & timely     
access to m$ically necess>y c>e =       
high-risk pregnant wom5 f out-(-,/ate   
provid]s4  7f7 ,data collection  7#a7   
,provid] report+ requirem5ts ,9 ord] to 
receive paym5ts f a ,/ate "u subsection 
7c71 a pregnancy m$ical home1 or a      
designat$ provid]1 a team ( heal? c>e   
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team1 %all report to ! ,/ate1 at
 su* "t & 9 su* =m & mann] z may be     
requir$ by ! ,/ate or ! ,secret>y1 !    
foll[+ in=mation3 7,a7 ,) respect to ea*
 su* designat$ provid]1 team ( heal? c>e
 pr(essionals op]at+ ) su* a provid]1 & 
heal? team 7designat$ z a pregnancy     
m$ical home71 ! "n1 ,national ,provid]  
,id5tification numb]1 address1 &        
specific heal? c>e s]vices (f]$ to be   
provid$ to high-risk pregnant wom5 :o h 
select$ su* provid]1 team ( heal? c>e   
pr(essionals1 or heal? team z ! wom5's  

pregnancy m$ical home4  7,b7 ,in=mation 
on all applicable measures = det]m9+ !  
quality ( s]vices provid$ by su*        
provid]1 team ( heal? c>e pr(essionals1 
or heal? team1 includ+1 to ! ext5t      
applicable1 mat]nal heal? quality       
measures & measures = c5t]s ( excell5ce 
= high-risk pregnant wom5 develop$ "u   
?is title4  7,c7 ,su* o!r in=mation z ! 
,secret>y %all specify 9 guidance4  7#b7
 ,/ate report+ requirem5ts  7,a7        
,compreh5sive report ,a ,/ate ) a ,/ate 
plan am5dm5t approv$ "u ?is section %all
 report to ! ,secret>y 7&1 ^u reque/1 to
 ! ,m$icaid & ,,*ip ,paym5t & ,access   
,commission71 at su* "t1 b at a m9imum  
frequ5cy ( e #ab mon?s1 & 9 su* =m &    
mann] det]m9$ by ! ,secret>y to be      
reasonable & m9imally burd5some1 !      
foll[+ in=mation3 7i7 ,in=mation        
describ$ 9 p>agraph 7#a74  7ii7 ,! numb]
 ( high-risk pregnant wom5 :o h enroll$ 
9 a pregnancy m$ical home pursuant to   
?is section4  7iii7 ,! nature1 numb]1 & 
preval5ce ( causes = id5tifi$ high-risk 

pregnancies among su* wom54  7iv7 ,!    
type ( deliv]y sy/ems & paym5t models   
us$ to provide s]vices to su* wom5 "u   
?is section4  7v7 ,! numb] & *>act]i/ics
 ( ! designat$ provid]s1 teams ( heal?  
c>e pr(essionals op]at+ ) su* provid]s1 
& heal? teams p>ticipat+ 9 ! option     
e/abli%$ "u ?is section1 includ+ ! numb]
 & *>act]i/ics ( out-(-,/ate provid]s1  
teams ( heal? c>e pr(essionals op]at+ ) 
su* provid]s1 & heal? teams :o h provid$
 heal? c>e items & s]vices to high-risk 
pregnant wom5 enroll$ 9 a pregnancy     
m$ical home pursuant to ?is section4    
7vi7 ,! ext5t to :i* su* wom5 receive   
heal? c>e items & s]vices "u ! ,/ate    
plan be=e1 dur+1 & aft] ! wom5's        
enrollm5t 9 su* a pregnancy m$ical home4
  7vii7 ,quality measures develop$      
specifically ) respect to heal? c>e     
items & s]vices provid$ to high-risk    
pregnant wom54  7viii7 ,:]e applicable1 
mortality data & data = ! associat$     
causes ( dea? = high-risk pregnant wom5 
enroll$ 9 a pregnancy m$ical home1 9    

accordance ) subsection 7g74 ,su* data  
%all include dea?s t occur :ile enroll$ 
9 a pregnancy m$ical home & = dea?s t   
occur aft] ! conclusion ( p>ticipation 9
 a pregnancy m$ical home b occur up to  
"o ye> po/p>tum4 ,= dea?s occurr+       
po/p>tum1 su* data %all di/+ui% betwe5  
dea?s occurr+ up to #db days po/p>tum & 
dea?s occurr+ betwe5 #dc days to up to  
#a ye> po/p>tum4 ,:]e applicable1 data  
report$ "u ?is clause %all be report$   
alongside comp>able data f a ,/ate's    
mat]nal mortality review committee1 z   
e/abli%$ 9 accordance ) section         
#cag,k7d7 ( ! ,public ,heal? ,s]vice    
,act1 = purposes ( fur!r id5tify+ &     
comp>+ /atewide tr5ds 9 mat]nal         
mortality among populations p>ticipat+ 9
 ! pregnancy m$ical home "u ?is section4
  7,b7 ,implem5tation report ,n lat] ?an
 #ah mon?s aft] a ,/ate has a ,/ate plan
 am5dm5t approv$ "u ?is section1 ! ,/ate
 %all submit to ! ,secret>y1 & make     
publicly available on ! appropriate     
,/ate website1 a report on h[ ! ,/ate is

 implem5t+ ! option e/abli%$ "u ?is     
section1 includ+ ?r\gh any be/ practices
 adopt$ by ! ,/ate4  7g7 ,confid5tiality
 ,a ,/ate ) a ,/ate plan am5dm5t "u ?is 
section %all e/abli% confid5tiality     
protections = ! purposes ( subsection   
7f77#b77;,a77viii7 to ensure1 at a      
m9imum1 t !re is no disclosure by !     
,/ate ( any id5tify+ in=mation ab\t any 
specific mat]nal mortality case4  7h7   
,rule ( con/ruction ,no?+ 9 ?is section 
%all be con/ru$ to require-- 7#a7 a     
high-risk pregnant woman to enroll 9 a  
pregnancy m$ical home "u ?is section2 or
  7#b7 a designat$ provid] or heal? team
 to act z a pregnancy m$ical home &     
provide s]vices 9 accordance ) ?is      
section if ! provid] or heal? team does 
n volunt>ily agree to act z a pregnancy 
m$ical home4  7i7 ,plann+ grants  7#a7  
,9 g5]al ,beg9n+ ,janu>y #a1 #bjba1 !   
,secret>y may aw>d plann+ grants to     
,/ates = purposes ( develop+ a paym5t   
model = a ,/ate plan am5dm5t "u ?is     
section4 ,a plann+ grant aw>d$ to a     

,/ate "u ?is p>agraph %all rema9        
available until exp5d$4  7#b7 ,/ate     
contribution ,a ,/ate aw>d$ a plann+    
grant %all contribute an am\nt equal to 
! ,/ate p]c5tage applicable to ! ,/ate  
"u section #aije7;b7 = ea* fiscal ye> = 
:i* ! grant is aw>d$4  7#c7 ,limitation 
,! total am\nt ( paym5ts made to ,/ates 
"u ?is subsection %all n exce$          
#e1jjj1jjj4  7j7 ,def9itions ,9 ?is     
section3 7#a7 ,designat$ provid] ,! t]m 
designat$ provid] means a physician     
7includ+ an ob/etrician-gynecologi/71   
hospital1 cl9ical practice or cl9ical   
gr\p practice1 prepaid inpati5t heal?   
plan or prepaid ambulatory heal? plan 7z
 def9$ by ! ,secret>y71 rural cl9ic1    
community heal? c5t]1 community m5tal   
heal? c5t]1 home heal? ag5cy1 or any o!r
 entity or provid] t is det]m9$ by !    
,/ate & approv$ by ! ,secret>y to be    
qualifi$ to be a pregnancy m$ical home  
on ! basis ( docum5tation evid5c+ t !   
entity has ! sy/ems1 exp]tise1 &        
infra/ructure 9 place to provide        

high-risk pregnancy coord9at$ c>e       
s]vices4 ,su* t]m may include provid]s  
:o are employ$ by1 or affiliat$ )1 a    
hospital4  7#b7 ,pregnancy m$ical home  
,! t]m pregnancy m$ical home means a    
designat$ provid] 7includ+ a provid] t  
op]ates 9 coord9ation ) a team ( heal?  
c>e pr(essionals7 or a heal? team t is  
select$ by a high-risk pregnant woman to
 provide high-risk pregnancy & po/p>tum 
coord9at$ c>e s]vices4  7#c7 ,heal? team
 ,! t]m heal? team has ! mean+ giv5 su* 
t]m = purposes ( section #cejb ( ,public
 ,law #aaa-adh4  7#d7 ,high-risk        
pregnancy coord9at$ c>e s]vices  7,a7 ,9
 g5]al ,! t]m high-risk pregnancy       
coord9at$ c>e s]vices means compreh5sive
 & timely high-quality s]vices describ$ 
9 subp>agraph 7,b7 t are provid$ by a   
designat$ provid]1 a team ( heal? c>e   
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team 7designat$ z a pregnancy   
m$ical home74  7,b7 ,s]vices describ$ ,!
 s]vices describ$ 9 ?is subp>agraph %all
 include-- 7i7 ) respect to a ,/ate     

elect+ to ! ,/ate plan am5dm5t option "u
 ?is section1 any m$ical assi/ance = :i*
 paym5t is available "u ! ,/ate plan or 
"u a waiv] ( su* plan2  7ii7 any item or
 s]vice relat$ to ! treatm5t ( a        
high-risk pregnant woman2  7iii7        
compreh5sive c>e managem5t2  7iv7 c>e   
coord9ation1 heal? promotion1 & provid+ 
access to ! full range ( mat]nal1       
ob/etric & gynecologic s]vices1 includ+ 
s]vices f out-(-,/ate provid]s2  7v7    
compreh5sive transitional c>e1 includ+  
appropriate foll[-up1 f inpati5t to o!r 
sett+s2  7vi7 pati5t & family support   
7includ+ au?oriz$ repres5tatives72      
7vii7 ref]rals to community & social    
support s]vices1 if relevant2 &  7viii7 
use ( heal? in=mation te*nology to l9k  
s]vices1 z feasible & appropriate4  7#e7
 ,high-risk pregnant woman  7,a7 ,9     
g5]al ,! t]m high-risk pregnant woman   
means an individual :o-- 7i7 is eligible
 = m$ical assi/ance "u ! ,/ate plan 7or 
"u a waiv] ( su* plan72  7ii7 is        
pregnant2 &  7iii7 meets ! def9ition ( a

 high-risk pregnancy "u section #aii4b (
 title #cb1 ,code ( ,f$]al ,regulations 
7or any successor regulation74  7,b7    
,cont9uation ( eligibility ,an          
individual describ$ 9 subp>agraph 7,a7  
%all be deem$ to be describ$ 9 su*      
subp>agraph ?r\gh ! e>li] (-- 7i7 ! end 
( ! mon? 9 :i* ! individual's           
eligibility = m$ical assi/ance "u !     
,/ate plan 7or waiv]7 ends2 &  7ii7 !   
la/ day ( ! #a-ye> p]iod t beg9s on !   
la/ day ( ! individual's pregnancy4     
7#f7 ,team ( heal? c>e pr(essionals ,!  
t]m team ( heal? c>e pr(essionals means 
a team ( heal? c>e pr(essionals 7z      
describ$ 9 ! ,/ate plan am5dm5t "u ?is  
section7 t may-- 7,a7 include-- 7i7     
physicians & o!r pr(essionals1 su* z    
gynecologi/-ob/etrician1 nurses1 nurse  
c>e coord9ators1 dietitians1            
nutritioni/s1 social work]s1 behavioral 
heal? pr(essionals1 physical !rapi/s1   
occupational !rapi/s1 or any            
pr(essionals t assi/ 9 pr5atal c>e1     
deliv]y1 or po/-p>tum c>e det]m9$ to be 

appropriate by ! ,/ate & approv$ by !   
,secret>y2  7ii7 an entity or individual
 :o is designat$ to coord9ate su* a     
team2 &  7iii7 community heal? work]s1  
int]pret]s1 & o!r individuals )         
culturally appropriate exp]tise2 &  7,b7
 provide c>e at a facility t is free/&+1
 virtual1 or bas$ at a hospital1        
community heal? c5t]1 community m5tal   
heal? c5t]1 rural cl9ic1 cl9ical        
practice or cl9ical gr\p practice1      
academic heal? c5t]1 or any entity      
det]m9$ to be appropriate by ! ,/ate &  
approv$ by ! ,secret>y4  4