HEALTH for MOM Act of 2020

II 116TH CONGRESS 2D SESSION S. 4863 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 OCTOBER 26 (legislative day, OCTOBER 19), 2020 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 2020’’ or the ‘‘HEALTH for MOM Act of 6 2020’’. 7 VerDate Sep 11 2014 20:50 Nov 04, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 2 •S 4863 IS SEC. 2. STATE OPTION TO PROVIDE COORDINATED CARE 1 THROUGH A PREGNANCY MEDICAL HOME 2 FOR HIGH-RISK PREGNANT 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 PREGNANCY MEDICAL 8 HOME FOR HIGH-RISK PREGNANT WOMEN. 9 ‘‘(a) IN GENERAL.—Notwithstanding section 10 1902(a)(1) (relating to statewideness) and section 11 1902(a)(10)(B) (relating to comparability), beginning Oc- 12 tober 1, 2022, a State, at its option as a State plan 13 amendment, may provide for medical assistance under this 14 title to high-risk pregnant women who choose to— 15 ‘‘(1) enroll in a pregnancy medical home under 16 this section by selecting a designated provider, a 17 team of health care professionals operating with 18 such a provider, or a health team as the woman’s 19 pregnancy medical home for purposes of providing 20 the woman with high-risk pregnancy coordinated 21 care services; or 22 ‘‘(2) receive such services from a designated 23 provider, a team of health care professionals oper- 24 ating with such a provider, or a health team that 25 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 3 •S 4863 IS has opted to participate in a pregnancy medical 1 home for high-risk pregnant women. 2 ‘‘(b) QUALIFICATION STANDARDS.—The Secretary 3 shall establish standards for qualification as a pregnancy 4 medical home or as a designated provider, team of health 5 care professionals operating with such a provider, or a 6 health team eligible for participation in a pregnancy med- 7 ical home for purposes of this section. Such standards 8 shall include requiring designated providers, teams of 9 health care professionals operating with such providers, 10 and health teams (designated a pregnancy medical home) 11 to demonstrate to the State the ability to do the following: 12 ‘‘(1) Coordinate prompt care for high-risk preg- 13 nant women. 14 ‘‘(2) Develop an individualized, comprehensive, 15 patient-centered care plan for high-risk pregnant 16 women that accommodates patient preferences. 17 ‘‘(3) Work in a culturally and linguistically ap- 18 propriate manner with the high-risk pregnant 19 woman to develop and incorporate into the woman’s 20 care plan, in a manner consistent with the needs of 21 the woman, ongoing home care, community-based 22 primary care, inpatient care, social support services, 23 and local hospital emergency care. 24 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 4 •S 4863 IS ‘‘(4) Coordinate access to necessary maternity 1 care services and programs for high-risk pregnant 2 women. 3 ‘‘(5) Collect and report information under sub- 4 section (f)(1). 5 ‘‘(c) PAYMENTS.— 6 ‘‘(1) IN GENERAL.—A State shall provide a des- 7 ignated provider, a team of health care professionals 8 operating with such a provider, or a health team 9 with payments for the provision of high-risk preg- 10 nancy and postpartum coordinated care services, to 11 each high-risk pregnant woman that selects such 12 provider, team of health care professionals, or health 13 team as the woman’s pregnancy medical home or 14 care provider. Payments made to a pregnancy med- 15 ical home or care provider for such services shall be 16 treated as medical assistance for purposes of section 17 1903(a), except that, during the first 2 fiscal year 18 quarters that the State plan amendment is in effect, 19 the Federal medical assistance percentage applicable 20 to such payments shall be increased by 15 percent- 21 age points, but in no case may exceed 90 percent. 22 ‘‘(2) METHODOLOGY.— 23 ‘‘(A) IN GENERAL.—The State shall speci- 24 fy in the State plan amendment the method- 25 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 5 •S 4863 IS ology the State will use for determining pay- 1 ment for the provision of high-risk pregnancy 2 coordinated care services or treatment during a 3 high-risk pregnancy. Such methodology for de- 4 termining payment— 5 ‘‘(i) may be based on— 6 ‘‘(I) a per-member per-month 7 basis for each high-risk pregnant 8 woman enrolled in the pregnancy 9 medical home; or 10 ‘‘(II) an alternate model of pay- 11 ment proposed by the State and ap- 12 proved by the Secretary; 13 ‘‘(ii) may be tiered to reflect, with re- 14 spect to each high-risk pregnant woman— 15 ‘‘(I) the severity of the risks as- 16 sociated with the woman’s pregnancy; 17 and 18 ‘‘(II) the level or amount of time 19 of care coordination required with re- 20 spect to the woman; and 21 ‘‘(iii) shall be established consistent 22 with section 1902(a)(30)(A). 23 ‘‘(B) DISTRIBUTION OF FINANCING.—For 24 purposes of a methodology under this section, 25 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 6 •S 4863 IS the methodology shall identify how any reim- 1 bursement or payment as made available under 2 this section to a pregnancy medical home will 3 be equitably shared among respective, contrib- 4 uting members of the pregnancy medical home 5 or the designated provider, team of health care 6 professionals with such a provider, or health 7 team. 8 ‘‘(d) COORDINATING CARE.— 9 ‘‘(1) HOSPITAL NOTIFICATION.—A State with a 10 State plan amendment approved under this section 11 shall require each hospital that is a participating 12 provider under the State plan (or a waiver of such 13 plan) to establish procedures in the case of a high- 14 risk pregnant woman that seeks treatment in the 15 emergency department of such hospital for— 16 ‘‘(A) providing the woman with informa- 17 tion, including following discharge, about preg- 18 nancy medical homes and opportunities for the 19 woman to access the pregnancy medical home 20 and its associated benefits; and 21 ‘‘(B) notifying the pregnancy medical home 22 in which the woman is enrolled, or the des- 23 ignated provider, team of health care profes- 24 sionals operating with such a provider, or 25 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 7 •S 4863 IS health team treating the woman, of the wom- 1 an’s treatment in the emergency department 2 and of the protocols for the pregnancy medical 3 home, designated provider, or team to be in- 4 volved in the woman’s emergency care or post- 5 discharge care. 6 ‘‘(2) EDUCATION WITH RESPECT TO AVAIL- 7 ABILITY OF A PREGNANCY MEDICAL HOME.— 8 ‘‘(A) IN GENERAL.—In order for a State 9 plan amendment to be approved under this sec- 10 tion, a State shall include in the State plan 11 amendment a description of the State’s process 12 for— 13 ‘‘(i) educating providers participating 14 in the State plan (or a waiver of such 15 plan) on the availability of pregnancy med- 16 ical homes for high-risk pregnant women, 17 including the process by which such pro- 18 viders can participate in or refer high-risk 19 pregnant women to an approved pregnancy 20 medical home or a designated provider, 21 team of health care professionals operating 22 such a provider, or health team; and 23 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 8 •S 4863 IS ‘‘(ii) educating high-risk pregnant 1 women on the availability of pregnancy 2 medical homes. 3 ‘‘(B) OUTREACH.—The process established 4 by the State under subparagraph (A) shall in- 5 clude the participation of entities or other pub- 6 lic or private organizations or entities that pro- 7 vide outreach and information on the avail- 8 ability of health care items and services to fami- 9 lies of individuals eligible to receive medical as- 10 sistance under the State plan (or a waiver of 11 such plan). 12 ‘‘(3) MENTAL HEALTH COORDINATION.—A 13 State with a State plan amendment approved under 14 this section shall consult and coordinate, as appro- 15 priate, with the Secretary in addressing issues re- 16 garding the prevention and treatment of mental 17 health conditions and substance use disorder among 18 high-risk pregnant women. 19 ‘‘(4) SOCIAL AND SUPPORT SERVICES.—A State 20 with a State plan amendment approved under this 21 section shall consult and coordinate, as appropriate, 22 with the Secretary in establishing means to connect 23 high-risk pregnant women receiving high-risk preg- 24 nancy coordinated care services under this section 25 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 9 •S 4863 IS with social and support services, including services 1 made available under maternal, infant, and early 2 childhood home visiting programs established under 3 section 511, and services made available under sec- 4 tion 330 H or title X of the Public Health Service 5 Act. 6 ‘‘(e) MONITORING.—A State shall include in the 7 State plan amendment— 8 ‘‘(1) a methodology for tracking reductions in 9 inpatient days and reductions in the total cost of 10 care resulting from improved care coordination and 11 management under this section; 12 ‘‘(2) a proposal for use of health information 13 technology in providing a pregnancy medical home 14 under this section and improving service delivery 15 and coordination across the care continuum; and 16 ‘‘(3) a methodology for tracking prompt and 17 timely access to medically necessary care for high- 18 risk pregnant women from out-of-State providers. 19 ‘‘(f) DATA COLLECTION.— 20 ‘‘(1) PROVIDER REPORTING REQUIREMENTS.— 21 In order to receive payments from a State under 22 subsection (c), a pregnancy medical home, or a des- 23 ignated provider, a team of health care professionals 24 operating with such a provider, or a health team, 25 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 10 •S 4863 IS shall report to the State, at such time and in such 1 form and manner as may be required by the State 2 or the Secretary, the following information: 3 ‘‘(A) With respect to each such designated 4 provider, team of health care professionals oper- 5 ating with such a provider, and health team 6 (designated as a pregnancy medical home), the 7 name, National Provider Identification number, 8 address, and specific health care services of- 9 fered to be provided to high-risk pregnant 10 women who have selected such provider, team 11 of health care professionals, or health team as 12 the women’s pregnancy medical home. 13 ‘‘(B) Information on all applicable meas- 14 ures for determining the quality of services pro- 15 vided by such provider, team of health care pro- 16 fessionals, or health team, including, to the ex- 17 tent applicable, maternal health quality meas- 18 ures and measures for centers of excellence for 19 high-risk pregnant women developed under this 20 title. 21 ‘‘(C) Such other information as the Sec- 22 retary shall specify in guidance. 23 ‘‘(2) STATE REPORTING REQUIREMENTS.— 24 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 11 •S 4863 IS ‘‘(A) COMPREHENSIVE REPORT.—A State 1 with a State plan amendment approved under 2 this section shall report to the Secretary (and, 3 upon request, to the Medicaid and CHIP Pay- 4 ment and Access Commission), at such time, 5 but at a minimum frequency of every 12 6 months, and in such form and manner deter- 7 mined by the Secretary to be reasonable and 8 minimally burdensome, the following informa- 9 tion: 10 ‘‘(i) Information described in para- 11 graph (1). 12 ‘‘(ii) The number of high-risk preg- 13 nant women who have enrolled in a preg- 14 nancy medical home pursuant to this sec- 15 tion. 16 ‘‘(iii) The nature, number, and preva- 17 lence of causes for identified high-risk 18 pregnancies among such women. 19 ‘‘(iv) The type of delivery systems and 20 payment models used to provide services to 21 such women under this section. 22 ‘‘(v) The number and characteristics 23 of the designated providers, teams of 24 health care professionals operating with 25 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 12 •S 4863 IS such providers, and health teams partici- 1 pating in the option established under this 2 section, including the number and charac- 3 teristics of out-of-State providers, teams of 4 health care professionals operating with 5 such providers, and health teams who have 6 provided health care items and services to 7 high-risk pregnant women enrolled in a 8 pregnancy medical home pursuant to this 9 section. 10 ‘‘(vi) The extent to which such women 11 receive health care items and services 12 under the State plan before, during, and 13 after the women’s enrollment in such a 14 pregnancy medical home. 15 ‘‘(vii) Quality measures developed spe- 16 cifically with respect to health care items 17 and services provided to high-risk pregnant 18 women. 19 ‘‘(viii) Where applicable, mortality 20 data and data for the associated causes of 21 death for high-risk pregnant women en- 22 rolled in a pregnancy medical home, in ac- 23 cordance with subsection (g). Such data 24 shall include deaths that occur while en- 25 VerDate Sep 11 2014 18:48 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S4863.IS S4863 13 •S 4863 IS rolled in a pregnancy medical home and for 1 deaths that occur after the conclusion of 2 participation in a pregnancy medical home 3 but occur up to one year postpartum. For 4 deaths occurring postp [Text truncated for display. Full text available on Congress.gov.]