HEALTH for MOM Act of 2021

II 117TH CONGRESS 1ST SESSION S. 1622 To amend title XIX of the Social Security Act to provide States with the option to provide coordinated care through a pregnancy medical home for high-risk pregnant women, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 13, 2021 Mr. PORTMAN (for himself and Ms. STABENOW) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XIX of the Social Security Act to provide States with the option to provide coordinated care through a pregnancy medical home for high-risk preg- nant women, 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Harnessing Effective 4 and Appropriate Long-Term Health for Moms On Med- 5 icaid Act of 2021’’ or the ‘‘HEALTH for MOM Act of 6 2021’’. 7 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 1622 IS SEC. 2. STATE OPTION TO PROVIDE COORDINATED CARE 1 THROUGH A HEALTH HOME FOR PREGNANT 2 AND POSTPARTUM WOMEN. 3 Title XIX of the Social Security Act (42 U.S.C. 1396 4 et seq.) is amended by inserting after section 1945A the 5 following new section: 6 ‘‘SEC. 1945B. STATE OPTION TO PROVIDE COORDINATED 7 CARE THROUGH A HEALTH HOME FOR PREG- 8 NANT AND POSTPARTUM WOMEN. 9 ‘‘(a) STATE OPTION.— 10 ‘‘(1) IN GENERAL.—Notwithstanding section 11 1902(a)(1) (relating to statewideness) and section 12 1902(a)(10)(B) (relating to comparability), begin- 13 ning April 1, 2023, a State, at its option as a State 14 plan amendment, may provide for medical assistance 15 under this title to an eligible woman who chooses 16 to— 17 ‘‘(A) enroll in a maternity health home 18 under this section by selecting a designated pro- 19 vider, a team of health care professionals oper- 20 ating with such a provider, or a health team as 21 the woman’s maternity health home for pur- 22 poses of providing the woman with pregnancy 23 and postpartum coordinated care services; or 24 ‘‘(B) receive such services from a des- 25 ignated provider, a team of health care profes- 26 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 1622 IS sionals operating with such a provider, or a 1 health team that has voluntarily opted to par- 2 ticipate in a maternity health home for eligible 3 women under this section. 4 ‘‘(2) ELIGIBLE WOMAN DEFINED.— 5 ‘‘(A) IN GENERAL.—In this section, the 6 term ‘eligible woman’ means an individual 7 who— 8 ‘‘(i) is eligible for medical assistance 9 under the State plan (or under a waiver of 10 such plan) for all items and services cov- 11 ered under the State plan (or waiver) that 12 are not less in amount, duration, or scope, 13 or are determined by the Secretary to be 14 substantially equivalent, to the medical as- 15 sistance available for an individual de- 16 scribed in subsection (a)(10)(A)(i); and 17 ‘‘(ii) is pregnant. 18 ‘‘(B) CONTINUATION OF ELIGIBILITY.—An 19 individual described in subparagraph (A) shall 20 be deemed to be described in such subpara- 21 graph through the earlier of— 22 ‘‘(i) the end of the month in which the 23 individual’s eligibility for medical assist- 24 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 1622 IS ance under the State plan (or waiver) 1 ends; and 2 ‘‘(ii) the last day of the 1-year period 3 that begins on the last day of the individ- 4 ual’s pregnancy. 5 ‘‘(C) EXCLUSION OF INDIVIDUALS ELIGI- 6 BLE FOR A LIMITED PREGNANCY-RELATED 7 ONLY BENEFIT PACKAGE.—Such term does not 8 include an individual who had a pregnancy end 9 within the last 365 days and whose eligibility 10 under such plan (or waiver) is limited to cov- 11 erage for a limited type of benefits and services. 12 ‘‘(b) QUALIFICATION STANDARDS.—The Secretary 13 shall establish standards for qualification as a maternity 14 health home or as a designated provider, team of health 15 care professionals operating with such a provider, or a 16 health team eligible for participation in a maternity health 17 home for purposes of this section. Such standards shall 18 include requiring designated providers, teams of health 19 care professionals operating with such providers, and 20 health teams (designated as a maternity health home) to 21 demonstrate to the State the ability to do the following: 22 ‘‘(1) Coordinate prompt care and access to ma- 23 ternity and postpartum care services, including serv- 24 ices provided by specialists, and programs for an eli- 25 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 1622 IS gible woman during pregnancy and during the pe- 1 riod for which she remains eligible as described in 2 subsection (a)(2)(B). 3 ‘‘(2) Develop an individualized, comprehensive, 4 patient-centered care plan for each eligible woman 5 that accommodates patient preferences and, if appli- 6 cable, reflects adjustments to the payment method- 7 ology described in subsection (c)(2)(B). 8 ‘‘(3) Develop and incorporate into each eligible 9 woman’s care plan, in a culturally and linguistically 10 appropriate manner consistent with the needs of the 11 eligible woman, ongoing home care, community- 12 based primary care, inpatient care, social support 13 services, behavioral health services, local hospital 14 emergency care, and to the extent, applicable, care 15 management and planning related to a change in an 16 eligible woman’s eligibility for medical assistance or 17 a change in health insurance coverage. 18 ‘‘(4) Coordinate with pediatric care providers, 19 as appropriate. 20 ‘‘(5) Collect and report information under sub- 21 section (f)(1). 22 ‘‘(c) PAYMENTS.— 23 ‘‘(1) IN GENERAL.—A State shall provide a des- 24 ignated provider, a team of health care professionals 25 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 1622 IS operating with such a provider, or a health team 1 with payments for the provision of pregnancy and 2 postpartum coordinated care services, to each eligi- 3 ble woman that selects such provider, team of health 4 care professionals, or health team as the woman’s 5 maternity health home or care provider. Payments 6 made to a maternity health home or care provider 7 for such services shall be treated as medical assist- 8 ance for purposes of section 1903(a), except that, 9 during the first 2 fiscal year quarters that the State 10 plan amendment is in effect, the Federal medical as- 11 sistance percentage applicable to such payments 12 shall be increased by 15 percentage points, but in no 13 case may exceed 90 percent. 14 ‘‘(2) METHODOLOGY.—The State shall specify 15 in the State plan amendment the methodology the 16 State will use for determining payment for the provi- 17 sion of pregnancy and postpartum coordinated care 18 services or treatment to an eligible woman. Such 19 methodology for determining payment— 20 ‘‘(A) may be based on— 21 ‘‘(i) a per-member per-month basis for 22 each eligible woman enrolled in the mater- 23 nity health home; 24 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 1622 IS ‘‘(ii) a prospective payment model, in 1 the case of payments to Federally qualified 2 health centers or a rural health clinics; or 3 ‘‘(iii) an alternate model of payment 4 (which may include a model developed 5 under a waiver under section 1115) pro- 6 posed by the State and approved by the 7 Secretary; 8 ‘‘(B) may be adjusted to reflect, with re- 9 spect to each eligible woman— 10 ‘‘(i) the severity of the risks associ- 11 ated with the woman’s pregnancy; 12 ‘‘(ii) the severity of the risks associ- 13 ated with the woman’s postpartum health 14 care needs; and 15 ‘‘(iii) the level or amount of time of 16 care coordination required with respect to 17 the woman; and 18 ‘‘(C) shall be established consistent with 19 section 1902(a)(30)(A). 20 ‘‘(d) COORDINATING CARE.— 21 ‘‘(1) HOSPITAL NOTIFICATION.—A State with a 22 State plan amendment approved under this section 23 shall require each hospital that is a participating 24 provider under the State plan (or under a waiver of 25 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 1622 IS such plan) to establish procedures in the case of an 1 eligible woman who seeks treatment in the emer- 2 gency department of such hospital for— 3 ‘‘(A) providing the woman with culturally 4 and linguistically appropriate information on 5 the respective treatment models and opportuni- 6 ties for the woman to access a maternity health 7 home and its associated benefits; and 8 ‘‘(B) notifying the maternity health home 9 in which the woman is enrolled, or the des- 10 ignated provider, team of health care profes- 11 sionals operating with such a provider, or 12 health team treating the woman, of the wom- 13 an’s treatment in the emergency department 14 and of the protocols for the maternity health 15 home, designated provider, or team to be in- 16 volved in the woman’s emergency care or post- 17 discharge care. 18 ‘‘(2) EDUCATION WITH RESPECT TO AVAIL- 19 ABILITY OF A MATERNITY HEALTH HOME.— 20 ‘‘(A) IN GENERAL.—In order for a State 21 plan amendment to be approved under this sec- 22 tion, a State shall include in the State plan 23 amendment a description of the State’s process 24 for— 25 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 1622 IS ‘‘(i) educating providers participating 1 in the State plan (or a waiver of such 2 plan) on the availability of maternity 3 health homes for eligible women, including 4 the process by which such providers can 5 participate in or refer eligible women to an 6 approved maternity health home or a des- 7 ignated provider, team of health care pro- 8 fessionals operating such a provider, or 9 health team; and 10 ‘‘(ii) educating eligible women, in a 11 culturally and linguistically appropriate 12 manner, on the availability of maternity 13 health homes. 14 ‘‘(B) OUTREACH.—The process established 15 by the State under subparagraph (A) shall in- 16 clude the participation of relevant stakeholders 17 or other public or private organizations or enti- 18 ties that provide outreach and information on 19 the availability of health care items and services 20 to families of individuals eligible to receive med- 21 ical assistance under the State plan (or a waiv- 22 er of such plan). 23 ‘‘(3) MENTAL HEALTH COORDINATION.—A 24 State with a State plan amendment approved under 25 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 1622 IS this section shall consult and coordinate, as appro- 1 priate, with the Secretary in addressing issues re- 2 garding the prevention, identification, and treatment 3 of mental health conditions and substance use dis- 4 orders among eligible women. 5 ‘‘(4) COORDINATION OF SOCIAL AND SUPPORT 6 SERVICES.—A State with a State plan amendment 7 approved under this section shall consult and coordi- 8 nate, as appropriate, with the Secretary in estab- 9 lishing means to connect eligible women receiving 10 pregnancy and postpartum care coordinated under 11 this section with social and support services, includ- 12 ing services made available under maternal, infant, 13 and early childhood home visiting programs estab- 14 lished under section 511, and services made avail- 15 able under section 330H or title X of the Public 16 Health Service Act. 17 ‘‘(e) MONITORING.—A State shall include in the 18 State plan amendment— 19 ‘‘(1) a methodology for tracking reductions in 20 inpatient days and reductions in the total cost of 21 care resulting from improved care coordination and 22 management under this section; 23 ‘‘(2) a proposal for use of health information 24 technology in providing an eligible woman with preg- 25 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 1622 IS nancy and postpartum coordinated care services as 1 specified under this section and improving service 2 delivery and coordination across the care continuum; 3 and 4 ‘‘(3) a methodology for tracking prompt and 5 timely access to medically necessary care for eligible 6 women from out-of-State providers. 7 ‘‘(f) DATA COLLECTION.— 8 ‘‘(1) PROVIDER REPORTING REQUIREMENTS.— 9 In order to receive payments from a State under 10 subsection (c), a maternity health home, or a des- 11 ignated provider, a team of health care professionals 12 operating with such a provider, or a health team, 13 shall report to the State, at such time and in such 14 form and manner as may be required by the State, 15 including through a health information exchange or 16 other public health data sharing entity, the following 17 information: 18 ‘‘(A) With respect to each such designated 19 provider, team of health care professionals oper- 20 ating with such a provider, and health team 21 (designated as a maternity health home), the 22 name, National Provider Identification number, 23 address, and specific health care services of- 24 fered to be provided to eligible women who have 25 VerDate Sep 11 2014 00:26 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1622.IS S1622 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 1622 IS selected such provider, team of health care pro- 1 fessionals, or health team as the women’s ma- 2 ternity health home. 3 ‘‘(B) Information on all applicable meas- 4 ures for determining the quality of services pro- 5 vided by such provider, team of health care pro- 6 fessionals, or health team, including, to the ex- 7 tent applicable, maternal and perinatal health 8 quality measures under section 1139B. 9 ‘‘(C) Such other information as the Sec- 10 retary shall specify in guidance. 11 ‘‘(2) STATE REPORTING REQUIREMENTS.— 12 ‘‘(A) COMPREHENSIVE REPORT.—A State 13 with a State plan amendment approved under 14 this section shall report to the Secretary (and, 15 upon request, to the Medicaid and CHIP Pay- 16 ment and Access Commission), at such time, 17 but at a minim [Text truncated for display. 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