,i #aahth ,,congress #b;d ,session ,h4 ,r4 #ijdi ,,in ,,the ,,house ,,of ,,representatives ,july #ae1 #bjbd,mr4 ,nunn of ,iowa 7for himself1 ,ms4 ,underwood1 and ,ms4 ,pressley7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,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 #bjbd or the ,,health for ,,mom ,act of #bjbd4 #b4 ,state option to provide coordinated care through a health home for pregnant and postpartum 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 health home for pregnant and postpartum women 7a7 ,state option 7#a7 ,in general ,notwithstanding section #aijb7;a77#a7 7relating to statewideness7 and section #aijb7;a77#aj77;,b7 7relating to comparability71 beginning #b years after the date of the enactment of this section1 a ,state1 at its option as a ,state plan amendment and after consultation with health care providers and individuals enrolled under such plan who are or have been pregnant1 may provide for medical assistance under this title to an eligible woman who chooses to-- 7,a7 enroll in a maternity health 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 maternity health home for purposes of providing the woman with pregnancy and postpartum 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 voluntarily opted to participate in a maternity health home for eligible women under this section4 7#b7 ,eligible woman defined 7,a7 ,in general ,in this section1 the term eligible woman means an individual who-- 7i7 is eligible for medical assistance under the ,state plan 7or under a waiver of such plan7 for all items and services covered under the ,state plan 7or waiver7 that are not less in amount1 duration1 or scope1 or are determined by the ,secretary to be substantially equivalent1 to the medical assistance available for an individual described in subsection 7a77#aj77;,a77i72 and 7ii7 is pregnant4 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,c7 ,exclusion of individuals eligible for a limited pregnancy-related only benefit package ,such term does not include an individual who had a pregnancy end within the last #cfe days and whose eligibility under such plan 7or waiver7 is limited to coverage for a limited type of benefits and services4 7b7 ,qualification standards ,the ,secretary shall establish standards for qualification as a maternity health 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 maternity health 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 as a maternity health home7 to demonstrate to the ,state the ability to do the following3 7#a7 ,coordinate prompt care and access to maternity and postpartum care services1 including services provided by specialists1 and programs for an eligible woman during pregnancy and during the period for which she remains eligible as described in subsection 7a77#b77;,b74 7#b7 ,develop an individualized1 comprehensive1 patient-centered care plan for each eligible woman that accommodates patient preferences and1 if applicable1 reflects adjustments to the payment methodology described in subsection 7c77#b77;,b74 7#c7 ,develop and incorporate into each eligible woman's care plan1 in a culturally and linguistically appropriate manner consistent with the needs of the eligible woman1 ongoing home care1 community-based primary care1 inpatient care1 social support services1 behavioral health services1 local hospital emergency care1 oral health care1 and to the extent1 applicable1 care management and planning related to a change in an eligible woman's eligibility for medical assistance or a change in health insurance coverage4 7#d7 ,coordinate with pediatric care providers1 community-based providers1 behavioral health providers1 social service providers1 local hospital and emergency care providers1 oral health providers1 specialists1 and providers of early intervention services to ensure full implementation of the client's care plan1 as appropriate4 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 pregnancy and postpartum coordinated care services1 to each eligible woman that selects such provider1 team of health care professionals1 or health team as the woman's maternity health home or care provider4 ,payments made to a maternity health home or care provider for such services shall be treated as medical assistance for purposes of section #aijc7;a71 except that1 during the first #d 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 ,the ,state shall specify in the ,state plan amendment the methodology the ,state will use for determining payment for the provision of pregnancy and postpartum coordinated care services or treatment to an eligible woman4 ,such methodology for determining payment-- 7,a7 may be based on-- 7i7 a per-member per-month basis for each eligible woman enrolled in the maternity health home2 7ii7 a prospective payment model1 in the case of payments to ,federally qualified health centers or a rural health clinics2 or 7iii7 an alternate model of payment 7which may include a model developed under a waiver under section #aaae7 proposed by the ,state and approved by the ,secretary2 7,b7 may be adjusted to reflect1 with respect to each eligible woman-- 7i7 the severity of the risks associated with the woman's pregnancy2 7ii7 the severity of the risks associated with the woman's postpartum health care needs2 and 7iii7 the level or amount of time of care coordination required with respect to the woman2 and 7,c7 shall be established consistent with section #aijb7;a77#cj77;,a74 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 under a waiver of such plan7 to establish procedures in the case of an eligible woman who seeks treatment in the emergency department of such hospital for-- 7,a7 providing the woman with culturally and linguistically appropriate information on the respective treatment models and opportunities for the woman to access a maternity health home and its associated benefits2 and 7,b7 notifying the maternity health 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 maternity health 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 maternity health 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 maternity health homes for eligible women1 including the process by which such providers can participate in or refer eligible women to an approved maternity health home or a designated provider1 team of health care professionals operating such a provider1 or health team2 and 7ii7 educating eligible women1 in a culturally and linguistically appropriate manner1 on the availability of maternity health homes4 7,b7 ,outreach ,the process established by the ,state under subparagraph 7,a7 shall include the participation of relevant stakeholders 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 prevention1 identification1 and treatment of mental health conditions and substance use disorders among eligible women4 7#d7 ,coordination of 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 eligible women receiving pregnancy and postpartum care coordinated 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 ,act1 the ,special ,supplemental ,nutrition ,program for ,women1 ,infants1 and ,children1 or under title ,v4 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 an eligible woman with pregnancy and postpartum coordinated care services as specified 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 eligible 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 maternity health 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 ,state1 including through a health information exchange or other public health data sharing entity1 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 maternity health home71 the name1 ,national ,provider ,identification number1 address1 and specific health care services offered to be provided to eligible women who have selected such provider1 team of health care professionals1 or health team as the women's maternity health 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 maternal1 perinatal1 and child health quality measures under section #aaci;,b4 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 including through a health information exchange or other public health data sharing entity1 the following information3 7i7 ,information described in paragraph 7#a74 7ii7 ,the number and1 to the extent available and while maintaining all relevant protecting privacy and confidentially protections1 disaggregated demographic information of eligible women who have enrolled in a maternity health home pursuant to this section4 7iii7 ,the number of maternity health homes in the ,state4 7iv7 ,the medical and behavioral health conditions or factors that contribute to severe maternal morbidity among eligible women enrolled in maternity health homes in the ,state4 7v7 ,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 maternity health home4 7vi7 ,where applicable1 mortality data and data for the associated causes of death for eligible women enrolled in a maternity health home under this section1 in accordance with subsection 7g74 ,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 maternity health home under this section4 7vii7 ,the type of delivery systems and payment models used to provide health home services to eligible individuals enrolled in a maternal health home under such amendment4 7viii7 ,information on hospitalizations1 morbidity1 and mortality of eligible individuals and their infants enrolled in a maternal health home in such ,state alongside comparable data from a ,state's maternal mortality review committee4 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;,a7 to ensure1 at a minimum1 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 case1 and that all relevant confidentiality and privacy protections1 including the requirements under #aijb7;a77#g77;,a71 are maintained4 7h7 ,rule of construction ,nothing in this section shall be construed to require-- 7#a7 an eligible woman to enroll in a maternity health home under this section2 or 7#b7 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 health team does not voluntarily agree to act as a maternity health home4 7i7 ,planning grants 7#a7 ,in general ,beginning ,october #a1 #bjbd1 from the amount appropriated under paragraph 7#b71 the ,secretary shall award planning grants to ,states for purposes of developing and submitting a ,state plan amendment under this section4 ,the ,secretary shall award a grant to each ,state that applies for a grant under this subsection1 but the ,secretary 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 women4 ,a planning grant awarded to a ,state under this subsection shall remain available until expended4 7#b7 ,appropriation ,there are authorized to be appropriated to the ,secretary #ej1jjj1jjj for the #b-year period beginning on the date of the enactment of this section1 for the purposes of making grants under this subsection1 to remain available until expended4 7#c7 ,limitation ,the total amount of payments made to ,states under this subsection shall not exceed #ej1jjj1jjj4 7j7 ,additional 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 rural clinic1 community health center1 community mental health center1 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 documentation evidencing that the entity has the systems1 expertise1 and infrastructure in place to provide pregnancy and postpartum coordinated care services4 ,such term may include providers who are employed by1 or affiliated with1 a hospital4 7#b7 ,maternity health home ,the term maternity health home means a designated provider 7including a provider that operates in coordination with a team of health care professionals7 or a health team is selected by an eligible woman to provide 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 ,pregnancy and postpartum coordinated care services 7,a7 ,in general ,the term pregnancy and postpartum coordinated care services means items and services related to the coordination of care for comprehensive and timely high-quality1 culturally and linguistically appropriate1 services described in subparagraph 7,b7 that are provided to an eligible woman by a designated provider1 a team of health care professionals operating with such a provider1 or a health team 7designated as a maternity health home74 7,b7 ,services described 7i7 ,in general ,the services described in this subparagraph shall include with respect to a ,state electing the ,state plan amendment option under this section1 any medical assistance for items and services for which payment is available under the ,state plan or under a waiver of such plan4 7ii7 ,other items and services ,in addition to medical assistance described in clause 7i71 the services described in this subparagraph shall include the following3 7,i7 ,comprehensive care management4 7,,ii7 ,care coordination 7including with pediatricians1 specialists1 and providers of early intervention services1 as appropriate71 health promotion1 and providing access to the full range of maternal1 obstetric1 and gynecologic services1 including services from out-of-,state providers4 7,,iii7 ,comprehensive transitional care1 including appropriate follow-up1 from inpatient to other settings4 7,,iv7 ,patient and family support 7including authorized representatives74 7,v7 ,referrals to community and social support services1 if relevant4 7,,vi7 ,use of health information technology to link services1 as feasible and appropriate4 7#e7 ,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 physicians1 including gynecologist-obstetricians1 pediatricians1 and other professionals such as physicians assistants1 advance practice nurses1 including certified midwives1 nurses1 nurse care coordinators1 dietitians1 nutritionists1 social workers1 behavioral health professionals1 physical counselors1 physical therapists1 occupational therapists1 or any professionals that assist in prenatal care1 delivery1 or postpartum care for which medical assistance is available under the ,state plan or a waiver of such plan and determined to be appropriate by the ,state and approved by the ,secretary2 7ii7 an entity or individual who is designated to coordinate such care delivered by the team2 and 7iii7 when appropriate and if otherwise eligible to furnish items and services that are reimbursable as medical assistance under the ,state plan or under a waiver of such plan1 doulas1 community health workers1 translators and interpreters1 and other individuals with culturally appropriate and trauma-informed 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 ,secretary1 or provide care at the home of an individual with respect to a home birth4 4