IMPACT to Save Moms Act

I 118TH CONGRESS 1ST SESSION H. R. 3346 To direct the Administrator of the Centers for Medicare & Medicaid Services to implement the Perinatal Care Alternative Payment Model Demonstra- tion Project to test various payment models with respect to maternity care provided to pregnant and postpartum individuals, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 15, 2023 Ms. SCHAKOWSKY (for herself, Mr. AGUILAR, Mr. ALLRED, Ms. BARRAGA´N, Mrs. BEATTY, Mr. BLUMENAUER, Ms. BLUNT ROCHESTER, Ms. BROWNLEY, Ms. BUDZINSKI, Ms. BUSH, Ms. CARAVEO, Mr. CARBAJAL, Mr. CARSON, Mr. CARTER of Louisiana, Mrs. CHERFILUS-MCCORMICK, Ms. CLARKE of New York, Mr. CLEAVER, Mr. COHEN, Ms. CRAIG, Ms. CROCKETT, Mr. DAVIS of Illinois, Ms. DEAN of Pennsylvania, Ms. ESCOBAR, Mr. ESPAILLAT, Mr. EVANS, Mrs. FOUSHEE, Mr. GARAMENDI, Ms. GARCIA of Texas, Mr. GARCI´A of Illinois, Mr. GREEN of Texas, Mrs. HAYES, Mr. HORSFORD, Mr. HUFFMAN, Mr. IVEY, Mr. JACKSON of Illi- nois, Ms. JACOBS, Ms. JAYAPAL, Mr. JOHNSON of Georgia, Ms. KAMLAGER-DOVE, Mr. KRISHNAMOORTHI, Ms. KUSTER, Ms. LEE of Cali- fornia, Mr. LIEU, Ms. LOFGREN, Mrs. MCBATH, Mrs. MCCLELLAN, Ms. MCCOLLUM, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG, Mr. MFUME, Mr. MORELLE, Mr. MOULTON, Ms. MOORE of Wisconsin, Mr. MRVAN, Mr. MULLIN, Mrs. NAPOLITANO, Mr. NEGUSE, Ms. OCASIO-CORTEZ, Mr. PAPPAS, Mr. PAYNE, Mr. PHILLIPS, Ms. PORTER, Ms. PRESSLEY, Mr. RUPPERSBERGER, Ms. SALINAS, Ms. SCANLON, Mr. SCHIFF, Mr. SCHNEIDER, Ms. SCHOLTEN, Mr. DAVID SCOTT of Georgia, Ms. SEWELL, Mr. SMITH of Washington, Mr. SOTO, Ms. SPANBERGER, Ms. STANSBURY, Ms. STRICKLAND, Mrs. SYKES, Mr. TAKANO, Ms. TLAIB, Ms. TOKUDA, Mr. TONKO, Mrs. TORRES of California, Mrs. TRAHAN, Mr. TRONE, Mr. VARGAS, Mr. VEASEY, Ms. VELA´ZQUEZ, Ms. WASSERMAN SCHULTZ, Mrs. WATSON COLEMAN, Ms. WEXTON, Ms. WILLIAMS of Georgia, Mr. PASCRELL, Ms. DELBENE, and Mr. LYNCH) introduced the following bill; which was referred to the Committee on Energy and Com- merce VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3346 IH A BILL To direct the Administrator of the Centers for Medicare & Medicaid Services to implement the Perinatal Care Alternative Payment Model Demonstration Project to test various payment models with respect to maternity care provided to pregnant and postpartum individuals, 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 ‘‘Innovative Maternal 4 Payment and Coverage To Save Moms Act’’ or the ‘‘IM- 5 PACT to Save Moms Act’’. 6 SEC. 2. PERINATAL CARE ALTERNATIVE PAYMENT MODEL 7 DEMONSTRATION PROJECT. 8 (a) IN GENERAL.—For the period of fiscal years 9 2024 through 2028, the Secretary of Health and Human 10 Services (referred to in this section as the ‘‘Secretary’’), 11 acting through the Administrator of the Centers for Medi- 12 care & Medicaid Services, shall establish and implement, 13 in accordance with the requirements of this section, a 14 demonstration project, to be known as the Perinatal Care 15 Alternative Payment Model Demonstration Project (re- 16 ferred to in this section as the ‘‘Demonstration Project’’), 17 for purposes of allowing States to test payment models 18 under their State plans under title XIX of the Social Secu- 19 VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3346 IH rity Act (42 U.S.C. 1396 et seq.) and State child health 1 plans under title XXI of such Act (42 U.S.C. 1397aa et 2 seq.) with respect to maternity care provided to pregnant 3 and postpartum individuals enrolled in such State plans 4 and State child health plans. 5 (b) COORDINATION.—In establishing the Demonstra- 6 tion Project, the Secretary shall coordinate with stake- 7 holders such as— 8 (1) State Medicaid programs; 9 (2) maternity care providers and organizations 10 representing maternity care providers; 11 (3) relevant organizations representing patients, 12 with a particular focus on patients from demo- 13 graphic groups with elevated rates of maternal mor- 14 tality, severe maternal morbidity, maternal health 15 disparities, or other adverse perinatal or childbirth 16 outcomes; 17 (4) relevant community-based organizations, 18 particularly organizations that seek to improve ma- 19 ternal health outcomes for individuals from demo- 20 graphic groups with elevated rates of maternal mor- 21 tality, severe maternal morbidity, maternal health 22 disparities, or other adverse perinatal or childbirth 23 outcomes; 24 (5) perinatal health workers; 25 VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3346 IH (6) relevant health insurance issuers; 1 (7) hospitals, health systems, midwifery prac- 2 tices, freestanding birth centers (as such term is de- 3 fined in paragraph (3)(B) of section 1905(l) of the 4 Social Security Act (42 U.S.C. 1396d(l))), Feder- 5 ally-qualified health centers (as such term is defined 6 in paragraph (2)(B) of such section), and rural 7 health clinics (as such term is defined in section 8 1861(aa) of such Act (42 U.S.C. 1395x(aa))); 9 (8) researchers and policy experts in fields re- 10 lated to maternity care payment models; and 11 (9) any other stakeholders as the Secretary de- 12 termines appropriate, with a particular focus on 13 stakeholders from demographic groups with elevated 14 rates of maternal mortality, severe maternal mor- 15 bidity, maternal health disparities, or other adverse 16 perinatal or childbirth outcomes. 17 (c) CONSIDERATIONS.—In establishing the Dem- 18 onstration Project, the Secretary shall consider any alter- 19 native payment model that— 20 (1) is designed to improve maternal health out- 21 comes for individuals from demographic groups with 22 elevated rates of maternal mortality, severe maternal 23 morbidity, maternal health disparities, or other ad- 24 verse perinatal or childbirth outcomes; 25 VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3346 IH (2) includes methods for stratifying patients by 1 pregnancy risk level and, as appropriate, adjusting 2 payments under such model to take into account 3 pregnancy risk level, including consideration of the 4 appropriate transfer of patients by pregnancy risk 5 level; 6 (3) establishes evidence-based quality metrics 7 for such payments; 8 (4) includes consideration of nonhospital birth 9 settings such as freestanding birth centers (as so de- 10 fined); 11 (5) includes consideration of social deter- 12 minants of maternal health; 13 (6) includes diverse maternity care teams that 14 include— 15 (A) maternity care providers, mental and 16 behavioral health care providers acting in ac- 17 cordance with State law, and registered dieti- 18 tians or nutrition professionals (as such term is 19 defined in section 1395x(vv)(2) of title 42, 20 United States Code)— 21 (i) from racially, ethnically, and pro- 22 fessionally diverse backgrounds; 23 VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3346 IH (ii) with experience practicing in ra- 1 cially and ethnically diverse communities; 2 or 3 (iii) who have undergone training on 4 implicit bias and racism; and 5 (B) perinatal health workers; or 6 (7) includes consideration of maternal mental 7 health conditions and substance use disorders. 8 (d) ELIGIBILITY.—To be eligible to participate in the 9 Demonstration Project, a State shall submit an applica- 10 tion to the Secretary at such time, in such manner, and 11 containing such information as the Secretary may require. 12 (e) EVALUATION.—The Secretary shall conduct an 13 evaluation of the Demonstration Project to determine the 14 impact of the Demonstration Project on— 15 (1) maternal health outcomes, with data strati- 16 fied by race, ethnicity, primary language, socio- 17 economic status, geography, insurance type, and 18 other factors as the Secretary determines appro- 19 priate; 20 (2) spending on maternity care by States par- 21 ticipating in the Demonstration Project; 22 (3) to the extent practicable, qualitative and 23 quantitative measures of patient experience; and 24 VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 3346 IH (4) any other areas of assessment that the Sec- 1 retary determines relevant. 2 (f) REPORT.—Not later than one year after the com- 3 pletion or termination date of the Demonstration Project, 4 the Secretary shall submit to the Congress, and make pub- 5 licly available, a report containing— 6 (1) the results of any evaluation conducted 7 under subsection (e); and 8 (2) a recommendation regarding whether the 9 Demonstration Project should be continued after fis- 10 cal year 2028 and expanded on a national basis. 11 (g) DEFINITIONS.—In this section: 12 (1) ALTERNATIVE PAYMENT MODEL.—The 13 term ‘‘alternative payment model’’ has the meaning 14 given such term in section 1833(z)(3)(C) of the So- 15 cial Security Act (42 U.S.C. 1395l(z)(3)(C)). 16 (2) MATERNAL MORTALITY.—The term ‘‘mater- 17 nal mortality’’ means a death occurring during or 18 within a 1-year period after pregnancy, caused by 19 pregnancy-related or childbirth complications, in- 20 cluding a suicide, overdose, or other death resulting 21 from a mental health or substance use disorder at- 22 tributed to or aggravated by pregnancy-related or 23 childbirth complications. 24 VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 3346 IH (2) MATERNITY CARE PROVIDER.—The term 1 ‘‘maternity care provider’’ means a health care pro- 2 vider who— 3 (A) is a physician, a physician assistant, a 4 midwife who meets, at a minimum, the inter- 5 national definition of a midwife and global 6 standards for midwifery education as estab- 7 lished by the International Confederation of 8 Midwives, an advanced practice registered 9 nurse, or a lactation consultant certified by the 10 International Board of Lactation Consultant 11 Examiners; and 12 (B) has a focus on maternal or perinatal 13 health. 14 (3) PERINATAL.—The term ‘‘perinatal’’ means 15 the period beginning on the day an individual be- 16 comes pregnant and ending on the last day of the 17 1-year period beginning on the last day of such indi- 18 vidual’s pregnancy. 19 (4) PERINATAL HEALTH WORKER.—The term 20 ‘‘perinatal health worker’’ means a nonclinical health 21 worker focused on maternal or perinatal health, such 22 as a doula, community health worker, peer sup- 23 porter, lactation educator or counselor, nutritionist 24 or dietitian, childbirth educator, social worker, home 25 VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 3346 IH visitor, patient navigator or coordinator, or language 1 interpreter. 2 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 3 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 4 refer to the 1-year period beginning on the last day 5 of the pregnancy of an individual. 6 (9) SEVERE MATERNAL MORBIDITY.—The term 7 ‘‘severe maternal morbidity’’ means a health condi- 8 tion, including mental health conditions and sub- 9 stance use disorders, attributed to or aggravated by 10 pregnancy or childbirth that results in significant 11 short-term or long-term consequences to the health 12 of the individual who was pregnant. 13 (10) SOCIAL DETERMINANTS OF MATERNAL 14 HEALTH.—The term ‘‘social determinants of mater- 15 nal health’’ means nonclinical factors that impact 16 maternal health outcomes. 17 (h) AUTHORIZATION OF APPROPRIATIONS.—There 18 are authorized to be appropriated such sums as are nec- 19 essary to carry out this section. 20 Æ VerDate Sep 11 2014 02:05 May 30, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H3346.IH H3346 kjohnson on DSK79L0C42PROD with BILLS