,,ii #aaith ,,congress #ast ,session ,s4 #bbhi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ae1 #bjbe,mr4 ,grassley 7for himself and ,ms4 ,hassan7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xix and ,,xxi of the ,social ,security ,act to improve maternal health coverage under ,medicaid and ,,chip1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,healthy ,moms and ,babies ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,definitions4,sec4 #c4 ,mandatory reporting by ,state ,medicaid programs on adult health care quality measures of maternal and perinatal health4,sec4 #d4 ,medicaid quality improvement initiatives to reduce rates of cesarean sections2 ,medicare requirement for hospitals to report on data on cesarean births4,sec4 #e4 ,state option to provide coordinated care through a health home for pregnant and postpartum women4,sec4 #f4 ,guidance on care coordination to support maternal health4,sec4 #g4 ,national reskilling of the maternity care workforce4,sec4 #h4 ,,macpac study on doulas and community health workers2 guidance on increasing access to doula services under ,medicaid4,sec4 #i4 ,demonstration projects to improve the delivery of maternal health care through telehealth4,sec4 #aj4 ,,cms report on coverage of remote physiologic monitoring devices and impact on maternal and child health outcomes under ,medicaid4,sec4 #aa4 ,guidance on community-based maternal health programs4,sec4 #ab4 ,developing guidance on maternal mortality and severe morbidity reduction for maternal care providers receiving payment under the ,medicaid program4,sec4 #ac4 ,program related to reducing cesarean births and increasing rates of vaginal birth after cesarean4,sec4 #ad4 ,collection of information related to social determinants of the health of ,medicaid and ,,chip beneficiaries4,sec4 #ae4 ,report on payment methodologies for transferring pregnant women between facilities before1 during1 and after childbirth4,sec4 #af4 ,medicaid guidance on ,state options to address social determinants of health for pregnant and postpartum women4,sec4 #ag4 ,payment error rate measurement 7,,perm7 audit and improvement requirements4 #b4 ,definitions ,in this ,act3 7#a7 ,,chip ,the term ,,chip means the ,children's ,health ,insurance ,program established under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq474 7#b7 ,comptroller ,general ,the term ,comptroller ,general means the ,comptroller ,general of the ,united ,states4 7#c7 ,group health plan2 health insurance issuer1 etc ,the terms group health plan1 health insurance coverage1 health insurance issuer1 group health insurance coverage1 and individual health insurance coverage have the meanings given such terms in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 7#d7 ,medicaid ,the term ,medicaid means the ,medicaid program established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#e7 ,medicaid managed care organization ,the term medicaid managed care organization has the meaning given that term in section #aijc7m77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#a77;,a774 7#f7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#g7 ,state ,the term ,state has the meaning given that term for purposes of titles ,v1 ,,xix1 and ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #gja et seq41 #acif et seq41 #acig;aa et seq474 #c4 ,mandatory reporting by ,state ,medicaid programs on adult health care quality measures of maternal and perinatal health ,section #aaci;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in paragraph 7#c77;,b7-- 7i7 in the subparagraph heading1 by inserting and maternal and perinatal health after behavioral health2 7ii7 by striking all behavioral health and inserting all behavioral health and maternal and perinatal health2 and 7iii7 by inserting and of maternal and perinatal health care for ,medicaid eligible adults after ,medicaid eligible adults2 and 7,b7 in paragraph 7#e77;,c7-- 7i7 in the subparagraph heading1 by inserting and maternal and perinatal health after behavioral health2 and 7ii7 by inserting and1 with respect to ,medicaid eligible adults1 maternal and perinatal health measures after behavioral health measures2 and 7#b7 in subsection 7d77#a77;,a71 by inserting and maternal and perinatal health after behavioral health4 #d4 ,medicaid quality improvement initiatives to reduce rates of cesarean sections2 ,medicare requirement for hospitals to report on data on cesarean births 7a7 ,medicaid state plan amendment ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7#a7 in paragraph 7#hf71 by striking and after the semicolon2 7#b7 in paragraph 7#hg71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#hg7 the following3 7#hh7 provide that1 not later than ,january #a1 #bjbg1 and annually thereafter through ,january #a1 #bjcg1 the ,state shall submit a report to the ,secretary1 that shall be made publicly available1 which contains with respect to the preceding calendar year-- 7,a7 the rate of low-risk cesarean delivery1 as defined by the ,secretary in consultation with relevant stakeholders1 for pregnant women eligible for medical assistance under the ,state plan or a waiver of such plan in the ,state1 as compared to the overall rate of cesarean delivery in the ,state2 7,b7 a description of the ,state's quality improvement activities to safely reduce the rate of low-risk cesarean delivery 7as so defined7 for pregnant women eligible for medical assistance under the ,state plan or a waiver of such plan in the ,state reported under subparagraph 7,a71 including initiatives aimed at reducing racial and ethnic health disparities1 hospital-level quality improvement initiatives1 taking into account hospital type and the patient population served1 and1 if applicable1 partnerships with ,state or regional perinatal quality collaboratives2 7,c7 for each report submitted after ,january #a1 #bjbg1 the percentage change 7if any7 in the rate of low-risk cesarean delivery 7as so defined7 for pregnant women eligible for medical assistance under the ,state plan or a waiver of such plan in the ,state reported under subparagraph 7,a7 from the rate reported for the most recent previous report2 and 7,d7 such other relevant data and information as determined by the ,secretary1 and in consultation with relevant stakeholders1 such as ,state initiatives and evaluations of quality improvement activities1 cesarean delivery rates1 and health outcomes4 4 7b7 ,,gao study regarding medicaid payment rates cesarean births 7#a7 ,study ,the ,comptroller ,general shall conduct a study regarding payment rates for cesarean births and vaginal births under ,state ,medicaid programs4 ,to the extent feasible and data are available1 the study shall include analyses of the following3 7,a7 ,payment rates for cesarean births and vaginal births paid by fee-for-service ,medicaid programs and by ,medicaid programs that contract with ,medicaid managed care organizations to furnish medical assistance under such programs2 7,b7 ,what is known about how ,medicaid payment rates have changed over time2 7,c7 ,what is known about how payment rates for cesarean and vaginal births by ,medicaid programs compare with the payment rates for such births by other sources of insurance coverage2 and 7,d7 ,such other factors related to payment rates for cesarean and vaginal births under ,medicaid as the ,comptroller ,general determines appropriate4 7#b7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7c7 ,,gao study on racial disparities in cesarean births 7#a7 ,in general ,the ,comptroller ,general shall conduct a study on racial disparities in the frequency of cesarean births4 ,to the extent feasible and data are available1 the study shall compare such information on low- and high-risk cesarean births1 differences by payer 7such as ,medicaid and private payers71 and hospital characteristics 7such as location or hospital type74 ,such study may consider other factors related to racial disparities in maternal health as the ,comptroller ,general deems appropriate4 7#b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7d7 ,medicare requirement for hospitals ,to report data on cesarean births 7#a7 ,requirement ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7,a7 by moving the indentation of subparagraph 7,w7 #b ems to the left2 7,b7 in subparagraph 7,x7-- 7i7 by moving the indentation #b ems to the left2 and 7ii7 by striking and at the end2 7,c7 in subparagraph 7,y71 by striking the period at the end and inserting 2 and2 and 7,d7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 in the case of a hospital1 to submit1 in a form and manner1 and at a time1 specified by the ,secretary1 data on the ,nulliparous1 ,term1 ,singleton1 ,vertex ,cesarean section 7,,ntsv ,c-section7 rate with respect to the hospital for the preceding year4 4 7#b7 ,incorporation into hospital quality reporting ,section #ahhf7;b77#c77;,b77viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77viii77 is amended by adding at the end the following new subclause3 7,,xiii7 ,effective for payments beginning with fiscal year #bjbg1 in expanding the number of measures under subclause 7,,iii71 the ,secretary shall adopt a measure relating to the ,nulliparous1 ,term1 ,singleton1 ,vertex ,cesarean section 7,,ntsv ,c-section7 rate for hospitals in inpatient settings4 ,not later than #bjbg1 the ,secretary shall incorporate such measure into the designation of maternity care quality hospitals1 as described in the final rule entitled ,medicare ,program2 ,hospital ,inpatient ,prospective ,payment ,systems for ,acute ,care ,hospitals and the ,long ,term ,care ,hospital ,prospective ,payment ,system and ,policy ,changes and ,fiscal ,year #bjbc ,rates2 ,quality ,programs and ,medicare ,promoting ,interoperability ,program ,requirements for ,eligible ,hospitals and ,critical ,access ,hospitals2 ,costs ,incurred for ,qualified and ,non-,qualified ,deferred ,compensation ,plans2 and ,changes to ,hospital and ,critical ,access ,hospital ,conditions of ,participation 7#hg ,fed4 ,reg4 #dhghj 7,august #aj1 #bjbb774 4 #e4 ,state option to provide coordinated care through a health home for pregnant and postpartum women ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by inserting after section #aide;,a the following new section3 #aide;,b4 ,state option to provide coordinated care through a health home for pregnant and postpartum women 7a7 ,state option 7#a7 ,in general ,notwithstanding section #aijb7;a77#a7 7relating to statewideness7 and section #aijb7;a77#aj77;,b7 7relating to comparability71 beginning ,april #a1 #bjbh1 a ,state1 at its option as a ,state plan amendment1 may provide for medical assistance under this title to an eligible woman who chooses to-- 7,a7 enroll in a maternity health home under this section by selecting a designated provider1 a team of health care professionals operating with such a provider1 or a health team as the woman's maternity health home for purposes of providing the woman with pregnancy and postpartum coordinated care services2 or 7,b7 receive such services from a designated provider1 a team of health care professionals operating with such a provider1 or a health team that has voluntarily opted to participate in a maternity health home for eligible women under this section4 7#b7 ,eligible woman defined ,in this section1 the term eligible woman 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 waiver7 that are not less in amount1 duration1 or scope1 or are determined by the ,secretary to be substantially equivalent1 to the medical assistance available for an individual described in subsection 7a77#aj77;,a77i72 and 7,b7 who-- 7i7 is pregnant2 or 7ii7 had a pregnancy end within the last #cfe days4 7b7 ,qualification standards ,the ,secretary shall establish standards for qualification as a maternity health home or as a designated provider1 team of health care professionals operating with such a provider1 or a health team eligible for participation in a maternity health home for purposes of this section4 ,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 designated providers1 teams of health care professionals operating with such providers1 and health teams 7designated as a maternity health home7 to demonstrate to the ,state the ability to do the following3 7#a7 ,coordinate prompt care and access to necessary maternity care services1 including services provided by specialists1 and programs for an eligible woman during her pregnancy and the #cfe-;day period beginning on the last day of her pregnancy4 7#b7 ,develop an individualized1 comprehensive1 patient-centered care plan for each eligible woman that accommodates patient preferences and1 if applicable1 reflects adjustments to the payment methodology described in subsection 7c77#b77;,b74 7#c7 ,develop and incorporate into each eligible woman's care plan1 in a culturally and linguistically appropriate manner consistent with the needs of the eligible woman1 ongoing home care1 community-based primary care1 inpatient care1 social support services1 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 woman losing eligibility for medical assistance under the ,state plan or waiver1 care management and planning related to a change in the eligible woman'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 with payments for the provision of pregnancy and postpartum coordinated care services1 to each eligible woman that selects such provider1 team of health care professionals1 or health team as the woman's maternity health home or care provider4 ,payments made to a maternity health home or care provider for such services shall be treated as medical assistance for purposes of section #aijc7;a74 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 woman's pregnancy and the #cfe-;day period beginning on the last day of her pregnancy4 ,such methodology for determining payment-- 7,a7 may be based on-- 7i7 a per-member per-month basis for each eligible woman enrolled in the maternity health home2 7ii7 a prospective payment model1 in the case of payments to ,federally qualified health centers or a rural health clinics2 or 7iii7 an alternate model of payment 7which may include a model developed under a waiver under section #aaae7 proposed by the ,state and approved by the ,secretary2 7,b7 may be adjusted to reflect1 with respect to each eligible woman-- 7i7 the severity of the risks associated with the woman's pregnancy2 7ii7 the severity of the risks associated with the woman's postpartum health care needs2 and 7iii7 the level or amount of time of care coordination required with respect to the woman2 and 7,c7 shall be established consistent with section #aijb7;a77#cj77;,a74 7d7 ,coordinating care 7#a7 ,hospital notification ,a ,state with a ,state plan amendment approved under this section shall require each hospital that is a participating provider under the ,state plan 7or under a waiver of such plan7 to establish procedures in the case of an eligible woman who seeks treatment in the emergency department of such hospital for-- 7,a7 providing the woman with culturally and linguistically appropriate information on the respective treatment models and opportunities for the woman to access a maternity health home and its associated benefits2 and 7,b7 notifying the maternity health home in which the woman is enrolled1 or the designated provider1 team of health care professionals operating with such a provider1 or health team treating the woman1 of the woman's treatment in the emergency department and of the protocols for the maternity health home1 designated provider1 or team to be involved in the woman's emergency care or post-discharge care4 7#b7 ,education with respect to availability of a maternity health home 7,a7 ,in general ,in order for a ,state plan amendment to be approved under this section1 a ,state shall include in the ,state plan amendment a description of the ,state's process for-- 7i7 educating providers participating in the ,state plan 7or a waiver of such plan7 on the availability of maternity health homes for eligible women1 including the process by which such providers can participate in or refer eligible women to an approved maternity health home or a designated provider1 team of health care professionals operating such a provider1 or health team2 and 7ii7 educating eligible women1 in a culturally and linguistically appropriate manner1 on the availability of maternity health homes4 7,b7 ,outreach ,the process established by the ,state under subparagraph 7,a7 shall include the participation of 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 women4 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 women 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 #eaa1 and services made available under section #ccj;,h or title ,x of the ,public ,health ,service ,act4 7e7 ,monitoring ,a ,state shall include in the ,state plan amendment-- 7#a7 a methodology for tracking reductions in inpatient days and reductions in the total cost of care resulting from improved care coordination and management under this section2 7#b7 a proposal for use of health information technology in providing an eligible woman with pregnancy and postpartum coordinated care services as specified under this section and improving service delivery and coordination across the care continuum2 and 7#c7 a methodology for tracking prompt and timely access to medically necessary care for eligible women from out-of-,state providers4 7f7 ,data collection 7#a7 ,provider reporting requirements ,in order to receive payments from a ,state under subsection 7c71 a maternity health home1 or a designated provider1 a team of health care professionals operating with such a provider1 or a health team1 shall report to the ,state1 at such time and in such form and manner as may be required by the ,state1 including through a health information exchange or other public health data sharing entity1 the following information3 7,a7 ,with respect to each such designated provider1 team of health care professionals operating with such a provider1 and health team 7designated as a maternity health home71 the name1 ,national ,provider ,identification number1 address1 and specific health care services offered to be provided to eligible women who have selected such provider1 team of health care professionals1 or health team as the women's maternity health home4 7,b7 ,information on measures from the core sets of child health quality measures and adult health quality measures under sections #aaci;,a and #aaci;,b that are identified by the ,secretary as being relevant to maternal1 perinatal1 or infant health4 7,c7 ,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,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 frequency of every #ab months1 and in such form and manner determined by the ,secretary to be reasonable and minimally burdensome1 including through a health information exchange or other public health data sharing entity1 the following information3 7i7 ,information described in paragraph 7#a74 7ii7 ,the number and1 to the extent available and while maintaining all relevant protecting privacy and confidentially protections1 disaggregated demographic information of eligible women who have enrolled in a maternity health home pursuant to this section4 7iii7 ,the number of maternity health homes in the ,state4 7iv7 ,the medical conditions or factors that contribute to severe maternal morbidity among eligible women enrolled in maternity health homes in the ,state4 7v7 ,the extent to which such women receive health care items and services under the ,state plan before1 during1 and after the women's enrollment in such a maternity health home4 7vi7 ,where applicable1 mortality data and data for the associated causes of death for eligible women enrolled in a maternity health home under this section1 in accordance with subsection 7g74 ,for deaths occurring postpartum1 such data shall distinguish between deaths occurring up to #db days postpartum and deaths occurring between #dc days to up to #a year postpartum4 ,where applicable1 data reported under this clause shall be reported alongside comparable data from a ,state's maternal mortality review committee1 as established in accordance with section #cag,k7d7 of the ,public ,health ,service ,act1 for purposes of further identifying and comparing statewide trends in maternal mortality among populations participating in the maternity health home under this section4 7,b7 ,implementation report ,not later than #ah months after a ,state has a ,state plan amendment approved under this section1 the ,state shall submit to the ,secretary1 and make publicly available on the appropriate ,state website1 a report on how the ,state is implementing the option established under this section1 including through any best practices adopted by the ,state4 7g7 ,confidentiality ,a ,state with a ,state plan amendment under this section shall establish confidentiality protections for the purposes of subsection 7f77#b77;,a7 to ensure1 at a minimum1 that there is no disclosure by the ,state of any identifying information about any specific eligible woman enrolled in a maternity health home or any maternal mortality case1 and that all relevant confidentiality and privacy protections1 including the requirements under #aijb7;a77#g77;,a71 are maintained4 7h7 ,rule of construction ,nothing in this section shall be construed to require-- 7#a7 an eligible woman to enroll in a maternity health home under this section2 or 7#b7 a designated provider or health team to act as a maternity health home and provide services in accordance with this section if the provider or health team does not voluntarily agree to act as a maternity health home4 7i7 ,planning grants 7#a7 ,in general ,beginning ,october #a1 #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 subsection1 but the ,secretary may determine the amount of the grant based on the merits of the application and the goal of the ,state to prioritize health outcomes for eligible women4 ,a planning grant awarded to a ,state under this subsection shall remain available until expended4 7#b7 ,appropriation ,there are authorized to be appropriated to the ,secretary #ej1jjj1jjj for the period of fiscal years #bjbf through #bjbh1 for the purposes of making grants under this subsection1 to remain available until expended4 7#c7 ,limitation ,the total amount of payments made to ,states under this subsection shall not exceed #ej1jjj1jjj4 7j7 ,additional definitions ,in this section3 7#a7 ,designated provider ,the term designated provider means a physician 7including an obstetrician-gynecologist71 hospital1 clinical practice or clinical group practice1 a medicaid managed care organization1 as defined in section #aijc7m77#a77;,a71 a prepaid inpatient health plan1 as defined in section #dch4b of title #db1 ,code of ,federal ,regulations 7or any successor regulation71 a prepaid ambulatory health plan1 as defined in such section 7or any successor regulation71 rural clinic1 community health center1 community mental health center1 or any other entity or provider that is determined by the ,state and approved by the ,secretary to be qualified to be a maternity health home on the basis of documentation evidencing that the entity has the systems1 expertise1 and infrastructure in place to provide pregnancy and postpartum coordinated care services4 ,such term may include providers who are employed by1 or affiliated with1 a hospital4 7#b7 ,maternity health home ,the term maternity health home means a designated provider 7including a provider that operates in coordination with a team of health care professionals7 or a health team is selected by an eligible woman to provide pregnancy and postpartum coordinated care services4 7#c7 ,health team ,the term health team has the meaning given such term for purposes of section #cejb of ,public ,law #aaa-adh4 7#d7 ,pregnancy and postpartum coordinated care services 7,a7 ,in general ,the term pregnancy and postpartum coordinated care services means items and services related to the coordination of care for comprehensive and timely high-quality1 culturally and linguistically appropriate1 services described in subparagraph 7,b7 that are provided by a designated provider1 a team of health care professionals operating with such a provider1 or a health team 7designated as a maternity health home74 7,b7 ,services described 7i7 ,in general ,the services described in this subparagraph shall include with respect to a ,state electing the ,state plan amendment option under this section1 any medical assistance for items and services for which payment is available under the ,state plan or under a waiver of such plan4 7ii7 ,other items and services ,in addition to medical assistance described in clause 7i71 the services described in this subparagraph shall include the following3 7,i7 ,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 a woman during the woman's pregnancy and the #a-year period beginning on the last day of her 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 pediatricians1 and other professionals such as physicians assistants1 advance practice nurses1 including certified nurse midwives1 nurses1 nurse care coordinators1 dietitians1 nutritionists1 social workers1 behavioral health professionals1 physical counselors1 physical therapists1 occupational therapists1 or any professionals that assist in prenatal care1 delivery1 or postpartum care for which medical assistance is available under the ,state plan or a waiver of such plan and determined to be appropriate by the ,state and approved by the ,secretary2 7ii7 an entity or individual who is designated to coordinate such care delivered by the team2 and 7iii7 when appropriate and if otherwise eligible to furnish items and services that are reimbursable as medical assistance under the ,state plan or under a waiver of such plan1 doulas1 community health workers1 translators and interpreters1 and other individuals with culturally appropriate and trauma-informed expertise2 and 7,b7 provide care at a facility that is freestanding1 virtual1 or based at a hospital1 community health center1 community mental health center1 rural clinic1 clinical practice or clinical group practice1 academic health center1 or any entity determined to be appropriate by the ,state and approved by the ,secretary4 4 #f4 ,guidance on care coordination to support maternal health ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall issue guidance for ,state ,medicaid programs on improved care coordination1 continuity of care1 and clinical integration to support the needs of pregnant and postpartum women for services eligible for ,medicaid payment4 ,such guidance shall identify best practices for care coordination for such women1 both with respect to fee-for-service ,state ,medicaid programs and ,state ,medicaid programs that contract with ,medicaid managed care organizations or other specified entities to furnish medical assistance for such women1 and shall illustrate strategies for-- 7#a7 enhancing primary care and maternity care coordination with specialists1 including cardiologists1 specialists in gestational diabetes1 dentists1 lactation specialists1 genetic counselors1 and behavioral health providers2 7#b7 integrating behavioral health providers to provide screening1 assessment1 treatment1 and referral for behavioral health needs1 including substance use disorders1 maternal depression1 anxiety1 intimate partner violence1 and other trauma2 7#c7 integrating into care teams or coordinating with nonclinical professionals1 including 7if licensed or credentialed by a ,state or ,state-authorized organization7 doulas1 peer support specialists1 and community health workers1 and how these services provided by such professionals may be eligible for ,federal financial participation under ,medicaid2 7#d7 screening pregnant and postpartum women for social needs and coordinating related services during the prenatal and postpartum periods to ensure social and physical supports are provided for such women during such periods and for their children2 7#e7 supporting women who have had a stillbirth2 7#f7 screening for maternal health1 behavioral health1 and social needs during well-child and pediatric care visits2 and 7#g7 streamlining and reducing duplication in care coordination efforts across and among providers1 plans1 and other entities for such women4 #g4 ,national reskilling of the maternity care workforce ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by inserting after section #cag,l-#a the following3 #cag,l-#b4 ,national reskilling of the maternity care workforce 7a7 ,establishment of national expert group 7#a7 ,in general ,the ,secretary shall establish a national expert group to evaluate national education on1 and practice of1 best birthing practices4 7#b7 ,members 7,a7 ,in general ,the group established under paragraph 7#a7 shall be composed of such members as the ,secretary appoints1 including-- 7i7 obstetricians and gynecologists1 family medicine physicians1 midwifes1 and nursing leaders2 7ii7 hospital administrators2 7iii7 graduate medical education leaders2 7iv7 doula leaders2 7v7 individuals with experience in community birth settings2 7vi7 patients2 7vii7 high-risk birth experts2 and 7viii7 quality improvement leaders4 7,b7 ,geographic diversity ,in appointing members under subparagraph 7,a71 the ,secretary shall ensure a balance of members representing rural areas and members representing urban areas4 7b7 ,duties ,the group established under subsection 7a7 shall-- 7#a7 examine evidence1 trends1 and differential use or access by income1 geographic area1 and race and ethnicity associated with birthing practices that include-- 7,a7 cesarean sections1 repeat cesarean1 and vaginal birth after cesarean2 7,b7 electronic fetal monitoring and intermittent auscultation2 7,c7 birth positions1 including upright positioning and ambulation2 7,d7 labor with doula support2 7,e7 evaluating indications for cesarean delivery1 including cervical dilation and duration of pushing2 7,f7 operative vaginal deliveries2 7,g7 manual fetal rotation2 7,h7 amnioinfusion and scalp stimulation2 and 7,i7 cervical ripening methods2 7#b7 assess the role of the culture of care1 maternity care financing1 and health education with respect to the trends under paragraph 7#a72 and 7#c7 identify case studies of the provision of exemplary birthing care4 7c7 ,recommendations ,the group established under subsection 7a7 shall1 not later than #a year after such establishment1 issue-- 7#a7 best practices for-- 7,a7 evaluating birthing skills2 7,b7 improving curricula for health professionals engaged in birthing2 and 7,c7 the incorporation of midwives and doulas into residency curricula for obstetricians2 and 7#b7 recommendations for policies and practices to improve maternity care overall4 4 #h4 ,,macpac study on doulas and community health workers2 guidance on increasing access to doula services under ,medicaid 7a7 ,,macpac study on doulas and community health workers 7#a7 ,in general ,as part of the first report required under section #aijj7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif7;b77#a77 after the date that is #a year after the date of enactment of this ,act1 the ,medicaid and ,,chip ,payment and ,access ,commission 7referred to in this section as ,,macpac7 shall include with such report a report on the coverage of doula services and the role of community health workers under ,state ,medicaid programs1 which shall include the following3 7,a7 ,information about coverage for doula services and community health worker services under ,state ,medicaid programs that currently provide coverage for such services1 including the type of doula services offered 7such as prenatal1 labor and delivery1 postpartum support1 and traditional doula services7 and information on the prevalence of doulas that care for individuals in their own communities4 7,b7 ,an analysis of strategies to facilitate the appropriate use of doula services in order to provide better care and achieve better maternal and infant health outcomes1 including strategies that ,states may use to assist with services for which ,federal financial participation is eligible under a ,state ,medicaid plan or a waiver of such a plan by recruiting1 training1 and certifying a diverse doula workforce1 particularly from underserved communities1 communities of color1 and communities facing linguistic or cultural barriers4 7,c7 ,provide examples of community health worker access in ,state ,medicaid programs and strategies employed by ,states to encourage a broad care team to manage ,medicaid patients4 7,d7 ,an assessment of the impact of the involvement of doulas and community health workers on maternal health outcomes4 7,e7 ,recommendations1 as ,,macpac deems appropriate1 for legislative and administrative actions to increase access to services that improve maternal health4 7#b7 ,stakeholder consultation ,in developing the report required under paragraph 7#a71 ,,macpac shall consult with relevant stakeholders4 7b7 ,guidance on increasing access to doula services under ,medicaid 7#a7 ,in general ,not later than #a year after the date that ,,macpac publishes the report required under subsection 7a71 the ,secretary shall issue guidance to ,states on increasing access to doula services under ,medicaid4 ,such guidance shall at a minimum include-- 7,a7 options for ,states to provide medical assistance for doula services under ,state ,medicaid programs2 7,b7 best practices for ensuring that doulas1 including community-based doulas1 receive reimbursement for doula services provided under a ,state ,medicaid program1 at a level that allows doulas to earn a living wage that accounts for their time and costs associated with providing care and community-based doula program administration2 and 7,c7 best practices for increasing access to doula services1 including services provided by community-based doulas1 under ,state ,medicaid programs4 7#b7 ,stakeholder consultation ,in developing the report required under paragraph 7#a71 the ,secretary shall consult with relevant stakeholders4 7c7 ,relevant stakeholders ,for purposes of subsections 7a77#b7 and 7b77#b71 relevant stakeholders shall include-- 7#a7 ,states2 7#b7 organizations representing consumers1 including those that are disproportionately impacted by poor maternal health outcomes2 7#c7 organizations and individuals representing doula services providers and community health workers1 including community-based doula programs and those who serve underserved communities1 communities of color and communities facing linguistic or cultural barriers2 and 7#d7 organizations representing health care providers4 #i4 ,demonstration projects to improve the delivery of maternal health care through telehealth 7a7 ,in general ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall award grants to ,states to conduct demonstration projects under this section that are designed to expand the use of telehealth in ,state ,medicaid programs for the delivery of health care to eligible pregnant or postpartum women4 7b7 ,eligible pregnant or postpartum woman defined 7#a7 ,in general ,in this section1 the term eligible pregnant or postpartum woman means a woman who is eligible for and receiving medical assistance under a ,state ,medicaid plan 7or waiver of such plan7 and who is or becomes pregnant4 7#b7 ,postpartum women ,such term includes a woman described in paragraph 7#a7 through the end of the month in which the #cfe-;day period beginning on the last day of the woman's pregnancy ends1 without regard to any change in income of the family of which she is a member4 7c7 ,application2 selection of ,states2 duration 7#a7 ,application 7,a7 ,in general ,to conduct a demonstration project under this section1 a ,state shall submit an application to the ,secretary at such time and in such manner as the ,secretary shall require4 ,under the demonstration project1 a ,state may include multiple proposed uses of grant funds1 and propose to focus on multiple populations1 as otherwise allowable under this section1 within a single application4 7,b7 ,required information ,a ,state application to conduct a demonstration project under this section shall include the following3 7i7 ,the population 7such as individuals residing in rural or medically underserved areas7 that the demonstration project will target4 7ii7 ,a description of how the ,state proposes to use funds awarded under this section to conduct the demonstration project to integrate or increase the integration of telehealth into the ,state ,medicaid program's existing delivery system for furnishing medical assistance to and improving the health care outcomes of eligible pregnant or postpartum women4 7iii7 ,a description of how the ,state will use funds to address racial or ethnic disparities in access to maternal health services or maternal health outcomes1 barriers to care1 including in rural or medically underserved communities1 other barriers to using telehealth1 such as those experienced by individuals with disabilities and individuals with limited ,english proficiency1 and as applicable1 barriers to the use of telehealth in tribal communities4 7iv7 ,a certification that the application meets the requirements of subparagraph 7,c74 7v7 ,such other information as the ,secretary shall require4 7,c7 ,consultation with health care stakeholders ,prior to the submission of an application to conduct a demonstration project under this section1 a ,state shall consult with health care systems and providers1 health plans 7if relevant71 consumer organizations and beneficiary advocates1 and community-based organizations or other stakeholders in the area that the demonstration project will target to ensure that the proposed project addresses the health care needs of eligible pregnant or postpartum women in such area4 7#b7 ,selection of ,states and duration of projects 7,a7 ,in general ,the ,secretary shall award grants to ,states that apply and meet the application requirements to conduct #d-year demonstration projects under this section4 ,a ,state may request1 and the ,secretary shall determine the appropriateness of1 an application of up to #aj1jjj1jjj4 7,b7 ,selection of projects ,in selecting a ,state to conduct a demonstration project under this section1 the ,secretary shall ensure that the ,state is aware of the #d-year duration of the project and shall determine the ,state has satisfied the application requirements4 7#c7 ,waiver of statewideness and comparability requirement ,the ,secretary shall waive compliance with section #aijb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#a77 7relating to statewideness7 and section #aijb7;a77#aj77;,b7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,b77 7relating to comparability7 to the extent necessary to allow selected ,states to conduct demonstration projects under this section4 7d7 ,use of grant funds ,a ,state may use funds from a grant awarded under this section to connect eligible pregnant or postpartum women to telehealth services delivered via telehealth that are furnished by-- 7#a7 primary and maternity care providers2 7#b7 health care specialists2 7#c7 behavioral health providers2 and 7#d7 other categories of health care providers identified by the ,secretary4 7e7 ,reports 7#a7 ,state reports ,each ,state that is awarded a grant to conduct a demonstration project under this section shall submit the following reports to the ,secretary3 7,a7 ,initial report ,an initial report on the first #ah months during which the demonstration project is conducted1 not later than the last day of the #aith month of the demonstration project1 as described in subparagraph 7,b74 7,b7 ,final report ,not later than #f months after the date on which the ,state's demonstration project ends1 a final report that includes the following3 7i7 ,the number of eligible pregnant or postpartum women served under the demonstration project4 7ii7 ,the activities and services funded under the demonstration project1 including the providers that received funds under the demonstration project4 7iii7 ,demographic information about the eligible pregnant or postpartum women served under the demonstration project1 if available4 7iv7 ,a description of the types of models or programs developed under the demonstration project4 7v7 ,how such models or programs impacted access to1 and utilization of1 telehealth services by eligible pregnant or postpartum women1 including a description of how such models or programs addressed racial or ethnic disparities in access or utilization4 7vi7 ,qualitative information on beneficiary experience4 7vii7 ,challenges faced and lessons learned by the ,state in integrating 7or increasing the integration of7 telehealth into the delivery system for furnishing medical assistance to eligible pregnant or postpartum women in the areas targeted under the demonstration project4 7#b7 ,reports to congress 7,a7 ,initial report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit a report to ,congress summarizing the information reported by ,states under paragraph 7#a77;,a74 7,b7 ,final report ,not later than #e years after the date of enactment of this ,act1 the ,secretary shall submit a report to ,congress summarizing the information reported by ,states under paragraph 7#a77;,b74 #aj4 ,,cms report on coverage of remote physiologic monitoring devices and impact on maternal and child health outcomes under ,medicaid 7a7 ,in general ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report containing information on authorities and ,state practices for covering remote physiological monitoring devices1 including limitations and barriers to such coverage and the impact on maternal health outcomes1 and to the extent appropriate1 recommendations on how to address such limitations or barriers related to coverage of remote physiologic devices under ,state ,medicaid programs1 including1 but not limited to1 pulse oximeters1 blood pressure cuffs1 scales1 and blood glucose monitors1 with the goal of improving maternal and child health outcomes for pregnant and postpartum women enrolled in ,state ,medicaid programs4 7b7 ,state resources ,not later than #f months after the submission of the report required by subsection 7a71 the ,secretary shall update resources for ,state ,medicaid programs1 such as ,state ,medicaid telehealth toolkits1 to be consistent with the recommendations provided in such report4 #aa4 ,guidance on community-based maternal health programs ,not later than #c years after the date of enactment of this ,act1 the ,secretary shall issue guidance to ,state ,medicaid programs to support the use of evidence-based community-based maternal health programs1 including programs that offer group prenatal care1 home visiting services1 childbirth and parenting education1 peer supports1 stillbirth prevention activities1 and substance use disorder and recovery supports1 under such programs1 and any other programs as determined by the ,secretary4 #ab4 ,developing guidance on maternal mortality and severe morbidity reduction for maternal care providers receiving payment under the ,medicaid program 7a7 ,in general ,subject to the availability of appropriations1 not later than #cf months after the date of enactment of this ,act1 the ,secretary shall1 in consultation with the ,advisory ,committee on ,reducing ,maternal ,deaths established under subsection 7c7 and the ,task ,force on ,maternal ,mental ,health established under section #aaac of division ,,ff of the ,consolidated ,appropriations ,act1 #bjbc 7,public ,law #aag-cbh71 publish on a public website of the ,centers for ,medicare ,medicaid ,services guidance for ,states on resources and strategies for hospitals1 freestanding birth centers 7as defined in section #aije7l77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#c77;,b7771 and other maternal care providers as determined by the ,secretary for reducing maternal mortality and severe morbidity in individuals who are eligible for and receiving medical assistance under ,medicaid or ,,chip4 7b7 ,updates ,the ,secretary shall1 in consultation with the ,advisory ,committee on ,reducing ,maternal ,deaths established under subsection 7c7 and the ,task ,force on ,maternal ,mental ,health established under section #aaac of division ,,ff of the ,consolidated ,appropriations ,act1 #bjbc 7,public ,law #aag-cbh71 update the guidance and resources described in subsection 7a7 at least once every #c years4 7c7 ,consultation with advisory committee 7#a7 ,establishment ,subject to the availability of appropriations1 not later than #ah months after the date of enactment of this ,act1 the ,secretary shall establish an advisory committee to be known as the ,national ,advisory ,committee on ,reducing ,maternal ,deaths 7referred to in this section as the ,advisory ,committee74 7#b7 ,duties ,the ,advisory ,committee shall provide consensus advice and guidance to the ,secretary on the development and compilation of the guidance described in subsection 7a7 7and any updates to such guidance74 7#c7 ,membership 7,a7 ,in general ,the ,secretary1 in consultation with such other heads of agencies1 as the ,secretary deems appropriate and in accordance with this paragraph1 shall appoint not more than #da members to the ,advisory ,committee4 ,in appointing such members1 the ,secretary shall ensure that-- 7i7 the total number of members of the ,advisory ,committee is an odd number2 and 7ii7 the total number of voting members who are not ,federal officials does not exceed the total number of voting ,federal members who are ,federal officials4 7,b7 ,required members 7i7 ,federal officials ,the ,advisory ,committee shall include as voting members the following ,federal officials1 or their designees3 7,i7 ,the ,secretary4 7,,ii7 ,the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7,,iii7 ,the ,director of the ,centers for ,disease ,control and ,prevention4 7,,iv7 ,the ,associate ,administrator of the ,maternal and ,child ,health ,bureau of the ,health ,resources and ,services ,administration4 7,v7 ,the ,director of the ,agency for ,healthcare ,research and ,quality4 7,,vi7 ,the ,national ,coordinator for ,health ,information ,technology4 7,,vii7 ,the ,director of the ,national ,institutes of ,health4 7,,viii7 ,the ,secretary of ,veterans ,affairs4 7,,ix7 ,the ,director of the ,indian ,health ,service4 7,x7 ,the ,deputy ,assistant ,secretary for ,minority ,health4 7,,xi7 ,the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration4 7,,xii7 ,the ,deputy ,assistant ,secretary for ,women's ,health4 7,,xiii7 ,such other ,federal officials or their designees as the ,secretary determines appropriate4 7ii7 ,non-,federal officials 7,i7 ,in general ,the ,advisory ,committee shall include the following as voting members3 7aa7 ,at least #a representative from a professional organization representing hospitals and health systems4 7bb7 ,at least #a representative from a medical professional organization representing primary care providers4 7cc7 ,at least #a representative from a medical professional organization representing general obstetrician-gynecologists4 7dd7 ,at least #a representative from a medical professional organization representing certified nurse-midwives4 7ee7 ,at least #a representative from a medical professional organization representing other maternal fetal medicine providers4 7ff7 ,at least #a representative from a medical professional organization representing anesthesiologists4 7gg7 ,at least #a representative from a medical professional organization representing emergency medicine physicians and urgent care providers4 7hh7 ,at least #a representative from a medical professional organization representing nurses4 7ii7 ,at least #a representative from a professional organization representing community health workers4 7jj7 ,at least #a representative from a professional organization representing doulas4 7kk7 ,at least #a representative from a professional organization representing perinatal psychiatrists4 7ll7 ,at least #a representative from ,state-affiliated programs or existing collaboratives with demonstrated expertise or success in improving maternal health4 7mm7 ,at least #a director of a ,state ,medicaid agency that has had demonstrated success in improving maternal health4 7nn7 ,at least #a representative from an accrediting organization for maternal health quality and safety standards4 7oo7 ,at least #a representative from a maternal patient advocacy organization with lived experience of severe maternal morbidity4 7pp7 ,at least #a medical professional who is an expert in the treatment of pregnant women with substance use disorder4 7,,ii7 ,requirements ,each individual selected to be a member under this clause shall-- 7aa7 have expertise in maternal health2 7bb7 not be a ,federal official2 and 7cc7 have experience working with populations that are at higher risk for maternal mortality or severe morbidity1 such as populations that experience racial1 ethnic1 and geographic health disparities1 pregnant and postpartum women experiencing a mental health disorder1 or pregnant or postpartum women with other comorbidities such as substance use disorders1 hypertension1 thyroid disorders1 and sickle cell disease4 7,c7 ,additional members 7i7 ,in general ,in addition to the members required to be appointed under subparagraph 7,b71 the ,secretary may appoint as non-voting members to the ,advisory ,committee such other individuals with relevant expertise or experience as the ,secretary shall determine appropriate1 which may include1 but is not limited to1 individuals described in clause 7ii74 7ii7 ,suggested additional members ,the individuals described in this clause are the following3 7,i7 ,representatives from ,state maternal mortality review committees and perinatal quality collaboratives4 7,,ii7 ,medical providers who care for women and infants during pregnancy and the postpartum period1 such as family practice physicians1 cardiologists1 pulmonology critical care specialists1 endocrinologists1 pediatricians1 and neonatologists4 7,,iii7 ,representatives from ,state and local public health departments1 including ,state ,medicaid ,agencies4 7,,iv7 ,subject matter experts in conducting outreach to women who are ,african-,american or belong to another minority group4 7,v7 ,directors of ,state agencies responsible for administering a ,state's maternal and child health services program under title ,v of the ,social ,security ,act 7#db ,u4,s4,c4 #gja et seq474 7,,vi7 ,experts in medical education or physician training4 7,,vii7 ,representatives from ,medicaid managed care organizations4 7#d7 ,applicability of ,,faca ,chapter #aj of title #e1 ,united ,states ,code1 shall apply to the committee established under this subsection4 7d7 ,contents ,the guidance described in subsection 7a7 shall include1 with respect to hospitals1 freestanding birth centers1 and other maternal care providers1 the following3 7#a7 ,best practices regarding evidence-based screening and clinician education initiatives relating to screening and treatment protocols for individuals who are at risk of experiencing complications related to pregnancy1 with an emphasis on individuals with preconditions directly linked to pregnancy complications and maternal mortality and severe morbidity1 including-- 7,a7 methods to identify individuals who are at risk of maternal mortality or severe morbidity1 including risk stratification2 7,b7 evidence-based risk factors associated with maternal mortality or severe morbidity and racial1 ethnic1 and geographic health disparities2 7,c7 evidence-based strategies to reduce risk factors associated with maternal mortality or severe morbidity through services which may be covered under ,medicaid or ,,chip1 including1 but not limited to1 activities by community health workers 7as such term is defined in section #baac of the ,social ,security ,act 7#db ,u4,s4,c4 #acigmm77 that are funded by a grant awarded under such section2 7,d7 resources available to such individuals1 such as nutrition assistance and education1 home visitation1 mental health and substance use disorder services1 smoking cessation programs1 prenatal care1 and other evidence-based maternal mortality or severe morbidity reduction programs2 7,e7 examples of educational materials used by providers of obstetrics services2 7,f7 methods for improving community centralized care1 including providing telehealth services or home visits to increase and facilitate access to and engagement in prenatal and postpartum care and collaboration with home health agencies1 community health centers1 local public health departments1 or clinics2 7,g7 guidance on medical record diagnosis codes linked to maternal mortality and severe morbidity1 including1 if applicable1 codes related to social risk factors1 and methods for educating clinicians on the proper use of such codes2 7,h7 risk appropriate transfer protocols during pregnancy1 childbirth1 and the postpartum period2 and 7,i7 any other information related to prevention and treatment of at-risk individuals determined appropriate by the ,secretary4 7#b7 ,guidance on monitoring programs for individuals who have been identified as at risk of complications related to pregnancy4 7#c7 ,best practices for such hospitals1 freestanding birth centers1 and providers to make pregnant women aware of the complications related to pregnancy4 7#d7 ,a fact sheet for providing pregnant women who are receiving care on an outpatient basis with a notice during the prenatal stage of pregnancy that-- 7,a7 explains the risks associated with pregnancy1 birth1 and the postpartum period 7including the risks of hemorrhage1 preterm birth1 sepsis1 eclampsia1 obstructed labor71 chronic conditions 7including high blood pressure1 diabetes1 heart disease1 depression1 and obesity7 correlated with adverse pregnancy outcomes1 risks associated with advanced maternal age1 and the importance of adhering to a personalized plan of care2 7,b7 highlights multimodal and evidence-based prevention and treatment techniques2 7,c7 highlights evidence-based programs and activities to reduce the incidence of stillbirth 7including tracking and awareness of fetal movements1 improvement of birth timing for pregnancies with risk factors1 initiatives that encourage safe sleeping positions during pregnancy1 screening and surveillance for fetal growth restriction1 efforts to achieve smoking cessation during pregnancy1 community-based programs that provide home visits or other types of support1 and any other research or evidence-based programming to prevent stillbirths72 7,d7 provides for a method 7through signature or otherwise7 for such an individual1 or a person acting on such individual's behalf1 to acknowledge receipt of such fact sheet2 7,e7 is worded in an easily understandable manner and made available in multiple languages and accessible formats determined appropriate by the ,secretary2 and 7,f7 includes any other information determined appropriate by the ,secretary4 7#e7 ,a template for a voluntary clinician checklist that outlines the minimum responsibilities that clinicians1 such as physicians1 certified nurse-midwives1 emergency room and urgent care providers1 nurses and others1 are expected to meet in order to promote quality and safety in the provision of obstetric services4 7#f7 ,a template for a voluntary checklist that outlines the minimum responsibilities that hospital leadership responsible for direct patient care1 such as the institution's president1 chief medical officer1 chief nursing officer1 or other hospital leadership that directly report to the president or chief executive officer of the institution1 should meet to promote hospital-wide initiatives that improve quality and safety in the provision of obstetric services4 7#g7 ,information on multi-stakeholder quality improvement initiatives1 such as the ,alliance for ,innovation on ,maternal ,health1 ,state perinatal quality improvement initiatives1 and other similar initiatives determined appropriate by the ,secretary1 including-- 7,a7 information about such improvement initiatives and how to join2 7,b7 information about public maternal data collection centers2 7,c7 information about quality metrics used and outcomes achieved by such improvement initiatives2 7,d7 information about data sharing techniques used by such improvement initiatives2 7,e7 information about data sources used by such improvement initiatives to identify maternal mortality and severe morbidity risks2 7,f7 information about interventions used by such improvement initiatives to mitigate risks of maternal mortality and severe morbidity2 7,g7 information about data collection techniques on race1 ethnicity1 geography1 age1 income1 and other demographic information used by such improvement initiatives2 and 7,h7 any other information determined appropriate by the ,secretary4 7e7 ,inclusion of best practices ,not later than #ah months after the date of the publication of the guidance required under subsection 7a71 the ,secretary shall update such guidance to include best practices identified by the ,secretary for such hospitals1 freestanding birth centers1 and providers to track maternal mortality and severe morbidity trends by clinicians at such hospitals1 freestanding birth centers1 and providers including-- 7#a7 ways to establish scoring systems1 which may include quality triggers and safety and quality metrics to score case and patient outcome metrics1 for such clinicians2 7#b7 methods to identify1 educate1 and improve such clinicians who may have higher rates of maternal mortality or severe morbidity compared to their regional or ,state peers 7taking into account differences in patient risk for adverse outcomes1 which may include social risk factors72 7#c7 methods for using such data and tracking to enhance research efforts focused on maternal health1 while also improving patient outcomes1 clinician education and training1 and coordination of care2 and 7#d7 any other information determined appropriate by the ,secretary4 7f7 ,cultural and linguistic appropriateness ,to the extent practicable1 the ,secretary should develop the guidance1 best practices1 fact sheets1 templates1 and other materials that are required under this section in a trauma-informed1 culturally and linguistically appropriate manner4 #ac4 ,program related to reducing cesarean births and increasing rates of vaginal birth after cesarean ,section #cag,k7a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;a77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking and to develop or support and inserting to develop or support2 and 7,b7 by inserting 1 and to establish a grant program1 or extend the ,alliance for ,innovation on ,maternal ,health1 for the establishment of perinatal quality collaboratives to reduce cesarean section rates and increase vaginal birth after cesarean rates before the period at the end2 and 7#b7 in paragraph 7#b71 by adding at the end the following3 7,e7 ,the ,secretary may establish a competitive grant program1 or extend existing programs1 including the ,alliance for ,innovation on ,maternal ,health1 for the establishment or support of perinatal quality collaboratives1 with a focus on maternity care health professional target areas and other areas with limited birthing resources1 to reduce cesarean birth rates and increase vaginal birth after cesarean rates1 including through-- 7i7 coordination with hospitals1 clinical teams1 obstetricians and gynecologists1 birthing centers and community-based maternal health organizations1 public health agencies1 midwives1 doulas1 patients and families1 and other relevant entities2 7ii7 providing support and training to hospital and clinical teams for quality improvement1 as appropriate2 7iii7 employing strategies that provide opportunities for health care professionals and clinical teams to collaborate across health care settings and disciplines1 including midwifery care1 doula support1 the integration of primary care and mental health1 and blended case payment rates2 7iv7 using data1 disaggregated by race and ethnicity1 to provide timely feedback across hospital and clinical teams1 document baseline cesarean and vaginal birth rates1 and measure progress2 and 7v7 promotion of existing evidence on the best practices for the safe reduction of primary cesarean births4 4 #ad4 ,collection of information related to social determinants of the health of ,medicaid and ,,chip beneficiaries 7a7 ,implementation assessment report to ,congress 7#a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit a report to ,congress that includes a description of whether and how information related to the social determinants of health for individuals eligible for medical assistance under ,medicaid or child health assistance or pregnancy-related assistance under ,,chip may be captured under the data systems for such programs as in effect on the date such report is submitted1 including-- 7,a7 a description of whether and how ,,icd-#aj codes 7or successor codes7 may be used to identify social determinants of health in programs such as ,medicaid and ,,chip1 and whether other claims file or demographic information may be employed2 and 7,b7 a description of whether existing data systems under ,medicaid and ,,chip could be employed to capture such information1 whether program or system changes would be required1 how privacy and confidentiality as required under applicable law and regulations would be maintained1 and the resources and timeframes at the ,federal and ,state levels that would be needed to make such changes4 7#b7 ,guidance for ,states ,the ,secretary shall issue detailed guidance for ,states concurrent with the submission of the report to ,congress under paragraph 7#a74 ,such guidance shall address-- 7,a7 whether and how information related to the social determinants of health for individuals eligible for medical assistance under ,medicaid or child health assistance or pregnancy-related assistance under ,,chip could be captured employing existing systems under such programs2 and 7,b7 implementation considerations for capturing such information1 including whether program or system changes would be required1 whether additional steps would be needed to maintain privacy and confidentiality as required under relevant laws and regulations1 and the resources and timeframes at that would be needed to make such changes4 7#c7 ,stakeholder input ,the ,secretary shall develop the report required under paragraph 7#a7 and the guidance required under paragraph 7#b7 with the input of relevant stakeholders1 such as ,state ,medicaid directors1 ,medicaid managed care organizations1 and other relevant ,federal agencies such as the ,centers for ,disease ,control and ,prevention1 the ,health ,resources ,services ,administration1 and the ,agency for ,healthcare ,research and ,quality4 7#d7 ,action plan report 7,a7 ,in general ,if the ,secretary determines in the report required under paragraph 7#a7 that information related to the social determinants of health for individuals eligible for medical assistance under ,medicaid or child health assistance or pregnancy-related assistance under ,,chip cannot be captured under the data systems for such programs as in effect on the date such report is submitted1 then1 not later than #f months after such date1 the ,secretary shall submit a second report to ,congress that contains an action plan for implementing the program or data systems changes needed in order for such information to be collected while maintaining privacy and confidentiality as required under relevant laws and regulations4 ,the action plan should be prepared so as to be implemented by the ,federal ,government and ,states not later than #b years after the date on which the report required under this paragraph is submitted to ,congress4 7,b7 ,revised guidance for states ,the ,secretary shall revise and reissue the guidance for ,states required under paragraph 7#b7 to take into account the action plan included in the report submitted to ,congress under subparagraph 7,a74 7#e7 ,authorization of appropriations 7,a7 ,federal costs ,there are authorized to be appropriated to the ,secretary1 #dj1jjj1jjj for purposes of preparing the reports required under this subsection and implementing the collection of information related to the social determinants of health for individuals eligible for medical assistance under ,medicaid or child health assistance or pregnancy-related assistance under ,,chip4 7,b7 ,state costs ,there are authorized to be appropriated to the ,secretary1 #ej1jjj1jjj for purposes of making payments to ,states in accordance with a methodology established by the ,secretary for ,state expenditures attributable to planning for and implementing the collection of such information in accordance with subsection 7d7 of section #aidf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifw-#e7 7as added by subsection 7b774 7b7 ,application to ,states ,section #aidf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifw-#e7 is amended by adding at the end the following3 7d7 ,collection of information related to social determinants of health 7#a7 ,development of collection methods 7,a7 ,in general ,subject to paragraph 7#e71 the ,secretary1 in consultation with the ,states1 shall develop a method for collecting standardized and aggregated ,state-level information related to social determinants that may factor into the health of beneficiaries under this title and beneficiaries under title ,,xxi which the ,states1 notwithstanding section #aijb7;a77#g7 and as a condition for meeting the requirements of section #aijb7;a77#f7 and section #bajg7;b77#a71 shall use to annually report such information3 7i7 ,a model uniform reporting field through the transformed ,medicaid ,statistical ,information ,system 7,t-,,msis7 7or a successor system7 or another appropriate reporting platform1 as approved by the ,secretary4 7ii7 ,a model uniform questionnaire or survey 7which may be included as part of an existing survey1 questionnaire1 or form administered by the ,secretary71 for purposes of the ,state or the ,secretary collecting such information by administering regularly but not less than annually a questionnaire or survey of beneficiaries under this title and beneficiaries under title ,,xxi4 7iii7 ,a model uniform form to be adapted for inclusion in the ,medicaid and ,,chip ,scorecard developed by the ,centers for ,medicare ,medicaid ,services1 for purposes of the ,secretary collecting such information4 7iv7 ,an alternative method identified by the ,secretary for collecting such information4 7,b7 ,implementation ,in carrying out the requirements of subparagraph 7,a71 the ,secretary shall-- 7i7 for purposes of the method described in clause 7i7 of such subparagraph1 determine the appropriate providers and frequency with which such providers shall complete the reporting field identified and report the information to the ,state2 7ii7 for purposes of the method described in clause 7ii7 of such subparagraph1 identify the means and frequency 7which shall be no less frequent than once per year7 with which a questionnaire or survey of beneficiaries is to be conducted2 7iii7 with respect to any method described in such subparagraph1 issue guidance for ensuring compliance with applicable laws regarding beneficiary informed consent1 privacy1 and anonymity with respect to the information collected under such method2 7iv7 with respect to the collection of information relating to beneficiaries who are children1 issue guidance on the collection of such information from a parent1 legal guardian1 or any other person who is legally authorized to share such information on behalf of the child when the direct collection of such information from children may not otherwise be feasible or appropriate2 and 7v7 regularly evaluate the method under such subparagraph and the information reported using such method1 and1 as needed1 make updates to the method and the information reported4 7#b7 ,social determinants of health ,the information collected in accordance with the method made available under paragraph 7#a7 shall1 to the extent practicable1 include standardized definitions for identifying social determinants of health needs identified in the ,,icd-#aj diagnostic codes ,z#ee through ,z#fe 7or any such successor diagnostic codes71 as defined by the ,healthy ,people #bjbj and related initiatives of the ,office of ,disease ,prevention and ,health ,promotion of the ,department of ,health and ,human ,services1 or any other standardized set of definitions for social determinants of health identified by the ,secretary4 ,such definitions shall incorporate measures for quantifying the relative severity of any such social determinant of health need identified in an individual4 7#c7 ,federal privacy requirements ,nothing in this subsection shall be construed to supersede any ,federal privacy or confidentiality requirement1 including the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif and section #edc of the ,public ,health ,service ,act and any regulations promulgated thereunder4 7#d7 ,application to territories 7,a7 ,in general ,to the extent that the ,secretary determines that it is not practicable for a ,state specified in subparagraph 7,b7 to report information in accordance with the method made available under paragraph 7#a71 this subsection shall not apply with respect to such ,state4 7,b7 ,territories specified ,the ,states specified in this subparagraph are ,puerto ,rico1 the ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,northern ,mariana ,islands4 7#e7 ,application 7,a7 ,in general ,subject to subparagraph 7,b71 the requirement for a ,state to collect information in accordance with the method made available under paragraph 7#a7 shall not apply to the ,state before the date that is #d years after the date of enactment of this subsection4 7,b7 ,alternative date ,if an action plan is submitted to ,congress under section #ad7;a77#d7 of the ,healthy ,moms and ,babies ,act1 in lieu of the date described in subparagraph 7,a71 the requirement for a ,state to collect information in accordance with the method made available under paragraph 7#a7 shall not apply to the ,state before the date specified in such action plan4 7#f7 ,appropriation ,there is appropriated to the ,secretary for fiscal year #bjbf and each fiscal year thereafter #a1jjj1jjj to carry out the provisions of this section and subsection 7b77#b77;,b74 4 7c7 ,report on data analyses ,section #aidf7;b77#b7 of such ,act 7#db ,u4,s4,c4 #acifw-#e7;b77#b77 is amended-- 7#a7 by striking ,not later than and inserting the following3 7,a7 ,initial reports ,not later than 2 and 7#b7 by adding at the end the following3 7,b7 ,reports on collection of information related to social determinants of health 7i7 ,in general ,not later than #e years after the date on which the requirement to collect information under subsection 7d7 is first applicable to ,states1 the ,secretary shall submit to ,congress a report that includes aggregate findings and trends across respective beneficiary populations for improving the identification of social determinants of health for beneficiaries under this title and beneficiaries under title ,,xxi based on analyses of the data collected under subsection 7d74 7ii7 ,interim report ,not later than #c years after the date of enactment of this subparagraph1 the ,secretary shall submit to ,congress an interim report on progress in developing1 implementing1 and utilizing the method selected by the ,secretary under subsection 7d77#a7 along with any available1 preliminary information that has been collected using such method4 4 7d7 ,conforming amendment ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended by adding at the end the following3 7,v7 ,section #aidf 7relating to addressing health care disparities74 4 #ae4 ,report on payment methodologies for transferring pregnant women between facilities before1 during1 and after childbirth 7a7 ,in general ,subject to the availability of appropriations1 not later than #cf months after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the payment methodologies under ,medicaid for the antepartum1 intrapartum1 and postpartum transfer of pregnant women from one health care facility to another1 including any potential disincentives or regulatory barriers to such transfers4 7b7 ,consultation ,in developing the report required under subsection 7a71 the ,secretary shall consult with the advisory committee established under section #ab7;c74 #af4 ,medicaid guidance on ,state options to address social determinants of health for pregnant and postpartum women 7a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall issue guidance to ,states and conduct one or more learning collaboratives to promote cross-state learning regarding options ,states may employ to address social determinants of health1 as defined by the ,healthy ,people #bjcj and related initiatives of the ,office of ,disease ,prevention and ,health ,promotion of the ,department of ,health and ,human ,services1 including for pregnant and postpartum women4 7b7 ,guidance requirements ,the guidance required under subsection 7a7 shall1 at a minimum1 describe the authorities that ,states may leverage to support addressing the social determinants of health for pregnant and postpartum women and outline best practices for such efforts4 7c7 ,learning collaborative requirements ,the learning collaboratives required under subsection 7a7 shall1 at a minimum1 include opportunities for ,states and other stakeholders to share innovative practices and approaches as they are being considered and developed1 share solutions related to challenges that multiple urban and rural ,states face1 and promote the uptake of approved1 effective interventions addressing social needs and determinants covered by the ,medicaid program4 #ag4 ,payment error rate measurement 7,,perm7 audit and improvement requirements 7a7 ,biennial ,,perm audit requirement ,beginning with fiscal year #bjbg1 the ,administrator shall conduct payment error rate measurement 7,,perm7 audits of each ,state ,medicaid program on a biennial basis4 7b7 ,,perm error rate reduction plan requirement ,beginning with fiscal year #bjbg1 any ,state with an overall ,,perm error rate exceeding #ae percent in a ,,perm audit conducted with respect to the ,state in the previous fiscal year shall publish a plan1 in coordination with1 and subject to the approval of1 the ,administrator1 for how the ,state will reduce its ,,perm error rate below #ae percent in the current fiscal year4 7c7 ,notification2 identification of sources of improper payments 7#a7 ,notification ,not later than #f months after the date of enactment of this ,act1 the ,administrator shall notify the contractor conducting ,,perm audits of the ,administrator's intent to modify contracts to require ,,perm audits not less than once every other year in each ,state4 7#b7 ,identification of sources of improper payments ,the ,administrator shall direct the contractor conducting ,,perm audits of ,state ,medicaid programs to identify areas known to be sources of improper payments under such programs to identify program areas or components known to be sources of high risk for improper payments under such programs4 7d7 ,state ,medicaid director letter ,not later than #ab months after the date of enactment of this ,act1 the ,administrator shall issue a ,state ,medicaid ,director letter regarding ,state requirements under ,federal law and regulations regarding avoiding and responding to improper payments under ,state ,medicaid programs4 7e7 ,state improper payment mitigation plans 7#a7 ,in general ,not later than ,january #a1 #bjbf1 each ,state ,medicaid program shall submit to the ,administrator a plan1 which shall include specific actions and timeframes for taking such actions and achieving specified results1 for mitigating improper payments under such program4 7#b7 ,publication of ,state plans ,the ,administrator shall make ,state plans submitted under paragraph 7#a7 available to the public4 7f7 ,definitions ,in this section3 7#a7 ,administrator ,the term ,administrator means the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7#b7 ,state ,the term ,state has the meaning given such term for purposes of title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,state ,medicaid program ,the term ,state ,medicaid program means a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 and includes any waiver of such a plan4