IMPACT to Save Moms Act

I 117TH CONGRESS 1ST SESSION H. R. 950 To require the Secretary of Health and Human Services to establish and implement a Perinatal Care Alternative Payment Model Demonstration Project, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 8, 2021 Ms. SCHAKOWSKY (for herself, Ms. UNDERWOOD, Ms. ADAMS, Mr. KHANNA, Ms. VELA´ZQUEZ, Mrs. MCBATH, Mr. SMITH of Washington, Ms. SCAN- LON, Mr. LAWSON of Florida, Mrs. HAYES, Mr. BUTTERFIELD, Ms. MOORE of Wisconsin, Ms. STRICKLAND, Mr. RYAN, Mr. SCHIFF, Mr. JOHNSON of Georgia, Mr. HORSFORD, Ms. WASSERMAN SCHULTZ, Ms. BARRAGA´N, Mr. DEUTCH, Mr. PAYNE, Mr. BLUMENAUER, Mr. MOULTON, Mr. SOTO, Mr. NADLER, Mr. TRONE, Ms. CLARKE of New York, Ms. BASS, Ms. PRESSLEY, Mr. EVANS, Ms. BLUNT ROCHESTER, Ms. CASTOR of Florida, Ms. SEWELL, and Ms. WILLIAMS of Georgia) in- troduced the following bill; which was referred to the Committee on En- ergy and Commerce A BILL To require the Secretary of Health and Human Services to establish and implement a Perinatal Care Alternative Payment Model Demonstration Project, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 950 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Innovative Maternal 2 Payment And Coverage To Save Moms Act’’ or the ‘‘IM- 3 PACT to Save Moms Act’’. 4 SEC. 2. PERINATAL CARE ALTERNATIVE PAYMENT MODEL 5 DEMONSTRATION PROJECT. 6 (a) IN GENERAL.—For the period of fiscal years 7 2022 through 2026, the Secretary of Health and Human 8 Services (referred to in this section as the ‘‘Secretary’’), 9 acting through the Administrator of the Centers for Medi- 10 care & Medicaid Services, shall establish and implement, 11 in accordance with the requirements of this section, a 12 demonstration project, to be known as the Perinatal Care 13 Alternative Payment Model Demonstration Project (re- 14 ferred to in this section as the ‘‘Demonstration Project’’), 15 for purposes of allowing States to test payment models 16 under their State plans under title XIX of the Social Secu- 17 rity Act (42 U.S.C. 1396 et seq.) and State child health 18 plans under title XXI of such Act (42 U.S.C. 1397aa et 19 seq.) with respect to maternity care provided to pregnant 20 and postpartum individuals enrolled in such State plans 21 and State child health plans. 22 (b) COORDINATION.—In establishing the Demonstra- 23 tion Project, the Secretary shall coordinate with stake- 24 holders such as— 25 (1) State Medicaid programs; 26 VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 950 IH (2) relevant organizations representing mater- 1 nal health care providers; 2 (3) relevant organizations representing patients, 3 with a particular focus on individuals from demo- 4 graphic groups with disproportionate rates of ad- 5 verse maternal health outcomes; 6 (4) relevant community-based organizations, 7 particularly organizations that seek to improve ma- 8 ternal health outcomes for individuals from demo- 9 graphic groups with disproportionate rates of ad- 10 verse maternal health outcomes; 11 (5) non-clinical perinatal health workers such as 12 doulas, community health workers, peer supporters, 13 certified lactation consultants, nutritionists and di- 14 eticians, social workers, home visitors, and naviga- 15 tors; 16 (6) relevant health insurance issuers; 17 (7) hospitals, health systems, freestanding birth 18 centers (as such term is defined in paragraph (3)(B) 19 of section 1905(l) of the Social Security Act (42 20 U.S.C. 1396d(l))), Federally-qualified health centers 21 (as such term is defined in paragraph (2)(B) of such 22 section), and rural health clinics (as such term is de- 23 fined in section 1861(aa) of such Act (42 U.S.C. 24 1395x(aa))); 25 VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 950 IH (8) researchers and policy experts in fields re- 1 lated to maternity care payment models; and 2 (9) any other stakeholders as the Secretary de- 3 termines appropriate, with a particular focus on 4 stakeholders from demographic groups with dis- 5 proportionate rates of adverse maternal health out- 6 comes. 7 (c) CONSIDERATIONS.—In establishing the Dem- 8 onstration Project, the Secretary shall consider each of the 9 following: 10 (1) Findings from any evaluations of the 11 Strong Start for Mothers and Newborns initiative 12 carried out by the Centers for Medicare & Medicaid 13 Services, the Health Resources and Services Admin- 14 istration, and the Administration on Children and 15 Families. 16 (2) Any alternative payment model that— 17 (A) is designed to improve maternal health 18 outcomes for racial and ethnic groups with dis- 19 proportionate rates of adverse maternal health 20 outcomes; 21 (B) includes methods for stratifying pa- 22 tients by pregnancy risk level and, as appro- 23 priate, adjusting payments under such model to 24 take into account pregnancy risk level; 25 VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 950 IH (C) establishes evidence-based quality 1 metrics for such payments; 2 (D) includes consideration of non-hospital 3 birth settings such as freestanding birth centers 4 (as so defined); 5 (E) includes consideration of social deter- 6 minants of health that are relevant to maternal 7 health outcomes such as housing, transpor- 8 tation, nutrition, and other non-clinical factors 9 that influence maternal health outcomes; or 10 (F) includes diverse maternity care teams 11 that include— 12 (i) maternity care providers, including 13 obstetrician-gynecologists, family physi- 14 cians, physician assistants, midwives who 15 meet, at a minimum, the international def- 16 inition of the term ‘‘midwife’’ and global 17 standards for midwifery education (as es- 18 tablished by the International Confed- 19 eration of Midwives), and nurse practi- 20 tioners— 21 (I) from racially, ethnically, and 22 professionally diverse backgrounds; 23 VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 950 IH (II) with experience practicing in 1 racially and ethnically diverse commu- 2 nities; or 3 (III) who have undergone train- 4 ings on racism, implicit bias, and ex- 5 plicit bias; and 6 (ii) non-clinical perinatal health work- 7 ers such as doulas, community health 8 workers, peer supporters, certified lacta- 9 tion consultants, nutritionists and dieti- 10 cians, social workers, home visitors, and 11 navigators. 12 (d) ELIGIBILITY.—To be eligible to participate in the 13 Demonstration Project, a State shall submit an applica- 14 tion to the Secretary at such time, in such manner, and 15 containing such information as the Secretary may require. 16 (e) EVALUATION.—The Secretary shall conduct an 17 evaluation of the Demonstration Project to determine the 18 impact of the Demonstration Project on— 19 (1) maternal health outcomes, with data strati- 20 fied by race, ethnicity, socioeconomic indicators, and 21 any other factors as the Secretary determines appro- 22 priate; 23 (2) spending on maternity care by States par- 24 ticipating in the Demonstration Project; 25 VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 950 IH (3) to the extent practicable, subjective meas- 1 ures of patient experience; and 2 (4) any other areas of assessment that the Sec- 3 retary determines relevant. 4 (f) REPORT.—Not later than one year after the com- 5 pletion or termination date of the Demonstration Project, 6 the Secretary shall submit to the Committee on Energy 7 and Commerce, the Committee on Ways and Means, and 8 the Committee on Education and Labor of the House of 9 Representatives and the Committee on Finance and the 10 Committee on Health, Education, Labor, and Pensions of 11 the Senate, and make publicly available, a report con- 12 taining— 13 (1) the results of any evaluation conducted 14 under subsection (e); and 15 (2) a recommendation regarding whether the 16 Demonstration Project should be continued after fis- 17 cal year 2026 and expanded on a national basis. 18 (g) AUTHORIZATION OF APPROPRIATIONS.—There 19 are authorized to be appropriated such sums as are nec- 20 essary to carry out this section. 21 (h) DEFINITIONS.—In this section: 22 (1) ALTERNATIVE PAYMENT MODEL.—The 23 term ‘‘alternative payment model’’ has the meaning 24 VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 950 IH given such term in section 1833(z)(3)(C) of the So- 1 cial Security Act (42 U.S.C. 1395l(z)(3)(C)). 2 (2) PERINATAL.—The term ‘‘perinatal’’ means 3 the period beginning on the day a woman becomes 4 pregnant and ending on the last day of the 1-year 5 period beginning on the last day of such woman’s 6 pregnancy. 7 SEC. 3. MACPAC REPORT. 8 (a) IN GENERAL.—Not later than two years after the 9 date of the enactment of this Act, the Medicaid and CHIP 10 Payment and Access Commission shall publish a report 11 on issues relating to the continuity of coverage under 12 State plans under title XIX of the Social Security Act (42 13 U.S.C. 1396 et seq.) and State child health plans under 14 title XXI of such Act (42 U.S.C. 1397aa et seq.) for preg- 15 nant and postpartum individuals. Such report shall, at a 16 minimum, include the following: 17 (1) An assessment of any existing policies 18 under such State plans and such State child health 19 plans regarding presumptive eligibility for pregnant 20 individuals while their application for enrollment in 21 such a State plan or such a State child health plan 22 is being processed. 23 (2) An assessment of any existing policies 24 under such State plans and such State child health 25 VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 950 IH plans regarding measures to ensure continuity of 1 coverage under such a State plan or such a State 2 child health plan for pregnant and postpartum indi- 3 viduals, including such individuals who need to 4 change their health insurance coverage during their 5 pregnancy or the postpartum period following their 6 pregnancy. 7 (3) An assessment of any existing policies 8 under such State plans and such State child health 9 plans regarding measures to automatically reenroll 10 individuals who are eligible to enroll under such a 11 State plan or such a State child health plan as a 12 parent. 13 (4) If determined appropriate by the Commis- 14 sion, any recommendations for the Department of 15 Health and Human Services, or such State plans 16 and such State child health plans, to ensure con- 17 tinuity of coverage under such a State plan or such 18 a State child health plan for pregnant and 19 postpartum women. 20 (b) POSTPARTUM DEFINED.—In this section, the 21 term ‘‘postpartum’’ means the 1-year period beginning on 22 the last day of a woman’s pregnancy. 23 Æ VerDate Sep 11 2014 22:23 Mar 05, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H950.IH H950 kjohnson on DSK79L0C42PROD with BILLS