,,ii  #aah? ,,congress  #a/ ,session    
,s4 #idh  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #bb1 #bjbc ,mr4   
,grassley 7= himself & ,ms4 ,hassan7    
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d titles     
,,xix & ,,xxi ( ! ,social ,security ,act
 to improve mat]nal heal? cov]age "u    
,m$icaid & ,,*ip1 & = o!r purposes4  #a4
 ,%ort title2 table ( cont5ts  7a7 ,%ort
 title ,?is ,act may be cit$ z ! ,heal?y
 ,moms & ,babies ,act4  7b7 ,table (    
cont5ts ,! table ( cont5ts = ?is ,act is
 z foll[s3  ,sec4 #a4 ,%ort title2 table
 ( cont5ts4 ,sec4 #b4 ,def9itions4 ,sec4
 #c4 ,m&atory report+ by ,/ate ,m$icaid 
programs on adult heal? c>e quality     
measures ( mat]nal & p]9atal heal?4     
,sec4 #d4 ,m$icaid quality improvem5t   
initiatives to r$uce rates ( ces>ean    
sections2 ,m$ic>e requirem5t = hospitals
 to report on data on ces>ean bir?s4    
,sec4 #e4 ,/ate option to provide       
coord9at$ c>e ?r\gh a heal? home =      

pregnant & po/p>tum wom54 ,sec4 #f4     
,guidance on c>e coord9ation to support 
mat]nal heal?4 ,sec4 #g4 ,national      
reskill+ ( ! mat]nity c>e work=ce4 ,sec4
 #h4 ,,macpac /udy on d\las & community 
heal? work]s2 guidance on increas+      
access to d\la s]vices "u ,m$icaid4     
,sec4 #i4 ,demon/ration projects to     
improve ! deliv]y ( mat]nal heal? c>e   
?r\gh teleheal?4 ,sec4 #aj4 ,,cms report
 on cov]age ( remote physiologic        
monitor+ devices & impact on mat]nal &  
*ild heal? outcomes "u ,m$icaid4 ,sec4  
#aa4 ,guidance on community-bas$ mat]nal
 heal? programs4 ,sec4 #ab4 ,develop+   
guidance on mat]nal mortality & sev]e   
morbidity r$uction = mat]nal c>e        
provid]s receiv+ paym5t "u ! ,m$icaid   
program4 ,sec4 #ac4 ,program relat$ to  
r$uc+ ces>ean bir?s & increas+ rates (  
vag9al bir? aft] ces>ean4 ,sec4 #ad4    
,collection ( in=mation relat$ to social
 det]m9ants ( ! heal? ( ,m$icaid & ,,*ip
 b5efici>ies4 ,sec4 #ae4 ,report on     
paym5t me?odologies = transf]r+ pregnant

 wom5 betwe5 facilities be=e1 dur+1 &   
aft] *ildbir?4 ,sec4 #af4 ,m$icaid      
guidance on ,/ate options to address    
social det]m9ants ( heal? = pregnant &  
po/p>tum wom54 ,sec4 #ag4 ,paym5t error 
rate measurem5t 7,,p]m7 audit &         
improvem5t requirem5ts4  #b4 ,def9itions
 ,9 ?is ,act3 7#a7 ,,*ip ,! t]m ,,*ip   
means ! ,*ildr5's ,heal? ,insurance     
,program e/abli%$ "u title ,,xxi ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acig;aa et seq474  7#b7 ,comptroll]    
,g5]al ,! t]m ,comptroll] ,g5]al means !
 ,comptroll] ,g5]al ( ! ,unit$ ,/ates4  
7#c7 ,gr\p heal? plan2 heal? insurance  
issu]1 etc ,! t]ms gr\p heal? plan1     
heal? insurance cov]age1 heal? insurance
 issu]1 gr\p heal? insurance cov]age1 & 
individual heal? insurance cov]age h !  
mean+s giv5 su* t]ms 9 section #bgia ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #cjj;gg-#ia74  7#d7 ,m$icaid  
,! t]m ,m$icaid means ! ,m$icaid program
 e/abli%$ "u title ,,xix ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acif et  

seq474  7#e7 ,m$icaid manag$ c>e        
organization ,! t]m m$icaid manag$ c>e  
organization has ! mean+ giv5 t t]m 9   
section #aijc7m77#a77;,a7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acif;b7m77#a77;,a774  7#f7 ,secret>y ,!
 t]m ,secret>y means ! ,secret>y (      
,heal? & ,human ,s]vices4  7#g7 ,/ate ,!
 t]m ,/ate has ! mean+ giv5 t t]m =     
purposes ( titles ,v1 ,,xix1 & ,,xxi ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#gja et seq4 #acif et seq41 #acig;aa et 
seq474  #c4 ,m&atory report+ by ,/ate   
,m$icaid programs on adult heal? c>e    
quality measures ( mat]nal & p]9atal    
heal? ,section #aaci;,b ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#i;b7 is am5d$-- 7#a7 9         
subsection 7b7--  7,a7 9 p>agraph       
7#c77;,b7-- 7i7 9 ! subp>agraph head+1  
by ins]t+ & mat]nal & p]9atal heal? aft]
 behavioral heal?2  7ii7 by /rik+ all   
behavioral heal? & ins]t+ all behavioral
 heal? & mat]nal & p]9atal heal?2 &     
7iii7 by ins]t+ & ( mat]nal & p]9atal   

heal? c>e = ,m$icaid eligible adults    
aft] ,m$icaid eligible adults2 &  7,b7 9
 p>agraph 7#e77;,c7-- 7i7 9 !           
subp>agraph head+1 by ins]t+ & mat]nal &
 p]9atal heal? aft] behavioral heal?2 & 
7ii7 by ins]t+ &1 ) respect to ,m$icaid 
eligible adults1 mat]nal & p]9atal heal?
 measures aft] behavioral heal?         
measures2 &  7#b7 9 subsection          
7d77#a77;,a71 by ins]t+ & mat]nal &     
p]9atal heal? aft] behavioral heal?4    
#d4 ,m$icaid quality improvem5t         
initiatives to r$uce rates ( ces>ean    
sections2 ,m$ic>e requirem5t = hospitals
 to report on data on ces>ean bir?s  7a7
 ,m$icaid /ate plan am5dm5t ,section    
#aijb7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;a7a77 is am5d$--   
7#a7 9 p>agraph 7#hf71 by /rik+ & aft] !
 semicolon2  7#b7 9 p>agraph 7#hg71 by  
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7#c7 by ins]t+ aft] p>agraph 7#hg7 !    
foll[+3  7#hh7 provide t1 n lat] ?an    
,janu>y #a1 #bjbe1 & annually !reaft]   
?r\gh ,janu>y #a1 #bjce1 ! ,/ate %all   

submit a report to ! ,secret>y1 t %all  
be made publicly available1 :i* conta9s 
) respect to ! prec$+ cal5d> ye>-- 7,a7 
! rate ( l[-risk ces>ean deliv]y1 z     
def9$ by ! ,secret>y 9 consultation )   
relevant /akehold]s1 = pregnant wom5    
eligible = m$ical assi/ance "u ! ,/ate  
plan or a waiv] ( su* plan 9 ! ,/ate1 z 
comp>$ to ! ov]all rate ( ces>ean       
deliv]y 9 ! ,/ate2  7,b7 a description (
 ! ,/ate's quality improvem5t activities
 to safely r$uce ! rate ( l[-risk       
ces>ean deliv]y 7z s def9$7 = pregnant  
wom5 eligible = m$ical assi/ance "u !   
,/ate plan or a waiv] ( su* plan 9 !    
,/ate report$ "u subp>agraph 7,a71      
includ+ initiatives aim$ at r$uc+ racial
 & e?nic heal? disp>ities1              
hospital-level quality improvem5t       
initiatives1 tak+ into acc\nt hospital  
type & ! pati5t population s]v$1 &1 if  
applicable1 p>tn]%ips ) ,/ate or        
regional p]9atal quality collaboratives2
  7,c7 = ea* report submitt$ aft]       
,janu>y #a1 #bjbe1 ! p]c5tage *ange 7if 

any7 9 ! rate ( l[-risk ces>ean deliv]y 
7z s def9$7 = pregnant wom5 eligible =  
m$ical assi/ance "u ! ,/ate plan or a   
waiv] ( su* plan 9 ! ,/ate report$ "u   
subp>agraph 7,a7 f ! rate report$ = !   
mo/ rec5t previ\s report2 &  7,d7 su*   
o!r relevant data & in=mation z det]m9$ 
by ! ,secret>y1 & 9 consultation )      
relevant /akehold]s1 su* z ,/ate        
initiatives & evaluations ( quality     
improvem5t activities1 ces>ean deliv]y  
rates1 & heal? outcomes4  4  7b7 ,gao   
/udy reg>d+ m$icaid paym5t rates ces>ean
 bir?s  7#a7 ,/udy ,! ,comptroll] ,g5]al
 %all conduct a /udy reg>d+ paym5t rates
 = ces>ean bir?s & vag9al bir?s "u ,/ate
 ,m$icaid programs4 ,to ! ext5t feasible
 & data are available1 ! /udy %all      
include analyses ( ! foll[+3  7,a7      
,paym5t rates = ces>ean bir?s & vag9al  
bir?s paid by fee-=-s]vice ,m$icaid     
programs & by ,m$icaid programs t       
contract ) ,m$icaid manag$ c>e          
organizations to furni% m$ical assi/ance
 "u su* programs2  7,b7 ,:at is kn[n    

ab\t h[ ,m$icaid paym5t rates h *ang$   
ov] "t2  7,c7 ,:at is kn[n ab\t h[      
paym5t rates = ces>ean & vag9al bir?s by
 ,m$icaid programs comp>e ) ! paym5t    
rates = su* bir?s by o!r s\rces (       
insurance cov]age2  7,d7 ,su* o!r       
factors relat$ to paym5t rates = ces>ean
 & vag9al bir?s "u ,m$icaid z !         
,comptroll] ,g5]al det]m9es appropriate4
  7#b7 ,report ,n lat] ?an #ah mon?s    
aft] ! date ( enactm5t ( ?is ,act1 !    
,comptroll] ,g5]al %all submit to       
,congress a report conta9+ ! results ( !
 /udy conduct$ "u p>agraph 7#a71 toge!r 
) recomm5dations = su* legislation &    
adm9i/rative action z ! ,comptroll]     
,g5]al det]m9es appropriate4  7c7 ,gao  
/udy on racial disp>ities 9 ces>ean     
bir?s  7#a7 ,9 g5]al ,! ,comptroll]     
,g5]al %all conduct a /udy on racial    
disp>ities 9 ! frequ5cy ( ces>ean bir?s4
 ,to ! ext5t feasible & data are        
available1 ! /udy %all comp>e su*       
in=mation on l[- & high-risk ces>ean    
bir?s1 diff]5ces by pay] 7su* z ,m$icaid

 & private pay]s71 & hospital           
*>act]i/ics 7su* z location or hospital 
type74 ,su* /udy may consid] o!r factors
 relat$ to racial disp>ities 9 mat]nal  
heal? z ! ,comptroll] ,g5]al deems      
appropriate4  7#b7 ,report ,n lat] ?an  
#b ye>s aft] ! date ( enactm5t ( ?is    
,act1 ! ,comptroll] ,g5]al %all submit  
to ,congress a report conta9+ ! results 
( ! /udy conduct$ "u p>agraph 7#a71     
toge!r ) recomm5dations = su*           
legislation & adm9i/rative action z !   
,comptroll] ,g5]al det]m9es appropriate4
  7d7 ,m$ic>e requirem5t = hospitals ,to
 report data on ces>ean bir?s  7#a7     
,requirem5t ,section #ahff7;a77#a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7a77#a77 is am5d$--  7,a7 by    
mov+ ! ind5tation ( subp>agraph 7,w7 #b 
ems to ! left2  7,b7 9 subp>agraph      
7,x7--  7i7 by mov+ ! ind5tation #b ems 
to ! left2 &  7ii7 by /rik+ & at ! end2 
7,c7 9 subp>agraph 7,y71 by /rik+ !     
p]iod at ! end & ins]t+ 2 &2 &  7,d7 by 
ins]t+ aft] subp>agraph 7,y7 ! foll[+   

new subp>agraph3  7,z7 9 ! case ( a     
hospital1 to submit1 9 a =m & mann]1 &  
at a "t1 specifi$ by ! ,secret>y1 data  
on ! ,nullip>\s1 ,t]m1 ,s+leton1 ,v]tex 
,ces>ean section 7,,ntsv ,c-section7    
rate ) respect to ! hospital = ! prec$+ 
ye>4  4  7#b7 ,incorporation into       
hospital quality report+ ,section       
#ahhf7;b77#c77;,b77viii7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acieww7b77#c77;,b77viii77 is am5d$ by  
add+ at ! end ! foll[+ new subclause3   
7,,xiii7 ,effective = paym5ts beg9n+ )  
fiscal ye> #bjbe1 9 exp&+ ! numb] (     
measures "u subclause 7,,iii71 !        
,secret>y %all adopt a measure relat+ to
 ! ,nullip>\s1 ,t]m1 ,s+leton1 ,v]tex   
,ces>ean section 7,,ntsv ,c-section7    
rate = hospitals 9 inpati5t sett+s4 ,n  
lat] ?an #bjbe1 ! ,secret>y %all        
incorporate su* measure into !          
designation ( mat]nity c>e quality      
hospitals1 z describ$ 9 ! f9al rule     
entitl$ ,m$ic>e ,program2 ,hospital     
,inpati5t ,prospective ,paym5t ,sy/ems =

 ,acute ,c>e ,hospitals & ! ,long ,t]m  
,c>e ,hospital ,prospective ,paym5t     
,sy/em & ,policy ,*anges & ,fiscal ,ye> 
#bjbc ,rates2 ,quality ,programs &      
,m$ic>e ,promot+ ,int]op]ability        
,program ,requirem5ts = ,eligible       
,hospitals & ,critical ,access          
,hospitals2 ,co/s ,incurr$ = ,qualifi$ &
 ,non-,qualifi$ ,def]r$ ,comp5sation    
,plans2 & ,*anges to ,hospital &        
,critical ,access ,hospital ,conditions 
( ,p>ticipation 7#hg ,f$4 ,reg4 #dhghj  
7,augu/ #aj1 #bjbb774  4  #e4 ,/ate     
option to provide coord9at$ c>e ?r\gh a 
heal? home = pregnant & po/p>tum 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 heal?    
home = pregnant & po/p>tum wom5  7a7    
,/ate option  7#a7 ,9 g5]al ,not)/&+    
section #aijb7;a77#a7 7relat+ to        
/atewid5ess7 & section                  
#aijb7;a77#aj77;,b7 7relat+ to          

comp>ability71 beg9n+ ,april #a1 #bjbf1 
a ,/ate1 at its option z a ,/ate plan   
am5dm5t1 may provide = m$ical assi/ance 
"u ?is title to an eligible woman :o    
*ooses to-- 7,a7 enroll 9 a mat]nity    
heal? home "u ?is section by select+ a  
designat$ provid]1 a team ( heal? c>e   
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team z ! woman's mat]nity heal? 
home = purposes ( provid+ ! woman )     
pregnancy & po/p>tum 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 volunt>ily opt$ to   
p>ticipate 9 a mat]nity heal? home =    
eligible wom5 "u ?is section4  7#b7     
,eligible woman def9$ ,9 ?is section1 ! 
t]m eligible woman means an individual--
  7,a7 :o is eligible = m$ical assi/ance
 "u ! ,/ate plan 7or "u a waiv] ( su*   
plan7 = all items & s]vices cov]$ "u !  
,/ate plan 7or waiv]7 t are n less 9    
am\nt1 duration1 or scope1 or are       
det]m9$ by ! ,secret>y to be            

sub/antially equival5t1 to ! m$ical     
assi/ance available = an individual     
describ$ 9 subsection 7a77#aj77;,a77i72 
&  7,b7 :o--  7i7 is pregnant2 or  7ii7 
_h a pregnancy end )9 ! la/ #cfe days4  
7b7 ,qualification /&>ds ,! ,secret>y   
%all e/abli% /&>ds = qualification z a  
mat]nity heal? 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 mat]nity    
heal? home = purposes ( ?is section4 ,9 
e/abli%+ su* /&>ds1 ! ,secret>y %all    
consid] be/ practices & models ( c>e us$
 by recipi5ts ( grants "u section #ccj,p
 ( ! ,public ,heal? ,s]vice ,act4 ,su*  
/&>ds %all include requir+ designat$    
provid]s1 teams ( heal? c>e pr(essionals
 op]at+ ) su* provid]s1 & heal? teams   
7designat$ z a mat]nity heal? home7 to  
demon/rate to ! ,/ate ! ability to d !  
foll[+3 7#a7 ,coord9ate prompt c>e &    
access to necess>y mat]nity c>e s]vices1
 includ+ s]vices provid$ by speciali/s1 
& programs = an eligible woman dur+ h]  

pregnancy & ! #cfe-;day p]iod beg9n+ on 
! la/ day ( h] pregnancy4  7#b7 ,develop
 an individualiz$1 compreh5sive1        
pati5t-c5t]$ c>e plan = ea* eligible    
woman t accommodates pati5t pref]5ces &1
 if applicable1 reflects adju/m5ts to ! 
paym5t me?odology describ$ 9 subsection 
7c77#b77;,b74  7#c7 ,develop &          
incorporate into ea* eligible woman's   
c>e plan1 9 a culturally & l+ui/ically  
appropriate mann] consi/5t ) ! ne$s ( ! 
eligible woman1 ongo+ home c>e1         
community-bas$ prim>y c>e1 inpati5t c>e1
 social support s]vices1 heal?-relat$   
social ne$s s]vices1 behavioral heal?   
s]vices1 local hospital em]g5cy c>e1 &1 
9 ! ev5t ( a *ange 9 income t w\ld      
result 9 ! eligible woman los+          
eligibility = m$ical assi/ance "u !     
,/ate plan or waiv]1 c>e managem5t &    
plann+ relat$ to a *ange 9 ! eligible   
woman's heal? insurance cov]age4  7#d7  
,coord9ate ) p$iatric c>e provid]s1 z   
appropriate4  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 ( pregnancy & po/p>tum        
coord9at$ c>e s]vices1 to ea* eligible  
woman t selects su* provid]1 team (     
heal? c>e pr(essionals1 or heal? team z 
! woman's mat]nity heal? home or c>e    
provid]4 ,paym5ts made to a mat]nity    
heal? home or c>e provid] = su* s]vices 
%all be treat$ z m$ical assi/ance =     
purposes ( section #aijc7;a74  7#b7     
,me?odology ,! ,/ate %all specify 9 !   
,/ate plan am5dm5t ! me?odology ! ,/ate 
w use = det]m9+ paym5t = ! provision (  
pregnancy & po/p>tum coord9at$ c>e      
s]vices or treatm5t dur+ an eligible    
woman's pregnancy & ! #cfe-;day p]iod   
beg9n+ on ! la/ day ( h] pregnancy4 ,su*
 me?odology = det]m9+ paym5t--  7,a7 may
 be bas$ on-- 7i7 a p]-memb] p]-mon?    
basis = ea* eligible woman enroll$ 9 !  
mat]nity heal? home2  7ii7 a prospective
 paym5t model1 9 ! case ( paym5ts to    

,f$]ally qualifi$ heal? c5t]s or a rural
 heal? cl9ics2 or  7iii7 an alt]nate    
model ( paym5t 7:i* may include a model 
develop$ "u a waiv] "u section #aaae7   
propos$ by ! ,/ate & approv$ by !       
,secret>y2  7,b7 may be adju/$ to       
reflect1 ) respect to ea* eligible      
woman-- 7i7 ! sev]ity ( ! risks         
associat$ ) ! woman's pregnancy2  7ii7 !
 sev]ity ( ! risks associat$ ) ! woman's
 po/p>tum heal? c>e ne$s2 &  7iii7 !    
level or am\nt ( "t ( c>e coord9ation   
requir$ ) respect to ! woman2 &  7,c7   
%all be e/abli%$ consi/5t ) section     
#aijb7;a77#cj77;,a74  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 
"u a waiv] ( su* plan7 to e/abli%       
proc$ures 9 ! case ( an eligible woman  
:o seeks treatm5t 9 ! em]g5cy dep>tm5t (
 su* hospital =--  7,a7 provid+ ! woman 
) culturally & l+ui/ically appropriate  
in=mation on ! respective treatm5t      

models & opportunities = ! woman to     
access a mat]nity heal? home & its      
associat$ b5efits2 &  7,b7 notify+ !    
mat]nity heal? 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 = ! mat]nity heal?     
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 mat]nity    
heal? 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 ( mat]nity  
heal? homes = eligible wom51 includ+ !  
process by :i* su* provid]s c p>ticipate
 9 or ref] eligible wom5 to an approv$  
mat]nity heal? home or a designat$      
provid]1 team ( heal? c>e pr(essionals  

op]at+ su* a provid]1 or heal? team2 &  
7ii7 educat+ eligible wom51 9 a         
culturally & l+ui/ically appropriate    
mann]1 on ! availability ( mat]nity     
heal? 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+ !    
prev5tion1 id5tification1 & treatm5t (  
m5tal heal? conditions & sub/ance use   
disord]s among eligible 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 eligible wom5 receiv+  
pregnancy & po/p>tum 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+ an  
eligible woman ) pregnancy & po/p>tum   
coord9at$ c>e s]vices z specifi$ "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 =
 eligible 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  
mat]nity heal? 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 !
 ,/ate1 includ+ ?r\gh a heal? in=mation 
ex*ange or o!r public heal? data %>+    
entity1 ! 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 mat]nity heal? home71 ! "n1 ,national
 ,provid] ,id5tification numb]1 address1
 & specific heal? c>e s]vices (f]$ to be
 provid$ to eligible wom5 :o h select$  
su* provid]1 team ( heal? c>e           
pr(essionals1 or heal? team z ! wom5's  
mat]nity heal? home4  7,b7 ,in=mation on
 measures f ! core sets ( *ild heal?    
quality measures & adult heal? quality  
measures "u sections #aaci;,a & #aaci;,b
 t are id5tifi$ by ! ,secret>y z be+    
relevant to mat]nal1 p]9atal1 or infant 
heal?4  7,c7 ,in=mation on all o!r      

applicable measures = det]m9+ ! quality 
( s]vices provid$ by su* provid]1 team (
 heal? c>e pr(essionals1 or heal? team4 
7,d7 ,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 includ+ ?r\gh a heal?       
in=mation ex*ange or o!r public heal?   
data %>+ entity1 ! foll[+ in=mation3    
7i7 ,in=mation describ$ 9 p>agraph 7#a74
  7ii7 ,! numb] &1 to ! ext5t available 
& :ile ma9ta9+ all relevant protect+    
privacy & confid5tially protections1    
disaggregat$ demographic in=mation (    
eligible wom5 :o h enroll$ 9 a mat]nity 
heal? home pursuant to ?is section4     
7iii7 ,! numb] ( mat]nity heal? homes 9 
! ,/ate4  7iv7 ,! m$ical conditions or  

factors t contribute to sev]e mat]nal   
morbidity among eligible wom5 enroll$ 9 
mat]nity heal? homes 9 ! ,/ate4  7v7 ,! 
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 
mat]nity heal? home4  7vi7 ,:]e         
applicable1 mortality data & data = !   
associat$ causes ( dea? = eligible wom5 
enroll$ 9 a mat]nity heal? home "u ?is  
section1 9 accordance ) subsection 7g74 
,= 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 ! mat]nity heal? 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;,a7 to ensure1 at
 a m9imum1 t !re is no disclosure by !  
,/ate ( any id5tify+ in=mation ab\t any 
specific eligible woman enroll$ 9 a     
mat]nity heal? home or any mat]nal      
mortality case1 & t all relevant        
confid5tiality & privacy protections1   
includ+ ! requirem5ts "u                
#aijb7;a77#g77;,a71 are ma9ta9$4  7h7   
,rule ( con/ruction ,no?+ 9 ?is section 
%all be con/ru$ to require-- 7#a7 an    
eligible woman to enroll 9 a mat]nity   
heal? home "u ?is section2 or  7#b7 a   
designat$ provid] or heal? team to act z

 a mat]nity heal? home & provide s]vices
 9 accordance ) ?is section if ! provid]
 or heal? team does n volunt>ily agree  
to act z a mat]nity heal? home4  7i7    
,plann+ grants  7#a7 ,9 g5]al ,beg9n+   
,octob] #a1 #bjbe1 f ! am\nt appropriat$
 "u p>agraph 7#b71 ! ,secret>y %all aw>d
 plann+ grants to ,/ates = purposes (   
develop+ & submitt+ a ,/ate plan am5dm5t
 "u ?is section4 ,! ,secret>y %all aw>d 
a grant to ea* ,/ate t applies = a grant
 "u ?is subsection1 b ! ,secret>y may   
det]m9e ! am\nt ( ! grant bas$ on !     
m]its ( ! application & ! goal ( ! ,/ate
 to prioritize heal? outcomes = eligible
 wom54 ,a plann+ grant aw>d$ to a ,/ate 
"u ?is subsection %all rema9 available  
until exp5d$4  7#b7 ,appropriation ,!re 
are au?oriz$ to be appropriat$ to !     
,secret>y #ej1jjj1jjj = ! p]iod ( fiscal
 ye>s #bjbd ?r\gh #bjbf1 = ! purposes ( 
mak+ grants "u ?is subsection1 to rema9 
available until exp5d$4  7#c7           
,limitation ,! total am\nt ( paym5ts    
made to ,/ates "u ?is subsection %all n 

exce$ #ej1jjj1jjj4  7j7 ,additional     
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 a m$icaid manag$ c>e          
organization1 z def9$ 9 section         
#aijc7m77#a77;,a71 a prepaid inpati5t   
heal? plan1 z def9$ 9 section #dch4b (  
title #db1 ,code ( ,f$]al ,regulations  
7or any successor regulation71 a prepaid
 ambulatory heal? plan1 z def9$ 9 su*   
section 7or any successor regulation71  
rural cl9ic1 community heal? c5t]1      
community m5tal heal? c5t]1 or any o!r  
entity or provid] t is det]m9$ by !     
,/ate & approv$ by ! ,secret>y to be    
qualifi$ to be a mat]nity heal? home on 
! basis ( docum5tation evid5c+ t !      
entity has ! sy/ems1 exp]tise1 &        
infra/ructure 9 place to provide        
pregnancy & po/p>tum coord9at$ c>e      
s]vices4 ,su* t]m may include provid]s  
:o are employ$ by1 or affiliat$ )1 a    

hospital4  7#b7 ,mat]nity heal? home ,! 
t]m mat]nity heal? home means a         
designat$ provid] 7includ+ a provid] t  
op]ates 9 coord9ation ) a team ( heal?  
c>e pr(essionals7 or a heal? team is    
select$ by an eligible woman to provide 
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 ,pregnancy & po/p>tum   
coord9at$ c>e s]vices  7,a7 ,9 g5]al ,! 
t]m pregnancy & po/p>tum coord9at$ c>e  
s]vices means items & s]vices relat$ to 
! coord9ation ( c>e = compreh5sive &    
timely high-quality1 culturally &       
l+ui/ically appropriate1 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 
mat]nity heal? home74  7,b7 ,s]vices    
describ$  7i7 ,9 g5]al ,! s]vices       
describ$ 9 ?is subp>agraph %all include 
) respect to a ,/ate elect+ ! ,/ate plan

 am5dm5t option "u ?is section1 any     
m$ical assi/ance = items & s]vices = :i*
 paym5t is available "u ! ,/ate plan or 
"u a waiv] ( su* plan4  7ii7 ,o!r items 
& s]vices ,9 addition to m$ical         
assi/ance describ$ 9 clause 7i71 !      
s]vices describ$ 9 ?is subp>agraph %all 
include ! foll[+3 7,i7 ,any item or     
s]vice = :i* m$ical assi/ance is o!rwise
 available "u ! ,/ate plan 7or a waiv] (
 su* plan7 relat$ to ! treatm5t ( a     
woman dur+ ! woman's pregnancy & !      
#a-ye> p]iod beg9n+ on ! la/ day ( h]   
pregnancy1 includ+ m5tal heal? &        
sub/ance use disord] s]vices4  7,,ii7   
,compreh5sive c>e managem5t4  7,,iii7   
,c>e coord9ation 7includ+ ) p$iatricians
 z appropriate71 heal? promotion1 &     
provid+ access to ! full range (        
mat]nal1 ob/etric1 & gynecologic        
s]vices1 includ+ s]vices f out-(-,/ate  
provid]s4  7,,iv7 ,compreh5sive         
transitional c>e1 includ+ appropriate   
foll[-up1 f inpati5t to o!r sett+s4     
7,v7 ,pati5t & family support 7includ+  

au?oriz$ repres5tatives74  7,,vi7       
,ref]rals to community & social support 
s]vices1 if relevant4  7,,vii7 ,use (   
heal? in=mation te*nology to l9k        
s]vices1 z feasible & appropriate4  7#e7
 ,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    
physicians1 includ+                     
gynecologi/-ob/etricians1 p$iatricians1 
& o!r pr(essionals su* z physicians     
assi/ants1 advance practice nurses1     
includ+ c]tifi$ nurse midwives1 nurses1 
nurse c>e coord9ators1 dietitians1      
nutritioni/s1 social work]s1 behavioral 
heal? pr(essionals1 physical c\nselors1 
physical !rapi/s1 occupational !rapi/s1 
or any pr(essionals t assi/ 9 pr5atal   
c>e1 deliv]y1 or po/p>tum c>e = :i*     
m$ical assi/ance is available "u ! ,/ate
 plan or a waiv] ( su* plan & det]m9$ to
 be appropriate by ! ,/ate & approv$ by 
! ,secret>y2  7ii7 an entity or         

individual :o is designat$ to coord9ate 
su* c>e deliv]$ by ! team2 &  7iii7 :5  
appropriate & if o!rwise eligible to    
furni% items & s]vices t are            
reimbursable z m$ical assi/ance "u !    
,/ate plan or "u a waiv] ( su* plan1    
d\las1 community heal? work]s1          
translators & int]pret]s1 & o!r         
individuals ) culturally appropriate &  
trauma-in=m$ 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  #f4 
,guidance on c>e coord9ation to support 
mat]nal heal? ,n lat] ?an #b ye>s aft] !
 date ( enactm5t ( ?is ,act1 ! ,secret>y
 %all issue guidance = ,/ate ,m$icaid   
programs on improv$ c>e coord9ation1    
cont9uity ( c>e1 & cl9ical integration  
to support ! ne$s ( pregnant & po/p>tum 
wom5 = s]vices eligible = ,m$icaid      

paym5t4 ,su* guidance %all id5tify be/  
practices = c>e coord9ation = su* wom51 
bo? ) respect to fee-=-s]vice ,/ate     
,m$icaid programs & ,/ate ,m$icaid      
programs t contract ) ,m$icaid manag$   
c>e organizations or o!r specifi$       
entities to furni% m$ical assi/ance =   
su* wom51 & %all illu/rate /rategies =--
 7#a7 enhanc+ prim>y c>e & mat]nity c>e 
coord9ation ) speciali/s1 includ+       
c>diologi/s1 speciali/s 9 ge/ational    
diabetes1 d5ti/s1 lactation speciali/s1 
g5etic c\nselors1 & behavioral heal?    
provid]s2  7#b7 integrat+ behavioral    
heal? provid]s to provide scre5+1       
assessm5t1 treatm5t1 & ref]ral =        
behavioral heal? ne$s1 includ+ sub/ance 
use disord]s1 mat]nal depression1       
anxiety1 intimate p>tn] viol5ce1 & o!r  
trauma2  7#c7 integrat+ into c>e teams  
or coord9at+ ) noncl9ical pr(essionals1 
includ+ 7if lic5s$ or cr$5tial$ by a    
,/ate or ,/ate-au?oriz$ organization7   
d\las1 pe] support speciali/s1 &        
community heal? work]s1 & h[ ^! s]vices 

provid$ by su* pr(essionals may be      
eligible = ,f$]al f9ancial p>ticipation 
"u ,m$icaid2  7#d7 scre5+ pregnant &    
po/p>tum wom5 = social ne$s & coord9at+ 
relat$ s]vices dur+ ! pr5atal & po/p>tum
 p]iods to ensure social & physical     
supports are provid$ = su* wom5 dur+ su*
 p]iods & = _! *ildr52  7#e7 support+   
wom5 :o h _h a /illbir?2  7#f7 scre5+ = 
mat]nal heal?1 behavioral heal?1 &      
social ne$s dur+ well-*ild & p$iatric   
c>e visits2 &  7#g7 /reaml9+ & r$uc+    
duplication 9 c>e coord9ation ef=ts     
across & among provid]s1 plans1 & o!r   
entities = su* wom54  #g4 ,national     
reskill+ ( ! mat]nity c>e work=ce ,"p ,b
 ( title ,,iii ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4 #bdc et     
seq47 is am5d$ by ins]t+ aft] section   
#cag,l-#a ! foll[+3  #cag,l-#b4         
,national reskill+ ( ! mat]nity c>e     
work=ce  7a7 ,e/abli%m5t ( national     
exp]t gr\p  7#a7 ,9 g5]al ,! ,secret>y  
%all e/abli% a national exp]t gr\p to   
evaluate national education on1 &       

practice (1 be/ bir?+ practices4  7#b7  
,memb]s  7,a7 ,9 g5]al ,! gr\p e/abli%$ 
"u p>agraph 7#a7 %all be compos$ ( su*  
memb]s z ! ,secret>y appo9ts1 includ+-- 
7i7 ob/etricians & gynecologi/s1 family 
m$ic9e physicians1 midwifes1 & nurs+    
lead]s2  7ii7 hospital adm9i/rators2    
7iii7 graduate m$ical education lead]s2 
7iv7 d\la lead]s2  7v7 individuals )    
exp]i5ce 9 community bir? sett+s2  7vi7 
pati5ts2  7vii7 high-risk bir? exp]ts2 &
  7viii7 quality improvem5t lead]s4     
7,b7 ,geographic div]sity ,9 appo9t+    
memb]s "u subp>agraph 7,a71 ! ,secret>y 
%all ensure a balance ( memb]s repres5t+
 rural areas & memb]s repres5t+ urban   
areas4  7b7 ,duties ,! gr\p e/abli%$ "u 
subsection 7a7 %all-- 7#a7 exam9e       
evid5ce1 tr5ds1 & diff]5tial use or     
access by income1 geographic area1 &    
race & e?nicity associat$ ) bir?+       
practices t include--  7,a7 ces>ean     
sections1 repeat ces>ean1 & vag9al bir? 
aft] ces>ean2  7,b7 electronic fetal    
monitor+ & int]mitt5t auscultation2     

7,c7 bir? positions1 includ+ upright    
position+ & ambulation2  7,d7 labor )   
d\la support2  7,e7 evaluat+ indications
 = ces>ean deliv]y1 includ+ c]vical     
dilation & duration ( pu%+2  7,f7       
op]ative vag9al deliv]ies2  7,g7 manual 
fetal rotation2  7,h7 amnio9fusion &    
scalp /imulation2 &  7,i7 c]vical rip5+ 
me?ods2  7#b7 assess ! role ( ! culture 
( c>e1 mat]nity c>e f9anc+1 & heal?     
education ) respect to ! tr5ds "u       
p>agraph 7#a72 &  7#c7 id5tify case     
/udies ( ! provision ( exempl>y bir?+   
c>e4  7c7 ,recomm5dations ,! gr\p       
e/abli%$ "u subsection 7a7 %all1 n lat] 
?an #a ye> aft] su* e/abli%m5t1 issue-- 
7#a7 be/ practices =-- 7,a7 evaluat+    
bir?+ skills2  7,b7 improv+ curricula = 
heal? pr(essionals engag$ 9 bir?+2 &    
7,c7 ! incorporation ( midwives & d\las 
into resid5cy curricula = ob/etricians2 
&  7#b7 recomm5dations = policies &     
practices to improve mat]nity c>e       
ov]all4  4  #h4 ,,macpac /udy on d\las &
 community heal? work]s2 guidance on    

increas+ access to d\la s]vices "u      
,m$icaid  7a7 ,,macpac /udy on d\las &  
community heal? work]s  7#a7 ,9 g5]al ,z
 "p ( ! fir/ report requir$ "u section  
#aijj7;b77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acif7;b77#a77 aft] !   
date t is #a ye> aft] ! date ( enactm5t 
( ?is ,act1 ! ,m$icaid & ,,*ip ,paym5t &
 ,access ,commission 7ref]r$ to 9 ?is   
section z ,,macpac7 %all include ) su*  
report a report on ! cov]age ( d\la     
s]vices & ! role ( community heal?      
work]s "u ,/ate ,m$icaid programs1 :i*  
%all include ! foll[+3  7,a7 ,in=mation 
ab\t cov]age = d\la s]vices & community 
heal? work] s]vices "u ,/ate ,m$icaid   
programs t curr5tly provide cov]age =   
su* s]vices1 includ+ ! type ( d\la      
s]vices (f]$ 7su* z pr5atal1 labor &    
deliv]y1 po/p>tum support1 & traditional
 d\la s]vices7 & in=mation on !         
preval5ce ( d\las t c>e = individuals 9 
_! own communities4  7,b7 ,an analysis (
 /rategies to facilitate ! appropriate  
use ( d\la s]vices 9 ord] to provide    

bett] c>e & a*ieve bett] mat]nal &      
infant heal? outcomes1 includ+ /rategies
 t ,/ates may use to assi/ ) s]vices =  
:i* ,f$]al f9ancial p>ticipation is     
eligible "u a ,/ate ,m$icaid plan or a  
waiv] ( su* a plan by recruit+1 tra9+1 &
 c]tify+ a div]se d\la work=ce1         
p>ticul>ly f und]s]v$ communities1      
communities ( color1 & communities fac+ 
l+ui/ic or cultural b>ri]s4  7,c7       
,provide examples ( community heal?     
work] access 9 ,/ate ,m$icaid programs &
 /rategies employ$ by ,/ates to enc\rage
 a broad c>e team to manage ,m$icaid    
pati5ts4  7,d7 ,an assessm5t ( ! impact 
( ! involvem5t ( d\las & community heal?
 work]s on mat]nal heal? outcomes4  7,e7
 ,recomm5dations1 z ,,macpac deems      
appropriate1 = legislative &            
adm9i/rative actions to increase access 
to s]vices t improve mat]nal heal?4     
7#b7 ,/akehold] consultation ,9 develop+
 ! report requir$ "u p>agraph 7#a71     
,,macpac %all consult ) relevant        
/akehold]s4  7b7 ,guidance on increas+  

access to d\la s]vices "u ,m$icaid  7#a7
 ,9 g5]al ,n lat] ?an #a ye> aft] ! date
 t ,,macpac publi%es ! report requir$ "u
 subsection 7a71 ! ,secret>y %all issue 
guidance to ,/ates on increas+ access to
 d\la s]vices "u ,m$icaid4 ,su* guidance
 %all at a m9imum include-- 7,a7 options
 = ,/ates to provide m$ical assi/ance = 
d\la s]vices "u ,/ate ,m$icaid programs2
  7,b7 be/ practices = ensur+ t d\las1  
includ+ community-bas$ d\las1 receive   
reimbursem5t = d\la s]vices provid$ "u a
 ,/ate ,m$icaid program1 at a level t   
all[s d\las to e>n a liv+ wage t acc\nts
 = _! "t & co/s associat$ ) provid+ c>e 
& community-bas$ d\la program           
adm9i/ration2 &  7,c7 be/ practices =   
increas+ access to d\la s]vices1 includ+
 s]vices provid$ by community-bas$      
d\las1 "u ,/ate ,m$icaid programs4  7#b7
 ,/akehold] consultation ,9 develop+ !  
report requir$ "u p>agraph 7#a71 !      
,secret>y %all consult ) relevant       
/akehold]s4  7c7 ,relevant /akehold]s ,=
 purposes ( subsections 7a77#b7 &       

7b77#b71 relevant /akehold]s %all       
include--  7#a7 ,/ates2  7#b7           
organizations repres5t+ consum]s1       
includ+ ^? t are disproportionately     
impact$ by poor mat]nal heal? outcomes2 
7#c7 organizations & individuals        
repres5t+ d\la s]vices provid]s &       
community heal? work]s1 includ+         
community-bas$ d\la programs & ^? :o    
s]ve und]s]v$ communities1 communities (
 color & communities fac+ l+ui/ic or    
cultural b>ri]s2 &  7#d7 organizations  
repres5t+ heal? c>e provid]s4  #i4      
,demon/ration projects to improve !     
deliv]y ( mat]nal heal? c>e ?r\gh       
teleheal?  7a7 ,9 g5]al ,n lat] ?an #ah 
mon?s aft] ! date ( enactm5t ( ?is ,act1
 ! ,secret>y %all aw>d grants to ,/ates 
to conduct demon/ration projects "u ?is 
section t are design$ to exp& ! use (   
teleheal? 9 ,/ate ,m$icaid programs = ! 
deliv]y ( heal? c>e to eligible pregnant
 or po/p>tum wom54  7b7 ,eligible       
pregnant or po/p>tum woman def9$  7#a7  
,9 g5]al ,9 ?is section1 ! t]m eligible 

pregnant or po/p>tum woman means a woman
 :o is eligible = & receiv+ m$ical      
assi/ance "u a ,/ate ,m$icaid plan 7or  
waiv] ( su* plan7 & :o is or becomes    
pregnant4  7#b7 ,po/p>tum wom5 ,su* t]m 
includes a woman describ$ 9 p>agraph    
7#a7 ?r\gh ! end ( ! mon? 9 :i* !       
#cfe-;day p]iod beg9n+ on ! la/ day ( ! 
woman's pregnancy ends1 )\t reg>d to any
 *ange 9 income ( ! family ( :i* %e is a
 memb]4  7c7 ,application2 selection (  
,/ates2 duration  7#a7 ,application     
7,a7 ,9 g5]al ,to conduct a demon/ration
 project "u ?is section1 a ,/ate %all   
submit an application to ! ,secret>y at 
su* "t & 9 su* mann] z ! ,secret>y %all 
require4 ,"u ! demon/ration project1 a  
,/ate may include multiple propos$ uses 
( grant funds1 & propose to focus on    
multiple populations1 z o!rwise all[able
 "u ?is section1 )9 a s+le application4 
7,b7 ,requir$ in=mation ,a ,/ate        
application to conduct a demon/ration   
project "u ?is section %all include !   
foll[+3 7i7 ,! population 7su* z        

individuals resid+ 9 rural or m$ically  
und]s]v$ areas7 t ! demon/ration project
 w t>get4  7ii7 ,a description ( h[ !   
,/ate proposes to use funds aw>d$ "u ?is
 section to conduct ! demon/ration      
project to integrate or increase !      
integration ( teleheal? into ! ,/ate    
,m$icaid program's exi/+ deliv]y sy/em =
 furni%+ m$ical assi/ance to & improv+ !
 heal? c>e outcomes ( eligible pregnant 
or po/p>tum wom54  7iii7 ,a description 
( h[ ! ,/ate w use funds to address     
racial or e?nic disp>ities 9 access to  
mat]nal heal? s]vices or mat]nal heal?  
outcomes1 b>ri]s to c>e1 includ+ 9 rural
 or m$ically und]s]v$ communities1 o!r  
b>ri]s to us+ teleheal?1 su* z ^?       
exp]i5c$ by individuals ) disabilities &
 individuals ) limit$ ,engli% pr(ici5cy1
 & z applicable1 b>ri]s to ! use (      
teleheal? 9 tribal communities4  7iv7 ,a
 c]tification t ! application meets !   
requirem5ts ( subp>agraph 7,c74  7v7    
,su* o!r in=mation z ! ,secret>y %all   
require4  7,c7 ,consultation ) heal? c>e

 /akehold]s ,prior to ! submission ( an 
application to conduct a demon/ration   
project "u ?is section1 a ,/ate %all    
consult ) heal? c>e sy/ems & provid]s1  
heal? plans 7if relevant71 consum]      
organizations & b5efici>y advocates1 &  
community-bas$ organizations or o!r     
/akehold]s 9 ! area t ! demon/ration    
project w t>get to ensure t ! propos$   
project addresses ! heal? c>e ne$s (    
eligible pregnant or po/p>tum wom5 9 su*
 area4  7#b7 ,selection ( ,/ates &      
duration ( projects  7,a7 ,9 g5]al ,!   
,secret>y %all aw>d grants to ,/ates t  
apply & meet ! application requirem5ts  
to conduct #d-ye> demon/ration projects 
"u ?is section4 ,a ,/ate may reque/1 & !
 ,secret>y %all det]m9e ! appropriat5ess
 (1 an application ( up to #aj1jjj1jjj4 
7,b7 ,selection ( projects ,9 select+ a 
,/ate to conduct a demon/ration project 
"u ?is section1 ! ,secret>y %all ensure 
t ! ,/ate is aw>e ( ! #d-ye> duration ( 
! project & %all det]m9e ! ,/ate has    
satisfi$ ! application requirem5ts4     

7#c7 ,waiv] ( /atewid5ess & comp>ability
 requirem5t ,! ,secret>y %all waive     
compliance ) section #aijb7;a77#a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#a77 7relat+ to /atewid5ess7 
& section #aijb7;a77#aj77;,b7 ( su* ,act
 7#db ,u4,s4,c4 #acif;a7a77#aj77;,b77   
7relat+ to comp>ability7 to ! ext5t     
necess>y to all[ select$ ,/ates to      
conduct demon/ration projects "u ?is    
section4  7d7 ,use ( grant funds ,a     
,/ate may use funds f a grant aw>d$ "u  
?is section to connect eligible pregnant
 or po/p>tum wom5 to teleheal? s]vices  
deliv]$ via teleheal? t are furni%$ by--
 7#a7 prim>y & mat]nity c>e provid]s2   
7#b7 heal? c>e speciali/s2  7#c7        
behavioral heal? provid]s2 &  7#d7 o!r  
categories ( heal? c>e provid]s id5tifi$
 by ! ,secret>y4  7e7 ,reports  7#a7    
,/ate reports ,ea* ,/ate t is aw>d$ a   
grant to conduct a demon/ration project 
"u ?is section %all submit ! foll[+     
reports to ! ,secret>y3  7,a7 ,initial  
report ,an initial report on ! fir/ #ah 

mon?s dur+ :i* ! demon/ration project is
 conduct$1 n lat] ?an ! la/ day ( ! #ai?
 mon? ( ! demon/ration project1 z       
describ$ 9 subp>agraph 7,b74  7,b7 ,f9al
 report ,n lat] ?an #f mon?s aft] ! date
 on :i* ! ,/ate's demon/ration project  
ends1 a f9al report t includes ! foll[+3
  7i7 ,! numb] ( eligible pregnant or   
po/p>tum wom5 s]v$ "u ! demon/ration    
project4  7ii7 ,! activities & s]vices  
fund$ "u ! demon/ration project1 includ+
 ! provid]s t receiv$ funds "u !        
demon/ration project4  7iii7            
,demographic in=mation ab\t ! eligible  
pregnant or po/p>tum wom5 s]v$ "u !     
demon/ration project1 if available4     
7iv7 ,a description ( ! types ( models  
or programs develop$ "u ! demon/ration  
project4  7v7 ,h[ su* models or programs
 impact$ access to1 & utilization (1    
teleheal? s]vices by eligible pregnant  
or po/p>tum wom51 includ+ a description 
( h[ su* models or programs address$    
racial or e?nic disp>ities 9 access or  
utilization4  7vi7 ,qualitative         

in=mation on b5efici>y exp]i5ce4  7vii7 
,*all5ges fac$ & lessons le>n$ by !     
,/ate 9 integrat+ 7or increas+ !        
integration (7 teleheal? into ! deliv]y 
sy/em = furni%+ m$ical assi/ance to     
eligible pregnant or po/p>tum wom5 9 !  
areas t>get$ "u ! demon/ration project4 
7#b7 ,reports to congress  7,a7 ,initial
 report ,n lat] ?an #b ye>s aft] ! date 
( enactm5t ( ?is ,act1 ! ,secret>y %all 
submit a report to ,congress summ>iz+ ! 
in=mation report$ by ,/ates "u p>agraph 
7#a77;,a74  7,b7 ,f9al report ,n lat]   
?an #e ye>s aft] ! date ( enactm5t ( ?is
 ,act1 ! ,secret>y %all submit a report 
to ,congress summ>iz+ ! in=mation       
report$ by ,/ates "u p>agraph 7#a77;,b74
  #aj4 ,,cms report on cov]age ( remote 
physiologic monitor+ devices & impact on
 mat]nal & *ild heal? outcomes "u       
,m$icaid  7a7 ,9 g5]al ,n lat] ?an #ah  
mon?s aft] ! date ( enactm5t ( ?is ,act1
 ! ,secret>y %all submit to ,congress a 
report conta9+ in=mation on au?orities &
 ,/ate practices = cov]+ remote         

physiological monitor+ devices1 includ+ 
limitations & b>ri]s to su* cov]age & ! 
impact on mat]nal heal? outcomes1 & to !
 ext5t appropriate1 recomm5dations on h[
 to address su* limitations or b>ri]s   
relat$ to cov]age ( remote physiologic  
devices "u ,/ate ,m$icaid programs1     
includ+1 b n limit$ to1 pulse oximet]s1 
blood pressure cuffs1 scales1 & blood   
glucose monitors1 ) ! goal ( improv+    
mat]nal & *ild heal? outcomes = pregnant
 & po/p>tum wom5 enroll$ 9 ,/ate        
,m$icaid programs4  7b7 ,/ate res\rces  
,n lat] ?an #f mon?s aft] ! submission (
 ! report requir$ by subsection 7a71 !  
,secret>y %all update res\rces = ,/ate  
,m$icaid programs1 su* z ,/ate ,m$icaid 
teleheal? toolkits1 to be consi/5t ) !  
recomm5dations provid$ 9 su* report4    
#aa4 ,guidance on community-bas$ mat]nal
 heal? programs ,n lat] ?an #c ye>s aft]
 ! date ( enactm5t ( ?is ,act1 !        
,secret>y %all issue guidance to ,/ate  
,m$icaid programs to support ! use (    
evid5ce-bas$ community-bas$ mat]nal     

heal? programs1 includ+ programs t (f]  
gr\p pr5atal c>e1 home visit+ s]vices1  
*ildbir? & p>5t+ education1 pe]         
supports1 /illbir? prev5tion activities1
 & sub/ance use disord] & recov]y       
supports1 "u su* programs1 & any o!r    
programs z det]m9$ by ! ,secret>y4  #ab4
 ,develop+ guidance on mat]nal mortality
 & sev]e morbidity r$uction = mat]nal   
c>e provid]s receiv+ paym5t "u !        
,m$icaid program  7a7 ,9 g5]al ,subject 
to ! availability ( appropriations1 n   
lat] ?an #cf mon?s aft] ! date (        
enactm5t ( ?is ,act1 ! ,secret>y %all1 9
 consultation ) ! ,advisory ,committee  
on ,r$uc+ ,mat]nal ,dea?s e/abli%$ "u   
subsection 7c7 & ! ,task ,=ce on        
,mat]nal ,m5tal ,heal? e/abli%$ "u      
section #aaac ( division ,,ff ( !       
,consolidat$ ,appropriations ,act1 #bjbc
 7,public ,law #aag-cbh71 publi% on a   
public website ( ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices guidance = ,/ates on  
res\rces & /rategies = hospitals1       
free/&+ bir? c5t]s 7z def9$ 9 section   

#aije7l77#c77;,b7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4                     
#acif;d7l77#c77;,b7771 & o!r mat]nal c>e
 provid]s z det]m9$ by ! ,secret>y =    
r$uc+ mat]nal mortality & sev]e         
morbidity 9 individuals :o are eligible 
= & receiv+ m$ical assi/ance "u ,m$icaid
 or ,,*ip4  7b7 ,updates ,! ,secret>y   
%all1 9 consultation ) ! ,advisory      
,committee on ,r$uc+ ,mat]nal ,dea?s    
e/abli%$ "u subsection 7c7 & ! ,task    
,=ce on ,mat]nal ,m5tal ,heal? e/abli%$ 
"u section #aaac ( division ,,ff ( !    
,consolidat$ ,appropriations ,act1 #bjbc
 7,public ,law #aag-cbh71 update !      
guidance & res\rces describ$ 9          
subsection 7a7 at lea/ once e #c ye>s4  
7c7 ,consultation ) advisory committee  
7#a7 ,e/abli%m5t ,subject to !          
availability ( appropriations1 n lat]   
?an #ah mon?s aft] ! date ( enactm5t (  
?is ,act1 ! ,secret>y %all e/abli% an   
advisory committee to be kn[n z !       
,national ,advisory ,committee on ,r$uc+
 ,mat]nal ,dea?s 7ref]r$ to 9 ?is       

section z ! ,advisory ,committee74  7#b7
 ,duties ,! ,advisory ,committee %all   
provide cons5sus advice & guidance to ! 
,secret>y on ! developm5t & compilation 
( ! guidance describ$ 9 subsection 7a7  
7& any updates to su* guidance74  7#c7  
,memb]%ip  7,a7 ,9 g5]al ,! ,secret>y1 9
 consultation ) su* o!r heads ( ag5cies1
 z ! ,secret>y deems appropriate & 9    
accordance ) ?is p>agraph1 %all appo9t n
 m ?an #da memb]s to ! ,advisory        
,committee4 ,9 appo9t+ su* memb]s1 !    
,secret>y %all ensure t-- 7i7 ! total   
numb] ( memb]s ( ! ,advisory ,committee 
is an odd numb]2 &  7ii7 ! total numb] (
 vot+ memb]s :o are n ,f$]al (ficials   
does n exce$ ! total numb] ( vot+ ,f$]al
 memb]s :o are ,f$]al (ficials4  7,b7   
,requir$ memb]s  7i7 ,f$]al (ficials ,! 
,advisory ,committee %all include z vot+
 memb]s ! foll[+ ,f$]al (ficials1 or _! 
designees3  7,i7 ,! ,secret>y4  7,,ii7  
,! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices4  7,,iii7 ,! ,director
 ( ! ,c5t]s = ,disease ,control &       

,prev5tion4  7,,iv7 ,! ,associate       
,adm9i/rator ( ! ,mat]nal & ,*ild ,heal?
 ,bureau ( ! ,heal? ,res\rces & ,s]vices
 ,adm9i/ration4  7,v7 ,! ,director ( !  
,ag5cy = ,heal?c>e ,rese>* & ,quality4  
7,,vi7 ,! ,national ,coord9ator = ,heal?
 ,in=mation ,te*nology4  7,,vii7 ,!     
,director ( ! ,national ,in/itutes (    
,heal?4  7,,viii7 ,! ,secret>y (        
,vet]ans ,affairs4  7,,ix7 ,! ,director 
( ! ,indian ,heal? ,s]vice4  7,x7 ,!    
,deputy ,assi/ant ,secret>y = ,m9ority  
,heal?4  7,,xi7 ,! ,adm9i/rator ( !     
,sub/ance ,abuse & ,m5tal ,heal?        
,s]vices ,adm9i/ration4  7,,xii7 ,!     
,deputy ,assi/ant ,secret>y = ,wom5's   
,heal?4  7,,xiii7 ,su* o!r ,f$]al       
(ficials or _! designees z ! ,secret>y  
det]m9es appropriate4  7ii7 ,non-,f$]al 
(ficials  7,i7 ,9 g5]al ,! ,advisory    
,committee %all include ! foll[+ z vot+ 
memb]s3  7aa7 ,at lea/ #a repres5tative 
f a pr(essional organization repres5t+  
hospitals & heal? sy/ems4  7bb7 ,at lea/
 #a repres5tative f a m$ical pr(essional

 organization repres5t+ prim>y c>e      
provid]s4  7cc7 ,at lea/ #a             
repres5tative f a m$ical pr(essional    
organization repres5t+ g5]al            
ob/etrician-gynecologi/s4  7dd7 ,at lea/
 #a repres5tative f a m$ical pr(essional
 organization repres5t+ c]tifi$         
nurse-midwives4  7ee7 ,at lea/ #a       
repres5tative f a m$ical pr(essional    
organization repres5t+ o!r mat]nal fetal
 m$ic9e provid]s4  7ff7 ,at lea/ #a     
repres5tative f a m$ical pr(essional    
organization repres5t+ ane/hesiologi/s4 
7gg7 ,at lea/ #a repres5tative f a      
m$ical pr(essional organization         
repres5t+ em]g5cy m$ic9e physicians &   
urg5t c>e provid]s4  7hh7 ,at lea/ #a   
repres5tative f a m$ical pr(essional    
organization repres5t+ nurses4  7ii7 ,at
 lea/ #a repres5tative f a pr(essional  
organization repres5t+ community heal?  
work]s4  7jj7 ,at lea/ #a repres5tative 
f a pr(essional organization repres5t+  
d\las4  7kk7 ,at lea/ #a repres5tative f
 a pr(essional organization repres5t+   

p]9atal psy*iatri/s4  7ll7 ,at lea/ #a  
repres5tative f ,/ate-affiliat$ programs
 or exi/+ collaboratives ) demon/rat$   
exp]tise or success 9 improv+ mat]nal   
heal?4  7mm7 ,at lea/ #a director ( a   
,/ate ,m$icaid ag5cy t has _h demon/rat$
 success 9 improv+ mat]nal heal?4  7nn7 
,at lea/ #a repres5tative f an accr$it+ 
organization = mat]nal heal? quality &  
safety /&>ds4  7oo7 ,at lea/ #a         
repres5tative f a mat]nal pati5t        
advocacy organization ) liv$ exp]i5ce ( 
sev]e mat]nal morbidity4  7pp7 ,at lea/ 
#a m$ical pr(essional :o is an exp]t 9 !
 treatm5t ( pregnant wom5 ) sub/ance use
 disord]4  7,,ii7 ,requirem5ts ,ea*     
individual select$ to be a memb] "u ?is 
clause %all-- 7aa7 h exp]tise 9 mat]nal 
heal?2  7bb7 n be a ,f$]al (ficial2 &   
7cc7 h exp]i5ce work+ ) populations t   
are at high] risk = mat]nal mortality or
 sev]e morbidity1 su* z populations t   
exp]i5ce racial1 e?nic1 & geographic    
heal? disp>ities1 pregnant & po/p>tum   
wom5 exp]i5c+ a m5tal heal? disord]1 or 

pregnant or po/p>tum wom5 ) o!r         
comorbidities su* z sub/ance use        
disord]s1 hyp]t5sion1 ?yroid disord]s1 &
 sickle cell disease4  7,c7 ,additional 
memb]s  7i7 ,9 g5]al ,9 addition to !   
memb]s requir$ to be appo9t$ "u         
subp>agraph 7,b71 ! ,secret>y may appo9t
 z non-vot+ memb]s to ! ,advisory       
,committee su* o!r individuals )        
relevant exp]tise or exp]i5ce z !       
,secret>y %all det]m9e appropriate1 :i* 
may include1 b is n limit$ to1          
individuals describ$ 9 clause 7ii74     
7ii7 ,sugge/$ additional memb]s ,!      
individuals describ$ 9 ?is clause are ! 
foll[+3  7,i7 ,repres5tatives f ,/ate   
mat]nal mortality review committees &   
p]9atal quality collaboratives4  7,,ii7 
,m$ical provid]s :o c>e = wom5 & infants
 dur+ pregnancy & ! po/p>tum p]iod1 su* 
z family practice physicians1           
c>diologi/s1 pulmonology critical c>e   
speciali/s1 endocr9ologi/s1             
p$iatricians1 & neonatologi/s4  7,,iii7 
,repres5tatives f ,/ate & local public  

heal? dep>tm5ts1 includ+ ,/ate ,m$icaid 
,ag5cies4  7,,iv7 ,subject matt] exp]ts 
9 conduct+ outrea* to wom5 :o are       
,african ,am]ican or belong to ano!r    
m9ority gr\p4  7,v7 ,directors ( ,/ate  
ag5cies responsible = adm9i/]+ a ,/ate's
 mat]nal & *ild heal? s]vices program "u
 title ,v ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #gja et seq474  7,,vi7   
,exp]ts 9 m$ical education or physician 
tra9+4  7,,vii7 ,repres5tatives f       
,m$icaid manag$ c>e organizations4  7#d7
 ,applicability ( ,,faca ,*apt] #aj (   
title #e1 ,unit$ ,/ates ,code1 %all     
apply to ! committee e/abli%$ "u ?is    
subsection4  7d7 ,cont5ts ,! guidance   
describ$ 9 subsection 7a7 %all include1 
) respect to hospitals1 free/&+ bir?    
c5t]s1 & o!r mat]nal c>e provid]s1 !    
foll[+3 7#a7 ,be/ practices reg>d+      
evid5ce-bas$ scre5+ & cl9ician education
 initiatives relat+ to scre5+ & treatm5t
 protocols = individuals :o are at risk 
( exp]i5c+ complications relat$ to      
pregnancy1 ) an emphasis on individuals 

) preconditions directly l9k$ to        
pregnancy complications & mat]nal       
mortality & sev]e morbidity1 includ+--  
7,a7 me?ods to id5tify individuals :o   
are at risk ( mat]nal mortality or sev]e
 morbidity1 includ+ risk /ratification2 
7,b7 evid5ce-bas$ risk factors associat$
 ) mat]nal mortality or sev]e morbidity 
& racial1 e?nic1 & geographic heal?     
disp>ities2  7,c7 evid5ce-bas$ /rategies
 to r$uce risk factors associat$ )      
mat]nal mortality or sev]e morbidity    
?r\gh s]vices :i* may be cov]$ "u       
,m$icaid or ,,*ip1 includ+1 b n limit$  
to1 activities by community heal? work]s
 7z su* t]m is def9$ 9 section #baac ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acigmm77 t are fund$ by a grant aw>d$  
"u su* section2  7,d7 res\rces available
 to su* individuals1 su* z nutrition    
assi/ance & education1 home visitation1 
m5tal heal? & sub/ance use disord]      
s]vices1 smok+ cessation programs1      
pre-natal c>e1 & o!r evid5ce-bas$       
mat]nal mortality or sev]e morbidity    

r$uction programs2  7,e7 examples (     
educational mat]ials us$ by provid]s (  
ob/etrics s]vices2  7,f7 me?ods =       
improv+ community c5traliz$ c>e1 includ+
 provid+ teleheal? s]vices or home      
visits to increase & facilitate access  
to & engagem5t 9 pr5atal & po/p>tum c>e 
& collaboration ) home heal? ag5cies1   
community heal? c5t]s1 local public     
heal? dep>tm5ts1 or cl9ics2  7,g7       
guidance on m$ical record diagnosis     
codes l9k$ to mat]nal mortality & sev]e 
morbidity1 includ+1 if applicable1 codes
 relat$ to social risk factors1 & me?ods
 = educat+ cl9icians on ! prop] use (   
su* codes2  7,h7 risk appropriate       
transf] protocols dur+ pregnancy1       
*ildbir?1 & ! po/p>tum p]iod2 &  7,i7   
any o!r in=mation relat$ to prev5tion & 
treatm5t ( at-risk individuals det]m9$  
appropriate by ! ,secret>y4  7#b7       
,guidance on monitor+ programs =        
individuals :o h be5 id5tifi$ z at risk 
( complications relat$ to pregnancy4    
7#c7 ,be/ practices = su* hospitals1    

free/&+ bir? c5t]s1 & provid]s to make  
pregnant wom5 aw>e ( ! complications    
relat$ to pregnancy4  7#d7 ,a fact %eet 
= provid+ pregnant wom5 :o are receiv+  
c>e on an outpati5t basis ) a notice    
dur+ ! pr5atal /age ( pregnancy t--     
7,a7 expla9s ! risks associat$ )        
pregnancy1 bir?1 & ! po/p>tum p]iod     
7includ+ ! risks ( hemorrhage1 pret]m   
bir?1 sepsis1 eclampsia1 ob/ruct$       
labor71 *ronic conditions 7includ+ high 
blood pressure1 diabetes1 he>t disease1 
depression1 & obesity7 correlat$ )      
adv]se pregnancy outcomes1 risks        
associat$ ) advanc$ mat]nal age1 & !    
importance ( adh]+ to a p]sonaliz$ plan 
( c>e2  7,b7 highlights multimodal &    
evid5ce-bas$ prev5tion & treatm5t       
te*niques2  7,c7 highlights evid5ce-bas$
 programs & activities to r$uce !       
incid5ce ( /illbir? 7includ+ track+ &   
aw>5ess ( fetal movem5ts1 improvem5t (  
bir? tim+ = pregnancies ) risk factors1 
initiatives t enc\rage safe sleep+      
positions dur+ pregnancy1 scre5+ &      

surveillance = fetal gr[? re/riction1   
ef=ts to a*ieve smok+ cessation dur+    
pregnancy1 community-bas$ programs t    
provide home visits or o!r types (      
support1 & any o!r rese>* or            
evid5ce-bas$ programm+ to prev5t        
/illbir?s72  7,d7 provides = a me?od    
7?r\gh signature or o!rwise7 = su* an   
individual1 or a p]son act+ on su*      
individual's behalf1 to ackn[l$ge       
receipt ( su* fact %eet2  7,e7 is word$ 
9 an easily und]/&able mann] & made     
available 9 multiple languages &        
accessible =mats det]m9$ appropriate by 
! ,secret>y2 &  7,f7 includes any o!r   
in=mation det]m9$ appropriate by !      
,secret>y4  7#e7 ,a template = a        
volunt>y cl9ician *eckli/ t outl9es !   
m9imum responsibilities t cl9icians1 su*
 z physicians1 c]tifi$ nurse-midwives1  
em]g5cy room & urg5t c>e provid]s1      
nurses & o!rs1 are expect$ to meet 9    
ord] to promote quality & safety 9 !    
provision ( ob/etric s]vices4  7#f7 ,a  
template = a volunt>y *eckli/ t outl9es 

! m9imum responsibilities t hospital    
lead]%ip responsible = direct pati5t    
c>e1 su* z ! in/itution's presid5t1 *ief
 m$ical (fic]1 *ief nurs+ (fic]1 or o!r 
hospital lead]%ip t directly report to !
 presid5t or *ief executive (fic] ( !   
in/itution1 %\ld meet to promote        
hospital-wide initiatives t improve     
quality & safety 9 ! provision (        
ob/etric s]vices4  7#g7 ,in=mation on   
multi-/akehold] quality improvem5t      
initiatives1 su* z ! ,alliance =        
,innovation on ,mat]nal ,heal?1 ,/ate   
p]9atal quality improvem5t initiatives1 
& o!r simil> initiatives det]m9$        
appropriate by ! ,secret>y1 includ+--   
7,a7 in=mation ab\t su* improvem5t      
initiatives & h[ to jo92  7,b7 in=mation
 ab\t public mat]nal data collection    
c5t]s2  7,c7 in=mation ab\t quality     
metrics us$ & outcomes a*iev$ by su*    
improvem5t initiatives2  7,d7 in=mation 
ab\t data %>+ te*niques us$ by su*      
improvem5t initiatives2  7,e7 in=mation 
ab\t data s\rces us$ by su* improvem5t  

initiatives to id5tify mat]nal mortality
 & sev]e morbidity risks2  7,f7         
in=mation ab\t int]v5tions us$ by su*   
improvem5t initiatives to mitigate risks
 ( mat]nal mortality & sev]e morbidity2 
7,g7 in=mation ab\t data collection     
te*niques on race1 e?nicity1 geography1 
age1 income1 & o!r demographic in=mation
 us$ by su* improvem5t initiatives2 &   
7,h7 any o!r in=mation det]m9$          
appropriate by ! ,secret>y4  7e7        
,inclusion ( be/ practices ,n lat] ?an  
#ah mon?s aft] ! date ( ! publication ( 
! guidance requir$ "u subsection 7a71 ! 
,secret>y %all update su* guidance to   
include be/ practices id5tifi$ by !     
,secret>y = su* hospitals1 free/&+ bir? 
c5t]s1 & provid]s to track mat]nal      
mortality & sev]e morbidity tr5ds by    
cl9icians at su* hospitals1 free/&+ bir?
 c5t]s1 & provid]s includ+--  7#a7 ways 
to e/abli% scor+ sy/ems1 :i* may include
 quality trigg]s & safety & quality     
metrics to score case & pati5t outcome  
metrics1 = su* cl9icians2  7#b7 me?ods  

to id5tify1 educate1 & improve su*      
cl9icians :o may h high] rates ( mat]nal
 mortality or sev]e morbidity comp>$ to 
_! regional or ,/ate pe]s 7tak+ into    
acc\nt diff]5ces 9 pati5t risk = adv]se 
outcomes1 :i* may include social risk   
factors72  7#c7 me?ods = us+ su* data & 
track+ to enhance rese>* ef=ts focus$ on
 mat]nal heal?1 :ile also improv+ pati5t
 outcomes1 cl9ician education & tra9+1 &
 coord9ation ( c>e2 &  7#d7 any o!r     
in=mation det]m9$ appropriate by !      
,secret>y4  7f7 ,cultural & l+ui/ic     
appropriat5ess ,to ! ext5t practicable1 
! ,secret>y %\ld develop ! guidance1 be/
 practices1 fact %eets1 templates1 & o!r
 mat]ials t are requir$ "u ?is section 9
 a trauma-in=m$1 culturally &           
l+ui/ically appropriate mann]4  #ac4    
,program relat$ to r$uc+ ces>ean bir?s &
 increas+ rates ( vag9al bir? aft]      
ces>ean ,section #cag,k7a7 ( ! ,public  
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bdg;b-#ab7;a77 is am5d$--  7#a7 9      
p>agraph 7#a7-- 7,a7 by /rik+ & to      

develop or support & ins]t+ to develop  
or support2 &  7,b7 by ins]t+ 1 & to    
e/abli% a grant program1 or ext5d !     
,alliance = ,innovation on ,mat]nal     
,heal?1 = ! e/abli%m5t ( p]9atal quality
 collaboratives to r$uce ces>ean section
 rates & increase vag9al bir? aft]      
ces>ean rates be=e ! p]iod at ! end2 &  
7#b7 9 p>agraph 7#b71 by add+ at ! end !
 foll[+3  7,e7 ,! ,secret>y may e/abli% 
a competitive grant program1 or ext5d   
exi/+ programs1 includ+ ! ,alliance =   
,innovation on ,mat]nal ,heal?1 = !     
e/abli%m5t or support ( p]9atal quality 
collaboratives1 ) a focus on mat]nity   
c>e heal? pr(essional t>get areas & o!r 
areas ) limit$ bir?+ res\rces1 to r$uce 
ces>ean bir? rates & increase vag9al    
bir? aft] ces>ean rates1 includ+ ?r\gh--
 7i7 coord9ation ) hospitals1 cl9ical   
teams1 ob/etricians & gynecologi/s1     
bir?+ c5t]s & community-bas$ mat]nal    
heal? organizations1 public heal?       
ag5cies1 midwives1 d\las1 pati5ts &     
families1 & o!r relevant entities2  7ii7

 provid+ support & tra9+ to hospital &  
cl9ical teams = quality improvem5t1 z   
appropriate2  7iii7 employ+ /rategies t 
provide opportunities = heal? c>e       
pr(essionals & cl9ical teams to         
collaborate across heal? c>e sett+s &   
discipl9es1 includ+ midwif]y c>e1 d\la  
support1 ! integration ( prim>y c>e &   
m5tal heal?1 & bl5d$ case paym5t rates2 
7iv7 us+ data1 disaggregat$ by race &   
e?nicity1 to provide timely fe$back     
across hospital & cl9ical teams1 docum5t
 basel9e ces>ean & vag9al bir? rates1 & 
measure progress2 &  7v7 promotion (    
exi/+ evid5ce on ! be/ practices = !    
safe r$uction ( prim>y ces>ean bir?s4  4
  #ad4 ,collection ( in=mation relat$ to
 social det]m9ants ( ! heal? ( ,m$icaid 
& ,,*ip b5efici>ies  7a7 ,implem5tation 
assessm5t report to ,congress  7#a7 ,9  
g5]al ,n lat] ?an #b ye>s aft] ! date ( 
enactm5t ( ?is ,act1 ! ,secret>y %all   
submit a report to ,congress t includes 
a description ( :e!r & h[ in=mation     
relat$ to ! social det]m9ants ( heal? = 

individuals eligible = m$ical assi/ance 
"u ,m$icaid or *ild heal? assi/ance or  
pregnancy-relat$ assi/ance "u ,,*ip may 
be captur$ "u ! data sy/ems = su*       
programs z 9 effect on ! date su* report
 is submitt$1 includ+-- 7,a7 a          
description ( :e!r & h[ ,,icd-#aj codes 
7or successor codes7 may be us$ to      
id5tify social det]m9ants ( heal? 9     
programs su* z ,m$icaid & ,,*ip1 & :e!r 
o!r claims file or demographic in=mation
 may be employ$2 &  7,b7 a description (
 :e!r exi/+ data sy/ems "u ,m$icaid &   
,,*ip c\ld be employ$ to capture su*    
in=mation1 :e!r program or sy/em *anges 
w\ld be requir$1 h[ privacy &           
confid5tiality z requir$ "u applicable  
law & regulations w\ld be ma9ta9$1 & !  
res\rces & timeframes at ! ,f$]al &     
,/ate levels t w\ld be ne$$ to make su* 
*anges4  7#b7 ,guidance = ,/ates ,!     
,secret>y %all issue detail$ guidance = 
,/ates concurr5t ) ! submission ( !     
report to ,congress "u p>agraph 7#a74   
,su* guidance %all address--  7,a7 :e!r 

& h[ in=mation relat$ to ! social       
det]m9ants ( heal? = individuals        
eligible = m$ical assi/ance "u ,m$icaid 
or *ild heal? assi/ance or              
pregnancy-relat$ assi/ance "u ,,*ip c\ld
 be captur$ employ+ exi/+ sy/ems "u su* 
programs2 &  7,b7 implem5tation         
consid]ations = captur+ su* in=mation1  
includ+ :e!r program or sy/em *anges    
w\ld be requir$1 :e!r additional /eps   
w\ld be ne$$ to ma9ta9 privacy &        
confid5tiality z requir$ "u relevant    
laws & regulations1 & ! res\rces &      
timeframes at t w\ld be ne$$ to make su*
 *anges4  7#c7 ,/akehold] input ,!      
,secret>y %all develop ! report requir$ 
"u p>agraph 7#a7 & ! guidance requir$ "u
 p>agraph 7#b7 ) ! input ( relevant     
/akehold]s1 su* z ,/ate ,m$icaid        
directors1 ,m$icaid manag$ c>e          
organizations1 & o!r relevant ,f$]al    
ag5cies su* z ! ,c5t]s = ,disease       
,control & ,prev5tion1 ! ,heal?         
,res\rces ,s]vices ,adm9i/ration1 & !   
,ag5cy = ,heal?c>e ,rese>* & ,quality4  

7#d7 ,action plan report  7,a7 ,9 g5]al 
,if ! ,secret>y det]m9es 9 ! report     
requir$ "u p>agraph 7#a7 t in=mation    
relat$ to ! social det]m9ants ( heal? = 
individuals eligible = m$ical assi/ance 
"u ,m$icaid or *ild heal? assi/ance or  
pregnancy-relat$ assi/ance "u ,,*ip _c  
be captur$ "u ! data sy/ems = su*       
programs z 9 effect on ! date su* report
 is submitt$1 !n1 n lat] ?an #f mon?s   
aft] su* date1 ! ,secret>y %all submit a
 second report to ,congress t conta9s an
 action plan = implem5t+ ! program or   
data sy/ems *anges ne$$ 9 ord] = su*    
in=mation to be collect$ :ile ma9ta9+   
privacy & confid5tiality z requir$ "u   
relevant laws & regulations4 ,! action  
plan %\ld be prep>$ s z to be implem5t$ 
by ! ,f$]al ,gov]nm5t & ,/ates n lat]   
?an #b ye>s aft] ! date on :i* ! report 
requir$ "u ?is p>agraph is submitt$ to  
,congress4  7,b7 ,revis$ guidance =     
/ates ,! ,secret>y %all revise & reissue
 ! guidance = ,/ates requir$ "u p>agraph
 7#b7 to take into acc\nt ! action plan 

includ$ 9 ! report submitt$ to ,congress
 "u subp>agraph 7,a74  7#e7             
,au?orization ( appropriations  7,a7    
,f$]al co/s ,!re are au?oriz$ to be     
appropriat$ to ! ,secret>y1 #dj1jjj1jjj 
= purposes ( prep>+ ! reports requir$ "u
 ?is subsection & implem5t+ ! collection
 ( in=mation relat$ to ! social         
det]m9ants ( heal? = individuals        
eligible = m$ical assi/ance "u ,m$icaid 
or *ild heal? assi/ance or              
pregnancy-relat$ assi/ance "u ,,*ip4    
7,b7 ,/ate co/s ,!re are au?oriz$ to be 
appropriat$ to ! ,secret>y1 #ej1jjj1jjj 
= purposes ( mak+ paym5ts to ,/ates 9   
accordance ) a me?odology e/abli%$ by ! 
,secret>y = ,/ate exp5ditures           
attributable to plann+ = & implem5t+ !  
collection ( su* in=mation 9 accordance 
) subsection 7d7 ( section #aidf ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acifw-#e7 7z add$ by subsection 7b774  
7b7 ,application to ,/ates ,section     
#aidf ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acifw-#e7 is am5d$ by add+ at

 ! end ! foll[+3  7d7 ,collection (     
in=mation relat$ to social det]m9ants ( 
heal?  7#a7 ,developm5t ( collection    
me?ods  7,a7 ,9 g5]al ,subject to       
p>agraph 7#e71 ! ,secret>y1 9           
consultation ) ! ,/ates1 %all develop a 
me?od = collect+ /&>diz$ & aggregat$    
,/ate-level in=mation relat$ to social  
det]m9ants t may factor into ! heal? (  
b5efici>ies "u ?is title & b5efici>ies  
"u title ,,xxi :i* ! ,/ates1 not)/&+    
section #aijb7;a77#g7 & z a condition = 
meet+ ! requirem5ts ( section           
#aijb7;a77#f7 & section #bajg7;b77#a71  
%all use to annually report su*         
in=mation3 7i7 ,a model uni=m report+   
field ?r\gh ! trans=m$ ,m$icaid         
,/ati/ical ,in=mation ,sy/em 7,t-,,msis7
 7or a successor sy/em7 or ano!r        
appropriate report+ plat=m1 z approv$ by
 ! ,secret>y4  7ii7 ,a model uni=m      
que/ionnaire or survey 7:i* may be      
includ$ z "p ( an exi/+ survey1         
que/ionnaire1 or =m adm9i/]$ by !       
,secret>y71 = purposes ( ! ,/ate or !   

,secret>y collect+ su* in=mation by     
adm9i/]+ regul>ly b n less ?an annually 
a que/ionnaire or survey ( b5efici>ies  
"u ?is title & b5efici>ies "u title     
,,xxi4  7iii7 ,a model uni=m =m to be   
adapt$ = inclusion 9 ! ,m$icaid & ,,*ip 
,scorec>d develop$ by ! ,c5t]s = ,m$ic>e
  ,m$icaid ,s]vices1 = purposes ( !     
,secret>y collect+ su* in=mation4  7iv7 
,an alt]native me?od id5tifi$ by !      
,secret>y = collect+ su* in=mation4     
7,b7 ,implem5tation ,9 c>ry+ out !      
requirem5ts ( subp>agraph 7,a71 !       
,secret>y %all--  7i7 = purposes ( !    
me?od describ$ 9 clause 7i7 ( su*       
subp>agraph1 det]m9e ! appropriate      
provid]s & frequ5cy ) :i* su* provid]s  
%all complete ! report+ field id5tifi$ &
 report ! in=mation to ! ,/ate2  7ii7 = 
purposes ( ! me?od describ$ 9 clause    
7ii7 ( su* subp>agraph1 id5tify ! means 
& frequ5cy 7:i* %all be no less frequ5t 
?an once p] ye>7 ) :i* a que/ionnaire or
 survey ( b5efici>ies is to be conduct$2
  7iii7 ) respect to any me?od describ$ 

9 su* subp>agraph1 issue guidance =     
ensur+ compliance ) applicable laws     
reg>d+ b5efici>y in=m$ cons5t1 privacy1 
& anonymity ) respect to ! in=mation    
collect$ "u su* me?od2  7iv7 ) respect  
to ! collection ( in=mation relat+ to   
b5efici>ies :o are *ildr51 issue        
guidance on ! collection ( su* in=mation
 f a p>5t1 legal gu>dian1 or any o!r    
p]son :o is legally au?oriz$ to %>e su* 
in=mation on behalf ( ! *ild :5 ! direct
 collection ( su* in=mation f *ildr5 may
 n o!rwise be feasible or appropriate2 &
  7v7 regul>ly evaluate ! me?od "u su*  
subp>agraph & ! in=mation report$ us+   
su* me?od1 &1 z ne$$1 make updates to ! 
me?od & ! in=mation report$4  7#b7      
,social det]m9ants ( heal? ,! in=mation 
collect$ 9 accordance ) ! me?od made    
available "u p>agraph 7#a7 %all1 to !   
ext5t practicable1 include /&>diz$      
def9itions = id5tify+ social det]m9ants 
( heal? ne$s id5tifi$ 9 ! ,,icd-#aj     
diagno/ic codes ,z#ee ?r\gh ,z#fe 7or   
any su* successor diagno/ic codes71 z   

def9$ by ! ,heal?y ,p #bjbj & relat$    
initiatives ( ! ,(fice ( ,disease       
,prev5tion & ,heal? ,promotion ( !      
,dep>tm5t ( ,heal? & ,human ,s]vices1 or
 any o!r /&>diz$ set ( def9itions =     
social det]m9ants ( heal? id5tifi$ by ! 
,secret>y4 ,su* def9itions %all         
incorporate measures = quantify+ !      
relative sev]ity ( any su* social       
det]m9ant ( heal? ne$ id5tifi$ 9 an     
individual4  7#c7 ,f$]al privacy        
requirem5ts ,no?+ 9 ?is subsection %all 
be con/ru$ to sup]s$e any ,f$]al privacy
 or confid5tiality requirem5t1 includ+ !
 regulations promulgat$ "u section      
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif & section #edc ( ! ,public ,heal? 
,s]vice ,act & any regulations          
promulgat$ !reund]4  7#d7 ,application  
to t]ritories  7,a7 ,9 g5]al ,to ! ext5t
 t ! ,secret>y det]m9es t x is n        
practicable = a ,/ate specifi$ 9        
subp>agraph 7,b7 to report in=mation 9  
accordance ) ! me?od made available "u  

p>agraph 7#a71 ?is subsection %all n    
apply ) respect to su* ,/ate4  7,b7     
,t]ritories specifi$ ,! ,/ates specifi$ 
9 ?is subp>agraph are ,pu]to ,rico1 !   
,virg9 ,isl&s1 ,guam1 ,am]ican ,samoa1 &
 ! ,nor!rn ,m>iana ,isl&s4  7#e7        
,application  7,a7 ,9 g5]al ,subject to 
subp>agraph 7,b71 ! requirem5t = a ,/ate
 to collect in=mation 9 accordance ) !  
me?od made available "u p>agraph 7#a7   
%all n apply to ! ,/ate be=e ! date t is
 #d ye>s aft] ! date ( enactm5t ( ?is   
subsection4  7,b7 ,alt]native date ,if  
an action plan is submitt$ to ,congress 
"u section #ad7;a77#d7 ( ! ,heal?y ,moms
 & ,babies ,act1 9 lieu ( ! date        
describ$ 9 subp>agraph 7,a71 !          
requirem5t = a ,/ate to collect         
in=mation 9 accordance ) ! me?od made   
available "u p>agraph 7#a7 %all n apply 
to ! ,/ate be=e ! date specifi$ 9 su*   
action plan4  7#f7 ,appropriation ,!re  
is appropriat$ to ! ,secret>y = fiscal  
ye> #bjbd & ea* fiscal ye> !reaft]      
#a1jjj1jjj to c>ry out ! provisions (   

?is section & subsection 7b77#b77;,b74  
4  7c7 ,report on data analyses ,section
 #aidf7;b77#b7 ( su* ,act 7#db ,u4,s4,c4
 #acifw-#e7;b77#b77 is am5d$-- 7#a7 by  
/rik+ ,n lat] ?an & ins]t+ ! foll[+3    
7,a7 ,initial reports ,n lat] ?an  2 &  
7#b7 by add+ at ! end ! foll[+3  7,b7   
,reports on collection ( in=mation      
relat$ to social det]m9ants ( heal?  7i7
 ,9 g5]al ,n lat] ?an #e ye>s aft] !    
date on :i* ! requirem5t to collect     
in=mation "u subsection 7d7 is fir/     
applicable to ,/ates1 ! ,secret>y %all  
submit to ,congress a report t includes 
aggregate f9d+s & tr5ds across          
respective b5efici>y populations =      
improv+ ! id5tification ( social        
det]m9ants ( heal? = b5efici>ies "u ?is 
title & b5efici>ies "u title ,,xxi bas$ 
on analyses ( ! data collect$ "u        
subsection 7d74  7ii7 ,int]im report ,n 
lat] ?an #c ye>s aft] ! date ( enactm5t 
( ?is subp>agraph1 ! ,secret>y %all     
submit to ,congress an int]im report on 
progress 9 develop+1 implem5t+1 &       

utiliz+ ! me?od select$ by ! ,secret>y  
"u subsection 7d77#a7 along ) any       
available1 prelim9>y in=mation t has be5
 collect$ us+ su* me?od4  4  7d7 ,con=m+
 am5dm5t ,section #bajg7;e77#a7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acig;gg7e77#a77 is am5d$ by add+ at !  
end ! foll[+3  7,u7 ,section #aidf      
7relat+ to address+ heal? c>e           
disp>ities74  4  #ae4 ,report on paym5t 
me?odologies = transf]r+ pregnant wom5  
betwe5 facilities be=e1 dur+1 & aft]    
*ildbir?  7a7 ,9 g5]al ,subject to !    
availability ( appropriations1 n lat]   
?an #cf mon?s aft] ! date ( enactm5t (  
?is ,act1 ! ,secret>y %all submit to    
,congress a report on ! paym5t          
me?odologies "u ,m$icaid = ! antep>tum1 
intrap>tum1 & po/p>tum transf] (        
pregnant wom5 f "o heal? c>e facility to
 ano!r1 includ+ any pot5tial dis9c5tives
 or regulatory b>ri]s to su* transf]s4  
7b7 ,consultation ,9 develop+ ! report  
requir$ "u subsection 7a71 ! ,secret>y  
%all consult ) ! advisory committee     

e/abli%$ "u section #ab7;c74  #af4      
,m$icaid guidance on ,/ate options to   
address social det]m9ants ( heal? =     
pregnant & po/p>tum wom5  7a7 ,9 g5]al  
,n lat] ?an #b ye>s aft] ! date (       
enactm5t ( ?is ,act1 ! ,secret>y %all   
issue guidance to ,/ates & conduct "o or
 m le>n+ collaboratives to promote      
cross-/ate le>n+ reg>d+ options ,/ates  
may employ to address social det]m9ants 
( heal?1 z def9$ by ! ,heal?y ,p #bjcj &
 relat$ initiatives ( ! ,(fice (        
,disease ,prev5tion & ,heal? ,promotion 
( ! ,dep>tm5t ( ,heal? & ,human         
,s]vices1 includ+ = pregnant & po/p>tum 
wom54  7b7 ,guidance requirem5ts ,!     
guidance requir$ "u subsection 7a7 %all1
 at a m9imum1 describe ! au?orities t   
,/ates may lev]age to support address+ !
 social det]m9ants ( heal? = pregnant & 
po/p>tum wom5 & outl9e be/ practices =  
su* ef=ts4  7c7 ,le>n+ collaborative    
requirem5ts ,! le>n+ collaboratives     
requir$ "u subsection 7a7 %all1 at a    
m9imum1 include opportunities = ,/ates &

 o!r /akehold]s to %>e innovative       
practices & approa*es z !y are be+      
consid]$ & develop$1 %>e solutions      
relat$ to *all5ges t multiple urban &   
rural ,/ates face1 & promote ! uptake ( 
approv$1 effective int]v5tions address+ 
social ne$s & det]m9ants cov]$ by !     
,m$icaid program4  #ag4 ,paym5t error   
rate measurem5t 7,,p]m7 audit &         
improvem5t requirem5ts  7a7 ,bi5nial    
,,p]m audit requirem5t ,beg9n+ ) fiscal 
ye> #bjbe1 ! ,adm9i/rator %all conduct  
paym5t error rate measurem5t 7,,p]m7    
audits ( ea* ,/ate ,m$icaid program on a
 bi5nial basis4  7b7 ,,p]m error rate   
r$uction plan requirem5t ,beg9n+ )      
fiscal ye> #bjbe1 any ,/ate ) an ov]all 
,,p]m error rate exce$+ #ae p]c5t 9 a   
,,p]m audit conduct$ ) respect to !     
,/ate 9 ! previ\s fiscal ye> %all publi%
 a plan1 9 coord9ation )1 & subject to !
 approval (1 ! ,adm9i/rator1 = h[ !     
,/ate w r$uce its ,,p]m error rate bel[ 
#ae p]c5t 9 ! curr5t fiscal ye>4  7c7   
,notification2 id5tification ( s\rces ( 

improp] paym5ts  7#a7 ,notification ,n  
lat] ?an #f mon?s aft] ! date ( enactm5t
 ( ?is ,act1 ! ,adm9i/rator %all notify 
! contractor conduct+ ,,p]m audits ( !  
,adm9i/rator's int5t to modify contracts
 to require ,,p]m audits n less ?an once
 e o!r ye> 9 ea* ,/ate4  7#b7           
,id5tification ( s\rces ( improp]       
paym5ts ,! ,adm9i/rator %all direct !   
contractor conduct+ ,,p]m audits ( ,/ate
 ,m$icaid programs to id5tify areas kn[n
 to be s\rces ( improp] paym5ts "u su*  
programs to id5tify program areas or    
compon5ts kn[n to be s\rces ( high risk 
= improp] paym5ts "u su* programs4  7d7 
,/ate ,m$icaid director lett] ,n lat]   
?an #ab mon?s aft] ! date ( enactm5t (  
?is ,act1 ! ,adm9i/rator %all issue a   
,/ate ,m$icaid ,director lett] reg>d+   
,/ate requirem5ts "u ,f$]al law &       
regulations reg>d+ avoid+ & respond+ to 
improp] paym5ts "u ,/ate ,m$icaid       
programs4  7e7 ,/ate improp] paym5t     
mitigation plans  7#a7 ,9 g5]al ,n lat] 
?an ,janu>y #a1 #bjbd1 ea* ,/ate        

,m$icaid program %all submit to !       
,adm9i/rator a plan1 :i* %all include   
specific actions & timeframes = tak+ su*
 actions & a*iev+ specifi$ results1 =   
mitigat+ improp] paym5ts "u su* program4
  7#b7 ,publication ( ,/ate plans ,!    
,adm9i/rator %all make ,/ate plans      
submitt$ "u p>agraph 7#a7 available to !
 public4  7f7 ,def9itions ,9 ?is        
section3 7#a7 ,adm9i/rator ,! t]m       
,adm9i/rator means ! ,adm9i/rator ( !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4    
7#b7 ,/ate ,! t]m ,/ate has ! mean+ giv5
 su* t]m = purposes ( title ,,xix ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq474  7#c7 ,/ate ,m$icaid    
program ,! t]m ,/ate ,m$icaid program   
means a ,/ate plan "u title ,,xix ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq471 & includes any waiv] (  
su* a plan4