,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #cidb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,june #ab1 #bjbe,ms4  
,bonamici 7= h]self & ,ms4 ,kelly (     
,ill9ois7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d titles     
,,xix & ,,xxi ( ! ,social ,security ,act
 to enhance f9ancial support = rural &  
safety net hospitals provid+ mat]nity1  
labor1 & deliv]y s]vices to vuln]able   
populations1 & = o!r purposes4  #a4     
,%ort title2 table ( cont5ts  7a7 ,%ort 
title ,?is ,act may be cit$ z ! ,keep+  
,ob/etrics ,local ,act4  7b7 ,table (   
cont5ts ,! table ( cont5ts = ?is ,act is
 z foll[s3  ,sec4 #a4 ,%ort title2 table
 ( cont5ts4 ,,title ,i--,enhanc+        
f9ancial support = rural & safety net   
hospitals t provide ob/etric s]vices    

,sec4 #aja4 ,/ate /udies & ,,hhs report 
on co/s ( provid+ mat]nity1 labor1 &    
deliv]y s]vices4 ,sec4 #ajb4 ,requir+   
adequate paym5t rates "u ,m$icaid =     
mat]nity1 labor1 & deliv]y s]vices at   
eligible hospitals4 ,sec4 #ajc4         
,increas$ ,f$]al f9ancial p>ticipation =
 mat]nity1 labor1 & deliv]y s]vices     
furni%$ by eligible hospitals4 ,sec4    
#ajd4 ,labor & deliv]y s]vices an*or    
paym5ts4 ,sec4 #aje4 ,application (     
adequate paym5t requirem5t & increas$   
,f$]al f9ancial p>ticipation requirem5ts
 to ,,*ip4 ,sec4 #ajf4 ,disreg>d+       
increas$ & additional paym5ts to        
hospitals = purposes ( o!r supplem5tal  
paym5ts & upp] paym5t limits4 ,,title   
,,ii--,exp& ,cov]age ( ,mat]nal ,heal?  
,c>e ,sec4 #bja4 ,requir+ #ab-mon?      
cont9u\s1 full b5efit cov]age = pregnant
 individuals "u ,m$icaid & ,,*ip4 ,sec4 
#bjb4 ,heal? homes = pregnant & po/p>tum
 wom54 ,sec4 #bjc4 ,guidance on support+
 & improv+ access to ,m$icaid & ,,*ip   
cov]age ( s]vices provid$ by d\las &    

c]ta9 mat]nal heal? pr(essionals4 ,sec4 
#bjd4 ,m$icaid & ,,*ip increas$ f9ancial
 support = depression & anxiety scre5+  
dur+ ! p]9atal & po/p>tum p]iods4 ,sec4 
#bje4 ,presumptive eligibility =        
pregnant individuals4 ,,title           
,,iii--,inve/ 9 ! ,mat]nal ,heal? ,c>e  
,work=ce ,sec4 #cja4 ,em]g5cy ob/etric  
work=ce support4 ,sec4 #cjb4 ,/reaml9$  
scre5+ & enrollm5t ( provid]s (         
mat]nity1 labor1 & deliv]y s]vices 9    
neighbor+ ,/ates4 ,,title ,,iv--,requir+
 ,public ,communication ( ,ob/etrics    
,data & ,unit ,closures ,sec4 #dja4     
,timely notifications ( imp5d+ hospital 
ob/etric unit closures4 ,sec4 #djb4     
,collection ( data relat+ to hospital   
labor & deliv]y s]vices4  ,i ,enhanc+   
f9ancial support = rural & safety net   
hospitals t provide ob/etric s]vices    
#aja4 ,/ate /udies & ,,hhs report on    
co/s ( provid+ mat]nity1 labor1 &       
deliv]y s]vices  7a7 ,/ate /udy  7#a7 ,9
 g5]al ,n lat] ?an #bd mon?s aft] ! date
 ( enactm5t ( ?is ,act1 & e #e ye>s     

!reaft]1 ea* ,/ate 7z su* t]m is def9$ 9
 section #aaja7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acja7;a77#a77 = purposes ( titles ,,xix
 & ,,xxi ( su* ,act7 %all conduct a /udy
 on ! co/s ( provid+ mat]nity1 labor1 & 
deliv]y s]vices 9 applicable hospitals  
7z def9$ 9 p>agraph 7#c77 & submit !    
results ( su* /udy to ! ,secret>y (     
,heal? & ,human ,s]vices 7ref]r$ to 9   
?is section z ! ,secret>y74  7#b7       
,cont5t ( /udy ,a ,/ate /udy requir$ "u 
p>agraph 7#a7 %all include ! foll[+     
in=mation 7to ! ext5t practicable7 )    
respect to mat]nity1 labor1 & deliv]y   
s]vices furni%$ by applicable hospitals 
locat$ 9 ! ,/ate3  7,a7 ,an e/imate ( ! 
co/ ( provid+ mat]nity1 labor1 & deliv]y
 s]vices at applicable hospitals1 bas$  
on ! exp5ditures a repres5tative sample 
( su* hospitals incurr$ = provid+ su*   
s]vices dur+ ! #b mo/ rec5t ye>s = :i*  
data is available4  7,b7 ,an e/imate ( !
 co/ ( provid+ mat]nity1 labor1 &       
deliv]y s]vices at applicable hospitals 

t ceas$ provid+ labor & deliv]y s]vices 
)9 ! pa/ #e ye>s1 bas$ on ! exp5ditures 
a repres5tative sample ( su* hospitals  
incurr$ = provid+ su* s]vices dur+ ! #b 
mo/ rec5t ye>s = :i* data is available4 
7,c7 ,to ! ext5t data all[s1 an analysis
 ( ! ext5t to :i* geographic location1  
community demographics1 & local economic
 factors 7z def9$ by ! ,secret>y7 affect
 ! co/ ( provid+ mat]nity1 labor1 &     
deliv]y s]vices at applicable hospitals1
 includ+ ! co/ ( s]vices t support !    
provision ( mat]nity1 labor1 & deliv]y  
s]vices4  7,d7 ,! am\nts applicable     
hospitals are paid = mat]nity1 labor1 & 
deliv]y s]vices1 by geographic location 
& hospital size1 "u--  7i7 ,m$ic>e2     
7ii7 ! ,/ate ,m$icaid program1 includ+  
paym5t am\nts = su* s]vices "u          
fee-=-s]vice paym5t arrangem5ts & "u    
manag$ c>e 7z applicable72  7iii7 !     
,/ate ,,*ip plan1 includ+ paym5t am\nts 
= su* s]vices "u fee-=-s]vice paym5t    
arrangem5ts & "u manag$ c>e 7z          
applicable72 &  7iv7 private heal?      

insurance4  7,e7 ,a comp>ative paym5t   
rate analysis-- 7i7 comp>+ paym5t rates 
= mat]nity1 labor1 & deliv]y s]vices    
7inclusive ( all paym5ts receiv$ by     
applicable hospitals = furni%+ mat]nity1
 labor1 & deliv]y s]vices7 "u ! ,/ate   
,m$icaid fee-=-s]vice program to su*    
paym5t rates = su* s]vices "u ,m$ic>e 7z
 describ$ 9 section #ddg4bjc7;b77#c7 (  
title #db1 ,code ( ,f$]al ,regulations71
 o!r ,f$]ally-fund$ or ,/ate-fund$      
programs 7includ+1 to ! ext5t data is   
available1 ,m$icaid manag$ c>e rates71 &
 to ! paym5t rates = su* s]vices1 to !  
ext5t data is available1 ( private heal?
 insur]s )9 geographic areas ( ! ,/ate2 
&  7ii7 analyz+ diff]5t paym5t me?ods = 
su* s]vices1 su* z ! use ( bundl$       
paym5ts1 quality inc5tives1 & l[-volume 
adju/m5ts4  7,f7 ,an evaluation1 us+ su*
 me?odology & p>amet]s e/abli%$ by !    
,secret>y1 ( :e!r ea* hospital locat$ 9 
! ,/ate t furni%es mat]nity1 labor1 &   
deliv]y s]vices is expect$ to exp]i5ce 9
 ! next #c ye>s significant *anges 9    

p>ticul> exp5ditures or types (         
reimbursem5t = mat]nity1 labor1 &       
deliv]y s]vices4  7#c7 ,applicable      
hospital def9$ ,= purposes ( ?is        
subsection1 ! t]m applicable hospital   
means any hospital locat$ 9 a ,/ate t   
meets ei!r ( ! foll[+ crit]ia3 7,a7 ,!  
hospital provides labor & deliv]y       
s]vices & m ?an #ej p]c5t ( ! hospital's
 bir?s 79 ! mo/ rec5t ye> = :i* su* data
 is available7 are f9anc$ by ! ,m$icaid 
program or ,,*ip4  7,b7 ,! hospital--   
7i7 is locat$ 9 a rural area 7z def9$ by
 ! ,f$]al ,(fice ( ,rural ,heal? ,policy
 = ! purpose ( rural heal? grant        
programs adm9i/]$ by su* ,(fice72  7ii7 
bas$ on ! mo/ rec5t #b ye>s ( data      
available 7z det]m9$ by ! ,secret>y71   
furni%$ s]vices = less ?an an av]age (  
#cjj bir?s p] ye>2 &  7iii7 provides    
labor & deliv]y s]vices4  7#d7          
,assi/ance to small hospitals 9 compil+ 
co/ in=mation ,!re are appropriat$ to ! 
,secret>y = fiscal ye> #bjbf1           
#aj1jjj1jjj = ! purpose ( provid+ grants

 & te*nical assi/ance to a hospital     
describ$ 9 p>agraph 7#c77;,b7 to enable 
su* hospital to compile detail$         
in=mation = use 9 ! ,/ate /udies requir$
 "u p>agraph 7#a71 to rema9 available   
until exp5d$4  7#e7 ,,hhs report on     
,/ate /udies ,= ea* ye> 9 :i* a ,/ate is
 requir$ to conduct a /udy "u p>agraph  
7#a71 ! ,secret>y %all issue1 n lat] ?an
 #ab mon?s aft] ! date on :i* ! ,/ate   
submits to ! ,secret>y ! data describ$ 9
 su* p>agraph1 a publicly available     
report t compiles & details ! results ( 
su* /udy & includes ! in=mation describ$
 9 p>agraph 7#b74  7b7 ,,hhs report on  
national data collection f9d+s ,n lat]  
?an #c ye>s aft] ! date ( enactm5t ( ?is
 ,act1 ! ,secret>y %all submit to       
,congress1 & make publicly available1 a 
report analyz+ ! fir/ /udies conduct$ by
 ,/ates "u subsection 7a77#a71 includ+  
recomm5dations = improv+ data collection
 on ! co/ ( provid+ mat]nity1 labor1 &  
deliv]y s]vices4  7c7 ,implem5tation    
fund+ ,9 addition to ! am\nt appropriat$

 "u subsection 7a77#d71 !re are         
appropriat$1 out ( any funds 9 !        
,treasury n o!rwise obligat$1 #c1jjj1jjj
 = fiscal ye> #bjbf1 to rema9 available 
until exp5d$1 to ! ,secret>y ( ,heal? & 
,human ,s]vices = purposes ( implem5t+  
?is section4  #ajb4 ,requir+ adequate   
paym5t rates "u ,m$icaid = mat]nity1    
labor1 & deliv]y s]vices at eligible    
hospitals  7a7  ,fee-=-,s]vice paym5ts  
,section #aijb ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 
7#a7 9 subsection 7a77#ac7--  7,a7 by   
/rik+ & at ! end ( subp>agraph 7,b72    
7,b7 by add+ & at ! end ( subp>agraph   
7,c72 &  7,c7 by add+ at ! end ! foll[+ 
new subp>agraph3  7,d7 = ea* fiscal ye> 
beg9n+ ) fiscal ye> #bjbg1 paym5t =     
mat]nity1 labor1 & deliv]y s]vices 7z   
def9$ 9 subsection 7uu77 furni%$ dur+   
su* fiscal ye> 9 an eligible hospital 7z
 def9$ 9 su* subsection7 at a rate t is 
n less ?an ! m9imum paym5t rate specifi$
 = ! fiscal ye> 9 p>agraph 7#d7 ( su*   
subsection2  2 &  7#b7 by add+ at ! end 

! foll[+ new subsection3  7uu7          
,mat]nity1 labor1 & deliv]y s]vices &   
eligible hospitals def9$ ,= purposes (  
subsection 7a77#ac77;,d7--  7#a7        
,mat]nity1 labor1 & deliv]y s]vices     
7,a7  ,9 g5]al  ,! t]m mat]nity1 labor1 
& deliv]y s]vices means su* inpati5t    
hospital s]vices & outpati5t hospital   
s]vices1 includ+ behavioral heal?       
s]vices1 t are provid$ 9 relation to    
mat]nity c>e or labor & deliv]y1        
id5tifi$ by appropriate ,,icd & ,,cpt   
codes1 z ! ,secret>y %all specify aft]  
consultation ) pr(essional or m$ical    
societies ) exp]tise 9 pregnancy1       
*ildbir?1 & po/p>tum c>e4  7,b7  ,scope 
,su* t]m %all n be limit$ 9 application1
 = any eligible hospital1 only to       
s]vices t relate to a bir? t occurs 9 ! 
hospital4  7,c7  ,rulemak+  ,n lat] ?an 
,july #a1 #bjbf1 ! ,secret>y %all issue 
an int]im f9al rule specify+ :i* s]vices
 %all be consid]$ mat]nity1 labor1 &    
deliv]y s]vices = purposes ( ?is        
subsection & subsection 7a77#ac77;,d74  

7#b7  ,eligible hospital  7,a7  ,9 g5]al
  ,! t]m eligible hospital means1 )     
respect to a ,/ate & fiscal ye>--  7i7 a
 hospital t is locat$ 9 a rural area 7z 
def9$ by ! ,f$]al ,(fice ( ,rural ,heal?
 ,policy = ! purpose ( rural heal? grant
 programs adm9i/]$ by su* ,(fice72  7ii7
 a critical access hospital 7z def9$ 9  
section #ahfa7mm77#a772  7iii7 a        
hospital op]at$ by ! ,indian ,heal?     
,s]vice or an ,indian ,tribe "u !       
,indian ,self-,det]m9ation & ,education 
,assi/ance ,act2  7iv7 a hospital = :i*1
 9 ! mo/ rec5t #ab-mon? p]iod = :i* data
 is available1 at lea/ #ej p]c5t ( all  
bir?s = :i* ! hospital provid$ mat]nity1
 labor1 & deliv]y s]vices dur+ su*      
fiscal ye> 7 qualify+ bir?s2 or  7v7 a  
hospital t is able to demon/rate1 ?r\gh 
a process to be det]m9$ by ! ,secret>y1 
t1 = ! applicable fiscal ye>1 ! hospital
 projects t at lea/ #ej p]c5t ( all     
bir?s = :i* ! hospital w provide        
mat]nity1 labor1 & deliv]y s]vices dur+ 
su* fiscal ye> w be qualify+ bir?s4     

7,b7  ,id5tification ( eligible         
hospitals  ,ea* ,/ate1 subject to !     
approval ( ! ,secret>y1 %all id5tify !  
hospitals 9 ! ,/ate t are eligible      
hospitals ) respect to a fiscal ye>4    
7#c7  ,qualify+ bir?  ,= purposes (     
p>agraph 7#b71 ! t]m qualify+ bir? means
 a bir? = :i* any mat]nity1 labor1 &    
deliv]y s]vices associat$ ) ! bir?--    
7,a7 7 paid = "u a ,/ate plan "u ?is    
title 7or "u a waiv] ( su* a plan7 or "u
 a ,/ate *ild heal? plan "u title ,,xxi 
7or "u a waiv] ( su* a plan72  7,b7 7   
paid = "u title ,,xviii2  7,c7 7 provid$
 by ! ,indian ,heal? ,s]vice or a       
,native ,hawaiian heal? c>e sy/em 7z    
def9$ 9 section #ab ( ! ,native         
,hawaiian ,heal? ,c>e ,improvem5t ,act72
 or  7,d7 7 provid$ to a pati5t :o does 
n h m9imum ess5tial cov]age 7z def9$ 9  
section #ejjj;,a7f7 ( ! ,int]nal ,rev5ue
 ,code ( #aihf7 & 7 n fully paid = by   
su* pati5t4  7#d7  ,m9imum paym5t rate  
specifi$  ,! m9imum paym5t rate specifi$
 9 ?is p>agraph is1 ) respect to an     

eligible hospital & mat]nal1 labor1 &   
deliv]y s]vices--  7,a7 = fiscal ye>    
#bjbg1 #aej p]c5t ( ! paym5t rate t w\ld
 apply = su* s]vices & hospital "u title
 ,,xviii2 &  7,b7 = ea* p]iod ( #e      
fiscal ye>s beg9n+ ) fiscal ye>s #bjbh  
?r\gh #bjcb1 a paym5t rate t is det]m9$ 
= su* p]iod by ! ,secret>y to accurately
 reflect ! co/s incurr$ by eligible     
hospitals 9 provid+ su* s]vices1 in=m$  
by ! results ( ! mo/ rec5t ,/ate /udies 
submitt$ to ! ,secret>y "u section      
#aja7;a7 ( ! ,keep+ ,ob/etrics ,local   
,act4  4  7b7 ,"u ,m$icaid manag$ c>e   
plans ,section #aicb7;f7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acifu-#b7;f77 is am5d$-- 7#a7 9 !      
head+1 by ins]t+ & mat]nity1 labor1 &   
deliv]y s]vices at eligible hospitals   
aft] s]vices2 &  7#b7 by /rik+ describ$ 
9 section #aijb7;a77#ac77;,c7 & ins]t+  
describ$ 9 subp>agraph 7,c7 ( section   
#aijb7;a77#ac7 or mat]nity1 labor1 &    
deliv]y s]vices describ$ 9 subp>agraph  
7,d7 ( su* section t are furni%$ by an  

eligible hospital 7z def9$ 9 section    
#aije7uu774  #ajc4 ,increas$ ,f$]al     
f9ancial p>ticipation = mat]nity1 labor1
 & deliv]y s]vices furni%$ by eligible  
hospitals ,section #aije ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is am5d$--  7#a7 9 subsection 7b71 by   
/rik+ & 7ii7 & ins]t+ 7ii71 & 7kk72 &   
7#b7 by add+ at ! end ! foll[+ new      
subsection3  7kk7 ,mat]nity1 labor1 &   
deliv]y s]vices  7#a7 ,9 g5]al ,not)/&+ 
subsection 7b71 ) respect to ,/ate      
exp5ditures = m$ical assi/ance =        
mat]nity1 labor1 & deliv]y s]vices      
furni%$ by an eligible hospital 7z su*  
t]ms are def9$ 9 section #aijb7uu77 9 a 
fiscal qu>t] t beg9s on or aft] ,octob] 
#a1 #bjbf-- 7,a7 ! ,f$]al m$ical        
assi/ance p]c5tage applicable to !      
enhanc$ paym5t rate am\nt ( su*         
exp5ditures 7z det]m9$ = ! ,/ate & qu>t]
 "u p>agraph 7#b77;,a77 %all be equal to
 #ajj p]c5t2 &  7,b7 subject to p>agraph
 7#c71 ! ,f$]al m$ical assi/ance        
p]c5tage applicable to ! base paym5t    

rate am\nt ( su* exp5ditures 7z det]m9$ 
= ! ,/ate & qu>t] "u p>agraph 7#b77;,b77
 %all be equal to ! enhanc$ ,,fmap      
det]m9$ = ! ,/ate & qu>t] "u section    
#baje7;b74  7#b7 ,det]m9ation ( enhanc$ 
paym5t rate am\nt & base paym5t rate    
am\nt  7,a7 ,enhanc$ paym5t rate am\nt  
7i7 ,9 g5]al ,= purposes ( p>agraph     
7#a77;,a71 ! enhanc$ paym5t rate am\nt =
 a ,/ate & fiscal qu>t] is equal to !   
am\nt ( ,/ate exp5ditures = m$ical      
assi/ance = mat]nity1 labor1 & deliv]y  
s]vices furni%$ by an eligible hospital 
7z su* t]ms are def9$ 9 section         
#aijb7uu77 9 su* fiscal qu>t] t is      
attributable to ! am\nt by :i* ! m9imum 
paym5t rate requir$ "u section          
#aijb7;a77#ac77;,d7 7or1 by application1
 section #aicb7;f77 exce$s ! base paym5t
 rate applicable to su* s]vices1 z      
det]m9$ = ! ,/ate1 qu>t]1 & s]vices "u  
clause 7ii74  7ii7 ,base paym5t rate ,= 
purposes ( clause 7i71 ! base paym5t    
rate det]m9$ = a ,/ate1 a fiscal qu>t]1 
& mat]nity1 labor1 & deliv]y s]vices 7z 

def9$ 9 section #aijb7uu77 %all be equal
 to-- 7,i7 ! paym5t rate applicable to  
su* s]vices "u ! ,/ate plan 7or "u a    
waiv] ( su* plan7 z ( ,janu>y #a1 #bjbe2
 increas$ by  7,,ii7 ! p]c5tage increase
 9 ! m$ical c>e compon5t ( ! consum]    
price index = all urban consum]s f      
,janu>y ( #bjbe to ! mon? end+ on ! day 
be=e ! #a/ day ( su* fiscal qu>t]4  7,b7
 ,base paym5t rate am\nt ,= purposes (  
p>agraph 7#a77;,b71 ! base paym5t rate  
am\nt = a ,/ate & fiscal qu>t] is equal 
to--  7i7 ! total am\nt ( ,/ate         
exp5ditures = m$ical assi/ance =        
mat]nity1 labor1 & deliv]y s]vices      
furni%$ by an eligible hospital 7z su*  
t]ms are def9$ 9 section #aijb7uu77 9   
su* fiscal qu>t]2 m9us  7ii7 ! enhanc$  
paym5t rate am\nt det]m9$ = ! ,/ate &   
fiscal qu>t] "u subp>agraph 7,a74  7#c7 
,application ( high] mat* ,subp>agraph  
7,b7 ( p>agraph 7#a7 %all n apply 9 !   
case ( ,/ate exp5ditures describ$ 9 su* 
subp>agraph if ! application ( su*      
subp>agraph w\ld result 9 a l[] ,f$]al  

m$ical assi/ance p]c5tage = su*         
exp5ditures ?an w\ld o!rwise apply )\t !
 application ( su* p>agraph4  7#d7      
,exclusion ( exp5ditures f t]ritorial   
caps ,any paym5t made to a t]ritory =   
m$ical assi/ance t is subject to !      
,f$]al m$ical assi/ance p]c5tage        
specifi$ 9 p>agraph 7#a77;,a7 or !      
enhanc$ ,,fmap ref]r$ to 9 p>agraph     
7#a77;,b7 %all n be tak5 into acc\nt =  
purposes ( apply+ paym5t limits "u      
subsections 7f7 & 7g7 ( section #aajh4  
4  #ajd4 ,labor & deliv]y s]vices an*or 
paym5ts  7a7 ,/ate requirem5t ,section  
#aijb7;a77#ac77;,a7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#ac77;,a77 is am5d$-- 7#a7 9 
clause 7iii71 by /rik+ & at ! end2  7#b7
 9 clause 7iv71 by /rik+ ! semicolon at 
! end & ins]t+ 1 &2 &  7#c7 by add+ at !
 end ! foll[+ new clause3  7v7 9 ! case 
( hospitals1 su* rates take into acc\nt 
79 a mann] consi/5t ) section #aibc;,a7 
! situation ( l[ volume ob/etric        
hospitals 7z su* t]m is def9$ 9 su*     

section72  4  7b7 ,requir+ an*or paym5ts
 = l[ volume ob/etric hospitals ,title  
,,xix ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif et seq47 is am5d$ by    
ins]t+ ! foll[+ aft] section #aibc3     
#aibc;,a4 ,an*or paym5ts = labor &      
deliv]y s]vices provid$ by l[ volume    
ob/etric hospitals  7a7 ,implem5tation (
 requirem5t ,a ,/ate plan "u ?is title  
%all n be consid]$ to meet ! requirem5t 
( section #aijb7;a77#ac77;,a77v7 7ins(> 
z x requires paym5ts to hospitals to    
take into acc\nt ! situation ( l[ volume
 ob/etric hospitals71 z ( ,octob] #a1   
#bjbf1 unless ! ,/ate has submitt$ to ! 
,secret>y1 by n lat] ?an su* date1 an   
am5dm5t to su* plan t provides = an     
annual an*or paym5t to su* hospitals1   
consi/5t ) subsection 7c74  7b7         
,def9itions ,9 ?is section3  7#a7       
,ant5atal transf] ,! t]m ant5atal       
transf] means1 ) respect to a hospital1 
a pregnant individual :o 0 expect$ to   
receive labor & deliv]y s]vices at !    
hospital b :o is transf]r$ to a diff]5t 

hospital because ( a ne$ = labor &      
deliv]y s]vices t are n available at !  
transf]r+ hospital4  7#b7 ,deliv]y      
volume ,! t]m deliv]y volume means1 )   
respect to a hospital & a fiscal ye>1 ! 
total numb] ( bir?s occurr+ 91 &        
ant5atal transf]s made by1 su* hospital 
dur+ su* ye>4  7#c7 ,labor & deliv]y    
rev5ue floor ,! t]m labor & deliv]y     
rev5ue floor means1 ) respect to a l[   
volume ob/etric hospital & a fiscal ye>1
 ! am\nt equal to ! sum (-- 7,a7 !      
product (--  7i7 ! deliv]y volume = su* 
hospital & fiscal ye>2 &  7ii7 ! p]     
deliv]y am\nt = su* fiscal ye>2 &  7,b7 
! /&by capacity am\nt = su* fiscal ye>4 
7#d7 ,labor & deliv]y s]vices ,! t]m    
labor & deliv]y s]vices means su*       
inpati5t & outpati5t hospital s]vices   
relat$ to labor & deliv]y1 includ+      
s]vices relat$ to ant5atal transf]s1    
id5tifi$ by appropriate ,,icd & ,,cpt   
codes1 z ! ,secret>y %all specify 9     
consultation ) pr(essional or m$ical    
societies ) exp]tise 9 ?is area4  7#e7  

,l[ volume ob/etric hospital ,! t]m l[  
volume ob/etric hospital means1 )       
respect to a hospital & a fiscal ye>1 a 
hospital-- 7,a7 t is an eligible        
hospital 7z def9$ 9 section             
#aijb7uu77#b772  7,b7 9 :i* ! av]age    
numb] ( bir?s = :i* ! hospital provid$  
labor & deliv]y s]vices dur+ ! prec$+ #c
 fiscal ye>s is less ?an #cjj bir?s p]  
ye>2  7,c7 t did n provide labor &      
deliv]y s]vices 9 ! prec$+ fiscal ye>1 b
 9 :i* ! av]age numb] ( bir?s = :i* !   
hospital provid$ labor & deliv]y s]vices
 dur+ ! mo/ rec5t #c fiscal ye>s 9 :i* !
 hospital provid$ labor & deliv]y       
s]vices is less ?an #cjj bir?s p] ye>2  
7,d7 t is n describ$ 9 subp>agraphs 7,b7
 or 7,c7 b1 9 ! applicable fiscal ye>1  
provides labor & deliv]y s]vices = few] 
?an #cjj bir?s2 or  7,e7 t is n describ$
 9 subp>agraphs 7,b7 ?r\gh 7,d7 b is    
c]tifi$ by ! ,/ate 9 :i* ! hospital is  
locat$ z meet+ su* crit]ia z ! ,secret>y
 %all e/abli% = id5tify+ hospitals t are
 ess5tial to meet+ ! ne$s ( an und]s]v$ 

population1 su* z s]v+ a population )   
limit$ ,engli% pr(ici5cy1 s]v+ specific 
racial or e?nic populations1 or o!r     
factors4  7#f7 ,m$icaid labor & deliv]y 
rev5ue floor ,! t]m ,m$icaid labor &    
deliv]y rev5ue floor means1 ) respect to
 a l[ volume ob/etric hospital & a      
fiscal ye>1 ! product (-- 7,a7 ! labor &
 deliv]y rev5ue floor = su* hospital &  
fiscal ye>2 &  7,b7 ! p]c5tage ( !      
deliv]y volume ( su* hospital 9 su*     
fiscal ye> t 7 paid = "u a ,/ate plan "u
 ?is title 7or "u a waiv] ( su* a plan7 
or "u a ,/ate *ild heal? plan "u title  
,,xxi 7or "u a waiv] ( su* a plan74     
7#g7 ,p] deliv]y am\nt  7,a7 ,9 g5]al ,!
 t]m p] deliv]y am\nt means1 ) respect  
to a fiscal ye>1 an am\nt1 z det]m9$ "u 
subp>agraph 7,b71 t repres5ts ! m>g9al  
co/ to a l[ volume ob/etric hospital ( a
 bir? or an ant5atal transf]4  7,b7     
,det]m9ation ( p] deliv]y am\nt  7i7    
,fiscal ye> #bjbh ,= fiscal ye> #bjbh1 !
 p] deliv]y am\nt %all be #aj1jjj4  7ii7
 ,index+ ,subject to clause 7iii71 = ea*

 fiscal ye> aft] fiscal ye> #bjbh1 ! p] 
deliv]y am\nt %all be ! am\nt t appli$  
"u ?is subp>agraph = ! prec$+ fiscal ye>
 increas$ by ! p]c5tage increase 9 !    
m$ical c>e compon5t ( ! consum] price   
index = all urban consum]s = ! #ab-mon? 
p]iod end+ ) ,septemb] ( su* prec$+     
fiscal ye>4  7iii7 ,p]iodic revision (  
p] deliv]y am\nt ,n less ?an once e #e  
fiscal ye>s1 ! ,secret>y %all collect & 
analyze data on ! co/s ( labor & deliv]y
 s]vices at l[ volume ob/etric hospitals
 &1 ?r\gh rulemak+1 %all e/abli% a new  
p] deliv]y am\nt = purposes ( ?is       
section to ensure t su* am\nt accurately
 reflects ! m>g9al co/ to a l[ volume   
ob/etric hospital ( a bir? or an        
ant5atal deliv]y4  7#h7 ,/&by capacity  
am\nt  7,a7 ,9 g5]al ,! t]m /&by        
capacity am\nt means1 ) respect to a    
fiscal ye>1 an am\nt1 z det]m9$ "u      
subp>agraph 7,b71 t repres5ts ! m9imum  
level ( exp5ditures by a l[ volume      
ob/etric hospital t is necess>y to      
ensure t adequate p]sonnel1 equipm5t1 & 

facilities are available at all times to
 provide labor & deliv]y s]vices4  7,b7 
,det]m9ation ( /&by capacity am\nt  7i7 
,fiscal ye> #bjbh ,= fiscal ye> #bjbh1 !
 /&by capacity am\nt %all be #a1bjj1jjj4
  7ii7 ,index+ ,subject to clause 7iii71
 = ea* fiscal ye> aft] fiscal ye> #bjbh1
 ! /&by capacity am\nt %all be ! am\nt t
 appli$ "u ?is subp>agraph = ! prec$+   
fiscal ye> increas$ by ! p]c5tage       
increase 9 ! m$ical c>e compon5t ( !    
consum] price index = all urban consum]s
 = ! #ab-mon? p]iod end+ ) ,septemb] (  
su* prec$+ fiscal ye>4  7iii7 ,p]iodic  
revision ( /&by capacity am\nt ,n less  
?an once e #e fiscal ye>s1 ! ,secret>y  
%all collect & analyze data on ! co/s ( 
labor & deliv]y s]vices at l[ volume    
ob/etric hospitals &1 ?r\gh rulemak+1   
%all e/abli% a new /&by capacity am\nt =
 purposes ( ?is section to ensure t su* 
am\nt accurately reflects ! m9imum level
 ( exp5ditures by a l[ volume ob/etric  
hospital t is necess>y to ensure t      
adequate p]sonnel1 equipm5t1 &          

facilities are available at all times to
 provide labor & deliv]y s]vices4  7c7  
,an*or paym5t = l[ volume ob/etric      
hospitals ,n lat] ?an #c mon?s aft] !   
end ( ea* fiscal ye> beg9n+ ) fiscal ye>
 #bjbh1 ea* ,/ate %all pay to ea* l[    
volume ob/etric hospital 9 ! ,/ate an   
am\nt t is equal to ! am\nt 7if any7 by 
:i*--  7#a7 ! ,m$icaid labor & deliv]y  
rev5ue floor = ! hospital & fiscal ye>2 
exce$s  7#b7 ! total am\nt ( all paym5ts
 made to ! l[ volume ob/etric hospital  
"u ! ,/ate plan "u ?is title 7or "u a   
waiv] ( su* plan7 & "u ! ,/ate *ild     
heal? plan "u title ,,xxi 7or "u a waiv]
 ( su* plan7 7o!r ?an paym5ts "u ?is    
section7 = labor & deliv]y s]vices      
provid$ by su* hospital dur+ su* fiscal 
ye>4  7d7 ,requirem5ts = receipt (      
paym5ts ,no an*or paym5t %all be made to
 a l[ volume ob/etric hospital "u ?is   
section = a fiscal ye> unless ! hospital
 c satisfy ! foll[+ requirem5ts3 7#a7   
,skills ma9t5ance & tra9+ activities ,! 
hospital demon/rates to ! satisfaction (

 ! ,/ate t ! hospital conducts &        
completes skills ma9t5ance & tra9+      
activities1 includ+ cont9u+ education & 
tra9+ to support ma9t5ance ( ob/etric   
skills1 t satisfy su* requirem5ts z !   
,secret>y1 tak+ into consid]ation       
nationally recogniz$ ob/etrics skills1  
ma9t5ance1 & tra9+ /&>ds su* z /&>ds    
publi%$ by ! ,am]ican ,college (        
,ob/etricians & ,gynecologi/s & !       
,association ( ,wom5's ,heal?1          
,ob/etric1 & ,neonatal ,nurses1 %all    
specify = ! purposes ( ?is section4     
7#b7 ,cont9u$ provision ( labor &       
deliv]y s]vices  7,a7 ,9 g5]al ,!       
hospital & ! ,/ate ent] into a contract 
"u :i*1 9 ex*ange = su* paym5t "u ?is   
section = a fiscal ye>1 ! hospital      
agrees to cont9ue to provide labor &    
deliv]y s]vices-- 7i7 = ! p]iod t beg9s 
) su* fiscal ye> & ends on ! la/ day ( !
 second fiscal ye> t foll[s su* fiscal  
ye>2 &  7ii7 at a level t is n less ?an 
! level at :i* ! hospital provid$ su*   
s]vices 9 ! fiscal ye> to :i* su* paym5t

 relates1 unless ! hospital c demon/rate
 t ! ne$ = s]vices 9 ! community has    
decreas$ & t ! new level ( s]vices w be 
adequate to meet t ne$4  7,b7 ,recov]y (
 paym5t 9 ! ev5t ( brea* ( contract by  
hospital ,! t]ms ( ! contract betwe5 a  
hospital & a ,/ate requir$ "u           
subp>agraph 7,a7 %all provide t if !    
hospital does n provide labor & deliv]y 
s]vices z requir$ "u ! contract ?r\gh\t 
! p]iod describ$ 9 su* subp>agraph = any
 reason 7includ+ 9 ! ev5t ( ! hospital's
 bankruptcy or closure7 ! ,/ate may     
recov] ! full am\nt ( ! paym5t "u ?is   
section to :i* ! contract relates & 9 ! 
ev5t ( ! hospital's bankruptcy1 ! ,/ate 
%all be giv5 pref]r$ cr$itor /atus =    
purposes ( ! collection ( su* paym5t4   
7#c7 ,utilization ( funds = labor &     
deliv]y s]vices  7,a7 ,9 g5]al ,!       
hospital & ! ,/ate ent] into a contract 
"u :i*1 9 ex*ange = su* paym5t "u ?is   
section1 ! hospital agrees to utilize   
funds receiv$ "u su* paym5t = !         
provision ( labor & deliv]y s]vices 9 ! 

community s]v$ by ! hospital4  7,b7     
,recov]y ( paym5t 9 ! ev5t ( brea* (    
contract by hospital ,! t]ms ( !        
contract betwe5 a hospital & a ,/ate    
requir$ "u subp>agraph 7,a7 %all provide
 t if ! hospital does n utilize paym5t  
funds = labor & deliv]y s]vices z       
requir$ "u ! contract = any reason      
7includ+ 9 ! ev5t ( ! hospital's        
bankruptcy or closure7 ! ,/ate may      
recov] ! full am\nt ( ! paym5t "u ?is   
section to :i* ! contract relates & 9 ! 
ev5t ( ! hospital's bankruptcy1 ! ,/ate 
%all be giv5 pref]r$ cr$itor /atus =    
purposes ( ! collection ( su* paym5t4   
7e7 ,treatm5t ( paym5ts2 recov]y (      
paym5ts  7#a7 ,9 g5]al ,paym5ts made by 
a ,/ate "u ?is section = a fiscal ye>-- 
7,a7 %all be 9 addition to any o!r      
paym5ts made to hospitals = labor &     
deliv]y s]vices "u ! ,/ate plan 7or a   
waiv] ( su* plan7 "u ?is title1 "u !    
,/ate *ild heal? assi/ance plan "u title
 ,,xxi 7or "u a waiv] ( su* plan71 or "u
 title ,,xviii = ! fiscal ye>1 includ+  

disproportionate %>e hospital paym5ts "u
 section #aibc or section               
#ahhf7;d77#e77;,f7 & o!r supplem5tal    
paym5ts t are n made "u ?is section2 &  
7,b7 %all be treat$ z m$ical assi/ance =
 :i* paym5t is made "u section          
#aijc7;a71 except t ! ,f$]al m$ical     
assi/ance p]c5tage applicable to am\nts 
exp5d$ by a ,/ate = su* paym5ts %all be 
equal to ! enhanc$ ,,fmap det]m9$ = !   
,/ate & fiscal ye> "u section #baje7;b74
  7#b7 ,paym5ts recov]$ by a ,/ate ,if a
 ,/ate recov]s any am\nt ( a paym5t made
 by a ,/ate "u ?is section 7:e!r        
pursuant to p>agraphs 7#b77;,b7 or      
7#c77;,b7 ( subsection 7d7 or o!rwise71 
! am\nt s recov]$ %all be treat$ z an   
ov]paym5t recov]$ by ! ,/ate "u section 
#aijc7;d74  4  7c7 ,con=m+ am5dm5ts     
,title ,,xix ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif et seq47 is am5d$ z
 foll[s3 7#a7 ,9 section #aijc--  7,a7 9
 subsection 7d77#f77;,b7-- 7i7 by /rik+ 
relat$ to ! total am\nt & ins]t+ !      
foll[+3 8relat$ to--  7i7 ! total am\nt 

2  7ii7 by /rik+ ! p]iod at ! end &     
ins]t+ 2 &2 &  7iii7 by add+ at ! end ! 
foll[+ new clause3  7ii7 ! total am\nt (
 paym5ts made to individual provid]s 7by
 provid]7 "u section #aibc;,a dur+ su*  
fiscal ye>4  2 &  7,b7 9 subsection     
7bb77#b77;,b7-- 7i7 9 ! head]1 by ins]t+
 & l[ volume ob/etric hospital aft]     
,,d%2 &  7ii7 by ins]t+ or a paym5t made
 to a l[ volume ob/etric hospital "u    
section #aibc;,a be=e ! p]iod4  7#b7 ,9 
section #aije--  7,a7 9 subsection 7cc71
 by /rik+ section #aibc ! second place x
 appe>s & ins]t+ section #aibc or       
#aibc;,a2 &  7,b7 9 subsection          
7ii77#b77;,a71 by ins]t+ or paym5ts to  
l[ volume ob/etric hospitals describ$ 9 
section #aibc;,a be=e ! semicolon4      
#aje4 ,application ( adequate paym5t    
requirem5t & increas$ ,f$]al f9ancial   
p>ticipation requirem5ts to ,,*ip       
,section #bajg7;e77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acig;gg7e77#a77 is am5d$-- 7#a7 by     
r$esignat+ subp>agraphs 7,b7 ?r\gh 7,u7 

z subp>agraphs 7,c7 ?r\gh 7,v71         
respectively2 &  7#b7 by ins]t+ aft]    
subp>agraph 7,a7 ! foll[+ new           
subp>agraph3  7,b7 ,section             
#aijb7;a77#ac77;,d7 & section #aije7kk7 
7relat+ to ! m9imum paym5t rate requir$ 
= mat]nity1 labor1 & deliv]y s]vices    
furni%$ by an eligible hospital & ,f$]al
 f9ancial p>ticipation = ,/ate          
exp5ditures = su* s]vices74  4  #ajf4   
,disreg>d+ increas$ & additional paym5ts
 to hospitals = purposes ( o!r          
supplem5tal paym5ts & upp] paym5t limits
 ,a hospital's eligibility = any        
,f$]ally-fund$ supplem5tal paym5t       
7includ+ a disproportionate %>e paym5t  
"u section #ahhf7;d77#e77;,f7 or #aibc (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieww7d77#e77;,f71 #acifr-#d771 !    
det]m9ation ( ! am\nt ( su* paym5t1 & ! 
application ( any ,f$]al limitation on !
 aggregate am\nt ( paym5ts t a ,/ate may
 make to ! hospital 7includ+ any upp]   
paym5t limitation71 %all be det]m9$ )\t 
reg>d to ! am\nt ( any increase to a    

paym5t receiv$ by a hospital or any     
additional paym5t made to a hospital t  
is attributable to ! am5dm5ts made by   
?is title4  ,,ii ,exp& ,cov]age (       
,mat]nal ,heal? ,c>e  #bja4 ,requir+    
#ab-mon? cont9u\s1 full b5efit cov]age =
 pregnant individuals "u ,m$icaid &     
,,*ip  7a7 ,m$icaid ,section #aijb ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7 is am5d$-- 7#a7 9 subsection   
7a7--  7,a7 9 p>agraph 7#aj71 9 ! matt] 
foll[+ subp>agraph 7,g71 by /rik+       
7,,vii7 ! m$ical assi/ance made         
available to an individual describ$ 9   
subsection 7l77#a77;,a7 :o is eligible =
 m$ical assi/ance only because (        
subp>agraph 7,a77i77,,iv7 or            
7,a77ii77,,ix7 %all be limit$ to m$ical 
assi/ance = s]vices relat$ to pregnancy 
7includ+ pr5atal1 deliv]y1 po/p>tum1 &  
family plann+ s]vices71 m$ical assi/ance
 = s]vices relat$ to o!r conditions :i* 
may complicate pregnancy1 & m$ical      
assi/ance = vacc9es describ$ 9 section  
#aije7;a77#d77;,e7 & ! adm9i/ration (   

su* vacc9es dur+ ! p]iod describ$ 9 su* 
section1 & ins]t+ 7,,vii7 ,repeal$12    
7,b7 9 p>agraph 7#hf71 by /rik+ & at !  
end2  7,c7 9 p>agraph 7#hg71 by /rik+ ! 
p]iod at ! end & ins]t+ 2 &2 &  7,d7 by 
ins]t+ aft] p>agraph 7#hg7 ! foll[+ new 
p>agraph3  7#hh7 provide t ! ,/ate plan 
is 9 compliance ) subsection 7e77#af74  
2 &  7#b7 9 subsection 7e77#af7--  7,a7 
9 subp>agraph 7,a71 by /rik+ ,at !      
option ( ! ,/ate1 ! ,/ate plan 7or waiv]
 ( su* ,/ate plan7 may provide & ins]t+ 
,a ,/ate plan 7or waiv] ( su* ,/ate     
plan7 %all provide2  7,b7 9 subp>agraph 
7,b71 9 ! matt] prec$+ clause 7i71 by   
/rik+ by a ,/ate mak+ an election "u ?is
 p>agraph & ins]t+ "u a ,/ate plan 7or a
 waiv] ( su* ,/ate plan72 &  7,c7 9     
subp>agraph 7,c7-- 7i7 by /rik+ ,a ,/ate
 mak+ an election "u ?is p>agraph &     
ins]t+ ,9 ! case ( a ,/ate2 &  7ii7 by  
/rik+ %all also make ! election & ins]t+
 ! ,/ate %all provide cov]age4  7b7     
,,*ip  7#a7 ,9 g5]al ,subp>agraph 7,k7 (
 section #bajg7;e77#a7 ( ! ,social      

,security ,act 7#db ,u4,s4,c4           
#acig;gg7e77#a771 z r$esignat$ by       
section #aje1 is am5d$ to read z foll[s3
  7,k7 ,p>agraphs 7#e7 & 7#af7 ( section
 #aijb7;e7 7relat+ to ! requirem5t to   
provide m$ical assi/ance "u ! ,/ate plan
 or waiv] consi/+ ( full b5efits dur+   
pregnancy & ?r\gh\t ! #ab-mon? p]iod t  
beg9s on ! la/ day ( ! individual's     
pregnancy & ends on ! la/ day ( ! mon? 9
 :i* su* #ab-mon? p]iod ends74  4  7#b7 
,con=m+ am5dm5t ,section                
#baab7;d77#b77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acigll7d77#b77;,a77 is am5d$ by /rik+ !
 mon? 9 :i* ! #fj-;day p]iod & all t    
foll[s ?r\gh pursuant to section        
#bajg7;e77#a714  7c7 ,effective date    
7#a7 ,9 g5]al ,subject to p>agraphs 7#b7
 & 7#c71 ! am5dm5ts made by subsections 
7a7 & 7b7 %all take effect on ! #a/ day 
( ! #a/ cal5d> qu>t] t beg9s on or aft] 
! date t is #a ye> aft] ! date (        
enactm5t ( ?is ,act4  7#b7 ,exception = 
,/ate legislation ,9 ! case ( a ,/ate   

plan "u title ,,xix ( ! ,social         
,security ,act or a ,/ate *ild heal?    
plan "u title ,,xxi ( su* ,act t !      
,secret>y ( ,heal? & ,human ,s]vices    
det]m9es requires ,/ate legislation 9   
ord] = ! respective plan to meet any    
requirem5t impos$ by am5dm5ts made by   
?is subsection1 ! respective plan %all n
 be reg>d$ z fail+ to comply ) !        
requirem5ts ( su* title solely on !     
basis ( its failure to meet su* an      
additional requirem5t be=e ! #a/ day ( !
 #a/ cal5d> qu>t] beg9n+ aft] ! close ( 
! #a/ regul> session ( ! ,/ate          
legislature t beg9s aft] ! date (       
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        
legislature4  7#c7 ,/ate option = e>li] 
effective date ,a ,/ate may elect to h  
subsection 7e77#af7 ( section #aijb ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7 & subp>agraph 7,k7 ( section   

#bajg7;e77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;gg7e77#a771 z     
r$esignat$ by section #aje & am5d$ by   
subsection 7b7 ( ?is section1 take      
effect ) respect to ! ,/ate on ! #a/ day
 ( any fiscal qu>t] t beg9s be=e ! date 
describ$ 9 p>agraph 7#a7 & apply to     
am\nts payable to ! ,/ate = exp5ditures 
= m$ical assi/ance1 *ild heal?          
assi/ance1 or pregnancy-relat$ assi/ance
 to pregnant or po/p>tum individuals    
furni%$ on or aft] su* day4  #bjb4      
,heal? homes = pregnant & po/p>tum wom5 
7a7 ,m$icaid ,title ,,xix ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is am5d$ 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 individuals  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+ ,janu>y #a1 #bjbh1

 a ,/ate1 at its option z a ,/ate plan  
am5dm5t1 may provide = m$ical assi/ance 
"u ?is title to an eligible individual  
:o *ooses to--  7,a7 enroll 9 a mat]nity
 heal? home "u ?is section by select+ a 
designat$ provid]1 a team ( heal? c>e   
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team z ! individual's mat]nity  
heal? home = purposes ( provid+ !       
individual ) 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          
individuals "u ?is section4  7#b7       
,eligible individual def9$ ,9 ?is       
section1 ! t]m eligible individual 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 "u a  
waiv] ( su* plan72  7,b7 :o is n enroll$
 9 a heal? home "u section #aide or     

#aide;,a2 &  7,c7 ei!r--  7i7 :o is     
pregnant2 or  7ii7 ^: pregnancy has end$
 & is )9 ! #ab-mon? p]iod t beg9s on !  
la/ day ( ! individual's pregnancy &    
ends on ! la/ day ( ! mon? 9 :i* su*    
#ab-mon? p]iod ends4  7b7 ,qualification
 /&>ds ,! ,secret>y %all e/abli% /&>ds =
 qualification z a mat]nity heal? home  
or z a designat$ provid]1 a 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+ a designat$       
provid]1 a team ( heal? c>e pr(essionals
 op]at+ ) su* a provid]1 & a heal? team 
designat$ z a mat]nity heal? home 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 individual dur+
 ! individual's pregnancy & ! #cfe-;day 
p]iod beg9n+ on ! la/ day ( su*         
pregnancy4  7#b7 ,develop an            
individualiz$1 compreh5sive1            
pati5t-c5t]$ c>e plan = ea* eligible    
individual 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 individual's c>e plan1 9 a     
culturally & l+ui/ically appropriate    
mann] consi/5t ) ! ne$s ( ! eligible    
individual1 ongo+ home c>e1             
community-bas$ prim>y c>e1 inpati5t c>e1
 social support s]vices1 heal?-relat$   
social ne$s s]vices1 behavioral heal?   
s]vices1 local hospital em]g5cy c>e1 &1 
9 ! ev5t ( a *ange 9 income t w\ld      
result 9 ! eligible individual los+     
eligibility = m$ical assi/ance "u !     
,/ate plan 7or "u a waiv] ( su* plan71  
c>e managem5t & plann+ relat$ to a *ange
 9 ! eligible individual'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 designat$ z a mat]nity     
heal? home ) paym5ts = ! provision (    
heal? home s]vices to ea* eligible      
individual t selects su* provid]1 team (
 heal? c>e pr(essionals1 or heal? team z
 ! eligible individual's heal? home4    
,paym5ts made to a designat$ provid]1 a 
team ( heal? c>e pr(essionals op]at+ )  
su* a provid]1 or a heal? team = su*    
s]vices %all be treat$ z m$ical         
assi/ance = purposes ( section          
#aijc7;a71 except t1 dur+ ! fir/ #h     
fiscal ye> qu>t]s t ! ,/ate plan am5dm5t
 is 9 effect1 ! ,f$]al m$ical assi/ance 
p]c5tage applicable to su* paym5ts %all 
be equal to #ij p]c5t4  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    
individual's pregnancy & ! #cfe-;day    
p]iod beg9n+ on ! la/ day ( su*         
pregnancy4 ,su* me?odology = det]m9+    
paym5t--  7,a7 may be bas$ on-- 7i7 a   
p]-memb] p]-mon? basis = ea* eligible   
individual enroll$ 9 a 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 propos$
 by ! ,/ate & approv$ by ! ,secret>y2   
7,b7 may be adju/$ to reflect1 ) respect
 to ea* eligible individual--  7i7 !    
sev]ity ( ! risks associat$ ) !         
individual's pregnancy2  7ii7 ! sev]ity 
( ! risks associat$ ) ! individual's    
po/p>tum heal? c>e ne$s2 &  7iii7 !     
level or am\nt ( "t ( c>e coord9ation   
requir$ ) respect to ! individual2 &    
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$ures 9 ! case ( an eligible        
individual :o seeks treatm5t 9 ! em]g5cy
 dep>tm5t ( su* hospital =--  7,a7      
provid+ ! individual ) culturally &     
l+ui/ically appropriate in=mation       
suppli$ by ! ,/ate describ+ ! respective
 treatm5t models & opportunities = !    
individual to access a mat]nity heal?   
home & its associat$ b5efits2 &  7,b7   
notify+ ! mat]nity heal? home 9 :i* !   
individual is enroll$1 or ! designat$   
provid]1 team ( heal? c>e pr(essionals  
op]at+ ) su* a provid]1 or heal? team   
treat+ ! individual1 ( ! individual's   
treatm5t 9 ! em]g5cy dep>tm5t & ( !     
protocols = ! mat]nity heal? home1      
designat$ provid]1 or team to be involv$
 9 ! individual'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 individuals1     
includ+ ! process by :i* su* provid]s c 
p>ticipate 9 or ref] an eligible        
individual 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? team designat$ z a    
mat]nity heal? home2 &  7ii7 educat+    
eligible individuals1 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 individuals4    
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 individuals   
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 #eaa & s]vices made available
 "u section #ccj;,h or title ,x ( !     
,public ,heal? ,s]vice ,act4  7#e7      
,coord9ation ) grant program = integrat$
 s]vices = pregnant & po/p>tum wom5 ,a  
,/ate ) a ,/ate plan am5dm5t approv$ "u 
?is section %all consult & coord9ate1 z 

appropriate1 ) ! ,secret>y ) respect to 
! provision ( m$ical assi/ance to       
eligible individuals enroll$ 9 a        
mat]nity heal? home "u ?is section &    
grantees deliv]+ integrat$ heal? c>e    
s]vices to pregnant & po/p>tum wom5 "u  
section #ccj,p ( ! ,public ,heal?       
,s]vice ,act 7includ+1 if applicable1 ! 
,/ate74  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         
individual ) 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 individuals 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? team designat$ z a mat]nity     
heal? home1 %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 designat$ z a mat]nity heal? 
home1 ! "n1 ,national ,provid]          
,id5tification numb]1 address1 &        
specific heal? c>e s]vices (f]$ to be   
provid$ to any eligible individual :o   
has select$ su* provid]1 team ( heal?   
c>e pr(essionals1 or heal? team z !     
eligible individual's mat]nity heal?    
home4  7,b7 ,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,c7 ,in=mation conc]n+ ! factors       
describ$ 9 p>agraph 7#b77;,a77vi7       
receiv$ f heal? risk assessm5ts (       
eligible individuals conduct$ & complet$
 by ! designat$ provid]1 team ( heal?   
c>e pr(essionals op]at+ ) su* a provid]1
 or heal? team designat$ z a mat]nity   
heal? home4  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$icaid & ,,*ip ,paym5t & ,access   
,commission71 at su* "t1 b at a m9imum  
annually1 & 9 su* =m & mann] det]m9$ by 
! ,secret>y to be reasonable & m9imally 
burd5some1 ! foll[+ in=mation3  7i7     
,in=mation describ$ 9 p>agraph 7#a74    
7ii7 ,! numb] &1 to ! ext5t available & 
:ile ma9ta9+ all relevant privacy &     
confid5tially protections1 disaggregat$ 
demographic in=mation 7includ+ in=mation
 on geography7 ( eligible individuals :o
 h enroll$ 9 a mat]nity heal? home      

pursuant to ?is section4  7iii7 ,! numb]
 ( mat]nity heal? homes 9 ! ,/ate       
designat$ "u ?is section4  7iv7 ,!      
m$ical conditions or factors t          
contribute to sev]e mat]nal morbidity   
among eligible individuals enroll$ 9    
mat]nity heal? homes 9 ! ,/ate4  7v7 ,! 
ext5t to :i* su* individuals receive    
heal? c>e items & s]vices "u ! ,/ate    
plan be=e1 dur+1 & aft] an individual's 
enrollm5t 9 su* a mat]nity heal? home4  
7vi7 ,:]e applicable1 mortality data &  
data = ! associat$ causes (             
pregnancy-relat$ dea? = eligible        
individuals 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 individual enroll$ 9 a mat]nity
 heal? home or any mat]nal mortality    
case1 & t all relevant confid5tiality & 
privacy protections1 includ+ !          
requirem5ts "u section                  

#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 individual 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+ ,janu>y #a1 #bjbg1 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 subsection &
 meets ! application crit]ia e/abli%$ by
 ! ,secret>y1 & ! ,secret>y may det]m9e 
! am\nt ( ! grant bas$ on ! m]its ( !   
application & ! goal ( ! ,/ate to       
prioritize heal? outcomes = eligible    
individuals4 ,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 =
 fiscal ye> #bjbg1 = ! 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/ or1 if          
applicable1 a c]tifi$ nurse midwife1 or 
c]tifi$ pr(essional midwife :o meets or 
exce$s ! education & tra9+ /&>ds ( !    
,int]national ,conf$]ation ( ,midwives &
 :o is lic5s$ to practice )9 ! ,/ate71 a
 hospital1 cl9ical practice or cl9ical  
gr\p practice1 rural heal? 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 or      
provid] 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 ,heal? team ,! t]m heal?
 team has ! mean+ giv5 su* t]m =        
purposes ( section #cejb ( ,public ,law 
#aaa-adh4  7#c7 ,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 t is  
select$ by an eligible individual to    
provide pregnancy & po/p>tum coord9at$  
c>e s]vices4  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 designat$ z a  
mat]nity heal? home4  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 ( an    
individual dur+ ! individual's pregnancy
 & ! #a-ye> p]iod beg9n+ on ! la/ day ( 
su* 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 c]tifi$ nurse 
midwives1 or c]tifi$ pr(essional        
midwives :o meet or exce$ ! education & 
tra9+ /&>ds ( ! ,int]national           
,conf$]ation ( ,midwives & :o are lic5s$
 to practice )9 ! ,/ate1 family         
physicians1 prim>y c>e physicians1      
p$iatricians1 & o!r pr(essionals su* z  

physicians assi/ants1 advance practice  
nurses1 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 

heal? 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    
7b7 ,applicability to ,,*ip ,section    
#bajg7;e77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;gg7e77#a771 z     
am5d$ by section #aje1 is am5d$ by add+ 
at ! end ! foll[+ new subp>agraph3  7,w7
 ,section #aide;,b 7relat+ to optional  
heal? homes = pregnant & po/p>tum       
individuals74  4  #bjc4 ,guidance on    
support+ & improv+ access to ,m$icaid & 
,,*ip cov]age ( s]vices provid$ by d\las
 & c]ta9 mat]nal heal? pr(essionals ,n  
lat] ?an #a ye> aft] ! date ( ! enactm5t
 ( ?is ,act1 ! ,secret>y ( ,heal? &     
,human ,s]vices %all issue & publi%     
guidance = ,/ates conc]n+ options =     
support+ & improv+ access to cov]age &  
paym5t "u a ,/ate plan "u title ,,xix ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acif et seq47 or "u a waiv] ( su* plan1
 & "u a ,/ate *ild heal? plan "u title  
,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa

 et seq47 or "u a waiv] ( su* plan1 =   
s]vices provid$ by d\las1 c]tifi$ nurse 
midwives1 c]tifi$ midwives1 or c]tifi$  
pr(essional midwives1 :o meet or exce$ !
 education & tra9+ /&>ds ( !            
,int]national ,conf$]ation ( ,midwives &
 :o are lic5s$ to practice )9 ! ,/ate & 
c]ta9 mat]nal heal? pr(essionals        
7specifi$ by ! ,secret>y7-- 7#a7 9 rural
 areas2  7#b7 across a cont9uum ( c>e2 &
  7#c7 among v>i$ provid] sett+s &      
paym5t & c>e models1 includ+ manag$ c>e4
  #bjd4 ,m$icaid & ,,*ip increas$       
f9ancial support = depression & anxiety 
scre5+ dur+ ! p]9atal & po/p>tum p]iods 
7a7 ,m$icaid ,section #aije ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acif;d71 
z am5d$ by section #ajc1 is fur!r       
am5d$-- 7#a7 9 ! fir/ s5t5ce (          
subsection 7b71 by /rik+ subsection     
7a77#d77;,d7 & ins]t+ subsections       
7a77#d77;,d7 & 7ll72 &  7#b7 by add+ at 
! end ! foll[+3  7ll7 ,increas$ ,,fmap =
 depression & anxiety scre5+ dur+ !     
p]9atal & po/p>tum p]iods  7#a7 ,9 g5]al

 ,= purposes ( clause 7#e7 ( ! fir/     
s5t5ce ( subsection 7b71 s]vices        
describ$ 9 ?is subsection are scre5+    
s]vices provid$ to an individual :o is  
eligible = su* assi/ance on ! basis (   
be+ pregnant t include at a m9imum--    
7,a7 dur+ ! p]9atal p]iod1 at lea/ #a   
scre5+ = depression & anxiety symptoms  
us+ a /&>diz$1 validat$ tool2 &  7,b7   
dur+ ! po/p>tum p]iod1 a full assessm5t 
( mood & emotional well-be+1 includ+    
scre5+ = po/p>tum depression & anxiety1 
us+ a /&>diz$1 validat$ tool4  7#b7     
,exclusion f t]ritorial caps ,!         
additional am\nt paid to a t]ritory =   
exp5ditures = m$ical assi/ance = s]vices
 describ$ 9 p>agraph 7#a7 z a result ( !
 application ( clause 7#e7 ( ! fir/     
s5t5ce ( subsection 7b7 %all n be tak5  
into acc\nt = purposes ( apply+ paym5t  
limits "u subsections 7f7 & 7g7 (       
section #aajh4  4  7b7 ,,*ip ,section   
#baje7;c7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acig;ee7c77 is am5d$ by 
add+ at ! end ! foll[+ new p>agraph3    

7#ac7  ,enhanc$ paym5t = depression &   
anxiety scre5+ dur+ ! p]9atal & po/p>tum
 p]iods  ,not)/&+ subsection 7b71 !     
enhanc$ ,,fmap ) respect to paym5ts "u  
subsection 7a7 = exp5ditures "u ! ,/ate 
*ild heal? plan 7or a waiv] ( su* plan7 
%all be increas$ by #a p]c5tage po9t )  
respect to exp5ditures = s]vices        
describ$ 9 section #aije7ll77#a7 t are  
provid$ "u ! plan 7or waiv]7 to an      
individual :o is eligible = su*         
assi/ance on ! basis ( be+ pregnant     
7includ+ pregnancy-relat$ assi/ance     
provid$ to a t>get$ l[-income pregnant  
woman 7z def9$ 9 section #baab7;d771    
pregnancy-relat$ assi/ance provid$ to an
 individual :o is eligible = su*        
assi/ance ?r\gh application ( section   
#aijc7v77#d77;,a77i7 "u section         
#bajg7;e77#a71 or any o!r assi/ance "u !
 plan 7or waiv]7 provid$ to an          
individual :o is eligible = su*         
assi/ance on ! basis ( be+ pregnant7 &  
dur+ ! #ab-mon? p]iod t beg9s on ! la/  
day ( ! individual's pregnancy & ends on

 ! la/ day ( ! mon? 9 :i* su* #ab-mon?  
p]iod ends 7includ+ any su* assi/ance   
provid$ dur+ ! mon? 9 :i* su* p]iod     
ends74  4  7c7 ,effective date ,!       
am5dm5ts made by ?is section %all take  
effect on ! fir/ day ( ! fir/ fiscal    
qu>t] t beg9s on or aft] ! date t is #a 
ye> aft] ! date ( enactm5t ( ?is        
section4  #bje4 ,presumptive eligibility
 = pregnant individuals  7a7 ,9 g5]al   
7#a7 ,requirem5t ,section #aibj7;a7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acifr-#a7;a77 is am5d$ by /rik+ may    
provide & ins]t+ %all provide4  7#b7    
,application ,section #aibj ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acifr-#a7
 is am5d$ by add+ at ! end ! foll[+ new 
subsection3  7f7 ,application ,a ,/ate  
%all provide to a pregnant woman a      
presumptive eligibility p]iod 9         
accordance ) ?is section )\t reg>d to   
:e!r ! individual w\ld o!rwise qualify =
 a presumptive eligibility p]iod ! ,/ate
 has elect$ to provide "u section       
#aibj;,a1 #aibj;,b1 or #aibj;,c4  4  7b7

 ,con=m+ am5dm5ts  7#a7 ,section        
#aijb7;a77#dg7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7a77#dg77 is 
am5d$ to read z foll[s3  7#dg7 provide--
  7,a7  7i7 = mak+ ambulatory pr5atal   
c>e available to pregnant wom5 dur+ a   
presumptive eligibility p]iod 9         
accordance ) section #aibj2 &  7ii7 at !
 option ( ! ,/ate--  7,i7 = mak+ m$ical 
assi/ance = items & s]vices describ$ 9  
subsection 7a7 ( section #aibj;,a       
available to *ildr5 dur+ a presumptive  
eligibility p]iod 9 accordance ) su*    
section2  7,,ii7 = mak+ m$ical assi/ance
 available to individuals describ$ 9    
subsection 7a7 ( section #aibj;,b dur+ a
 presumptive eligibility p]iod 9        
accordance ) su* section2 &  7,,iii7 =  
mak+ m$ical assi/ance available to      
individuals describ$ 9 subsection 7a7 ( 
section #aibj;,c dur+ a presumptive     
eligibility p]iod 9 accordance ) su*    
section2 &  7,b7 t any hospital t is a  
p>ticipat+ provid] "u ! ,/ate plan may  
elect to be a qualifi$ entity = purposes

 ( det]m9+1 on ! basis ( prelim9>y      
in=mation1 :e!r any individual is       
eligible = m$ical assi/ance "u ! ,/ate  
plan or "u a waiv] ( ! plan = purposes (
 provid+ ! individual ) m$ical assi/ance
 dur+ a presumptive eligibility p]iod1 9
 ! same mann]1 & subject to ! same      
requirem5ts1 z apply ) respect to       
populations describ$ 9 section #aibj1   
#aibj;,a1 #aibj;,b1 or #aibj;,c 7)\t    
reg>d to :e!r ! ,/ate has elect$ to     
provide = a presumptive eligibility     
p]iod "u sections #aibj;,a1 #aibj;,b1 or
 #aibj;,c71 subject to su* guidance z ! 
,secret>y %all e/abli%2  4  7#b7        
,section #aibj7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr-#a7;e77 is  
am5d$-- 7,a7 by /rik+ ,if ! ,/ate has   
elect$ ! option to provide a presumptive
 eligibility p]iod "u ?is section or    
section #aibj;,a1 ! & ins]t+ ,!2 &  7,b7
 by /rik+ #aibj;,a1 subject to & ins]t+ 
#aibj;,a 7if ! ,/ate has elect$ !       
option71 subject to4  7#c7 ,section     
#bajg7;e77#a77,r7 ( ! ,social ,security 

,act 7#db ,u4,s4,c4 #acig;gg7e77#a77,r77
 is am5d$ by ins]t+ #aibj 7relat+ to    
presumptive eligibility = pregnant wom5 
& section be=e #aibj;,a4  7#d7 ,section 
#baab7;c7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acigll7c77 is am5d$--   
7,a7 9 ! head+1 by /rik+ ,option ,to    
,provide2 &  7,b7 by /rik+ may elect &  
ins]t+ %all elect4  ,,iii ,inve/ 9 !    
,mat]nal ,heal? ,c>e ,work=ce  #cja4    
,em]g5cy ob/etric work=ce support  7a7  
,9 g5]al ,section #bjc;,a ( ! ,public   
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bjd;a7 is am5d$--  7#a7 9 subsection   
7a7-- 7,a7 9 p>agraph 7#a71 9 ! matt]   
prec$+ subp>agraph 7,a71 by ins]t+ &    
urg5t mat]nal heal? c>e ne$s aft] public
 heal? c>e ne$s2  7,b7 9 p>agraph 7#c71 
by ins]t+ or urg5t mat]nal heal? c>e ne$
 aft] public heal? c>e ne$2  7,c7 9     
p>agraph 7#e7--  7i7 9 subp>agraph 7,c71
 by /rik+ or at ! end2  7ii7 9          
subp>agraph 7,d71 by /rik+ ! p]iod at ! 
end & ins]t+ 2 or2 &  7iii7 by add+ at !
 end ! foll[+3  7,e7 any urg5t ne$1 n   

ris+ to ! level ( an em]g5cy describ$ 9 
subp>agraph 7,d71 t1 9 ! judgm5t ( !    
,secret>y1 if n address$1 c\ld result 9 
an em]g5cy t w\ld be appropriate = !    
deploym5t ( ! ,commission$ ,corps4  2 & 
7,d7 by add+ at ! end ! foll[+3  7#f7   
,urg5t mat]nal heal? c>e ne$  7,a7 ,9   
g5]al ,= purposes ( ?is section &       
section #bad1 ! t]m urg5t mat]nal heal? 
c>e ne$1 ) respect to an area1 means a  
mat]nal heal? c>e ne$1 z det]m9$ by !   
,secret>y1 9 consultation ) ! ,attorney 
,g5]al1 aris+ z a result ( ! closure or 
imm95t closure ( a hospital or o!r heal?
 c>e facility 9 su* area1 or ! loss (   
work]s employ$ by su* hospital or heal? 
c>e facility :o are tra9$ to provide    
mat]nal heal? c>e s]vices4  7,b7        
,consid]ations ,9 det]m9+ :e!r !re is an
 urg5t mat]nal heal? c>e ne$ = purposes 
( subp>agraph 7,a7 ) respect to an area1
 ! ,secret>y %all consid] :e!r su*      
closure1 imm95t closure1 or loss (      
work]s has impact$ access by individuals
 9 su* area to a full range ( mat]nal   

heal? c>e s]vices1 includ+ pr5atal      
s]vices1 labor & deliv]y s]vices1       
po/natal s]vices1 mat]nal & po/p>tum    
m5tal heal? s]vices1 behavioral heal?   
s]vices1 & reproductive heal? s]vices4  
2  7#b7 9 subsection 7b7--  7,a7 9      
p>agraph 7#a71 by ins]t+ or urg5t       
mat]nal heal? c>e ne$s aft] public heal?
 c>e ne$s2 &  7,b7 9 ea* ( p>agraphs    
7#b7 & 7#d77;,b71 by ins]t+ or urg5t    
mat]nal heal? c>e ne$ aft] public heal? 
c>e ne$2 &  7#c7 9 subsection 7c71 by   
ins]t+ or urg5t mat]nal heal? c>e ne$   
aft] public heal? c>e ne$4  7b7 ,detail 
( p]sonnel ,section #bad ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bae7
 is am5d$--  7#a7 by r$esignat+         
subsection 7e7 z subsection 7f72  7#b7  
by ins]t+ aft] subsection 7d7 ! foll[+3 
7e7  7#a7 ,^u ! reque/ ( an eligible    
entity ) respect to a hospital or o!r   
heal? c>e facility ! closure1 imm95t    
closure1 or loss ( work]s ( :i* l$ to an
 urg5t mat]nal heal? c>e ne$ 9 an area1 
p]sonnel may be detail$ by ! ,secret>y =

 ! purpose ( assi/+ su* eligible entity 
9 "w relat$ to su* urg5t mat]nal heal?  
c>e ne$4  7#b7 7,a7 ,p]sonnel detail$ "u
 p>agraph 7#a7 %all be paid f applicable
 appropriations ( ! ,s]vice4  7,b7 ,9 ! 
case ( detail ( p]sonnel "u p>agraph    
7#a7 to be paid f applicable ,s]vice    
appropriations1 ! ,secret>y may         
condition su* detail on an agreem5t by !
 eligible entity conc]n$ t su* eligible 
entity conc]n$ %all reimburse ! ,unit$  
,/ates = a portion ( ! am\nt ( su*      
paym5ts made by ! ,s]vice4  7,c7 ,!     
s]vices ( p]sonnel :ile detail$ pursuant
 to ?is subsection %all be consid]$ z   
hav+ be5 p]=m$ 9 ! ,s]vice = purposes ( 
! computation ( basic pay1 promotion1   
retirem5t1 comp5sation = injury or dea?1
 & ! b5efits provid$ by section #bab4   
7#c7 ,! ,secret>y may condition a detail
 ( p]sonnel "u p>agraph 7#a7 on an      
agreem5t by ! eligible entity conc]n$ t 
su* eligible entity conc]n$ %all-- 7,a7 
9 ! case ( an imm95t closure or a loss (
 work]s1 z det]m9$ by ! ,secret>y--  7i7

 ma9ta9 ! mat]nal heal? c>e s]vices 9 ! 
applicable area to ! maximum ext5t      
practicable1 includ+ by hir+ tempor>y   
work]s1 until ! date on :i* ! p]sonnel  
are detail$ to su* area2 &  7ii7 submit 
to ! ,secret>y a plan = hir+ & reta9+   
heal? practition]s 9 ! %ort- & long-t]m1
 bo? dur+ p]iods 9 :i* p]sonnel are     
detail$ to su* applicable area & p]iods 
9 :i* p]sonnel are n detail$ to su*     
applicable area2  7,b7 9 ! case ( a     
closure1 submit to ! ,secret>y a plan = 
work+ )1 z applicable1 ,/ate & local    
ag5cies & local /akehold]s to transition
 pati5ts to alt]nate s\rces ( safe      
mat]nal heal? c>e s]vices2 &  7,c7      
commit to an assessm5t by ! ,secret>y ( 
! workplace practices ( su* eligible    
entity conc]n$1 if applicable4  7#d7 ,9 
?is subsection--  7,a7 ! t]m eligible   
entity means-- 7i7 a ,/ate2  7ii7 a     
political subdivision ( a ,/ate2 or     
7iii7 a ,tribal1 nonpr(it1 or o!r heal? 
c>e entity2 &  7,b7 ! t]m p]sonnel means
 an employee or (fic] ( ! ,commission$  

,corps4  2 &  7#c7 9 subsection 7f7 7z s
 r$esignat$71 by ins]t+ or an urg5t     
mat]nal heal? c>e ne$ be=e ! p]iod at ! 
end4  7c7 ,fund+ = commission$ corps ( !
 public heal? s]vice ,section #bjc ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bjd7 is am5d$ by add+ at !   
end ! foll[+3  7e7 ,op]ations ( !       
,commission$ ,corps ( ! ,public ,heal?  
,s]vice  7#a7 ,9 g5]al ,! ,secret>y %all
 c>ry out duties & responsibilities     
relat+ to ! op]ations ( ! ,commission$  
,corps ( ! ,s]vice1 includ+ ! foll[+3   
7,a7 ,enhance ! processes & sy/ems ( !  
,s]vice's ,headqu>t]s op]ations4  7,b7  
,maximize ! =ce managem5t1 requir$ tra9+
 opportunities 7z det]m9$ by ! ,secret>y
 "u section #bjc;,a7a77#a771 op]ational 
capacity1 & mission read9ess ( ! ,regul>
 ,corps1 ! ,ready ,res]ve ,corps1 & !   
,public ,heal? ,em]g5cy ,response ,/rike
 ,teams1 a subcompon5t ( ! ,regul>      
,corps4  7,c7 ,recruit & reta9 qualifi$ 
pr(essionals suit$ to s]v+ und]s]v$ &   
vuln]able communities by-- 7i7 improv+  

onbo>d+ timel9es1 provid+ (fic]         
placem5ts to align ) mission ne$s1      
ensur+ adequate (fic] morale & wellness 
res\rces1 & inc5tiviz+ recruit]s &      
recruits2 &  7ii7 exp&+ tra9+           
opportunities1 includ+ tra9+ ( p]sonnel 
to deliv] mat]nal heal? c>e s]vices1    
provid+ cr$5tial+ support = high dem&   
skill sets1 & enri*+ lead]%ip & rese>*  
pot5tial4  7,d7 ,improve deploym5t      
processes & prep>e mission teams to     
execute r\t9e & em]g5t public heal?     
ev5ts4  7,e7 ,e/abli% a legislative     
liaison (fice to c>ry out legislative   
affairs functions "u ! direction ( !    
,secret>y4  7#b7 ,au?orization (        
appropriations ,9 addition to am\nts    
o!rwise au?oriz$ to be appropriat$ = !  
,commission$ ,corps ( ! ,s]vice1 !re is 
au?oriz$ to be appropriat$ to !         
,secret>y to c>ry out p>agraph 7#a7     
#aej1jjj1jjj = fiscal ye> #bjbg & ea*   
fiscal ye> !reaft]4  4  #cjb4 ,/reaml9$ 
scre5+ & enrollm5t ( provid]s (         
mat]nity1 labor1 & deliv]y s]vices 9    

neighbor+ ,/ates  7a7 ,application to   
,m$icaid ,section #aijb7kk7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acif;a7kk77 is am5d$ by add+ at ! end !
 foll[+ new p>agraph3  7#aj7 ,/reaml9$  
enrollm5t process = eligible out-(-,/ate
 provid]s ( mat]nity1 labor1 & deliv]y  
s]vices  7,a7 ,9 g5]al ,! ,/ate adopts &
 implem5ts a process t enables an       
eligible out-(-,/ate provid] to enroll z
 a provid] 9 ! ,/ate plan )\t impos+ any
 scre5+ requirem5ts t are 9 addition to 
! requirem5ts impos$ on 9-,/ate         
provid]s4 ,an eligible out-(-,/ate      
provid] t enrolls 9 ! ,/ate plan ?r\gh  
su* process %all be s enroll$ = a #e-ye>
 p]iod 7unless ! provid] is t]m9at$ or  
exclud$ f p>ticipation dur+ su* p]iod7 &
 may revalidate su* enrollm5t ?r\gh su* 
process = subsequ5t #e-ye> p]iods4  7,b7
 ,eligible out-(-,/ate provid] ,9 ?is   
p>agraph1 ! t]m eligible out-(-,/ate    
provid] means1 ) respect to a ,/ate1 a  
provid]-- 7i7 t furni%es mat]nity1      
labor1 & deliv]y s]vices 7z def9$ 9     

subsection 7uu77#a771 or provides ord]s 
or ref]rals = su* s]vices1 = :i* paym5t 
is available "u ! ,/ate plan ( ! ,/ate2 
7ii7 t is locat$ 9 a neighbor+ ,/ate 7z 
def9$ by ! ,secret>y72  7iii7 ) respect 
to :i* ! ,secret>y has det]m9$ !re is a 
limit$ risk ( fraud1 wa/e1 or abuse =   
purposes ( det]m9+ ! level ( scre5+ to  
be conduct$ "u section                  
#ahff7;j77#b77;,b72  7iv7 t has be5     
scre5$ "u su* section #ahff7;j77#b77;,b7
 = purposes ( enroll+ 9 ! ,m$ic>e       
program "u title ,,xviii or ! ,/ate plan
 ( ! ,/ate 9 :i* su* provid] is locat$2 
&  7v7 t has n be5 exclud$ f            
p>ticipation 9 ! ,m$ic>e program "u su* 
title or ! ,m$icaid program "u ?is      
title4  4  7b7 ,con=m+ am5dm5ts  7#a7   
,section #aijb7;a77#gg7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#gg77 is am5d$ by ins]t+     
enrollm5t1 aft] scre5+14  7#b7 ,section 
#aijb7kk7 ( su* ,act 7#db ,u4,s4,c4     
#acif;a7kk771 z am5d$ by subsection 7a71
 is fur!r am5d$--  7,a7 9 ! subsection  

head+1 by ins]t+ ,enrollm5t1 aft]       
,scre5+12 &  7,b7 9 p>agraph 7#i71 by   
/rik+ ,no?+ & ins]t+ ,except z provid$ 9
 p>agraph 7#aj71 no?+4  7c7 ,application
 to ,,*ip ,section #bajg7;e77#a77;,g7 ( 
su* ,act 7#db ,u4,s4,c4                 
#acig;gg7e77#a77;,g77 is am5d$ by ins]t+
 enrollm5t1 aft] scre5+14  7d7 ,guidance
 on scre5+ & enroll+ out-(-,/ate        
provid]s ( mat]nity1 labor1 & deliv]y   
s]vices ,n lat] ?an ,janu>y #a1 #bjbh1 !
 ,secret>y ( ,heal? & ,human ,s]vices   
%all issue 7& update z ! ,secret>y      
det]m9es necess>y7 guidance to ,/ate    
,m$icaid & ,,*ip directors on be/       
practices = scre5+ & enroll+ out-(-,/ate
 provid]s ( mat]nity1 labor1 & deliv]y  
s]vices 9 accordance ) p>agraph 7#aj7 ( 
section #aijb7kk7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acif;a7kk77 &      
section #bajg7;e77#a77;,g7 ( su* ,act   
7#db ,u4,s4,c4 #acig;gg7e77#a77;,g77 7z 
add$ & am5d$ by ?is section7 & includ+  
be/ practices = scre5+ & enroll+        
out-(-,/ate provid]s 9 manag$ c>e plans4

  7e7 ,effective date ,! am5dm5ts made  
by ?is section take effect on ,janu>y   
#a1 #bjbh4  ,,iv ,requir+ ,public       
,communication ( ,ob/etrics ,data &     
,unit ,closures  #dja4 ,timely          
notifications ( imp5d+ hospital ob/etric
 unit closures  7a7 ,9 g5]al ,section   
#ahff7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;cc7a77#a77 is     
am5d$--  7#a7 9 subp>agraph 7,x71 by    
/rik+ & at ! end2  7#b7 9 subp>agraph   
7,y77ii77,v71 by /rik+ ! p]iod & ins]t+ 
1 &2 &  7#c7 by ins]t+ aft] subp>agraph 
7,y7 ! foll[+ new subp>agraph3  7,z7    
beg9n+ #ahj days aft] ! date ( !        
enactm5t ( ?is subp>agraph1 9 ! case ( a
 hospital1 n less ?an #ahj days prior to
 ! closure ( any ob/etric unit ( !      
hospital1 to submit to ! ,secret>y1 any 
relevant local & ,/ate ag5cies1 & !     
community a notification1 :i* %all      
include--  7i7 a report analyz+ ! impact
 ! closure w h on ! community1 includ+  
data on any adv]se outcomes & increase 9
 co/s relat+ to ob/etric s]vices = su*  

community2  7ii7 /eps ! hospital w take 
to id5tify o!r heal? c>e provid]s t c   
alleviate any s]vice gaps z a result ( !
 closure2  7iii7 ! cause ( ! closure (  
su* ob/etric unit2  7iv7 data reg>d+    
hi/oric transportation co/s relat$ to   
ob/etric s]vices 9 su* community2 &  7v7
 any additional in=mation z may be      
requir$ by ! ,secret>y4  4  7b7 ,/ate   
requirem5t ,to po/ reports ,section     
#aijb7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;a7a771 z am5d$ by  
section #bja7;a77#a71 is fur!r am5d$--  
7#a7 9 p>agraph 7#hg71 by /rik+ & at !  
end2  7#b7 9 p>agraph 7#hh71 by /rik+ ! 
p]iod at ! end & ins]t+ 2 &2 &  7#c7 by 
ins]t+ aft] p>agraph 7#hh7 ! foll[+ new 
p>agraph3  7#hi7 provide t ! ,/ate w    
make publicly available1 on ! website ( 
any relevant ,/ate ag5cy1 any report    
receiv$ by ! ,/ate f a hospital pursuant
 to section #ahff7;a77#a77,z77i74  2 &  
#djb4 ,collection ( data relat+ to      
hospital labor & deliv]y s]vices        
,section #ahff7;a77#a7 ( ! ,social      

,security ,act 7#db ,u4,s4,c4           
#acie;cc7a77#a771 z am5d$ by section    
#dja1 is am5d$-- 7#a7 9 subp>agraph     
7,y77ii77,v71 by /rik+ & at ! end2  7#b7
 9 subp>agraph 7,z71 by /rik+ ! p]iod & 
ins]t+ 1 &2 &  7#c7 by add+ at ! end !  
foll[+ new subp>agraph3  7,,aa7 9 ! case
 ( a hospital1 to include 9 co/ reports 
submitt$ "u ?is title = co/ report+     
p]iods beg9n+ on or aft] ,july #a1      
#bjbf-- 7i7 ! numb] ( bir?s t occurr$ at
 su* hospital dur+ ! co/ report+ p]iod1 
del9eat$ by ! numb] ( ces>ean bir?s &   
vag9al bir?s2  7ii7 ! numb] ( ant5atal &
 po/p>tum transf]s f ! hospital to o!r  
hospitals2  7iii7 data on ! numb] &     
*>act]i/ics ( ! /aff provid+ labor &    
deliv]y s]vices at su* hospital2  7iv7 !
 exp5ses ! hospital incurr$ = provid+   
labor & deliv]y s]vices at su* hospital1
 includ+ nurs+ c>e1 ane/hesia1 & op]at+ 
room s]vices2  7v7 ! am\nt ! hospital   
sp5t = on-call cov]age = labor & deliv]y
 s]vices by physicians & midwives2 &    
7vi7 ! am\nt & s\rces ( rev5ue receiv$  

by su* hospital = labor & deliv]y       
s]vices1 includ+ paym5ts receiv$ =--    
7,i7 items & s]vices furni%$ to         
individuals eligible = cov]age "u a     
,/ate plan "u title ,,xix 7or a waiv] ( 
su* a plan72  7,,ii7 items & s]vices    
furni%$ to individuals ) o!r =ms ( heal?
 insurance or ?ird-p>ty cov]age2 &      
7,,iii7 items & s]vices furni%$ to      
individuals )\t heal? insurance or o!r  
s\rce ( ?ird p>ty cov]age4  4