Healthy Moms and Babies Act

II 118TH CONGRESS 1ST SESSION S. 948 To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 22, 2023 Mr. GRASSLEY (for himself and Ms. HASSAN) introduced the following bill; 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 CHIP, 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; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Healthy Moms and Babies Act’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. Sec. 2. Definitions. Sec. 3. Mandatory reporting by State Medicaid programs on adult health care quality measures of maternal and perinatal health. VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 2 •S 948 IS Sec. 4. Medicaid quality improvement initiatives to reduce rates of cesarean sec- tions; Medicare requirement for hospitals to report on data on cesarean births. Sec. 5. State option to provide coordinated care through a health home for pregnant and postpartum women. Sec. 6. Guidance on care coordination to support maternal health. Sec. 7. National reskilling of the maternity care workforce. Sec. 8. MACPAC study on doulas and community health workers; guidance on increasing access to doula services under Medicaid. Sec. 9. Demonstration projects to improve the delivery of maternal health care through telehealth. Sec. 10. CMS report on coverage of remote physiologic monitoring devices and impact on maternal and child health outcomes under Medicaid. Sec. 11. Guidance on community-based maternal health programs. Sec. 12. Developing guidance on maternal mortality and severe morbidity re- duction for maternal care providers receiving payment under the Medicaid program. Sec. 13. Program related to reducing cesarean births and increasing rates of vaginal birth after cesarean. Sec. 14. Collection of information related to social determinants of the health of Medicaid and CHIP beneficiaries. Sec. 15. Report on payment methodologies for transferring pregnant women be- tween facilities before, during, and after childbirth. Sec. 16. Medicaid guidance on State options to address social determinants of health for pregnant and postpartum women. Sec. 17. Payment error rate measurement (PERM) audit and improvement re- quirements. SEC. 2. DEFINITIONS. 1 In this Act: 2 (1) CHIP.—The term ‘‘CHIP’’ means the Chil- 3 dren’s Health Insurance Program established under 4 title XXI of the Social Security Act (42 U.S.C. 5 1397aa et seq.). 6 (2) COMPTROLLER GENERAL.—The term 7 ‘‘Comptroller General’’ means the Comptroller Gen- 8 eral of the United States. 9 (3) GROUP HEALTH PLAN; HEALTH INSURANCE 10 ISSUER, ETC.—The terms ‘‘group health plan’’, 11 ‘‘health insurance coverage’’, ‘‘health insurance 12 issuer’’, ‘‘group health insurance coverage’’, and ‘‘in- 13 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 3 •S 948 IS dividual health insurance coverage’’ have the mean- 1 ings given such terms in section 2791 of the Public 2 Health Service Act (42 U.S.C. 300gg–91). 3 (4) MEDICAID.—The term ‘‘Medicaid’’ means 4 the Medicaid program established under title XIX of 5 the Social Security Act (42 U.S.C. 1396 et seq.). 6 (5) MEDICAID MANAGED CARE ORGANIZA- 7 TION.—The term ‘‘medicaid managed care organiza- 8 tion’’ has the meaning given that term in section 9 1903(m)(1)(A) of the Social Security Act (42 U.S.C. 10 1396b(m)(1)(A)). 11 (6) SECRETARY.—The term ‘‘Secretary’’ means 12 the Secretary of Health and Human Services. 13 (7) STATE.—The term ‘‘State’’ has the mean- 14 ing given that term for purposes of titles V, XIX, 15 and XXI of the Social Security Act (42 U.S.C. 701 16 et seq. 1396 et seq., 1397aa et seq.). 17 SEC. 3. MANDATORY REPORTING BY STATE MEDICAID PRO- 18 GRAMS ON ADULT HEALTH CARE QUALITY 19 MEASURES OF MATERNAL AND PERINATAL 20 HEALTH. 21 Section 1139B of the Social Security Act (42 U.S.C. 22 1320b–9b) is amended— 23 (1) in subsection (b)— 24 (A) in paragraph (3)(B)— 25 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 4 •S 948 IS (i) in the subparagraph heading, by 1 inserting ‘‘AND MATERNAL AND 2 PERINATAL HEALTH’’ after ‘‘BEHAVIORAL 3 HEALTH’’; 4 (ii) by striking ‘‘all behavioral health’’ 5 and inserting ‘‘all behavioral health and 6 maternal and perinatal health’’; and 7 (iii) by inserting ‘‘and of maternal 8 and perinatal health care for Medicaid eli- 9 gible adults’’ after ‘‘Medicaid eligible 10 adults’’; and 11 (B) in paragraph (5)(C)— 12 (i) in the subparagraph heading, by 13 inserting ‘‘AND MATERNAL AND 14 PERINATAL HEALTH’’ after ‘‘BEHAVIORAL 15 HEALTH’’; and 16 (ii) by inserting ‘‘and, with respect to 17 Medicaid eligible adults, maternal and 18 perinatal health measures’’ after ‘‘behav- 19 ioral health measures’’; and 20 (2) in subsection (d)(1)(A), by inserting ‘‘and 21 maternal and perinatal health’’ after ‘‘behavioral 22 health’’. 23 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 5 •S 948 IS SEC. 4. MEDICAID QUALITY IMPROVEMENT INITIATIVES TO 1 REDUCE RATES OF CESAREAN SECTIONS; 2 MEDICARE REQUIREMENT FOR HOSPITALS 3 TO REPORT ON DATA ON CESAREAN BIRTHS. 4 (a) MEDICAID STATE PLAN AMENDMENT.—Section 5 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) 6 is amended— 7 (1) in paragraph (86), by striking ‘‘and’’ after 8 the semicolon; 9 (2) in paragraph (87), by striking the period at 10 the end and inserting ‘‘; and’’; and 11 (3) by inserting after paragraph (87) the fol- 12 lowing: 13 ‘‘(88) provide that, not later than January 1, 14 2025, and annually thereafter through January 1, 15 2035, the State shall submit a report to the Sec- 16 retary, that shall be made publicly available, which 17 contains with respect to the preceding calendar 18 year— 19 ‘‘(A) the rate of low-risk cesarean delivery, 20 as defined by the Secretary in consultation with 21 relevant stakeholders, for pregnant women eligi- 22 ble for medical assistance under the State plan 23 or a waiver of such plan in the State, as com- 24 pared to the overall rate of cesarean delivery in 25 the State; 26 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 6 •S 948 IS ‘‘(B) a description of the State’s quality 1 improvement activities to safely reduce the rate 2 of low-risk cesarean delivery (as so defined) for 3 pregnant women eligible for medical assistance 4 under the State plan or a waiver of such plan 5 in the State reported under subparagraph (A), 6 including initiatives aimed at reducing racial 7 and ethnic health disparities, hospital-level 8 quality improvement initiatives, taking into ac- 9 count hospital type and the patient population 10 served, and, if applicable, partnerships with 11 State or regional perinatal quality 12 collaboratives; 13 ‘‘(C) for each report submitted after Janu- 14 ary 1, 2025, the percentage change (if any) in 15 the rate of low-risk cesarean delivery (as so de- 16 fined) for pregnant women eligible for medical 17 assistance under the State plan or a waiver of 18 such plan in the State reported under subpara- 19 graph (A) from the rate reported for the most 20 recent previous report; and 21 ‘‘(D) such other relevant data and infor- 22 mation as determined by the Secretary, and in 23 consultation with relevant stakeholders, such as 24 State initiatives and evaluations of quality im- 25 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 7 •S 948 IS provement activities, cesarean delivery rates, 1 and health outcomes.’’. 2 (b) GAO STUDY REGARDING MEDICAID PAYMENT 3 RATES CESAREAN BIRTHS.— 4 (1) STUDY.—The Comptroller General shall 5 conduct a study regarding payment rates for cesar- 6 ean births and vaginal births under State Medicaid 7 programs. To the extent feasible and data are avail- 8 able, the study shall include analyses of the fol- 9 lowing: 10 (A) Payment rates for cesarean births and 11 vaginal births paid by fee-for-service Medicaid 12 programs and by Medicaid programs that con- 13 tract with Medicaid managed care organizations 14 to furnish medical assistance under such pro- 15 grams; 16 (B) What is known about how Medicaid 17 payment rates have changed over time; 18 (C) What is known about how payment 19 rates for cesarean and vaginal births by Med- 20 icaid programs compare with the payment rates 21 for such births by other sources of insurance 22 coverage; 23 (D) Such other factors related to payment 24 rates for cesarean and vaginal births under 25 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 8 •S 948 IS Medicaid as the Comptroller General deter- 1 mines appropriate. 2 (2) REPORT.—Not later than 18 months after 3 the date of enactment of this Act, the Comptroller 4 General shall submit to Congress a report containing 5 the results of the study conducted under paragraph 6 (1), together with recommendations for such legisla- 7 tion and administrative action as the Comptroller 8 General determines appropriate. 9 (c) GAO STUDY ON RACIAL DISPARITIES IN CESAR- 10 EAN BIRTHS.— 11 (1) IN GENERAL.—The Comptroller General 12 shall conduct a study on racial disparities in the fre- 13 quency of cesarean births. To the extent feasible and 14 data are available, the study shall compare such in- 15 formation on low- and high-risk cesarean births, dif- 16 ferences by payer (such as Medicaid and private 17 payers), and hospital characteristics (such as loca- 18 tion or hospital type). Such study may consider 19 other factors related to racial disparities in maternal 20 health as the Comptroller General deems appro- 21 priate. 22 (2) REPORT.—Not later than 2 years after the 23 date of enactment of this Act, the Comptroller Gen- 24 eral shall submit to Congress a report containing the 25 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 9 •S 948 IS results of the study conducted under paragraph (1), 1 together with recommendations for such legislation 2 and administrative action as the Comptroller Gen- 3 eral determines appropriate. 4 (d) MEDICARE REQUIREMENT FOR HOSPITALS TO 5 REPORT DATA ON CESAREAN BIRTHS.— 6 (1) REQUIREMENT.—Section 1866(a)(1) of the 7 Social Security Act (42 U.S.C. 1395cc(a)(1)) is 8 amended— 9 (A) by moving the indentation of subpara- 10 graph (W) 2 ems to the left; 11 (B) in subparagraph (X)— 12 (i) by moving the indentation 2 ems 13 to the left; and 14 (ii) by striking ‘‘and’’ at the end; 15 (C) in subparagraph (Y), by striking the 16 period at the end and inserting ‘‘; and’’; and 17 (D) by inserting after subparagraph (Y) 18 the following new subparagraph: 19 ‘‘(Z) in the case of a hospital, to submit, in a 20 form and manner, and at a time, specified by the 21 Secretary, data on the Nulliparous, Term, Singleton, 22 Vertex Cesarean section (NTSV C-section) rate with 23 respect to the hospital for the preceding year.’’. 24 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 10 •S 948 IS (2) INCORPORATION INTO HOSPITAL QUALITY 1 REPORTING.—Section 1886(b)(3)(B)(viii) of the So- 2 cial Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) 3 is amended by adding at the end the following new 4 subclause: 5 ‘‘(XIII) Effective for payments beginning with fiscal 6 year 2025, in expanding the number of measures under 7 subclause (III), the Secretary shall adopt a measure relat- 8 ing to the Nulliparous, Term, Singleton, Vertex Cesarean 9 section (NTSV C-section) rate for hospitals in inpatient 10 settings. Not later than 2025, the Secretary shall incor- 11 porate such measure into the designation of maternity 12 care quality hospitals, as described in the final rule enti- 13 tled ‘Medicare Program; Hospital Inpatient Prospective 14 Payment Systems for Acute Care Hospitals and the Long 15 Term Care Hospital Prospective Payment System and 16 Policy Changes and Fiscal Year 2023 Rates; Quality Pro- 17 grams and Medicare Promoting Interoperability Program 18 Requirements for Eligible Hospitals and Critical Access 19 Hospitals; Costs Incurred for Qualified and Non-Qualified 20 Deferred Compensation Plans; and Changes to Hospital 21 and Critical Access Hospital Conditions of Participation’ 22 (87 Fed. Reg. 48780 (August 10, 2022)).’’. 23 VerDate Sep 11 2014 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 11 •S 948 IS SEC. 5. 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, 2026, 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 20:15 Apr 14, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948 kjohnson on DSK79L0C42PROD with BILLS 12 •S 948 IS sionals operating with such a provider, or a 1 [Text truncated for display. 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