,i #aaith ,,congress #ast ,session ,h4 ,r4 #cidb ,,in ,,the ,,house ,,of ,,representatives ,june #ab1 #bjbe,ms4 ,bonamici 7for herself and ,ms4 ,kelly of ,illinois7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend titles ,,xix and ,,xxi of the ,social ,security ,act to enhance financial support for rural and safety net hospitals providing maternity1 labor1 and delivery services to vulnerable populations1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,keeping ,obstetrics ,local ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,enhancing financial support for rural and safety net hospitals that provide obstetric services ,sec4 #aja4 ,state studies and ,,hhs report on costs of providing maternity1 labor1 and delivery services4 ,sec4 #ajb4 ,requiring adequate payment rates under ,medicaid for maternity1 labor1 and delivery services at eligible hospitals4 ,sec4 #ajc4 ,increased ,federal financial participation for maternity1 labor1 and delivery services furnished by eligible hospitals4 ,sec4 #ajd4 ,labor and delivery services anchor payments4 ,sec4 #aje4 ,application of adequate payment requirement and increased ,federal financial participation requirements to ,,chip4 ,sec4 #ajf4 ,disregarding increased and additional payments to hospitals for purposes of other supplemental payments and upper payment limits4 ,,title ,,ii--,expand ,coverage of ,maternal ,health ,care ,sec4 #bja4 ,requiring #ab-month continuous1 full benefit coverage for pregnant individuals under ,medicaid and ,,chip4 ,sec4 #bjb4 ,health homes for pregnant and postpartum women4 ,sec4 #bjc4 ,guidance on supporting and improving access to ,medicaid and ,,chip coverage of services provided by doulas and certain maternal health professionals4 ,sec4 #bjd4 ,medicaid and ,,chip increased financial support for depression and anxiety screening during the perinatal and postpartum periods4 ,sec4 #bje4 ,presumptive eligibility for pregnant individuals4 ,,title ,,iii--,invest in the ,maternal ,health ,care ,workforce ,sec4 #cja4 ,emergency obstetric workforce support4 ,sec4 #cjb4 ,streamlined screening and enrollment of providers of maternity1 labor1 and delivery services in neighboring ,states4 ,,title ,,iv--,requiring ,public ,communication of ,obstetrics ,data and ,unit ,closures ,sec4 #dja4 ,timely notifications of impending hospital obstetric unit closures4 ,sec4 #djb4 ,collection of data relating to hospital labor and delivery services4 ,i ,enhancing financial support for rural and safety net hospitals that provide obstetric services #aja4 ,state studies and ,,hhs report on costs of providing maternity1 labor1 and delivery services 7a7 ,state study 7#a7 ,in general ,not later than #bd months after the date of enactment of this ,act1 and every #e years thereafter1 each ,state 7as such term is defined in section #aaja7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#a77 for purposes of titles ,,xix and ,,xxi of such ,act7 shall conduct a study on the costs of providing maternity1 labor1 and delivery services in applicable hospitals 7as defined in paragraph 7#c77 and submit the results of such study to the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary74 7#b7 ,content of study ,a ,state study required under paragraph 7#a7 shall include the following information 7to the extent practicable7 with respect to maternity1 labor1 and delivery services furnished by applicable hospitals located in the ,state3 7,a7 ,an estimate of the cost of providing maternity1 labor1 and delivery services at applicable hospitals1 based on the expenditures a representative sample of such hospitals incurred for providing such services during the #b most recent years for which data is available4 7,b7 ,an estimate of the cost of providing maternity1 labor1 and delivery services at applicable hospitals that ceased providing labor and delivery services within the past #e years1 based on the expenditures a representative sample of such hospitals incurred for providing such services during the #b most recent years for which data is available4 7,c7 ,to the extent data allows1 an analysis of the extent to which geographic location1 community demographics1 and local economic factors 7as defined by the ,secretary7 affect the cost of providing maternity1 labor1 and delivery services at applicable hospitals1 including the cost of services that support the provision of maternity1 labor1 and delivery services4 7,d7 ,the amounts applicable hospitals are paid for maternity1 labor1 and delivery services1 by geographic location and hospital size1 under-- 7i7 ,medicare2 7ii7 the ,state ,medicaid program1 including payment amounts for such services under fee-for-service payment arrangements and under managed care 7as applicable72 7iii7 the ,state ,,chip plan1 including payment amounts for such services under fee-for-service payment arrangements and under managed care 7as applicable72 and 7iv7 private health insurance4 7,e7 ,a comparative payment rate analysis-- 7i7 comparing payment rates for maternity1 labor1 and delivery services 7inclusive of all payments received by applicable hospitals for furnishing maternity1 labor1 and delivery services7 under the ,state ,medicaid fee-for-service program to such payment rates for such services under ,medicare 7as described in section #ddg4bjc7;b77#c7 of title #db1 ,code of ,federal ,regulations71 other ,federally-funded or ,state-funded programs 7including1 to the extent data is available1 ,medicaid managed care rates71 and to the payment rates for such services1 to the extent data is available1 of private health insurers within geographic areas of the ,state2 and 7ii7 analyzing different payment methods for such services1 such as the use of bundled payments1 quality incentives1 and low-volume adjustments4 7,f7 ,an evaluation1 using such methodology and parameters established by the ,secretary1 of whether each hospital located in the ,state that furnishes maternity1 labor1 and delivery services is expected to experience in the next #c years significant changes in particular expenditures or types of reimbursement for maternity1 labor1 and delivery services4 7#c7 ,applicable hospital defined ,for purposes of this subsection1 the term applicable hospital means any hospital located in a ,state that meets either of the following criteria3 7,a7 ,the hospital provides labor and delivery services and more than #ej percent of the hospital's births 7in the most recent year for which such data is available7 are financed by the ,medicaid program or ,,chip4 7,b7 ,the hospital-- 7i7 is located in a rural area 7as defined by the ,federal ,office of ,rural ,health ,policy for the purpose of rural health grant programs administered by such ,office72 7ii7 based on the most recent #b years of data available 7as determined by the ,secretary71 furnished services for less than an average of #cjj births per year2 and 7iii7 provides labor and delivery services4 7#d7 ,assistance to small hospitals in compiling cost information ,there are appropriated to the ,secretary for fiscal year #bjbf1 #aj1jjj1jjj for the purpose of providing grants and technical assistance to a hospital described in paragraph 7#c77;,b7 to enable such hospital to compile detailed information for use in the ,state studies required under paragraph 7#a71 to remain available until expended4 7#e7 ,,hhs report on ,state studies ,for each year in which a ,state is required to conduct a study under paragraph 7#a71 the ,secretary shall issue1 not later than #ab months after the date on which the ,state submits to the ,secretary the data described in such paragraph1 a publicly available report that compiles and details the results of such study and includes the information described in paragraph 7#b74 7b7 ,,hhs report on national data collection findings ,not later than #c years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress1 and make publicly available1 a report analyzing the first studies conducted by ,states under subsection 7a77#a71 including recommendations for improving data collection on the cost of providing maternity1 labor1 and delivery services4 7c7 ,implementation funding ,in addition to the amount appropriated under subsection 7a77#d71 there are appropriated1 out of any funds in the ,treasury not otherwise obligated1 #c1jjj1jjj for fiscal year #bjbf1 to remain available until expended1 to the ,secretary of ,health and ,human ,services for purposes of implementing this section4 #ajb4 ,requiring adequate payment rates under ,medicaid for maternity1 labor1 and delivery services at eligible hospitals 7a7 ,fee-for-,service payments ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a77#ac7-- 7,a7 by striking and at the end of subparagraph 7,b72 7,b7 by adding and at the end of subparagraph 7,c72 and 7,c7 by adding at the end the following new subparagraph3 7,d7 for each fiscal year beginning with fiscal year #bjbg1 payment for maternity1 labor1 and delivery services 7as defined in subsection 7uu77 furnished during such fiscal year in an eligible hospital 7as defined in such subsection7 at a rate that is not less than the minimum payment rate specified for the fiscal year in paragraph 7#d7 of such subsection2 2 and 7#b7 by adding at the end the following new subsection3 7uu7 ,maternity1 labor1 and delivery services and eligible hospitals defined ,for purposes of subsection 7a77#ac77;,d7-- 7#a7 ,maternity1 labor1 and delivery services 7,a7 ,in general ,the term maternity1 labor1 and delivery services means such inpatient hospital services and outpatient hospital services1 including behavioral health services1 that are provided in relation to maternity care or labor and delivery1 identified by appropriate ,,icd and ,,cpt codes1 as the ,secretary shall specify after consultation with professional or medical societies with expertise in pregnancy1 childbirth1 and postpartum care4 7,b7 ,scope ,such term shall not be limited in application1 for any eligible hospital1 only to services that relate to a birth that occurs in the hospital4 7,c7 ,rulemaking ,not later than ,july #a1 #bjbf1 the ,secretary shall issue an interim final rule specifying which services shall be considered maternity1 labor1 and delivery services for purposes of this subsection and subsection 7a77#ac77;,d74 7#b7 ,eligible hospital 7,a7 ,in general ,the term eligible hospital means1 with respect to a ,state and fiscal year-- 7i7 a hospital that is located in a rural area 7as defined by the ,federal ,office of ,rural ,health ,policy for the purpose of rural health grant programs administered by such ,office72 7ii7 a critical access hospital 7as defined in section #ahfa7mm77#a772 7iii7 a hospital operated by the ,indian ,health ,service or an ,indian ,tribe under the ,indian ,self-,determination and ,education ,assistance ,act2 7iv7 a hospital for which1 in the most recent #ab-month period for which data is available1 at least #ej percent of all births for which the hospital provided maternity1 labor1 and delivery services during such fiscal year were qualifying births2 or 7v7 a hospital that is able to demonstrate1 through a process to be determined by the ,secretary1 that1 for the applicable fiscal year1 the hospital projects that at least #ej percent of all births for which the hospital will provide maternity1 labor1 and delivery services during such fiscal year will be qualifying births4 7,b7 ,identification of eligible hospitals ,each ,state1 subject to the approval of the ,secretary1 shall identify the hospitals in the ,state that are eligible hospitals with respect to a fiscal year4 7#c7 ,qualifying birth ,for purposes of paragraph 7#b71 the term qualifying birth means a birth for which any maternity1 labor1 and delivery services associated with the birth-- 7,a7 were paid for under a ,state plan under this title 7or under a waiver of such a plan7 or under a ,state child health plan under title ,,xxi 7or under a waiver of such a plan72 7,b7 were paid for under title ,,xviii2 7,c7 were provided by the ,indian ,health ,service or a ,native ,hawaiian health care system 7as defined in section #ab of the ,native ,hawaiian ,health ,care ,improvement ,act72 or 7,d7 were provided to a patient who does not have minimum essential coverage 7as defined in section #ejjj;,a7f7 of the ,internal ,revenue ,code of #aihf7 and were not fully paid for by such patient4 7#d7 ,minimum payment rate specified ,the minimum payment rate specified in this paragraph is1 with respect to an eligible hospital and maternal1 labor1 and delivery services-- 7,a7 for fiscal year #bjbg1 #aej percent of the payment rate that would apply for such services and hospital under title ,,xviii2 and 7,b7 for each period of #e fiscal years beginning with fiscal years #bjbh through #bjcb1 a payment rate that is determined for such period by the ,secretary to accurately reflect the costs incurred by eligible hospitals in providing such services1 informed by the results of the most recent ,state studies submitted to the ,secretary under section #aja7;a7 of the ,keeping ,obstetrics ,local ,act4 4 7b7 ,under ,medicaid managed care plans ,section #aicb7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;f77 is amended-- 7#a7 in the heading1 by inserting and maternity1 labor1 and delivery services at eligible hospitals after services2 and 7#b7 by striking described in section #aijb7;a77#ac77;,c7 and inserting described in subparagraph 7,c7 of section #aijb7;a77#ac7 or maternity1 labor1 and delivery services described in subparagraph 7,d7 of such section that are furnished by an eligible hospital 7as defined in section #aije7uu774 #ajc4 ,increased ,federal financial participation for maternity1 labor1 and delivery services furnished by eligible hospitals ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7b71 by striking and 7ii7 and inserting 7ii71 and 7kk72 and 7#b7 by adding at the end the following new subsection3 7kk7 ,maternity1 labor1 and delivery services 7#a7 ,in general ,notwithstanding subsection 7b71 with respect to ,state expenditures for medical assistance for maternity1 labor1 and delivery services furnished by an eligible hospital 7as such terms are defined in section #aijb7uu77 in a fiscal quarter that begins on or after ,october #a1 #bjbf-- 7,a7 the ,federal medical assistance percentage applicable to the enhanced payment rate amount of such expenditures 7as determined for the ,state and quarter under paragraph 7#b77;,a77 shall be equal to #ajj percent2 and 7,b7 subject to paragraph 7#c71 the ,federal medical assistance percentage applicable to the base payment rate amount of such expenditures 7as determined for the ,state and quarter under paragraph 7#b77;,b77 shall be equal to the enhanced ,,fmap determined for the ,state and quarter under section #baje7;b74 7#b7 ,determination of enhanced payment rate amount and base payment rate amount 7,a7 ,enhanced payment rate amount 7i7 ,in general ,for purposes of paragraph 7#a77;,a71 the enhanced payment rate amount for a ,state and fiscal quarter is equal to the amount of ,state expenditures for medical assistance for maternity1 labor1 and delivery services furnished by an eligible hospital 7as such terms are defined in section #aijb7uu77 in such fiscal quarter that is attributable to the amount by which the minimum payment rate required under section #aijb7;a77#ac77;,d7 7or1 by application1 section #aicb7;f77 exceeds the base payment rate applicable to such services1 as determined for the ,state1 quarter1 and services under clause 7ii74 7ii7 ,base payment rate ,for purposes of clause 7i71 the base payment rate determined for a ,state1 a fiscal quarter1 and maternity1 labor1 and delivery services 7as defined in section #aijb7uu77 shall be equal to-- 7,i7 the payment rate applicable to such services under the ,state plan 7or under a waiver of such plan7 as of ,january #a1 #bjbe2 increased by 7,,ii7 the percentage increase in the medical care component of the consumer price index for all urban consumers from ,january of #bjbe to the month ending on the day before the #ast day of such fiscal quarter4 7,b7 ,base payment rate amount ,for purposes of paragraph 7#a77;,b71 the base payment rate amount for a ,state and fiscal quarter is equal to-- 7i7 the total amount of ,state expenditures for medical assistance for maternity1 labor1 and delivery services furnished by an eligible hospital 7as such terms are defined in section #aijb7uu77 in such fiscal quarter2 minus 7ii7 the enhanced payment rate amount determined for the ,state and fiscal quarter under subparagraph 7,a74 7#c7 ,application of higher match ,subparagraph 7,b7 of paragraph 7#a7 shall not apply in the case of ,state expenditures described in such subparagraph if the application of such subparagraph would result in a lower ,federal medical assistance percentage for such expenditures than would otherwise apply without the application of such paragraph4 7#d7 ,exclusion of expenditures from territorial caps ,any payment made to a territory for medical assistance that is subject to the ,federal medical assistance percentage specified in paragraph 7#a77;,a7 or the enhanced ,,fmap referred to in paragraph 7#a77;,b7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g7 of section #aajh4 4 #ajd4 ,labor and delivery services anchor payments 7a7 ,state requirement ,section #aijb7;a77#ac77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77;,a77 is amended-- 7#a7 in clause 7iii71 by striking and at the end2 7#b7 in clause 7iv71 by striking the semicolon at the end and inserting 1 and2 and 7#c7 by adding at the end the following new clause3 7v7 in the case of hospitals1 such rates take into account 7in a manner consistent with section #aibc;,a7 the situation of low volume obstetric hospitals 7as such term is defined in such section72 4 7b7 ,requiring anchor payments for low volume obstetric hospitals ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by inserting the following after section #aibc3 #aibc;,a4 ,anchor payments for labor and delivery services provided by low volume obstetric hospitals 7a7 ,implementation of requirement ,a ,state plan under this title shall not be considered to meet the requirement of section #aijb7;a77#ac77;,a77v7 7insofar as it requires payments to hospitals to take into account the situation of low volume obstetric hospitals71 as of ,october #a1 #bjbf1 unless the ,state has submitted to the ,secretary1 by not later than such date1 an amendment to such plan that provides for an annual anchor payment to such hospitals1 consistent with subsection 7c74 7b7 ,definitions ,in this section3 7#a7 ,antenatal transfer ,the term antenatal transfer means1 with respect to a hospital1 a pregnant individual who was expected to receive labor and delivery services at the hospital but who is transferred to a different hospital because of a need for labor and delivery services that are not available at the transferring hospital4 7#b7 ,delivery volume ,the term delivery volume means1 with respect to a hospital and a fiscal year1 the total number of births occurring in1 and antenatal transfers made by1 such hospital during such year4 7#c7 ,labor and delivery revenue floor ,the term labor and delivery revenue floor means1 with respect to a low volume obstetric hospital and a fiscal year1 the amount equal to the sum of-- 7,a7 the product of-- 7i7 the delivery volume for such hospital and fiscal year2 and 7ii7 the per delivery amount for such fiscal year2 and 7,b7 the standby capacity amount for such fiscal year4 7#d7 ,labor and delivery services ,the term labor and delivery services means such inpatient and outpatient hospital services related to labor and delivery1 including services related to antenatal transfers1 identified by appropriate ,,icd and ,,cpt codes1 as the ,secretary shall specify in consultation with professional or medical societies with expertise in this area4 7#e7 ,low volume obstetric hospital ,the term low volume obstetric hospital means1 with respect to a hospital and a fiscal year1 a hospital-- 7,a7 that is an eligible hospital 7as defined in section #aijb7uu77#b772 7,b7 in which the average number of births for which the hospital provided labor and delivery services during the preceding #c fiscal years is less than #cjj births per year2 7,c7 that did not provide labor and delivery services in the preceding fiscal year1 but in which the average number of births for which the hospital provided labor and delivery services during the most recent #c fiscal years in which the hospital provided labor and delivery services is less than #cjj births per year2 7,d7 that is not described in subparagraphs 7,b7 or 7,c7 but1 in the applicable fiscal year1 provides labor and delivery services for fewer than #cjj births2 or 7,e7 that is not described in subparagraphs 7,b7 through 7,d7 but is certified by the ,state in which the hospital is located as meeting such criteria as the ,secretary shall establish for identifying hospitals that are essential to meeting the needs of an underserved population1 such as serving a population with limited ,english proficiency1 serving specific racial or ethnic populations1 or other factors4 7#f7 ,medicaid labor and delivery revenue floor ,the term ,medicaid labor and delivery revenue floor means1 with respect to a low volume obstetric hospital and a fiscal year1 the product of-- 7,a7 the labor and delivery revenue floor for such hospital and fiscal year2 and 7,b7 the percentage of the delivery volume of such hospital in such fiscal year that were paid for under a ,state plan under this title 7or under a waiver of such a plan7 or under a ,state child health plan under title ,,xxi 7or under a waiver of such a plan74 7#g7 ,per delivery amount 7,a7 ,in general ,the term per delivery amount means1 with respect to a fiscal year1 an amount1 as determined under subparagraph 7,b71 that represents the marginal cost to a low volume obstetric hospital of a birth or an antenatal transfer4 7,b7 ,determination of per delivery amount 7i7 ,fiscal year #bjbh ,for fiscal year #bjbh1 the per delivery amount shall be #aj1jjj4 7ii7 ,indexing ,subject to clause 7iii71 for each fiscal year after fiscal year #bjbh1 the per delivery amount shall be the amount that applied under this subparagraph for the preceding fiscal year increased by the percentage increase in the medical care component of the consumer price index for all urban consumers for the #ab-month period ending with ,september of such preceding fiscal year4 7iii7 ,periodic revision of per delivery amount ,not less than once every #e fiscal years1 the ,secretary shall collect and analyze data on the costs of labor and delivery services at low volume obstetric hospitals and1 through rulemaking1 shall establish a new per delivery amount for purposes of this section to ensure that such amount accurately reflects the marginal cost to a low volume obstetric hospital of a birth or an antenatal delivery4 7#h7 ,standby capacity amount 7,a7 ,in general ,the term standby capacity amount means1 with respect to a fiscal year1 an amount1 as determined under subparagraph 7,b71 that represents the minimum level of expenditures by a low volume obstetric hospital that is necessary to ensure that adequate personnel1 equipment1 and facilities are available at all times to provide labor and delivery services4 7,b7 ,determination of standby capacity amount 7i7 ,fiscal year #bjbh ,for fiscal year #bjbh1 the standby capacity amount shall be #a1bjj1jjj4 7ii7 ,indexing ,subject to clause 7iii71 for each fiscal year after fiscal year #bjbh1 the standby capacity amount shall be the amount that applied under this subparagraph for the preceding fiscal year increased by the percentage increase in the medical care component of the consumer price index for all urban consumers for the #ab-month period ending with ,september of such preceding fiscal year4 7iii7 ,periodic revision of standby capacity amount ,not less than once every #e fiscal years1 the ,secretary shall collect and analyze data on the costs of labor and delivery services at low volume obstetric hospitals and1 through rulemaking1 shall establish a new standby capacity amount for purposes of this section to ensure that such amount accurately reflects the minimum level of expenditures by a low volume obstetric hospital that is necessary to ensure that adequate personnel1 equipment1 and facilities are available at all times to provide labor and delivery services4 7c7 ,anchor payment for low volume obstetric hospitals ,not later than #c months after the end of each fiscal year beginning with fiscal year #bjbh1 each ,state shall pay to each low volume obstetric hospital in the ,state an amount that is equal to the amount 7if any7 by which-- 7#a7 the ,medicaid labor and delivery revenue floor for the hospital and fiscal year2 exceeds 7#b7 the total amount of all payments made to the low volume obstetric hospital under the ,state plan under this title 7or under a waiver of such plan7 and under the ,state child health plan under title ,,xxi 7or under a waiver of such plan7 7other than payments under this section7 for labor and delivery services provided by such hospital during such fiscal year4 7d7 ,requirements for receipt of payments ,no anchor payment shall be made to a low volume obstetric hospital under this section for a fiscal year unless the hospital can satisfy the following requirements3 7#a7 ,skills maintenance and training activities ,the hospital demonstrates to the satisfaction of the ,state that the hospital conducts and completes skills maintenance and training activities1 including continuing education and training to support maintenance of obstetric skills1 that satisfy such requirements as the ,secretary1 taking into consideration nationally recognized obstetrics skills1 maintenance1 and training standards such as standards published by the ,american ,college of ,obstetricians and ,gynecologists and the ,association of ,women's ,health1 ,obstetric1 and ,neonatal ,nurses1 shall specify for the purposes of this section4 7#b7 ,continued provision of labor and delivery services 7,a7 ,in general ,the hospital and the ,state enter into a contract under which1 in exchange for such payment under this section for a fiscal year1 the hospital agrees to continue to provide labor and delivery services-- 7i7 for the period that begins with such fiscal year and ends on the last day of the second fiscal year that follows such fiscal year2 and 7ii7 at a level that is not less than the level at which the hospital provided such services in the fiscal year to which such payment relates1 unless the hospital can demonstrate that the need for services in the community has decreased and that the new level of services will be adequate to meet that need4 7,b7 ,recovery of payment in the event of breach of contract by hospital ,the terms of the contract between a hospital and a ,state required under subparagraph 7,a7 shall provide that if the hospital does not provide labor and delivery services as required under the contract throughout the period described in such subparagraph for any reason 7including in the event of the hospital's bankruptcy or closure7 the ,state may recover the full amount of the payment under this section to which the contract relates and in the event of the hospital's bankruptcy1 the ,state shall be given preferred creditor status for purposes of the collection of such payment4 7#c7 ,utilization of funds for labor and delivery services 7,a7 ,in general ,the hospital and the ,state enter into a contract under which1 in exchange for such payment under this section1 the hospital agrees to utilize funds received under such payment for the provision of labor and delivery services in the community served by the hospital4 7,b7 ,recovery of payment in the event of breach of contract by hospital ,the terms of the contract between a hospital and a ,state required under subparagraph 7,a7 shall provide that if the hospital does not utilize payment funds for labor and delivery services as required under the contract for any reason 7including in the event of the hospital's bankruptcy or closure7 the ,state may recover the full amount of the payment under this section to which the contract relates and in the event of the hospital's bankruptcy1 the ,state shall be given preferred creditor status for purposes of the collection of such payment4 7e7 ,treatment of payments2 recovery of payments 7#a7 ,in general ,payments made by a ,state under this section for a fiscal year-- 7,a7 shall be in addition to any other payments made to hospitals for labor and delivery services under the ,state plan 7or a waiver of such plan7 under this title1 under the ,state child health assistance plan under title ,,xxi 7or under a waiver of such plan71 or under title ,,xviii for the fiscal year1 including disproportionate share hospital payments under section #aibc or section #ahhf7;d77#e77;,f7 and other supplemental payments that are not made under this section2 and 7,b7 shall be treated as medical assistance for which payment is made under section #aijc7;a71 except that the ,federal medical assistance percentage applicable to amounts expended by a ,state for such payments shall be equal to the enhanced ,,fmap determined for the ,state and fiscal year under section #baje7;b74 7#b7 ,payments recovered by a ,state ,if a ,state recovers any amount of a payment made by a ,state under this section 7whether pursuant to paragraphs 7#b77;,b7 or 7#c77;,b7 of subsection 7d7 or otherwise71 the amount so recovered shall be treated as an overpayment recovered by the ,state under section #aijc7;d74 4 7c7 ,conforming amendments ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended as follows3 7#a7 ,in section #aijc-- 7,a7 in subsection 7d77#f77;,b7-- 7i7 by striking related to the total amount and inserting the following3 8related to-- 7i7 the total amount 2 7ii7 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new clause3 7ii7 the total amount of payments made to individual providers 7by provider7 under section #aibc;,a during such fiscal year4 2 and 7,b7 in subsection 7bb77#b77;,b7-- 7i7 in the header1 by inserting and low volume obstetric hospital after ,,dsh2 and 7ii7 by inserting or a payment made to a low volume obstetric hospital under section #aibc;,a before the period4 7#b7 ,in section #aije-- 7,a7 in subsection 7cc71 by striking section #aibc the second place it appears and inserting section #aibc or #aibc;,a2 and 7,b7 in subsection 7ii77#b77;,a71 by inserting or payments to low volume obstetric hospitals described in section #aibc;,a before the semicolon4 #aje4 ,application of adequate payment requirement and increased ,federal financial participation requirements to ,,chip ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7#a7 by redesignating subparagraphs 7,b7 through 7,u7 as subparagraphs 7,c7 through 7,v71 respectively2 and 7#b7 by inserting after subparagraph 7,a7 the following new subparagraph3 7,b7 ,section #aijb7;a77#ac77;,d7 and section #aije7kk7 7relating to the minimum payment rate required for maternity1 labor1 and delivery services furnished by an eligible hospital and ,federal financial participation for ,state expenditures for such services74 4 #ajf4 ,disregarding increased and additional payments to hospitals for purposes of other supplemental payments and upper payment limits ,a hospital's eligibility for any ,federally-funded supplemental payment 7including a disproportionate share payment under section #ahhf7;d77#e77;,f7 or #aibc of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f71 #acifr-#d771 the determination of the amount of such payment1 and the application of any ,federal limitation on the aggregate amount of payments that a ,state may make to the hospital 7including any upper payment limitation71 shall be determined without regard to the amount of any increase to a payment received by a hospital or any additional payment made to a hospital that is attributable to the amendments made by this title4 ,,ii ,expand ,coverage of ,maternal ,health ,care #bja4 ,requiring #ab-month continuous1 full benefit coverage for pregnant individuals under ,medicaid and ,,chip 7a7 ,medicaid ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#aj71 in the matter following subparagraph 7,g71 by striking 7,,vii7 the medical assistance made available to an individual described in subsection 7l77#a77;,a7 who is eligible for medical assistance only because of subparagraph 7,a77i77,,iv7 or 7,a77ii77,,ix7 shall be limited to medical assistance for services related to pregnancy 7including prenatal1 delivery1 postpartum1 and family planning services71 medical assistance for services related to other conditions which may complicate pregnancy1 and medical assistance for vaccines described in section #aije7;a77#d77;,e7 and the administration of such vaccines during the period described in such section1 and inserting 7,,vii7 ,repealed12 7,b7 in paragraph 7#hf71 by striking and at the end2 7,c7 in paragraph 7#hg71 by striking the period at the end and inserting 2 and2 and 7,d7 by inserting after paragraph 7#hg7 the following new paragraph3 7#hh7 provide that the ,state plan is in compliance with subsection 7e77#af74 2 and 7#b7 in subsection 7e77#af7-- 7,a7 in subparagraph 7,a71 by striking ,at the option of the ,state1 the ,state plan 7or waiver of such ,state plan7 may provide and inserting ,a ,state plan 7or waiver of such ,state plan7 shall provide2 7,b7 in subparagraph 7,b71 in the matter preceding clause 7i71 by striking by a ,state making an election under this paragraph and inserting under a ,state plan 7or a waiver of such ,state plan72 and 7,c7 in subparagraph 7,c7-- 7i7 by striking ,a ,state making an election under this paragraph and inserting ,in the case of a ,state2 and 7ii7 by striking shall also make the election and inserting the ,state shall provide coverage4 7b7 ,,chip 7#a7 ,in general ,subparagraph 7,k7 of section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a771 as redesignated by section #aje1 is amended to read as follows3 7,k7 ,paragraphs 7#e7 and 7#af7 of section #aijb7;e7 7relating to the requirement to provide medical assistance under the ,state plan or waiver consisting of full benefits during pregnancy and throughout the #ab-month period that begins on the last day of the individual's pregnancy and ends on the last day of the month in which such #ab-month period ends74 4 7#b7 ,conforming amendment ,section #baab7;d77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is amended by striking the month in which the #fj-;day period and all that follows through pursuant to section #bajg7;e77#a714 7c7 ,effective date 7#a7 ,in general ,subject to paragraphs 7#b7 and 7#c71 the amendments made by subsections 7a7 and 7b7 shall take effect on the #ast day of the #ast calendar quarter that begins on or after the date that is #a year after the date of enactment of this ,act4 7#b7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act or a ,state child health plan under title ,,xxi of such ,act that the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan to meet any requirement imposed by amendments made by this subsection1 the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the #ast day of the #ast calendar quarter beginning after the close of the #ast regular session of the ,state legislature that begins after the date of enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 7#c7 ,state option for earlier effective date ,a ,state may elect to have subsection 7e77#af7 of section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 and subparagraph 7,k7 of section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a771 as redesignated by section #aje and amended by subsection 7b7 of this section1 take effect with respect to the ,state on the #ast day of any fiscal quarter that begins before the date described in paragraph 7#a7 and apply to amounts payable to the ,state for expenditures for medical assistance1 child health assistance1 or pregnancy-related assistance to pregnant or postpartum individuals furnished on or after such day4 #bjb4 ,health homes for pregnant and postpartum women 7a7 ,medicaid ,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 individuals 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 ,january #a1 #bjbh1 a ,state1 at its option as a ,state plan amendment1 may provide for medical assistance under this title to an eligible individual 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 individual's maternity health home for purposes of providing the individual 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 individuals under this section4 7#b7 ,eligible individual defined ,in this section1 the term eligible individual means an individual-- 7,a7 who 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 under a waiver of such plan72 7,b7 who is not enrolled in a health home under section #aide or #aide;,a2 and 7,c7 either-- 7i7 who is pregnant2 or 7ii7 whose pregnancy has ended and is within the #ab-month period that begins on the last day of the individual's pregnancy and ends on the last day of the month in which such #ab-month period ends4 7b7 ,qualification standards ,the ,secretary shall establish standards for qualification as a maternity health home or as a designated provider1 a 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 ,in establishing such standards1 the ,secretary shall consider best practices and models of care used by recipients of grants under section #ccj,p of the ,public ,health ,service ,act4 ,such standards shall include requiring a designated provider1 a team of health care professionals operating with such a provider1 and a health team designated as a maternity health home to demonstrate to the ,state the ability to do the following3 7#a7 ,coordinate prompt care and access to necessary maternity care services1 including services provided by specialists1 and programs for an eligible individual during the individual's pregnancy and the #cfe-;day period beginning on the last day of such pregnancy4 7#b7 ,develop an individualized1 comprehensive1 patient-centered care plan for each eligible individual 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 individual's care plan1 in a culturally and linguistically appropriate manner consistent with the needs of the eligible individual1 ongoing home care1 community-based primary care1 inpatient care1 social support services1 health-related social needs services1 behavioral health services1 local hospital emergency care1 and1 in the event of a change in income that would result in the eligible individual losing eligibility for medical assistance under the ,state plan 7or under a waiver of such plan71 care management and planning related to a change in the eligible individual's health insurance coverage4 7#d7 ,coordinate with pediatric care providers1 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 designated as a maternity health home with payments for the provision of health home services to each eligible individual that selects such provider1 team of health care professionals1 or health team as the eligible individual's health home4 ,payments made to a designated provider1 a team of health care professionals operating with such a provider1 or a health team for such services shall be treated as medical assistance for purposes of section #aijc7;a71 except that1 during the first #h fiscal year quarters that the ,state plan amendment is in effect1 the ,federal medical assistance percentage applicable to such payments shall be equal to #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 during an eligible individual's pregnancy and the #cfe-;day period beginning on the last day of such pregnancy4 ,such methodology for determining payment-- 7,a7 may be based on-- 7i7 a per-member per-month basis for each eligible individual enrolled in a 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 proposed by the ,state and approved by the ,secretary2 7,b7 may be adjusted to reflect1 with respect to each eligible individual-- 7i7 the severity of the risks associated with the individual's pregnancy2 7ii7 the severity of the risks associated with the individual's postpartum health care needs2 and 7iii7 the level or amount of time of care coordination required with respect to the individual2 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 individual who seeks treatment in the emergency department of such hospital for-- 7,a7 providing the individual with culturally and linguistically appropriate information supplied by the ,state describing the respective treatment models and opportunities for the individual to access a maternity health home and its associated benefits2 and 7,b7 notifying the maternity health home in which the individual is enrolled1 or the designated provider1 team of health care professionals operating with such a provider1 or health team treating the individual1 of the individual's treatment in the emergency department and of the protocols for the maternity health home1 designated provider1 or team to be involved in the individual'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 individuals1 including the process by which such providers can participate in or refer an eligible individual to an approved maternity health home or a designated provider1 team of health care professionals operating such a provider1 or health team designated as a maternity health home2 and 7ii7 educating eligible individuals1 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 entities or other public or private organizations or entities that provide outreach and information on the availability of health care items and services to families of individuals eligible to receive medical assistance under the ,state plan 7or a waiver of such plan74 7#c7 ,mental health coordination ,a ,state with a ,state plan amendment approved under this section shall consult and coordinate1 as appropriate1 with the ,secretary in addressing issues regarding the prevention1 identification1 and treatment of mental health conditions and substance use disorders among eligible individuals4 7#d7 ,social and support services ,a ,state with a ,state plan amendment approved under this section shall consult and coordinate1 as appropriate1 with the ,secretary in establishing means to connect eligible individuals receiving pregnancy and postpartum coordinated care services under this section with social and support services1 including services made available under maternal1 infant1 and early childhood home visiting programs established under section #eaa and services made available under section #ccj;,h or title ,x of the ,public ,health ,service ,act4 7#e7 ,coordination with grant program for integrated services for pregnant and postpartum women ,a ,state with a ,state plan amendment approved under this section shall consult and coordinate1 as appropriate1 with the ,secretary with respect to the provision of medical assistance to eligible individuals enrolled in a maternity health home under this section and grantees delivering integrated health care services to pregnant and postpartum women under section #ccj,p of the ,public ,health ,service ,act 7including1 if applicable1 the ,state74 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 individual 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 individuals 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 team designated as a maternity health home1 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 designated as a maternity health home1 the name1 ,national ,provider ,identification number1 address1 and specific health care services offered to be provided to any eligible individual who has selected such provider1 team of health care professionals1 or health team as the eligible individual's maternity health home4 7,b7 ,information on all other applicable measures for determining the quality of services provided by such provider1 team of health care professionals1 or health team4 7,c7 ,information concerning the factors described in paragraph 7#b77;,a77vi7 received from health risk assessments of eligible individuals conducted and completed by the designated provider1 team of health care professionals operating with such a provider1 or health team designated as a maternity health home4 7,d7 ,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 annually1 and in such form and manner determined by the ,secretary to be reasonable and minimally burdensome1 the following information3 7i7 ,information described in paragraph 7#a74 7ii7 ,the number and1 to the extent available and while maintaining all relevant privacy and confidentially protections1 disaggregated demographic information 7including information on geography7 of eligible individuals who have enrolled in a maternity health home pursuant to this section4 7iii7 ,the number of maternity health homes in the ,state designated under this section4 7iv7 ,the medical conditions or factors that contribute to severe maternal morbidity among eligible individuals enrolled in maternity health homes in the ,state4 7v7 ,the extent to which such individuals receive health care items and services under the ,state plan before1 during1 and after an individual's enrollment in such a maternity health home4 7vi7 ,where applicable1 mortality data and data for the associated causes of pregnancy-related death for eligible individuals 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 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 individual enrolled in a maternity health home or any maternal mortality case1 and that all relevant confidentiality and privacy protections1 including the requirements under section #aijb7;a77#g77;,a71 are maintained4 7h7 ,rule of construction ,nothing in this section shall be construed to require-- 7#a7 an eligible individual 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 ,january #a1 #bjbg1 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 subsection and meets the application criteria established by the ,secretary1 and 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 individuals4 ,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 fiscal year #bjbg1 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-gynecologist or1 if applicable1 a certified nurse midwife1 or certified professional midwife who meets or exceeds the education and training standards of the ,international ,confederation of ,midwives and who is licensed to practice within the ,state71 a hospital1 clinical practice or clinical group practice1 rural health 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 or provider 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 ,health team ,the term health team has the meaning given such term for purposes of section #cejb of ,public ,law #aaa-adh4 7#c7 ,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 that is selected by an eligible individual to provide pregnancy and postpartum coordinated care services4 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 by a designated provider1 a team of health care professionals operating with such a provider1 or a health team designated as a maternity health home4 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 ,any item or service for which medical assistance is otherwise available under the ,state plan 7or a waiver of such plan7 related to the treatment of an individual during the individual's pregnancy and the #a-year period beginning on the last day of such pregnancy1 including mental health and substance use disorder services4 7,,ii7 ,comprehensive care management4 7,,iii7 ,care coordination 7including with pediatricians 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,,iv7 ,comprehensive transitional care1 including appropriate follow-up1 from inpatient to other settings4 7,v7 ,patient and family support 7including authorized representatives74 7,,vi7 ,referrals to community and social support services1 if relevant4 7,,vii7 ,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 certified nurse midwives1 or certified professional midwives who meet or exceed the education and training standards of the ,international ,confederation of ,midwives and who are licensed to practice within the ,state1 family physicians1 primary care physicians1 pediatricians1 and other professionals such as physicians assistants1 advance practice nurses1 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 health clinic1 clinical practice or clinical group practice1 academic health center1 or any entity determined to be appropriate by the ,state and approved by the ,secretary4 4 7b7 ,applicability to ,,chip ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a771 as amended by section #aje1 is amended by adding at the end the following new subparagraph3 7,w7 ,section #aide;,b 7relating to optional health homes for pregnant and postpartum individuals74 4 #bjc4 ,guidance on supporting and improving access to ,medicaid and ,,chip coverage of services provided by doulas and certain maternal health professionals ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue and publish guidance for ,states concerning options for supporting and improving access to coverage and payment under a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or under a waiver of such plan1 and under a ,state child health plan under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq47 or under a waiver of such plan1 for services provided by doulas1 certified nurse midwives1 certified midwives1 or certified professional midwives1 who meet or exceed the education and training standards of the ,international ,confederation of ,midwives and who are licensed to practice within the ,state and certain maternal health professionals 7specified by the ,secretary7-- 7#a7 in rural areas2 7#b7 across a continuum of care2 and 7#c7 among varied provider settings and payment and care models1 including managed care4 #bjd4 ,medicaid and ,,chip increased financial support for depression and anxiety screening during the perinatal and postpartum periods 7a7 ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by section #ajc1 is further amended-- 7#a7 in the first sentence of subsection 7b71 by striking subsection 7a77#d77;,d7 and inserting subsections 7a77#d77;,d7 and 7ll72 and 7#b7 by adding at the end the following3 7ll7 ,increased ,,fmap for depression and anxiety screening during the perinatal and postpartum periods 7#a7 ,in general ,for purposes of clause 7#e7 of the first sentence of subsection 7b71 services described in this subsection are screening services provided to an individual who is eligible for such assistance on the basis of being pregnant that include at a minimum-- 7,a7 during the perinatal period1 at least #a screening for depression and anxiety symptoms using a standardized1 validated tool2 and 7,b7 during the postpartum period1 a full assessment of mood and emotional well-being1 including screening for postpartum depression and anxiety1 using a standardized1 validated tool4 7#b7 ,exclusion from territorial caps ,the additional amount paid to a territory for expenditures for medical assistance for services described in paragraph 7#a7 as a result of the application of clause 7#e7 of the first sentence of subsection 7b7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g7 of section #aajh4 4 7b7 ,,chip ,section #baje7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77 is amended by adding at the end the following new paragraph3 7#ac7 ,enhanced payment for depression and anxiety screening during the perinatal and postpartum periods ,notwithstanding subsection 7b71 the enhanced ,,fmap with respect to payments under subsection 7a7 for expenditures under the ,state child health plan 7or a waiver of such plan7 shall be increased by #a percentage point with respect to expenditures for services described in section #aije7ll77#a7 that are provided under the plan 7or waiver7 to an individual who is eligible for such assistance on the basis of being pregnant 7including pregnancy-related assistance provided to a targeted low-income pregnant woman 7as defined in section #baab7;d771 pregnancy-related assistance provided to an individual who is eligible for such assistance through application of section #aijc7v77#d77;,a77i7 under section #bajg7;e77#a71 or any other assistance under the plan 7or waiver7 provided to an individual who is eligible for such assistance on the basis of being pregnant7 and during the #ab-month period that begins on the last day of the individual's pregnancy and ends on the last day of the month in which such #ab-month period ends 7including any such assistance provided during the month in which such period ends74 4 7c7 ,effective date ,the amendments made by this section shall take effect on the first day of the first fiscal quarter that begins on or after the date that is #a year after the date of enactment of this section4 #bje4 ,presumptive eligibility for pregnant individuals 7a7 ,in general 7#a7 ,requirement ,section #aibj7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#a7;a77 is amended by striking may provide and inserting shall provide4 7#b7 ,application ,section #aibj of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#a7 is amended by adding at the end the following new subsection3 7f7 ,application ,a ,state shall provide to a pregnant woman a presumptive eligibility period in accordance with this section without regard to whether the individual would otherwise qualify for a presumptive eligibility period the ,state has elected to provide under section #aibj;,a1 #aibj;,b1 or #aibj;,c4 4 7b7 ,conforming amendments 7#a7 ,section #aijb7;a77#dg7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#dg77 is amended to read as follows3 7#dg7 provide-- 7,a7 7i7 for making ambulatory prenatal care available to pregnant women during a presumptive eligibility period in accordance with section #aibj2 and 7ii7 at the option of the ,state-- 7,i7 for making medical assistance for items and services described in subsection 7a7 of section #aibj;,a available to children during a presumptive eligibility period in accordance with such section2 7,,ii7 for making medical assistance available to individuals described in subsection 7a7 of section #aibj;,b during a presumptive eligibility period in accordance with such section2 and 7,,iii7 for making medical assistance available to individuals described in subsection 7a7 of section #aibj;,c during a presumptive eligibility period in accordance with such section2 and 7,b7 that any hospital that is a participating provider under the ,state plan may elect to be a qualified entity for purposes of determining1 on the basis of preliminary information1 whether any individual is eligible for medical assistance under the ,state plan or under a waiver of the plan for purposes of providing the individual with medical assistance during a presumptive eligibility period1 in the same manner1 and subject to the same requirements1 as apply with respect to populations described in section #aibj1 #aibj;,a1 #aibj;,b1 or #aibj;,c 7without regard to whether the ,state has elected to provide for a presumptive eligibility period under sections #aibj;,a1 #aibj;,b1 or #aibj;,c71 subject to such guidance as the ,secretary shall establish2 4 7#b7 ,section #aibj7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#a7;e77 is amended-- 7,a7 by striking ,if the ,state has elected the option to provide a presumptive eligibility period under this section or section #aibj;,a1 the and inserting ,the2 and 7,b7 by striking #aibj;,a1 subject to and inserting #aibj;,a 7if the ,state has elected the option71 subject to4 7#c7 ,section #bajg7;e77#a77,r7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77,r77 is amended by inserting #aibj 7relating to presumptive eligibility for pregnant women and section before #aibj;,a4 7#d7 ,section #baab7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acigll7c77 is amended-- 7,a7 in the heading1 by striking ,option ,to ,provide2 and 7,b7 by striking may elect and inserting shall elect4 ,,iii ,invest in the ,maternal ,health ,care ,workforce #cja4 ,emergency obstetric workforce support 7a7 ,in general ,section #bjc;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjd;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by inserting and urgent maternal health care needs after public health care needs2 7,b7 in paragraph 7#c71 by inserting or urgent maternal health care need after public health care need2 7,c7 in paragraph 7#e7-- 7i7 in subparagraph 7,c71 by striking or at the end2 7ii7 in subparagraph 7,d71 by striking the period at the end and inserting 2 or2 and 7iii7 by adding at the end the following3 7,e7 any urgent need1 not rising to the level of an emergency described in subparagraph 7,d71 that1 in the judgment of the ,secretary1 if not addressed1 could result in an emergency that would be appropriate for the deployment of the ,commissioned ,corps4 2 and 7,d7 by adding at the end the following3 7#f7 ,urgent maternal health care need 7,a7 ,in general ,for purposes of this section and section #bad1 the term urgent maternal health care need1 with respect to an area1 means a maternal health care need1 as determined by the ,secretary1 in consultation with the ,attorney ,general1 arising as a result of the closure or imminent closure of a hospital or other health care facility in such area1 or the loss of workers employed by such hospital or health care facility who are trained to provide maternal health care services4 7,b7 ,considerations ,in determining whether there is an urgent maternal health care need for purposes of subparagraph 7,a7 with respect to an area1 the ,secretary shall consider whether such closure1 imminent closure1 or loss of workers has impacted access by individuals in such area to a full range of maternal health care services1 including prenatal services1 labor and delivery services1 postnatal services1 maternal and postpartum mental health services1 behavioral health services1 and reproductive health services4 2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a71 by inserting or urgent maternal health care needs after public health care needs2 and 7,b7 in each of paragraphs 7#b7 and 7#d77;,b71 by inserting or urgent maternal health care need after public health care need2 and 7#c7 in subsection 7c71 by inserting or urgent maternal health care need after public health care need4 7b7 ,detail of personnel ,section #bad of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bae7 is amended-- 7#a7 by redesignating subsection 7e7 as subsection 7f72 7#b7 by inserting after subsection 7d7 the following3 7e7 7#a7 ,upon the request of an eligible entity with respect to a hospital or other health care facility the closure1 imminent closure1 or loss of workers of which led to an urgent maternal health care need in an area1 personnel may be detailed by the ,secretary for the purpose of assisting such eligible entity in work related to such urgent maternal health care need4 7#b7 7,a7 ,personnel detailed under paragraph 7#a7 shall be paid from applicable appropriations of the ,service4 7,b7 ,in the case of detail of personnel under paragraph 7#a7 to be paid from applicable ,service appropriations1 the ,secretary may condition such detail on an agreement by the eligible entity concerned that such eligible entity concerned shall reimburse the ,united ,states for a portion of the amount of such payments made by the ,service4 7,c7 ,the services of personnel while detailed pursuant to this subsection shall be considered as having been performed in the ,service for purposes of the computation of basic pay1 promotion1 retirement1 compensation for injury or death1 and the benefits provided by section #bab4 7#c7 ,the ,secretary may condition a detail of personnel under paragraph 7#a7 on an agreement by the eligible entity concerned that such eligible entity concerned shall-- 7,a7 in the case of an imminent closure or a loss of workers1 as determined by the ,secretary-- 7i7 maintain the maternal health care services in the applicable area to the maximum extent practicable1 including by hiring temporary workers1 until the date on which the personnel are detailed to such area2 and 7ii7 submit to the ,secretary a plan for hiring and retaining health practitioners in the short- and long-term1 both during periods in which personnel are detailed to such applicable area and periods in which personnel are not detailed to such applicable area2 7,b7 in the case of a closure1 submit to the ,secretary a plan for working with1 as applicable1 ,state and local agencies and local stakeholders to transition patients to alternate sources of safe maternal health care services2 and 7,c7 commit to an assessment by the ,secretary of the workplace practices of such eligible entity concerned1 if applicable4 7#d7 ,in this subsection-- 7,a7 the term eligible entity means-- 7i7 a ,state2 7ii7 a political subdivision of a ,state2 or 7iii7 a ,tribal1 nonprofit1 or other health care entity2 and 7,b7 the term personnel means an employee or officer of the ,commissioned ,corps4 2 and 7#c7 in subsection 7f7 7as so redesignated71 by inserting or an urgent maternal health care need before the period at the end4 7c7 ,funding for commissioned corps of the public health service ,section #bjc of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjd7 is amended by adding at the end the following3 7e7 ,operations of the ,commissioned ,corps of the ,public ,health ,service 7#a7 ,in general ,the ,secretary shall carry out duties and responsibilities relating to the operations of the ,commissioned ,corps of the ,service1 including the following3 7,a7 ,enhance the processes and systems of the ,service's ,headquarters operations4 7,b7 ,maximize the force management1 required training opportunities 7as determined by the ,secretary under section #bjc;,a7a77#a771 operational capacity1 and mission readiness of the ,regular ,corps1 the ,ready ,reserve ,corps1 and the ,public ,health ,emergency ,response ,strike ,teams1 a subcomponent of the ,regular ,corps4 7,c7 ,recruit and retain qualified professionals suited to serving underserved and vulnerable communities by-- 7i7 improving onboarding timelines1 providing officer placements to align with mission needs1 ensuring adequate officer morale and wellness resources1 and incentivizing recruiters and recruits2 and 7ii7 expanding training opportunities1 including training of personnel to deliver maternal health care services1 providing credentialing support for high demand skill sets1 and enriching leadership and research potential4 7,d7 ,improve deployment processes and prepare mission teams to execute routine and emergent public health events4 7,e7 ,establish a legislative liaison office to carry out legislative affairs functions under the direction of the ,secretary4 7#b7 ,authorization of appropriations ,in addition to amounts otherwise authorized to be appropriated for the ,commissioned ,corps of the ,service1 there is authorized to be appropriated to the ,secretary to carry out paragraph 7#a7 #aej1jjj1jjj for fiscal year #bjbg and each fiscal year thereafter4 4 #cjb4 ,streamlined screening and enrollment of providers of maternity1 labor1 and delivery services in neighboring ,states 7a7 ,application to ,medicaid ,section #aijb7kk7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7kk77 is amended by adding at the end the following new paragraph3 7#aj7 ,streamlined enrollment process for eligible out-of-,state providers of maternity1 labor1 and delivery services 7,a7 ,in general ,the ,state adopts and implements a process that enables an eligible out-of-,state provider to enroll as a provider in the ,state plan without imposing any screening requirements that are in addition to the requirements imposed on in-,state providers4 ,an eligible out-of-,state provider that enrolls in the ,state plan through such process shall be so enrolled for a #e-year period 7unless the provider is terminated or excluded from participation during such period7 and may revalidate such enrollment through such process for subsequent #e-year periods4 7,b7 ,eligible out-of-,state provider ,in this paragraph1 the term eligible out-of-,state provider means1 with respect to a ,state1 a provider-- 7i7 that furnishes maternity1 labor1 and delivery services 7as defined in subsection 7uu77#a771 or provides orders or referrals for such services1 for which payment is available under the ,state plan of the ,state2 7ii7 that is located in a neighboring ,state 7as defined by the ,secretary72 7iii7 with respect to which the ,secretary has determined there is a limited risk of fraud1 waste1 or abuse for purposes of determining the level of screening to be conducted under section #ahff7;j77#b77;,b72 7iv7 that has been screened under such section #ahff7;j77#b77;,b7 for purposes of enrolling in the ,medicare program under title ,,xviii or the ,state plan of the ,state in which such provider is located2 and 7v7 that has not been excluded from participation in the ,medicare program under such title or the ,medicaid program under this title4 4 7b7 ,conforming amendments 7#a7 ,section #aijb7;a77#gg7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#gg77 is amended by inserting enrollment1 after screening14 7#b7 ,section #aijb7kk7 of such ,act 7#db ,u4,s4,c4 #acif;a7kk771 as amended by subsection 7a71 is further amended-- 7,a7 in the subsection heading1 by inserting ,enrollment1 after ,screening12 and 7,b7 in paragraph 7#i71 by striking ,nothing and inserting ,except as provided in paragraph 7#aj71 nothing4 7c7 ,application to ,,chip ,section #bajg7;e77#a77;,g7 of such ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77;,g77 is amended by inserting enrollment1 after screening14 7d7 ,guidance on screening and enrolling out-of-,state providers of maternity1 labor1 and delivery services ,not later than ,january #a1 #bjbh1 the ,secretary of ,health and ,human ,services shall issue 7and update as the ,secretary determines necessary7 guidance to ,state ,medicaid and ,,chip directors on best practices for screening and enrolling out-of-,state providers of maternity1 labor1 and delivery services in accordance with paragraph 7#aj7 of section #aijb7kk7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7kk77 and section #bajg7;e77#a77;,g7 of such ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77;,g77 7as added and amended by this section7 and including best practices for screening and enrolling out-of-,state providers in managed care plans4 7e7 ,effective date ,the amendments made by this section take effect on ,january #a1 #bjbh4 ,,iv ,requiring ,public ,communication of ,obstetrics ,data and ,unit ,closures #dja4 ,timely notifications of impending hospital obstetric unit closures 7a7 ,in general ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7#a7 in subparagraph 7,x71 by striking and at the end2 7#b7 in subparagraph 7,y77ii77,v71 by striking the period and inserting 1 and2 and 7#c7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 beginning #ahj days after the date of the enactment of this subparagraph1 in the case of a hospital1 not less than #ahj days prior to the closure of any obstetric unit of the hospital1 to submit to the ,secretary1 any relevant local and ,state agencies1 and the community a notification1 which shall include-- 7i7 a report analyzing the impact the closure will have on the community1 including data on any adverse outcomes and increase in costs relating to obstetric services for such community2 7ii7 steps the hospital will take to identify other health care providers that can alleviate any service gaps as a result of the closure2 7iii7 the cause of the closure of such obstetric unit2 7iv7 data regarding historic transportation costs related to obstetric services in such community2 and 7v7 any additional information as may be required by the ,secretary4 4 7b7 ,state requirement ,to post reports ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 as amended by section #bja7;a77#a71 is further amended-- 7#a7 in paragraph 7#hg71 by striking and at the end2 7#b7 in paragraph 7#hh71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#hh7 the following new paragraph3 7#hi7 provide that the ,state will make publicly available1 on the website of any relevant ,state agency1 any report received by the ,state from a hospital pursuant to section #ahff7;a77#a77,z77i74 2 and #djb4 ,collection of data relating to hospital labor and delivery services ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a771 as amended by section #dja1 is amended-- 7#a7 in subparagraph 7,y77ii77,v71 by striking and at the end2 7#b7 in subparagraph 7,z71 by striking the period and inserting 1 and2 and 7#c7 by adding at the end the following new subparagraph3 7,,aa7 in the case of a hospital1 to include in cost reports submitted under this title for cost reporting periods beginning on or after ,july #a1 #bjbf-- 7i7 the number of births that occurred at such hospital during the cost reporting period1 delineated by the number of cesarean births and vaginal births2 7ii7 the number of antenatal and postpartum transfers from the hospital to other hospitals2 7iii7 data on the number and characteristics of the staff providing labor and delivery services at such hospital2 7iv7 the expenses the hospital incurred for providing labor and delivery services at such hospital1 including nursing care1 anesthesia1 and operating room services2 7v7 the amount the hospital spent for on-call coverage for labor and delivery services by physicians and midwives2 and 7vi7 the amount and sources of revenue received by such hospital for labor and delivery services1 including payments received for-- 7,i7 items and services furnished to individuals eligible for coverage under a ,state plan under title ,,xix 7or a waiver of such a plan72 7,,ii7 items and services furnished to individuals with other forms of health insurance or third-party coverage2 and 7,,iii7 items and services furnished to individuals without health insurance or other source of third party coverage4 4