119 S2059 IS: Keeping Obstetrics Local Act
U.S. Senate
2025-06-12
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents(a)This Act may be cited as the Keeping Obstetrics Local Act
.(b)The table of contents for this Act is as follows:Sec. 1. Short title; table of contents.TITLE I—Enhancing financial support for rural and safety net hospitals that provide obstetric servicesSec. 101. State studies and HHS report on costs of providing maternity, labor, and delivery services.Sec. 102. Requiring adequate payment rates under Medicaid for maternity, labor, and delivery services at eligible hospitals.Sec. 103. Increased Federal financial participation for maternity, labor, and delivery services furnished by eligible hospitals.Sec. 104. Labor and delivery services anchor payments.Sec. 105. Application of adequate payment requirement and increased Federal financial participation requirements to CHIP.Sec. 106. Disregarding increased and additional payments to hospitals for purposes of other supplemental payments and upper payment limits.TITLE II—Expand Coverage of Maternal Health CareSec. 201. Requiring 12-month continuous, full benefit coverage for pregnant individuals under Medicaid and CHIP.Sec. 202. Health homes for pregnant and postpartum women.Sec. 203. Guidance on supporting and improving access to Medicaid and CHIP coverage of services provided by doulas and certain maternal health professionals.Sec. 204. Medicaid and CHIP increased financial support for depression and anxiety screening during the perinatal and postpartum periods.Sec. 205. Presumptive eligibility for pregnant individuals.TITLE III—Invest in the Maternal Health Care WorkforceSec. 301. Emergency obstetric workforce support.Sec. 302. Streamlined screening and enrollment of providers of maternity, labor, and delivery services in neighboring States.TITLE IV—Requiring Public Communication of Obstetrics Data and Unit ClosuresSec. 401. Timely notifications of impending hospital obstetric unit closures.Sec. 402. Collection of data relating to hospital labor and delivery services.<enum>I</enum><header>Enhancing financial support for rural and safety net hospitals that provide obstetric services</header><section id="id5FC7628B52664E048AC6A7261E87C418"><enum>101.</enum><header>State studies and HHS report on costs of providing maternity, labor, and delivery services</header><subsection id="HEB52C9927F5A4B2FAFD02A5544F69403"><enum>(a)</enum><header>State study</header><paragraph id="HC29A8FD4106343F48F28CBB3BA4AE802"><enum>(1)</enum><header>In general</header><text>Not later than 24 months after the date of enactment of this Act, and every 5 years thereafter, each State (as such term is defined in section 1101(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1301">42 U.S.C. 1301(a)(1)</external-xref>) for purposes of titles XIX and XXI of such Act) shall conduct a study on the costs of providing maternity, labor, and delivery services in applicable hospitals (as defined in paragraph (3)) and submit the results of such study to the Secretary of Health and Human Services (referred to in this section as the <quote>Secretary</quote>).</text></paragraph><paragraph id="HF6880E49882D4CF9942AEDA7344C9178"><enum>(2)</enum><header>Content of study</header><text>A State study required under paragraph (1) shall include the following information (to the extent practicable) with respect to maternity, labor, and delivery services furnished by applicable hospitals located in the State:</text><subparagraph id="H99E1404824824E1CB3DBF023B333649F"><enum>(A)</enum><text>An estimate of the cost of providing maternity, labor, and delivery services at applicable hospitals, based on the expenditures a representative sample of such hospitals incurred for providing such services during the 2 most recent years for which data is available.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0E74A513E4D14F98851DAD86F528D461"><enum>(B)</enum><text>An estimate of the cost of providing maternity, labor, and delivery services at applicable hospitals that ceased providing labor and delivery services within the past 5 years, based on the expenditures a representative sample of such hospitals incurred for providing such services during the 2 most recent years for which data is available.</text></subparagraph><subparagraph id="HDFCF6454C3B54BEFA217E1B9ACC1780B"><enum>(C)</enum><text>To the extent data allows, an analysis of the extent to which geographic location, community demographics, and local economic factors (as defined by the Secretary) affect the cost of providing maternity, labor, and delivery services at applicable hospitals, including the cost of services that support the provision of maternity, labor, and delivery services.</text></subparagraph><subparagraph id="H4386D48007414D93983F259ACD86D42B"><enum>(D)</enum><text>The amounts applicable hospitals are paid for maternity, labor, and delivery services, by geographic location and hospital size, under—</text><clause commented="no" display-inline="no-display-inline" id="H30C5F5F7D6EF4051A398EFA7CDFC46F8"><enum>(i)</enum><text display-inline="yes-display-inline">Medicare;</text></clause><clause commented="no" display-inline="no-display-inline" id="H5D22A50F62C746D8A9058D3BA73664B1"><enum>(ii)</enum><text display-inline="yes-display-inline">the State Medicaid program, including payment amounts for such services under fee-for-service payment arrangements and under managed care (as applicable);</text></clause><clause commented="no" display-inline="no-display-inline" id="H5EF606EEFEEA482F97D9022E8E00D121"><enum>(iii)</enum><text display-inline="yes-display-inline">the State CHIP plan, including payment amounts for such services under fee-for-service payment arrangements and under managed care (as applicable); and</text></clause><clause commented="no" display-inline="no-display-inline" id="H024D7051B8E646F6912285A133CB5840"><enum>(iv)</enum><text display-inline="yes-display-inline">private health insurance.</text></clause></subparagraph><subparagraph id="H73EA42D2BD6B4F33B2B5C917F0FFC60C"><enum>(E)</enum><text>A comparative payment rate analysis—</text><clause id="H0D54BDF6ACA648A3A83F811B4DBC0598"> <enum>(i)</enum> <text>comparing payment rates for maternity, labor, and delivery services (inclusive of all payments received by applicable hospitals for furnishing maternity, labor, and delivery services) under the State Medicaid fee-for-service program to such payment rates for such services under Medicare (as described in section 447.203(b)(3) of title 42, Code of Federal Regulations), other Federally funded or State-funded programs (including, to the extent data is available, Medicaid managed care rates), and to the payment rates for such services, to the extent data is available, of private health insurers within geographic areas of the State; and</text>
</clause><clause id="H643FEB902B4C4736A2DA5D527D7800A3"><enum>(ii)</enum><text>analyzing different payment methods for such services, such as the use of bundled payments, quality incentives, and low-volume adjustments.</text></clause></subparagraph><subparagraph id="H6ADB28DC4F7148049BA398F9EE3B4E72"><enum>(F)</enum><text>An evaluation, using such methodology and parameters established by the Secretary, of whether each hospital located in the State that furnishes maternity, labor, and delivery services is expected to experience in the next 3 years significant changes in particular expenditures or types of reimbursement for maternity, labor, and delivery services.</text></subparagraph></paragraph><paragraph id="H6E1E64A19A084097B45F1A4CEE543156"><enum>(3)</enum><header>Applicable hospital defined</header><text>For purposes of this subsection, the term <term>applicable hospital</term> means any hospital located in a State that meets either of the following criteria:</text><subparagraph id="H6A98B73045CC45B2B932D160B4FD4F5E"><enum>(A)</enum><text>The hospital provides labor and delivery services and more than 50 percent of the hospital’s births (in the most recent year for which such data is available) are financed by the Medicaid program or CHIP.</text></subparagraph><subparagraph id="H41CD2BFF27A14BE986F00276DD61DEA3"><enum>(B)</enum><text>The hospital—</text><clause commented="no" display-inline="no-display-inline" id="H25B90EA7350E4EA7B90BF79DB84766C6"><enum>(i)</enum><text display-inline="yes-display-inline">is located in a rural area (as defined by the Federal Office of Rural Health Policy for the purpose of rural health grant programs administered by such Office);</text></clause><clause commented="no" display-inline="no-display-inline" id="HF7C9C7F152C84870B54580E68AD1467E"><enum>(ii)</enum><text display-inline="yes-display-inline">based on the most recent 2 years of data available (as determined by the Secretary), furnished services for less than an average of 300 births per year; and</text></clause><clause commented="no" display-inline="no-display-inline" id="H88BB3DC15FD2432DB5C5B7E83748E483"><enum>(iii)</enum><text>provides labor and delivery services.</text></clause></subparagraph></paragraph><paragraph commented="no" id="H9375AC925CE445399E47978C151C3DCE"><enum>(4)</enum><header>Assistance to small hospitals in compiling cost information</header><text>There are appropriated to the Secretary for fiscal year 2026, $10,000,000 for the purpose of providing grants and technical assistance to a hospital described in paragraph (3)(B) to enable such hospital to compile detailed information for use in the State studies required under paragraph (1), to remain available until expended.</text></paragraph><paragraph id="H2E9EEFFD491D4936A509CA535EF22292"><enum>(5)</enum><header>HHS report on State studies</header><text>For each year in which a State is required to conduct a study under paragraph (1), the Secretary shall issue, not later than 12 months after the date on which the State submits to the Secretary the data described in such paragraph, a publicly available report that compiles and details the results of such study and includes the information described in paragraph (2).</text></paragraph></subsection><subsection id="HC4A0000E43E24BB7A33BA772987071DE"><enum>(b)</enum><header>HHS report on national data collection findings</header><text>Not later than 3 years after the date of enactment of this Act, the Secretary shall submit to Congress, and make publicly available, a report analyzing the first studies conducted by States under subsection (a)(1), including recommendations for improving data collection on the cost of providing maternity, labor, and delivery services.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="HE2BA501F0C8E4DF7BF765767037A577B"><enum>(c)</enum><header>Implementation funding</header><text>In addition to the amount appropriated under subsection (a)(4), there are appropriated, out of any funds in the Treasury not otherwise obligated, $3,000,000 for fiscal year 2026, to remain available until expended, to the Secretary of Health and Human Services for purposes of implementing this section.</text></subsection></section><section id="idD1530BFEF5E14C599FB59B4AD52F6458"><enum>102.</enum><header>Requiring adequate payment rates under Medicaid for maternity, labor, and delivery services at eligible hospitals</header><subsection commented="no" display-inline="no-display-inline" id="idaf90fd92c9ad4854909dcc8ccdfec020"> <enum>(a)</enum> <header>Fee-for-Service payments</header> <text>Section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline"
id="id4f0938e9b0504f9990bf4e48f0b0c7d6">
<enum>(1)</enum>
<text>in subsection (a)(13)—</text> <subparagraph commented="no" display-inline="no-display-inline" id="id79b1ce67cc2a4d6f9f79236ab49f6a36"> <enum>(A)</enum> <text>by striking <quote>and</quote> at the end of subparagraph (B);</text>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="id373889333a984185b0dc68468ab20213">
<enum>(B)</enum>
<text>by adding <quote>and</quote> at the end of subparagraph (C); and</text>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="idd9a662a4c4af4410966715f679140f2a">
<enum>(C)</enum>
<text>by adding at the end the following new subparagraph:</text> <quoted-block style="OLC" id="id936932F00F5846169E7132A70FC2BBAA" act-name=""> <subparagraph id="id46FCBB8C3F4A4114AE047B7CF297D761"> <enum>(D)</enum> <text>for each fiscal year beginning with fiscal year 2027, payment for maternity, labor, and delivery services (as defined in subsection (uu)) furnished during such fiscal year in an eligible hospital (as defined in such subsection) at a rate that is not less than the minimum payment rate specified for the fiscal year in paragraph (4) of such subsection;</text>
</subparagraph>
<after-quoted-block>; and</after-quoted-block>
</quoted-block>
</subparagraph>
</paragraph>
<paragraph id="idc2aa1b8d225b4db6884937e3e3e34e55">
<enum>(2)</enum>
<text>by adding at the end the following new subsection:</text> <quoted-block style="OLC" id="id8BCB6B21CA9A40C4A66A361B63469F0A" act-name=""> <subsection id="id524AAC8804C0495D8D417A06A3D9C409"> <enum>(uu)</enum> <header>Maternity, labor, and delivery services and eligible hospitals defined</header> <text>For purposes of subsection (a)(13)(D)—</text>
<paragraph commented="no" display-inline="no-display-inline"
id="id1e60ed2cbd5e45bc8f7f2e3da6f85422">
<enum>(1)</enum>
<header>Maternity, labor, and delivery services</header>
<subparagraph commented="no" display-inline="no-display-inline"
id="idff76b811b8e94035b84acc0e8c75a33c">
<enum>(A)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">The term <term>maternity, labor, and delivery services</term> means such inpatient hospital services and outpatient hospital services, including behavioral health services, that are provided in relation to maternity care or labor and delivery, identified by appropriate ICD and CPT codes, as the Secretary shall specify after consultation with professional or medical societies with expertise in pregnancy, childbirth, and postpartum care.</text>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="id46fbff2613ba416387eae33f789971e0">
<enum>(B)</enum>
<header display-inline="yes-display-inline">Scope</header>
<text>Such term shall not be limited in application, for any eligible hospital, only to services that relate to a birth that occurs in the hospital.</text>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="idcb384718378547d7bc0fe0fb8fa6167c">
<enum>(C)</enum>
<header display-inline="yes-display-inline"
>Rulemaking</header>
<text>Not later than July 1, 2026, the Secretary shall issue an interim final rule specifying which services shall be considered maternity, labor, and delivery services for purposes of this subsection and subsection (a)(13)(D).</text>
</subparagraph>
</paragraph>
<paragraph commented="no" display-inline="no-display-inline"
id="ida0012d776e9d4d109083e6706ed7913d">
<enum>(2)</enum>
<header>Eligible hospital</header>
<subparagraph commented="no" display-inline="no-display-inline"
id="id2b17317080b24831a7b7927baa1232e7">
<enum>(A)</enum>
<header>In general</header>
<text display-inline="yes-display-inline">The term <term>eligible hospital</term> means, with respect to a State and fiscal year—</text>
<clause commented="no" display-inline="no-display-inline"
id="iddba300ccb258435f9f73753b353faffb">
<enum>(i)</enum>
<text display-inline="yes-display-inline">a hospital that is located in a rural area (as defined by the Federal Office of Rural Health Policy for the purpose of rural health grant programs administered by such Office);</text>
</clause>
<clause commented="no" display-inline="no-display-inline"
id="id0b822ab21e504fa1a25b7eb2d2b45810">
<enum>(ii)</enum>
<text>a critical access hospital (as defined in section 1861(mm)(1));</text>
</clause>
<clause commented="no" display-inline="no-display-inline"
id="id9cb6fa53f5aa4b2d96b1f65d477f53dc">
<enum>(iii)</enum>
<text>a hospital operated by the Indian Health Service or an Indian Tribe under the Indian Self-Determination and Education Assistance Act;</text>
</clause>
<clause commented="no" display-inline="no-display-inline"
id="id6f0712ffe5f34747aa16402d2e83458a">
<enum>(iv)</enum>
<text display-inline="yes-display-inline">a hospital for which, in the most recent 12-month period for which data is available, at least 50 percent of all births for which the hospital provided maternity, labor, and delivery services during such fiscal year were qualifying births; or</text>
</clause>
<clause commented="no" display-inline="no-display-inline"
id="id2294ADBD2E084F72963D78AFD3D0F1B0">
<enum>(v)</enum>
<text display-inline="yes-display-inline">a hospital that is able to demonstrate, through a process to be determined by the Secretary, that, for the applicable fiscal year, the hospital projects that at least 50 percent of all births for which the hospital will provide maternity, labor, and delivery services during such fiscal year will be qualifying births.</text>
</clause>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="id9cafe5d62c8e43da9153e3bfc32eac16">
<enum>(B)</enum>
<header>Identification of eligible hospitals</header>
<text>Each State, subject to the approval of the Secretary, shall identify the hospitals in the State that are eligible hospitals with respect to a fiscal year.</text>
</subparagraph>
</paragraph>
<paragraph commented="no" display-inline="no-display-inline"
id="id902FFBE176C9470EB362C942DE10ABAA">
<enum>(3)</enum>
<header>Qualifying birth</header>
<text>For purposes of paragraph (2), the term <term>qualifying birth</term> means a birth for which any maternity, labor, and delivery services associated with the birth—</text>
<subparagraph commented="no" display-inline="no-display-inline"
id="idcec30cacf82848948cbc9bc43c16def6">
<enum>(A)</enum>
<text display-inline="yes-display-inline">were paid for under a State plan under this title (or under a waiver of such a plan) or under a State child health plan under title XXI (or under a waiver of such a plan);</text>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="id0a74cbf8a6ad4fa4ab24fc953da6de07">
<enum>(B)</enum>
<text display-inline="yes-display-inline">were paid for under title XVIII;</text>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="id2339dd6fed594f67b8f8680706482405">
<enum>(C)</enum>
<text display-inline="yes-display-inline">were provided by the Indian Health Service or a Native Hawaiian health care system (as defined in section 12 of the Native Hawaiian Health Care Improvement Act); or</text>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="id03f332c863504a2c994bebf421efb24a">
<enum>(D)</enum>
<text display-inline="yes-display-inline">were provided to a patient who does not have minimum essential coverage (as defined in <external-xref legal-doc="usc" parsable-cite="usc/26/5000A">section 5000A(f)</external-xref> of the Internal Revenue Code of 1986) and were not fully paid for by such patient.</text>
</subparagraph>
</paragraph>
<paragraph commented="no" display-inline="no-display-inline"
id="ideca11b300f7b432dbc73bd8462cbae5a">
<enum>(4)</enum>
<header>Minimum payment rate specified</header>
<text display-inline="yes-display-inline">The minimum payment rate specified in this paragraph is, with respect to an eligible hospital and maternal, labor, and delivery services—</text>
<subparagraph commented="no" display-inline="no-display-inline"
id="idaebe82eaae614c7da9d4dbede6988365">
<enum>(A)</enum>
<text display-inline="yes-display-inline">for fiscal year 2027, 150 percent of the payment rate that would apply for such services and hospital under title XVIII; and</text>
</subparagraph>
<subparagraph commented="no" display-inline="no-display-inline"
id="id5cf1ccba7c2b4c399ba46d0b60429c22">
<enum>(B)</enum>
<text display-inline="yes-display-inline">for each period of 5 fiscal years beginning with fiscal years 2028 through 2032, a payment rate that is determined for such period by the Secretary to accurately reflect the costs incurred by eligible hospitals in providing such services, informed by the results of the most recent State studies submitted to the Secretary under section 101(a) of the <short-title>Keeping Obstetrics Local Act</short-title>.</text>
</subparagraph>
</paragraph>
</subsection>
<after-quoted-block>.</after-quoted-block>
</quoted-block>
</paragraph>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idbc169cb804d14ca38c5a5cb716e0afed"><enum>(b)</enum><header>Under Medicaid managed care plans</header><text>Section 1932(f) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-2">42 U.S.C. 1396u–2(f)</external-xref>) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="PD5055B46474933436195049F125ECD8"><enum>(1)</enum><text display-inline="yes-display-inline">in the heading, by inserting <quote><header-in-text level="subsection" style="OLC">and maternity, labor, and delivery services at eligible hospitals</header-in-text></quote> after <quote><header-in-text level="subsection" style="OLC">services</header-in-text></quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id925ed477e8d64b1290d7967f007b1220"><enum>(2)</enum><text display-inline="yes-display-inline">by striking <quote>described in section 1902(a)(13)(C)</quote> and inserting <quote>described in subparagraph (C) of section 1902(a)(13) or maternity, labor, and delivery services described in subparagraph (D) of such section that are furnished by an eligible hospital (as defined in section 1905(uu))</quote>.</text></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id664c2999e9e04d2da9b56809c2041a4e"><enum>103.</enum><header>Increased Federal financial participation for maternity, labor, and delivery services furnished by eligible hospitals</header><text display-inline="no-display-inline">Section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="id3babe9112e5346d3ad6e3e120d588b7e"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (b), by striking <quote>and (ii)</quote> and inserting <quote>(ii), and (kk)</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id2e73e6bbc55546de9c556efa004429c6"><enum>(2)</enum><text>by adding at the end the following new subsection:</text><quoted-block style="OLC" id="id0F8C7B0B5ACC442298A3C2D9AC807357" act-name=""><subsection id="idF6898367B90243698CA9FBB52B2F9C4A"><enum>(kk)</enum><header>Maternity, labor, and delivery services</header><paragraph commented="no" display-inline="no-display-inline" id="id21d4a7c1a9414ecb8c97b2fe1df279ae"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text>Notwithstanding subsection (b), with respect to State expenditures for medical assistance for maternity, labor, and delivery services furnished by an eligible hospital (as such terms are defined in section 1902(uu)) in a fiscal quarter that begins on or after October 1, 2026—</text><subparagraph commented="no" display-inline="no-display-inline" id="id9dacdd11556d4d70bba85e9ddb5fc130"><enum>(A)</enum><text display-inline="yes-display-inline">the Federal medical assistance percentage applicable to the enhanced payment rate amount of such expenditures (as determined for the State and quarter under paragraph (2)(A)) shall be equal to 100 percent; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id999f3257acb349ab9fff51324356250b"><enum>(B)</enum><text>subject to paragraph (3), the Federal medical assistance percentage applicable to the base payment rate amount of such expenditures (as determined for the State and quarter under paragraph (2)(B)) shall be equal to the enhanced FMAP determined for the State and quarter under section 2105(b).</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ide59b745b7bf346e6b6a2cd3aea26e8be"><enum>(2)</enum><header display-inline="yes-display-inline">Determination of enhanced payment rate amount and base payment rate amount</header><subparagraph commented="no" display-inline="no-display-inline" id="id86f332bd1abd4528a5f64b40adff90d0"><enum>(A)</enum><header>Enhanced payment rate amount</header><clause commented="no" display-inline="no-display-inline" id="id2BFF26F72E8D4A408F1266683FF3DF33"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">For purposes of paragraph (1)(A), the enhanced payment rate amount for a State and fiscal quarter is equal to the amount of State expenditures for medical assistance for maternity, labor, and delivery services furnished by an eligible hospital (as such terms are defined in section 1902(uu)) in such fiscal quarter that is attributable to the amount by which the minimum payment rate required under section 1902(a)(13)(D) (or, by application, section 1932(f)) exceeds the base payment rate applicable to such services, as determined for the State, quarter, and services under clause (ii).</text></clause><clause commented="no" display-inline="no-display-inline" id="ida5ce82ed8fdc41bb9e92f2b138c8a6ce"><enum>(ii)</enum><header>Base payment rate</header><text display-inline="yes-display-inline">For purposes of clause (i), the base payment rate determined for a State, a fiscal quarter, and maternity, labor, and delivery services (as defined in section 1902(uu)) shall be equal to—</text><subclause commented="no" display-inline="no-display-inline" id="idf7f5e5ec3dd04702b4b51d8b006beea4"><enum>(I)</enum><text display-inline="yes-display-inline">the payment rate applicable to such services under the State plan (or under a waiver of such plan) as of January 1, 2025; increased by</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id13fa26803d104233a7a0bcc0dea544bb"><enum>(II)</enum><text>the percentage increase in the medical care component of the consumer price index for all urban consumers from January of 2025 to the month ending on the day before the 1st day of such fiscal quarter.</text></subclause></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id52988D3392284D8E821CA5A55EED26A1"><enum>(B)</enum><header>Base payment rate amount</header><text>For purposes of paragraph (1)(B), the base payment rate amount for a State and fiscal quarter is equal to—</text><clause commented="no" display-inline="no-display-inline" id="idEE1D1EE5CD8E42B686CDFBC1F80D2259"><enum>(i)</enum><text>the total amount of State expenditures for medical assistance for maternity, labor, and delivery services furnished by an eligible hospital (as such terms are defined in section 1902(uu)) in such fiscal quarter; minus</text></clause><clause commented="no" display-inline="no-display-inline" id="id07121933BAA64223A1ED5014AE71BAD4"><enum>(ii)</enum><text display-inline="yes-display-inline">the enhanced payment rate amount determined for the State and fiscal quarter under subparagraph (A).</text></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idcc839dc08ce24b81ba48e40d1bee6d44"><enum>(3)</enum><header>Application of higher match</header><text display-inline="yes-display-inline">Subparagraph (B) of paragraph (1) shall not apply in the case of State expenditures described in such subparagraph if the application of such subparagraph would result in a lower Federal medical assistance percentage for such expenditures than would otherwise apply without the application of such paragraph.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6c91cad0954e4bbab9ca0c1269f403f3"><enum>(4)</enum><header display-inline="yes-display-inline">Exclusion of expenditures from territorial caps</header><text display-inline="yes-display-inline">Any payment made to a territory for medical assistance that is subject to the Federal medical assistance percentage specified in paragraph (1)(A) or the enhanced FMAP referred to in paragraph (1)(B) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section commented="no" display-inline="no-display-inline" id="id60143fc0c3e243629c41c95274955be2"><enum>104.</enum><header>Labor and delivery services anchor payments</header><subsection commented="no" display-inline="no-display-inline" id="idcba99056307d4f019c8d535599d9361c"><enum>(a)</enum><header display-inline="yes-display-inline">State requirement</header><text display-inline="yes-display-inline">Section 1902(a)(13)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(13)(A)</external-xref>) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="idfa1482d7effe439eb91b6651ec86dbe9"><enum>(1)</enum><text>in clause (iii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idea01ad5c0a7e4e77972903dd61740845"><enum>(2)</enum><text>in clause (iv), by striking the semicolon at the end and inserting <quote>, and</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id8e4e5bd2351d4079b360584337845bac"><enum>(3)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" id="idE9FCACBFD5F0404F8ECF74039168512E" act-name=""><clause id="id9A657F093E154B2283267576C5418F54"><enum>(v)</enum><text>in the case of hospitals, such rates take into account (in a manner consistent with section 1923A) the situation of low volume obstetric hospitals (as such term is defined in such section);</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id09473afe5feb4bff800e2f64de0205fa"><enum>(b)</enum><header>Requiring anchor payments for low volume obstetric hospitals</header><text>Title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) is amended by inserting the following after section 1923:</text><quoted-block style="OLC" id="idED77A8C9CA6745EE99E638AA0CA9984A" act-name=""><section id="id93F5B44AA4044FD8BF4EA5F216B86DEB"><enum>1923A.</enum><header>Anchor payments for labor and delivery services provided by low volume obstetric hospitals</header><subsection commented="no" display-inline="no-display-inline" id="id7ec503de0ec441a3ba54675eaa1ac3f7"><enum>(a)</enum><header display-inline="yes-display-inline">Implementation of requirement</header><text display-inline="yes-display-inline">A State plan under this title shall not be considered to meet the requirement of section 1902(a)(13)(A)(v) (insofar as it requires payments to hospitals to take into account the situation of low volume obstetric hospitals), as of October 1, 2026, unless the State has submitted to the Secretary, by not later than such date, an amendment to such plan that provides for an annual anchor payment to such hospitals, consistent with subsection (c).</text></subsection><subsection commented="no" display-inline="no-display-inline" id="id157681cac28e46548a82f910e2eacfba"><enum>(b)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph commented="no" display-inline="no-display-inline" id="id5871af78037d4a2aaa4dd6c48b3f78c4"><enum>(1)</enum><header>Antenatal transfer</header><text>The term <term>antenatal transfer</term> means, with respect to a hospital, a pregnant individual who was expected to receive labor and delivery services at the hospital but who is transferred to a different hospital because of a need for labor and delivery services that are not available at the transferring hospital.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idf08dd391e7474e0e96e908a2f1bc14a9"><enum>(2)</enum><header>Delivery volume</header><text>The term <term>delivery volume</term> means, with respect to a hospital and a fiscal year, the total number of births occurring in, and antenatal transfers made by, such hospital during such year.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1b6103b2f51e4262a53bbebf6db64a07"><enum>(3)</enum><header>Labor and delivery revenue floor</header><text>The term <term>labor and delivery revenue floor</term> means, with respect to a low volume obstetric hospital and a fiscal year, the amount equal to the sum of—</text><subparagraph commented="no" display-inline="no-display-inline" id="id548d6d98bea9498ba73e57f529db9540"><enum>(A)</enum><text display-inline="yes-display-inline">the product of—</text><clause commented="no" display-inline="no-display-inline" id="id01093817fc8c4e13afaa2d42afef9efe"><enum>(i)</enum><text display-inline="yes-display-inline">the delivery volume for such hospital and fiscal year; and</text></clause><clause commented="no" display-inline="no-display-inline" id="idaa6d2f2d87cd4a73bc7ff23c3c271962"><enum>(ii)</enum><text>the per delivery amount for such fiscal year; and</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idbf6b4f02b23a4d23a8e065e2034fb572"><enum>(B)</enum><text>the standby capacity amount for such fiscal year.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id12BE412381544FEC9AFF104801A9DFFC"><enum>(4)</enum><header display-inline="yes-display-inline">Labor and delivery services</header><text display-inline="yes-display-inline">The term <term>labor and delivery services</term> means such inpatient and outpatient hospital services related to labor and delivery, including services related to antenatal transfers, identified by appropriate ICD and CPT codes, as the Secretary shall specify in consultation with professional or medical societies with expertise in this area.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idd8df50f75c5c474d9e59bdf9108e57f3"><enum>(5)</enum><header display-inline="yes-display-inline">Low volume obstetric hospital</header><text>The term <term>low volume obstetric hospital</term> means, with respect to a hospital and a fiscal year, a hospital—</text><subparagraph commented="no" display-inline="no-display-inline" id="idefffe69de3904d5185e47d07cf2348ca"><enum>(A)</enum><text display-inline="yes-display-inline">that is an eligible hospital (as defined in section 1902(uu)(2));</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idd8fb09d1342541eba01d9963c6ffe19a"><enum>(B)</enum><text display-inline="yes-display-inline">in which the average number of births for which the hospital provided labor and delivery services during the preceding 3 fiscal years is less than 300 births per year;</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idbafb5babb06b49f7b0189eca08b2d379"><enum>(C)</enum><text>that did not provide labor and delivery services in the preceding fiscal year, but in which the average number of births for which the hospital provided labor and delivery services during the most recent 3 fiscal years in which the hospital provided labor and delivery services is less than 300 births per year;</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idb21b03d4291a4cbaad1a66a2ef206e79"><enum>(D)</enum><text display-inline="yes-display-inline">that is not described in subparagraphs (B) or (C) but, in the applicable fiscal year, provides labor and delivery services for fewer than 300 births; or</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ida02ae11c738a4ad692512470fc76ea2b"><enum>(E)</enum><text display-inline="yes-display-inline">that is not described in subparagraphs (B) through (D) but is certified by the State in which the hospital is located as meeting such criteria as the Secretary shall establish for identifying hospitals that are essential to meeting the needs of an underserved population, such as serving a population with limited English proficiency, serving specific racial or ethnic populations, or other factors.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id586cc3317e5543c4aa8d5f64cb69308a"><enum>(6)</enum><header>Medicaid labor and delivery revenue floor</header><text>The term <term>Medicaid labor and delivery revenue floor</term> means, with respect to a low volume obstetric hospital and a fiscal year, the product of—</text><subparagraph commented="no" display-inline="no-display-inline" id="id74dd04abd77449a1a1eccef9ee8e5de6"><enum>(A)</enum><text display-inline="yes-display-inline">the labor and delivery revenue floor for such hospital and fiscal year; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id09c18df8c54c49e8ae0a3ca87f418f27"><enum>(B)</enum><text>the percentage of the delivery volume of such hospital in such fiscal year that were paid for under a State plan under this title (or under a waiver of such a plan) or under a State child health plan under title XXI (or under a waiver of such a plan).</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ida43753396a17439daa5dddb20f5f75a1"><enum>(7)</enum><header>Per delivery amount</header><subparagraph commented="no" display-inline="no-display-inline" id="idbab449eddd93494b8b741ab28aec21a2"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The term <term>per delivery amount</term> means, with respect to a fiscal year, an amount, as determined under subparagraph (B), that represents the marginal cost to a low volume obstetric hospital of a birth or an antenatal transfer.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id998c05b1c8e04a4e80f7e40f37bba527"><enum>(B)</enum><header>Determination of per delivery amount</header><clause commented="no" display-inline="no-display-inline" id="id364d99f6bac54567850143edd94007ec"><enum>(i)</enum><header display-inline="yes-display-inline">Fiscal year 2028</header><text>For fiscal year 2028, the per delivery amount shall be $10,000.</text></clause><clause commented="no" display-inline="no-display-inline" id="id54D8FBF547234AB18BD4418E8FA3EA48"><enum>(ii)</enum><header>Indexing</header><text>Subject to clause (iii), for each fiscal year after fiscal year 2028, the per delivery amount shall be the amount that applied under this subparagraph for the preceding fiscal year increased by the percentage increase in the medical care component of the consumer price index for all urban consumers for the 12-month period ending with September of such preceding fiscal year.</text></clause><clause commented="no" display-inline="no-display-inline" id="id30854C7663D047839B0C8FD6C5B32418"><enum>(iii)</enum><header>Periodic revision of per delivery amount</header><text display-inline="yes-display-inline">Not less than once every 5 fiscal years, the Secretary shall collect and analyze data on the costs of labor and delivery services at low volume obstetric hospitals and, through rulemaking, shall establish a new per delivery amount for purposes of this section to ensure that such amount accurately reflects the marginal cost to a low volume obstetric hospital of a birth or an antenatal delivery.</text></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idbf1e6783778e40dba38fc750ee6be0fd"><enum>(8)</enum><header display-inline="yes-display-inline">Standby capacity amount</header><subparagraph commented="no" display-inline="no-display-inline" id="id4dc82bf4cfdf487b9156979f0d247128"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text>The term <term>standby capacity amount</term> means, with respect to a fiscal year, an amount, as determined under subparagraph (B), that represents the minimum level of expenditures by a low volume obstetric hospital that is necessary to ensure that adequate personnel, equipment, and facilities are available at all times to provide labor and delivery services.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ide67c19bf28c4436aae07642c2aa99af1"><enum>(B)</enum><header>Determination of standby capacity amount</header><clause commented="no" display-inline="no-display-inline" id="id35ecbd5d9fed461ba532b2c5bf84af00"><enum>(i)</enum><header display-inline="yes-display-inline">Fiscal year 2028</header><text>For fiscal year 2028, the standby capacity amount shall be $1,200,000.</text></clause><clause commented="no" display-inline="no-display-inline" id="id11fb7fbbece546768be3cc5a2d861974"><enum>(ii)</enum><header>Indexing</header><text>Subject to clause (iii), for each fiscal year after fiscal year 2028, the standby capacity amount shall be the amount that applied under this subparagraph for the preceding fiscal year increased by the percentage increase in the medical care component of the consumer price index for all urban consumers for the 12-month period ending with September of such preceding fiscal year.</text></clause><clause commented="no" display-inline="no-display-inline" id="id65589e244cae4cd48162313687a8935c"><enum>(iii)</enum><header>Periodic revision of standby capacity amount</header><text display-inline="yes-display-inline">Not less than once every 5 fiscal years, the Secretary shall collect and analyze data on the costs of labor and delivery services at low volume obstetric hospitals and, through rulemaking, shall establish a new standby capacity amount for purposes of this section to ensure that such amount accurately reflects the minimum level of expenditures by a low volume obstetric hospital that is necessary to ensure that adequate personnel, equipment, and facilities are available at all times to provide labor and delivery services.</text></clause></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id418ecd32da4b45b99504f26b5fd88374"><enum>(c)</enum><header display-inline="yes-display-inline">Anchor payment for low volume obstetric hospitals</header><text display-inline="yes-display-inline">Not later than 3 months after the end of each fiscal year beginning with fiscal year 2028, each State shall pay to each low volume obstetric hospital in the State an amount that is equal to the amount (if any) by which—</text><paragraph commented="no" display-inline="no-display-inline" id="idd0b1e31578984062a44237483c2fd53f"><enum>(1)</enum><text display-inline="yes-display-inline">the Medicaid labor and delivery revenue floor for the hospital and fiscal year; exceeds</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3dfcb2d0a1bd444582df6b263ffdee44"><enum>(2)</enum><text>the total amount of all payments made to the low volume obstetric hospital under the State plan under this title (or under a waiver of such plan) and under the State child health plan under title XXI (or under a waiver of such plan) (other than payments under this section) for labor and delivery services provided by such hospital during such fiscal year.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id0f84fa0d433b46d1b38c45d068efab5f"><enum>(d)</enum><header display-inline="yes-display-inline">Requirements for receipt of payments</header><text>No anchor payment shall be made to a low volume obstetric hospital under this section for a fiscal year unless the hospital can satisfy the following requirements:</text><paragraph commented="no" display-inline="no-display-inline" id="ide227ba6ffb2441beac272e469782a788"> <enum>(1)</enum> <header display-inline="yes-display-inline">Skills maintenance and training activities</header> <text>The hospital demonstrates to the satisfaction of the State that the hospital conducts and completes skills maintenance and training activities, including continuing education and training to support maintenance of obstetric skills, that satisfy such requirements as the Secretary, taking into consideration nationally recognized obstetrics skills, maintenance, and training standards such as standards published by the American College of Obstetricians and Gynecologists and the Association of Women’s Health, Obstetric, and Neonatal Nurses, shall specify for the purposes of this section.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id9c3baceba42c41f3abd79c91ec0c1b99"><enum>(2)</enum><header display-inline="yes-display-inline">Continued provision of labor and delivery services</header><subparagraph commented="no" display-inline="no-display-inline" id="id799e02c35f9742be9bc29e1cb04d96c6"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The hospital and the State enter into a contract under which, in exchange for such payment under this section for a fiscal year, the hospital agrees to continue to provide labor and delivery services—</text><clause commented="no" display-inline="no-display-inline" id="id49ce99ecb2e4436197a942f58e7eace6"><enum>(i)</enum><text display-inline="yes-display-inline">for the period that begins with such fiscal year and ends on the last day of the second fiscal year that follows such fiscal year; and</text></clause><clause commented="no" display-inline="no-display-inline" id="ida4c1d01a8454474183669487687f157c"><enum>(ii)</enum><text display-inline="yes-display-inline">at a level that is not less than the level at which the hospital provided such services in the fiscal year to which such payment relates, unless the hospital can demonstrate that the need for services in the community has decreased and that the new level of services will be adequate to meet that need.</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idbbf4a88c8b454e419027c55bd8229755"> <enum>(B)</enum> <header>Recovery of payment in the event of breach of contract by hospital</header> <text display-inline="yes-display-inline">The terms of the contract between a hospital and a State required under subparagraph (A) shall provide that if the hospital does not provide labor and delivery services as required under the contract throughout the period described in such subparagraph for any reason (including in the event of the hospital’s bankruptcy or closure) the State may recover the full amount of the payment under this section to which the contract relates and in the event of the hospital’s bankruptcy, the State shall be given preferred creditor status for purposes of the collection of such payment.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id7d88e448dc47458cbf7f5632628db7d2"><enum>(3)</enum><header>Utilization of funds for labor and delivery services</header><subparagraph commented="no" display-inline="no-display-inline" id="id02E2DA42CD3A425B92F91A952721CB41"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The hospital and the State enter into a contract under which, in exchange for such payment under this section, the hospital agrees to utilize funds received under such payment for the provision of labor and delivery services in the community served by the hospital.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idCF0E2B8EB24C480697FA30B555CB868B"> <enum>(B)</enum> <header>Recovery of payment in the event of breach of contract by hospital</header> <text display-inline="yes-display-inline">The terms of the contract between a hospital and a State required under subparagraph (A) shall provide that if the hospital does not utilize payment funds for labor and delivery services as required under the contract for any reason (including in the event of the hospital’s bankruptcy or closure) the State may recover the full amount of the payment under this section to which the contract relates and in the event of the hospital’s bankruptcy, the State shall be given preferred creditor status for purposes of the collection of such payment.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id3d4a7658e2f14d67b356f42e6b84574d"><enum>(e)</enum><header display-inline="yes-display-inline">Treatment of payments; recovery of payments</header><paragraph commented="no" display-inline="no-display-inline" id="id7bc27e65de974e02bba7387abee91c0a"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Payments made by a State under this section for a fiscal year—</text><subparagraph commented="no" display-inline="no-display-inline" id="id7aecd44f07784859999c19626c6661fe"><enum>(A)</enum><text display-inline="yes-display-inline">shall be in addition to any other payments made to hospitals for labor and delivery services under the State plan (or a waiver of such plan) under this title, under the State child health assistance plan under title XXI (or under a waiver of such plan), or under title XVIII for the fiscal year, including disproportionate share hospital payments under section 1923 or section 1886(d)(5)(F) and other supplemental payments that are not made under this section; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idc153b3e30db446a7927d66ccba9f871c"><enum>(B)</enum><text display-inline="yes-display-inline">shall be treated as medical assistance for which payment is made under section 1903(a), except that the Federal medical assistance percentage applicable to amounts expended by a State for such payments shall be equal to the enhanced FMAP determined for the State and fiscal year under section 2105(b).</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idfe88ce1c11f641f483563c3c9bd5ad32"><enum>(2)</enum><header display-inline="yes-display-inline">Payments recovered by a State</header><text display-inline="yes-display-inline">If a State recovers any amount of a payment made by a State under this section (whether pursuant to paragraphs (2)(B) or (3)(B) of subsection (d) or otherwise), the amount so recovered shall be treated as an overpayment recovered by the State under section 1903(d).</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" display-inline="no-display-inline" id="id3c4febb579b84bb4a2fade4b4b654fec"><enum>(c)</enum><header>Conforming amendments</header><text>Title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) is amended as follows:</text><paragraph id="id015e6d7210234e3ab6dcf5407e5d5a2f"><enum>(1)</enum><text>In section 1903—</text><subparagraph commented="no" display-inline="no-display-inline" id="id2cc5b16af04247f9a1fdffc7cc88dfa9"><enum>(A)</enum><text>in subsection (d)(6)(B)—</text><clause commented="no" display-inline="no-display-inline" id="idf2ad964e4d8b4c0b96d1779097177019"><enum>(i)</enum><text>by striking <quote>related to the total amount</quote> and inserting the following: “related to—</text><quoted-block style="OLC" id="id52A29E09398E471CB6D6196236061334" act-name=""><clause commented="no" indent="up1" id="idCBA19015B0454FF282FDF49E5B38BFBA"><enum>(i)</enum><text>the total amount</text></clause><after-quoted-block>; </after-quoted-block></quoted-block></clause><clause commented="no" display-inline="no-display-inline" id="id4e6f5edd375f4e70852b613927aba4e8"><enum>(ii)</enum><text>by striking the period at the end and inserting <quote>; and</quote>; and</text></clause><clause commented="no" display-inline="no-display-inline" id="id25251eacde6d4c759b3ff768a892bb68"><enum>(iii)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" id="id42DBDF847B2843C89BA268C48E503936" act-name=""><clause commented="no" indent="up1" id="id087B951A271F43C791A1AB75ECB50716"><enum>(ii)</enum><text>the total amount of payments made to individual providers (by provider) under section 1923A during such fiscal year.</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ida9914f25f5af436d927a2612be98cfaa"><enum>(B)</enum><text>in subsection (bb)(2)(B)—</text><clause commented="no" display-inline="no-display-inline" id="id8b54853656a04e44afa436e006fdc7f6"><enum>(i)</enum><text>in the header, by inserting <quote><header-in-text level="subparagraph" style="OLC">and low volume obstetric hospital</header-in-text></quote> after <quote><header-in-text level="subparagraph" style="OLC">DSH</header-in-text></quote>; and</text></clause><clause id="idce435ba151ed45bf838d07f702dbc983"><enum>(ii)</enum><text>by inserting <quote>or a payment made to a low volume obstetric hospital under section 1923A</quote> before the period.</text></clause></subparagraph></paragraph><paragraph id="id3980c75d0b944fcaac2d95844de546e3"><enum>(2)</enum><text>In section 1905—</text><subparagraph commented="no" display-inline="no-display-inline" id="ideb6c6b6aaacc4dc28b1537e9bbff2317"><enum>(A)</enum><text display-inline="yes-display-inline">in subsection (cc), by striking <quote>section 1923</quote> the second place it appears and inserting <quote>section 1923 or 1923A</quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id0627cf1ce5f84fdb84bf6724f986fcd6"><enum>(B)</enum><text>in subsection (ii)(2)(A), by inserting <quote>or payments to low volume obstetric hospitals described in section 1923A</quote> before the semicolon.</text></subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id2414790AA2124769A125A667803E4343"><enum>105.</enum><header>Application of adequate payment requirement and increased Federal financial participation requirements to CHIP</header><text display-inline="no-display-inline">Section 2107(e)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)</external-xref>) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="id0EDD6DD634914155A102DF94170E8B92"><enum>(1)</enum><text>by redesignating subparagraphs (B) through (U) as subparagraphs (C) through (V), respectively; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idB420C98A32C64C118CFA304CD7EF7ECC"><enum>(2)</enum><text>by inserting after subparagraph (A) the following new subparagraph:</text><quoted-block style="OLC" id="id2232F9DECD434BE8A56993469EED04A5" act-name=""><subparagraph commented="no" id="id946CE55D424849D5B4D9724FA547A8E4"><enum>(B)</enum><text>Section 1902(a)(13)(D) and section 1905(kk) (relating to the minimum payment rate required for maternity, labor, and delivery services furnished by an eligible hospital and Federal financial participation for State expenditures for such services).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section commented="no" display-inline="no-display-inline" section-type="subsequent-section" id="id44ea836879a045d9907afb1267911ef0"><enum>106.</enum><header>Disregarding increased and additional payments to hospitals for purposes of other supplemental payments and upper payment limits</header><text display-inline="no-display-inline">A hospital’s eligibility for any Federally funded supplemental payment (including a disproportionate share payment under section 1886(d)(5)(F) or 1923 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(5)(F)</external-xref>, 1396r–4)), the determination of the amount of such payment, and the application of any Federal limitation on the aggregate amount of payments that a State may make to the hospital (including any upper payment limitation), shall be determined without regard to the amount of any increase to a payment received by a hospital or any additional payment made to a hospital that is attributable to the amendments made by this title.</text></section><enum>II</enum><header>Expand Coverage of Maternal Health Care</header><section id="id459D59C514FA4DA7B3402D428B8BC15B"><enum>201.</enum><header>Requiring 12-month continuous, full benefit coverage for pregnant individuals under Medicaid and CHIP</header><subsection id="idCD2F5140EF3B48F8971F9A876E54F113"><enum>(a)</enum><header>Medicaid</header><text display-inline="yes-display-inline">Section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>) is amended—</text><paragraph id="id52C8ED5C87F142CBB9D1628948FB582A"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="id9e46f897835742c3aa15647f4919a6cf"><enum>(A)</enum><text>in paragraph (10), in the matter following subparagraph (G), by striking <quote>(VII) the medical assistance made available to an individual described in subsection (l)(1)(A) who is eligible for medical assistance only because of subparagraph (A)(i)(IV) or (A)(ii)(IX) shall be limited to medical assistance for services related to pregnancy (including prenatal, delivery, postpartum, and family planning services), medical assistance for services related to other conditions which may complicate pregnancy, and medical assistance for vaccines described in section 1905(a)(4)(E) and the administration of such vaccines during the period described in such section,</quote> and inserting <quote>(VII) [Repealed],</quote>;</text></subparagraph><subparagraph id="id159113942B594FFBABC802552220312C"><enum>(B)</enum><text>in paragraph (86), by striking <quote>and</quote> at the end;</text></subparagraph><subparagraph id="id856BC4D19F054016AED1AD4C8757BB4D"><enum>(C)</enum><text>in paragraph (87), by striking the period at the end and inserting <quote>; and</quote>; and</text></subparagraph><subparagraph id="id5A12CB079AF04BC7867BFBAC0FA35883"><enum>(D)</enum><text>by inserting after paragraph (87) the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id495A6AB12A4440A9A80DF8AC36EE102D"><paragraph id="idE8072CB1D39244419D8545EDBE8A53B3"><enum>(88)</enum><text display-inline="yes-display-inline">provide that the State plan is in compliance with subsection (e)(16).</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="idE2F9C9DCE0F74A8AA3ED72B73FF6763F"><enum>(2)</enum><text display-inline="yes-display-inline">in subsection (e)(16)—</text><subparagraph id="idB9A4E36D540B433BA02E1E8EDC225925"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (A), by striking <quote>At the option of the State, the State plan (or waiver of such State plan) may provide</quote> and inserting <quote>A State plan (or waiver of such State plan) shall provide</quote>;</text></subparagraph><subparagraph id="idAB0E0E540E7B4320B33F72B85E8290D0"><enum>(B)</enum><text display-inline="yes-display-inline">in subparagraph (B), in the matter preceding clause (i), by striking <quote>by a State making an election under this paragraph</quote> and inserting <quote>under a State plan (or a waiver of such State plan)</quote>; and</text></subparagraph><subparagraph id="id9D1C0D0008C840028FF119DA00106124"><enum>(C)</enum><text>in subparagraph (C)—</text><clause commented="no" display-inline="no-display-inline" id="id1A3D8FC09CD04126982C806440BC7889"><enum>(i)</enum><text display-inline="yes-display-inline">by striking <quote>A State making an election under this paragraph</quote> and inserting <quote>In the case of a State</quote>; and</text></clause><clause commented="no" display-inline="no-display-inline" id="id888F119AEB2C4F6FBA65212D48524989"><enum>(ii)</enum><text>by striking <quote>shall also make the election</quote> and inserting <quote>the State shall provide coverage</quote>.</text></clause></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id28E0CDAB9AB248D08DE7B7F25AEC2E15"><enum>(b)</enum><header>CHIP</header><paragraph id="idA1A74335A8834BC98257E7CD6AA526C7"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Subparagraph (K) of section 2107(e)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)</external-xref>), as redesignated by section 105, is amended to read as follows:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id3A3F03C0AA3248DBA993F1BE04CD3ABA"><subparagraph id="idDAD0D5BCA89A44108517F69E7BFC516E"> <enum>(K)</enum> <text display-inline="yes-display-inline">Paragraphs (5) and (16) of section 1902(e) (relating to the requirement to provide medical assistance under the State plan or waiver consisting of full benefits during pregnancy and throughout the 12-month period that begins on the last day of the individual’s pregnancy and ends on the last day of the month in which such 12-month period ends).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="id232FDEC3020A4CC7B9D4F37097BD6BD5"><enum>(2)</enum><header>Conforming amendment</header><text display-inline="yes-display-inline">Section 2112(d)(2)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397ll">42 U.S.C. 1397ll(d)(2)(A)</external-xref>) is amended by striking <quote>the month in which the 60-day period</quote> and all that follows through <quote>pursuant to section 2107(e)(1),</quote>.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idA301AE941B49470B9E938EF62D0DCE90"><enum>(c)</enum><header display-inline="yes-display-inline">Effective date</header><paragraph commented="no" id="idF438E009C7374254BA49DE0EF08E049D"> <enum>(1)</enum> <header>In general</header> <text display-inline="yes-display-inline">Subject to paragraphs (2) and (3), the amendments made by subsections (a) and (b) shall take effect on the 1st day of the 1st calendar quarter that begins on or after the date that is 1 year after the date of enactment of this Act.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id4ACC983A89B44695846C7285D637E38D"><enum>(2)</enum><header>Exception for State legislation</header><text display-inline="yes-display-inline">In the case of a State plan under title XIX of the Social Security Act or a State child health plan under title XXI of such Act that the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet any requirement imposed by amendments made by this subsection, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the 1st day of the 1st calendar quarter beginning after the close of the 1st regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idC2E3306D34484FF59A4FC386C255B558"><enum>(3)</enum><header>State option for earlier effective date</header><text>A State may elect to have subsection (e)(16) of section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>) and subparagraph (K) of section 2107(e)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)</external-xref>), as redesignated by section 105 and amended by subsection (b) of this section, take effect with respect to the State on the 1st day of any fiscal quarter that begins before the date described in paragraph (1) and apply to amounts payable to the State for expenditures for medical assistance, child health assistance, or pregnancy-related assistance to pregnant or postpartum individuals furnished on or after such day.</text></paragraph></subsection></section><section id="id350359746ac54ce5b3430dbdb5f8ebee"><enum>202.</enum><header>Health homes for pregnant and postpartum women</header><subsection commented="no" display-inline="no-display-inline" id="id5f7faa1c0e354390b2fa75433c2f745f"><enum>(a)</enum><header display-inline="yes-display-inline">Medicaid</header><text display-inline="yes-display-inline">Title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) is amended by inserting after section 1945A the following new section:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id2b326de92ec34a0f8bcba83c25367d60"><section id="id85d06ef279f244acad024eb8b16b2112"><enum>1945B.</enum><header>State option to provide coordinated care through a health home for pregnant and postpartum individuals</header><subsection id="id54d724531f8246e596d3988c41b1c524"><enum>(a)</enum><header>State option</header><paragraph id="id9786d7e859c64e9dbfaca374076e0e6e"><enum>(1)</enum><header>In general</header><text>Notwithstanding section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability), beginning January 1, 2028, a State, at its option as a State plan amendment, may provide for medical assistance under this title to an eligible individual who chooses to—</text><subparagraph id="id2d428214dcbc4b1c806530b6e85c73da"><enum>(A)</enum><text>enroll in a maternity health home under this section by selecting a designated provider, a team of health care professionals operating with such a provider, or a health team as the individual’s maternity health home for purposes of providing the individual with pregnancy and postpartum coordinated care services; or</text></subparagraph><subparagraph id="iddd04a0525a964446af74a23626850a56"><enum>(B)</enum><text>receive such services from a designated provider, a team of health care professionals operating with such a provider, or a health team that has voluntarily opted to participate in a maternity health home for eligible individuals under this section.</text></subparagraph></paragraph><paragraph id="id4c533cca06af4a7ea2f2d5472341493c"><enum>(2)</enum><header>Eligible individual defined</header><text>In this section, the term <term>eligible individual</term> means an individual—</text><subparagraph id="id4c67c7d6fc2a4826b560cd756a2c8acc"><enum>(A)</enum><text>who is eligible for medical assistance under the State plan (or under a waiver of such plan) for all items and services covered under the State plan (or under a waiver of such plan);</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id061f973dbfb14fc9bbd67e4f0b662762"><enum>(B)</enum><text display-inline="yes-display-inline">who is not enrolled in a health home under section 1945 or 1945A; and</text></subparagraph><subparagraph id="id2307fdb178854af1b8bf67c4d85a6cca"><enum>(C)</enum><text>either—</text><clause id="idae34f811edea425c888a52920926d912"><enum>(i)</enum><text>who is pregnant; or</text></clause><clause id="id4f058f758d9b4878b89c7cc7c5e2da6a"> <enum>(ii)</enum> <text>whose pregnancy has ended and is within the 12-month period that begins on the last day of the individual’s pregnancy and ends on the last day of the month in which such 12-month period ends.</text>
</clause></subparagraph></paragraph></subsection><subsection id="id3aabf6c924be46118951ce0c7f7595a1"><enum>(b)</enum><header>Qualification standards</header><text>The Secretary shall establish standards for qualification as a maternity health home or as a designated provider, a team of health care professionals operating with such a provider, or a health team eligible for participation in a maternity health home for purposes of this section. In establishing such standards, the Secretary shall consider best practices and models of care used by recipients of grants under section 330P of the Public Health Service Act. Such standards shall include requiring a designated provider, a team of health care professionals operating with such a provider, and a health team designated as a maternity health home to demonstrate to the State the ability to do the following:</text><paragraph id="id4a12a0edaa774753bc14674fbf265795"> <enum>(1)</enum> <text>Coordinate prompt care and access to necessary maternity care services, including services provided by specialists, and programs for an eligible individual during the individual’s pregnancy and the 365-day period beginning on the last day of such pregnancy.</text>
</paragraph><paragraph id="ida1ef45b2b9934e9ab1f794f5659b92b4"><enum>(2)</enum><text>Develop an individualized, comprehensive, patient-centered care plan for each eligible individual that accommodates patient preferences and, if applicable, reflects adjustments to the payment methodology described in subsection (c)(2)(B).</text></paragraph><paragraph id="id5299ae99d14d4350b4a7eaa98f5e0048"> <enum>(3)</enum> <text>Develop and incorporate into each eligible individual’s care plan, in a culturally and linguistically appropriate manner consistent with the needs of the eligible individual, ongoing home care, community-based primary care, inpatient care, social support services, health-related social needs services, behavioral health services, local hospital emergency care, and, in the event of a change in income that would result in the eligible individual losing eligibility for medical assistance under the State plan (or under a waiver of such plan), care management and planning related to a change in the eligible individual’s health insurance coverage.</text>
</paragraph><paragraph id="idc760935a95b0403e96e78284ef5ec780"><enum>(4)</enum><text>Coordinate with pediatric care providers, as appropriate.</text></paragraph><paragraph id="id908513f7cad045b58fe99fe63050b1ea"><enum>(5)</enum><text>Collect and report information under subsection (f)(1).</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="IDEA8A3E1CC83E4BCEAE577D010D8B31B5"><enum>(c)</enum><header display-inline="yes-display-inline">Payments</header><paragraph commented="no" display-inline="no-display-inline" id="IDC569B19BBF2E463CB1DC5F3AC7671918"> <enum>(1)</enum> <header>In general</header> <text>A State shall provide a designated provider, a team of health care professionals operating with such a provider, or a health team designated as a maternity health home with payments for the provision of health home services to each eligible individual that selects such provider, team of health care professionals, or health team as the eligible individual’s health home. Payments made to a designated provider, a team of health care professionals operating with such a provider, or a health team for such services shall be treated as medical assistance for purposes of section 1903(a), except that, during the first 8 fiscal year quarters that the State plan amendment is in effect, the Federal medical assistance percentage applicable to such payments shall be equal to 90 percent.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idd23ceb0335554f4bad31ad2473c9f212">
<enum>(2)</enum>
<header>Methodology</header>
<text>The State shall specify in the State plan amendment the methodology the State will use for determining payment for the provision of pregnancy and postpartum coordinated care services or treatment during an eligible individual’s pregnancy and the 365-day period beginning on the last day of such pregnancy. Such methodology for determining payment—</text>
<subparagraph commented="no"
id="ide4d260fe0a4f4a008a836eaf604c6bea">
<enum>(A)</enum>
<text>may be based on—</text> <clause commented="no" id="idde9a41dfd8584ca299b247e4ed4832dd"> <enum>(i)</enum> <text>a per-member per-month basis for each eligible individual enrolled in a maternity health home;</text>
</clause>
<clause commented="no"
id="idcfcb1ed8ced44099b4862eba9dc83b48">
<enum>(ii)</enum>
<text>a prospective payment model, in the case of payments to Federally qualified health centers or a rural health clinics; or</text>
</clause>
<clause commented="no"
id="idcd8311a5855a45f19334054d6b9181e0">
<enum>(iii)</enum>
<text>an alternate model of payment proposed by the State and approved by the Secretary;</text>
</clause>
</subparagraph>
<subparagraph commented="no"
id="id51f74d3e4aa94d1588ad30ff2d03962a">
<enum>(B)</enum>
<text>may be adjusted to reflect, with respect to each eligible individual—</text>
<clause commented="no"
id="id4ddf37a53d7544b5ac3e1b50729f4693">
<enum>(i)</enum>
<text>the severity of the risks associated with the individual’s pregnancy;</text>
</clause>
<clause commented="no"
id="ideae8e53190ba4584944c3d9be92bb041">
<enum>(ii)</enum>
<text>the severity of the risks associated with the individual’s postpartum health care needs; and</text>
</clause>
<clause commented="no"
id="id1956cf6713d1499186e6d96eaffe5d3f">
<enum>(iii)</enum>
<text>the level or amount of time of care coordination required with respect to the individual; and</text>
</clause>
</subparagraph>
<subparagraph commented="no"
id="id2284b58461bb4064a870b6eb75dde84a">
<enum>(C)</enum>
<text>shall be established consistent with section 1902(a)(30)(A).</text>
</subparagraph>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id578ef748111d45d6b41437084eb892ca"><enum>(d)</enum><header>Coordinating care</header><paragraph id="id7fc89396231841e6aa85e1ea40188a71"><enum>(1)</enum><header>Hospital notification</header><text>A State with a State plan amendment approved under this section shall require each hospital that is a participating provider under the State plan (or under a waiver of such plan) to establish procedures in the case of an eligible individual who seeks treatment in the emergency department of such hospital for—</text><subparagraph id="id165cb7a5b7ad4ac791f8cde63166c99c"><enum>(A)</enum><text>providing the individual with culturally and linguistically appropriate information supplied by the State describing the respective treatment models and opportunities for the individual to access a maternity health home and its associated benefits; and</text></subparagraph><subparagraph id="id54bc0f76d99544feabc56083219cd72a"> <enum>(B)</enum> <text>notifying the maternity health home in which the individual is enrolled, or the designated provider, team of health care professionals operating with such a provider, or health team treating the individual, of the individual’s treatment in the emergency department and of the protocols for the maternity health home, designated provider, or team to be involved in the individual’s emergency care or post-discharge care.</text>
</subparagraph></paragraph><paragraph id="iddd5bbcc074b44056b94f82cca4d79f9a"><enum>(2)</enum><header>Education with respect to availability of a maternity health home</header><subparagraph id="idd63d02de394142b3b2896053978e3dc3"><enum>(A)</enum><header>In general</header><text>In order for a State plan amendment to be approved under this section, a State shall include in the State plan amendment a description of the State’s process for—</text><clause id="id2bb6366d278949328903e0019113e1ba"><enum>(i)</enum><text>educating providers participating in the State plan (or a waiver of such plan) on the availability of maternity health homes for eligible individuals, including the process by which such providers can participate in or refer an eligible individual to an approved maternity health home or a designated provider, team of health care professionals operating such a provider, or health team designated as a maternity health home; and</text></clause><clause id="id89626fc857bd4fe6bc4b7cf016daaccb"><enum>(ii)</enum><text>educating eligible individuals, in a culturally and linguistically appropriate manner, on the availability of maternity health homes.</text></clause></subparagraph><subparagraph id="ide3b2c2026e044b0aaf0fa5875a646a28"><enum>(B)</enum><header>Outreach</header><text>The process established by the State under subparagraph (A) shall include the participation of entities or other public or private organizations or entities that provide outreach and information on the availability of health care items and services to families of individuals eligible to receive medical assistance under the State plan (or a waiver of such plan).</text></subparagraph></paragraph><paragraph id="id6fefb6582da44be3ad80f48272040311"><enum>(3)</enum><header>Mental health coordination</header><text>A State with a State plan amendment approved under this section shall consult and coordinate, as appropriate, with the Secretary in addressing issues regarding the prevention, identification, and treatment of mental health conditions and substance use disorders among eligible individuals.</text></paragraph><paragraph id="ide2fe20c12e58433189aaa9c725e88246"><enum>(4)</enum><header>Social and support services</header><text>A State with a State plan amendment approved under this section shall consult and coordinate, as appropriate, with the Secretary in establishing means to connect eligible individuals receiving pregnancy and postpartum coordinated care services under this section with social and support services, including services made available under maternal, infant, and early childhood home visiting programs established under section 511 and services made available under section 330H or title X of the Public Health Service Act.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id81dc4f65054141df943b079be6c3e2e8"><enum>(5)</enum><header>Coordination with grant program for integrated services for pregnant and postpartum women</header><text>A State with a State plan amendment approved under this section shall consult and coordinate, as appropriate, with the Secretary with respect to the provision of medical assistance to eligible individuals enrolled in a maternity health home under this section and grantees delivering integrated health care services to pregnant and postpartum women under section 330P of the Public Health Service Act (including, if applicable, the State).</text></paragraph></subsection><subsection id="id0c690cf17ac24cc8af94ae72bf4c4eae"><enum>(e)</enum><header>Monitoring</header><text>A State shall include in the State plan amendment—</text><paragraph id="id999ac6c3260946f3a9ac98a07d47e5dd"><enum>(1)</enum><text>a methodology for tracking reductions in inpatient days and reductions in the total cost of care resulting from improved care coordination and management under this section;</text></paragraph><paragraph id="idaddd0d11dce54cb7958ce0fb22f057fc"><enum>(2)</enum><text>a proposal for use of health information technology in providing an eligible individual with pregnancy and postpartum coordinated care services as specified under this section and improving service delivery and coordination across the care continuum; and</text></paragraph><paragraph id="id0a311c2694954329a73b50e93f1c250e"><enum>(3)</enum><text>a methodology for tracking prompt and timely access to medically necessary care for eligible individuals from out-of-State providers.</text></paragraph></subsection><subsection id="idb3f851042a5b426cbba6d5549521ec63"><enum>(f)</enum><header>Data collection</header><paragraph id="ida3eb1c2a35564c0783685959a757d449"><enum>(1)</enum><header>Provider reporting requirements</header><text>In order to receive payments from a State under subsection (c), a maternity health home, or a designated provider, a team of health care professionals operating with such a provider, or a health team designated as a maternity health home, shall report to the State, at such time and in such form and manner as may be required by the State, including through a health information exchange or other public health data sharing entity, the following information:</text><subparagraph id="id0b29690b2ff443e289fbfc0d7d3d184e"> <enum>(A)</enum> <text>With respect to each such designated provider, team of health care professionals operating with such a provider, and health team designated as a maternity health home, the name, National Provider Identification number, address, and specific health care services offered to be provided to any eligible individual who has selected such provider, team of health care professionals, or health team as the eligible individual’s maternity health home.</text>
</subparagraph><subparagraph id="id91e39f86fdeb4a90b415032f804afd5f"><enum>(B)</enum><text>Information on all other applicable measures for determining the quality of services provided by such provider, team of health care professionals, or health team.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ida64f8ed2dafe4ce0bce88e8a011cfd6a"><enum>(C)</enum><text>Information concerning the factors described in paragraph (2)(A)(vi) received from health risk assessments of eligible individuals conducted and completed by the designated provider, team of health care professionals operating with such a provider, or health team designated as a maternity health home.</text></subparagraph><subparagraph id="id627778ea70604cd49969f35fd98bd877"><enum>(D)</enum><text>Such other information as the Secretary shall specify in guidance.</text></subparagraph></paragraph><paragraph id="id78d9f92540b44c3584e8890648fab624"><enum>(2)</enum><header>State reporting requirements</header><subparagraph id="id141b1c13ec844c43959abd167cd98034"><enum>(A)</enum><header>Comprehensive report</header><text>A State with a State plan amendment approved under this section shall report to the Secretary (and, upon request, to the Medicaid and CHIP Payment and Access Commission), at such time, but at a minimum annually, and in such form and manner determined by the Secretary to be reasonable and minimally burdensome, the following information:</text><clause id="idc48b770b3eb94ddfa82d9220ae6c9cb3"><enum>(i)</enum><text>Information described in paragraph (1).</text></clause><clause id="idc12e8c51da9c482fb1ba28f442ea090a"><enum>(ii)</enum><text>The number and, to the extent available and while maintaining all relevant privacy and confidentially protections, disaggregated demographic information (including information on geography) of eligible individuals who have enrolled in a maternity health home pursuant to this section.</text></clause><clause id="idc7090257ed8b457cbe4a919d30efd7b6"><enum>(iii)</enum><text>The number of maternity health homes in the State designated under this section.</text></clause><clause id="id71bb5c22fa794635a7e0ec49dbe600c4"><enum>(iv)</enum><text>The medical conditions or factors that contribute to severe maternal morbidity among eligible individuals enrolled in maternity health homes in the State.</text></clause><clause id="idd9fbd97448f44f04b8810c12b258926a"><enum>(v)</enum><text>The extent to which such individuals receive health care items and services under the State plan before, during, and after an individual’s enrollment in such a maternity health home.</text></clause><clause id="id848f65cc07c9471da04a62c5e8dcfea4"><enum>(vi)</enum><text>Where applicable, mortality data and data for the associated causes of pregnancy-related death for eligible individuals enrolled in a maternity health home under this section, in accordance with subsection (g). For deaths occurring postpartum, such data shall distinguish between deaths occurring up to 42 days postpartum and deaths occurring between 43 days to up to 1 year postpartum. Where applicable, data reported under this clause shall be reported alongside comparable data from a State’s maternal mortality review committee, as established in accordance with section 317K(d) of the Public Health Service Act, for purposes of further identifying and comparing statewide trends in maternal mortality among populations participating in the maternity health home under this section.</text></clause></subparagraph><subparagraph id="ideeb9cf4ffdb74d69a818381419d0d044"><enum>(B)</enum><header>Implementation report</header><text>Not later than 18 months after a State has a State plan amendment approved under this section, the State shall submit to the Secretary, and make publicly available on the appropriate State website, a report on how the State is implementing the option established under this section, including through any best practices adopted by the State.</text></subparagraph></paragraph></subsection><subsection id="idb6e088ca1b984019bac80d06dcc567d7"><enum>(g)</enum><header>Confidentiality</header><text>A State with a State plan amendment under this section shall establish confidentiality protections for the purposes of subsection (f)(2)(A) to ensure, at a minimum, that there is no disclosure by the State of any identifying information about any specific eligible individual enrolled in a maternity health home or any maternal mortality case, and that all relevant confidentiality and privacy protections, including the requirements under section 1902(a)(7)(A), are maintained.</text></subsection><subsection id="id9fe799bd24e04c419389f942348eb5ad"><enum>(h)</enum><header>Rule of construction</header><text>Nothing in this section shall be construed to require—</text><paragraph id="id773e2839332c45869836dc2663e93b6d"><enum>(1)</enum><text>an eligible individual to enroll in a maternity health home under this section; or</text></paragraph><paragraph id="id7e9eb2591ad041cc9d76683cac016fe4"><enum>(2)</enum><text>a designated provider or health team to act as a maternity health home and provide services in accordance with this section if the provider or health team does not voluntarily agree to act as a maternity health home.</text></paragraph></subsection><subsection id="idee98e0001c4c4ba79b564b02fb9ed08f"><enum>(i)</enum><header>Planning grants</header><paragraph id="id848b088e9bda43b98324c2fa1c0035a7"><enum>(1)</enum><header>In general</header><text>Beginning January 1, 2027, from the amount appropriated under paragraph (2), the Secretary shall award planning grants to States for purposes of developing and submitting a State plan amendment under this section. The Secretary shall award a grant to each State that applies for a grant under this subsection and meets the application criteria established by the Secretary, and the Secretary may determine the amount of the grant based on the merits of the application and the goal of the State to prioritize health outcomes for eligible individuals. A planning grant awarded to a State under this subsection shall remain available until expended.</text></paragraph><paragraph id="id89f9720c4c8a46e38527665f255a1140"><enum>(2)</enum><header>Appropriation</header><text>There are authorized to be appropriated to the Secretary $50,000,000 for fiscal year 2027, for the purposes of making grants under this subsection, to remain available until expended.</text></paragraph><paragraph id="idee2fef914b7f41398a42628cf44d9cd1"><enum>(3)</enum><header>Limitation</header><text>The total amount of payments made to States under this subsection shall not exceed $50,000,000.</text></paragraph></subsection><subsection id="ida3aa3672ee834d5eb604f150faa587b9"><enum>(j)</enum><header>Additional definitions</header><text>In this section:</text><paragraph id="idfaf849da297a40619a2bcce9a5ece71b"><enum>(1)</enum><header>Designated provider</header><text>The term <term>designated provider</term> means a physician (including an obstetrician-gynecologist or, if applicable, a certified nurse midwife, or certified professional midwife who meets or exceeds the education and training standards of the International Confederation of Midwives and who is licensed to practice within the State), a hospital, clinical practice or clinical group practice, rural health clinic, community health center, community mental health center, or any other entity or provider that is determined by the State and approved by the Secretary to be qualified to be a maternity health home on the basis of documentation evidencing that the entity or provider has the systems, expertise, and infrastructure in place to provide pregnancy and postpartum coordinated care services. Such term may include providers who are employed by, or affiliated with, a hospital.</text></paragraph><paragraph id="id0f92d49b611945769884060475743689"><enum>(2)</enum><header>Health team</header><text>The term <term>health team</term> has the meaning given such term for purposes of section 3502 of <external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>.</text></paragraph><paragraph id="idc283f3ecc928475f8be09e4aa6a09ca9"><enum>(3)</enum><header>Maternity health home</header><text>The term <term>maternity health home</term> means a designated provider (including a provider that operates in coordination with a team of health care professionals) or a health team that is selected by an eligible individual to provide pregnancy and postpartum coordinated care services.</text></paragraph><paragraph id="id49349ec8eafb46e99a90c6a979874ce6"><enum>(4)</enum><header>Pregnancy and postpartum coordinated care services</header><subparagraph id="idee1bf288e4df473c9e2b90c95794cd2c"><enum>(A)</enum><header>In general</header><text>The term <term>pregnancy and postpartum coordinated care services</term> means items and services related to the coordination of care for comprehensive and timely high-quality, culturally and linguistically appropriate, services described in subparagraph (B) that are provided by a designated provider, a team of health care professionals operating with such a provider, or a health team designated as a maternity health home.</text></subparagraph><subparagraph id="id45773707d86b4d0fb4b34dbb08012f0b"><enum>(B)</enum><header>Services described</header><clause id="idad1c34ee44a44fa98b7be163476b7575"><enum>(i)</enum><header>In general</header><text>The services described in this subparagraph shall include with respect to a State electing the State plan amendment option under this section, any medical assistance for items and services for which payment is available under the State plan or under a waiver of such plan.</text></clause><clause id="id6c9fe4ab929a4129aed4160bebee5980"><enum>(ii)</enum><header>Other items and services</header><text>In addition to medical assistance described in clause (i), the services described in this subparagraph shall include the following:</text><subclause id="id6289b4530c184594875fb2b3d6cfe690"> <enum>(I)</enum> <text>Any item or service for which medical assistance is otherwise available under the State plan (or a waiver of such plan) related to the treatment of an individual during the individual’s pregnancy and the 1-year period beginning on the last day of such pregnancy, including mental health and substance use disorder services.</text>
</subclause><subclause id="id8b9f734b1ccd487096332fbeac480955"><enum>(II)</enum><text>Comprehensive care management.</text></subclause><subclause id="idd99d7332e8e5488f90c0b168d6c47621"><enum>(III)</enum><text>Care coordination (including with pediatricians as appropriate), health promotion, and providing access to the full range of maternal, obstetric, and gynecologic services, including services from out-of-State providers.</text></subclause><subclause id="id29e9fc903ebb4a31ab0dfc2f56a0d643"><enum>(IV)</enum><text>Comprehensive transitional care, including appropriate follow-up, from inpatient to other settings.</text></subclause><subclause id="id7129a52e6b8f4bf388cf6ee1d33a2a2c"><enum>(V)</enum><text>Patient and family support (including authorized representatives).</text></subclause><subclause id="idc2651df424944ce6ba904fae1c74d9f4"><enum>(VI)</enum><text>Referrals to community and social support services, if relevant.</text></subclause><subclause id="id9a82bd3981f1419bbde6d95fbf81eab1"><enum>(VII)</enum><text>Use of health information technology to link services, as feasible and appropriate.</text></subclause></clause></subparagraph></paragraph><paragraph id="idc06bde1a79464b0c8a26349ac70e769c"><enum>(5)</enum><header>Team of health care professionals</header><text>The term <term>team of health care professionals</term> means a team of health care professionals (as described in the State plan amendment under this section) that may—</text><subparagraph id="idbb87fca7b3624bf29bf6f999c38462d9"><enum>(A)</enum><text>include—</text><clause id="id21f9489413d74924af87aeced11219f1"><enum>(i)</enum><text>physicians, including gynecologist-obstetricians, certified nurse midwives, or certified professional midwives who meet or exceed the education and training standards of the International Confederation of Midwives and who are licensed to practice within the State, family physicians, primary care physicians, pediatricians, and other professionals such as physicians assistants, advance practice nurses, nurses, nurse care coordinators, dietitians, nutritionists, social workers, behavioral health professionals, physical counselors, physical therapists, occupational therapists, or any professionals that assist in prenatal care, delivery, or postpartum care for which medical assistance is available under the State plan or a waiver of such plan and determined to be appropriate by the State and approved by the Secretary;</text></clause><clause id="id8f53cf8a16124046a4218b1f954cc6df"><enum>(ii)</enum><text>an entity or individual who is designated to coordinate such care delivered by the team; and</text></clause><clause id="id24eb820e2a89401487372e3349c29320"><enum>(iii)</enum><text>when appropriate and if otherwise eligible to furnish items and services that are reimbursable as medical assistance under the State plan or under a waiver of such plan, doulas, community health workers, translators and interpreters, and other individuals with culturally appropriate and trauma-informed expertise; and</text></clause></subparagraph><subparagraph id="id499e3b0006914f0fa0c17258f1f1cc18"><enum>(B)</enum><text>provide care at a facility that is freestanding, virtual, or based at a hospital, community health center, community mental health center, rural health clinic, clinical practice or clinical group practice, academic health center, or any entity determined to be appropriate by the State and approved by the Secretary.</text></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id31620b35ad8b409cb9162067c76e4653"><enum>(b)</enum><header>Applicability to CHIP</header><text>Section 2107(e)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)</external-xref>), as amended by section 105, is amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idAA58E03831C44C5AAC701ABF57EEC168"><subparagraph commented="no" display-inline="no-display-inline" id="id147c386ba97641a9bf57a992961fd33d"><enum>(W)</enum><text>Section 1945B (relating to optional health homes for pregnant and postpartum individuals).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section commented="no" display-inline="no-display-inline" id="id5211AEEB86C1439C8C108DBEFF3A1FCB"><enum>203.</enum><header>Guidance on supporting and improving access to Medicaid and CHIP coverage of services provided by doulas and certain maternal health professionals</header><text display-inline="no-display-inline">Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue and publish guidance for States concerning options for supporting and improving access to coverage and payment under a State plan under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) or under a waiver of such plan, and under a State child health plan under title XXI of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397aa">42 U.S.C. 1397aa et seq.</external-xref>) or under a waiver of such plan, for services provided by doulas, certified nurse midwives, certified midwives, or certified professional midwives, who meet or exceed the education and training standards of the International Confederation of Midwives and who are licensed to practice within the State and certain maternal health professionals (specified by the Secretary)—</text><paragraph commented="no" display-inline="no-display-inline" id="idD2C0B020ADD34946A4C8BA19A14BC0B6"><enum>(1)</enum><text display-inline="yes-display-inline">in rural areas;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3DF8249D5A9F436A9144E42AF2EBD8A0"><enum>(2)</enum><text display-inline="yes-display-inline">across a continuum of care; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id42D273EAC9754D47B7C6582142106F43"><enum>(3)</enum><text display-inline="yes-display-inline">among varied provider settings and payment and care models, including managed care.</text></paragraph></section><section commented="no" display-inline="no-display-inline" id="id9FB7493255734000AB28912D589FC7D9"><enum>204.</enum><header>Medicaid and CHIP increased financial support for depression and anxiety screening during the perinatal and postpartum periods</header><subsection commented="no" display-inline="no-display-inline" id="idE42F1D52158E4CA8860403F85CFE5685"><enum>(a)</enum><header display-inline="yes-display-inline">Medicaid</header><text>Section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>), as amended by section 103, is further amended—</text><paragraph commented="no" display-inline="no-display-inline" id="id2C98FDC11FC74ACDB0C532BD43376863"><enum>(1)</enum><text display-inline="yes-display-inline">in the first sentence of subsection (b), by striking <quote>subsection (a)(4)(D)</quote> and inserting <quote>subsections (a)(4)(D) and (ll)</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id04C43B76B08D4C65AFA9D4266BE47291"><enum>(2)</enum><text>by adding at the end the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id64B7DAFB88E3489C8D4DAB4DC952DD82"><subsection commented="no" display-inline="no-display-inline" id="idB27CEB7AA0BE453EB6DFBB86F1DAF202"><enum>(ll)</enum><header>Increased FMAP for depression and anxiety screening during the perinatal and postpartum periods</header><paragraph commented="no" display-inline="no-display-inline" id="id46FB96FAEB6C44CC8B9A7ACA67C8AD0B"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">For purposes of clause (5) of the first sentence of subsection (b), services described in this subsection are screening services provided to an individual who is eligible for such assistance on the basis of being pregnant that include at a minimum—</text><subparagraph commented="no" display-inline="no-display-inline" id="idAD3DF29C066342E4A81C74586ECA5B6D"><enum>(A)</enum><text display-inline="yes-display-inline">during the perinatal period, at least 1 screening for depression and anxiety symptoms using a standardized, validated tool; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id2DB9C758C21449E59C355DFA05A51704"><enum>(B)</enum><text display-inline="yes-display-inline"> during the postpartum period, a full assessment of mood and emotional well-being, including screening for postpartum depression and anxiety, using a standardized, validated tool. </text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id8FFB85EB2A10420595778FB94C0B6422"><enum>(2)</enum><header display-inline="yes-display-inline">Exclusion from territorial caps</header><text display-inline="yes-display-inline">The additional amount paid to a territory for expenditures for medical assistance for services described in paragraph (1) as a result of the application of clause (5) of the first sentence of subsection (b) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idA0FF7DEDFA674E35BA89AC9B106D2A54"><enum>(b)</enum><header>CHIP</header><text>Section 2105(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397ee">42 U.S.C. 1397ee(c)</external-xref>) is amended by adding at the end the following new paragraph:</text><quoted-block style="traditional" display-inline="no-display-inline" id="id65824671C4764DC7A6061AC1FFBD2B50" act-name=""><paragraph commented="no" id="idF4A7C267EAC24329BC1B0337F62693B4"> <enum>(13)</enum> <header>Enhanced payment for depression and anxiety screening during the perinatal and postpartum periods</header> <text display-inline="yes-display-inline">Notwithstanding subsection (b), the enhanced FMAP with respect to payments under subsection (a) for expenditures under the State child health plan (or a waiver of such plan) shall be increased by 1 percentage point with respect to expenditures for services described in section 1905(ll)(1) that are provided under the plan (or waiver) to an individual who is eligible for such assistance on the basis of being pregnant (including pregnancy-related assistance provided to a targeted low-income pregnant woman (as defined in section 2112(d)), pregnancy-related assistance provided to an individual who is eligible for such assistance through application of section 1903(v)(4)(A)(i) under section 2107(e)(1), or any other assistance under the plan (or waiver) provided to an individual who is eligible for such assistance on the basis of being pregnant) and during the 12-month period that begins on the last day of the individual’s pregnancy and ends on the last day of the month in which such 12-month period ends (including any such assistance provided during the month in which such period ends).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id21bc05cc12a44a5ebc668d2e2434ebd7"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall take effect on the first day of the first fiscal quarter that begins on or after the date that is 1 year after the date of enactment of this section.</text></subsection></section><section commented="no" display-inline="no-display-inline" id="idb00d9fdbf34240f2970da5b558bb5ac0"><enum>205.</enum><header>Presumptive eligibility for pregnant individuals</header><subsection commented="no" display-inline="no-display-inline" id="id09c6c30ae2b34dc4a4790fed0497e1e9"><enum>(a)</enum><header>In general</header><paragraph commented="no" display-inline="no-display-inline" id="idb1b49457da67417a87edfdf96608012b"><enum>(1)</enum><header>Requirement</header><text display-inline="yes-display-inline">Section 1920(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-1">42 U.S.C. 1396r–1(a)</external-xref>) is amended by striking <quote>may provide</quote> and inserting <quote>shall provide</quote>.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idd6e264a4c72740c5904cd84b74a63f35"><enum>(2)</enum><header>Application</header><text display-inline="yes-display-inline">Section 1920 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-1">42 U.S.C. 1396r–1</external-xref>) is amended by adding at the end the following new subsection:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id0B6B402CDB6C496799468B0A64F44130"><subsection commented="no" display-inline="no-display-inline" id="idc3af3ba5a8884634b6639a2c41454397"><enum>(f)</enum><header>Application</header><text>A State shall provide to a pregnant woman a presumptive eligibility period in accordance with this section without regard to whether the individual would otherwise qualify for a presumptive eligibility period the State has elected to provide under section 1920A, 1920B, or 1920C.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id186fd8914ab04a3f94ef4e60ec83965b"><enum>(b)</enum><header>Conforming amendments</header><paragraph commented="no" display-inline="no-display-inline" id="idf978e0d3aa7f44d292bffe61bd196239"><enum>(1)</enum><text>Section 1902(a)(47) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(47)</external-xref>) is amended to read as follows:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id2335567AC2F241D1B5249526F89C14E7"><paragraph commented="no" display-inline="no-display-inline" id="IDA8FB721300C049A288AD339CFEFAA4E0"><enum>(47)</enum><text display-inline="yes-display-inline">provide—</text><subparagraph commented="no" display-inline="no-display-inline" id="IDBFAA37E4FC16462FBDA677B37461B691"><enum>(A)</enum><clause commented="no" display-inline="yes-display-inline" id="ID2D19A283697F4CC5A928DC55B8C9EAEA"><enum>(i)</enum><text>for making ambulatory prenatal care available to pregnant women during a presumptive eligibility period in accordance with section 1920; and</text></clause><clause commented="no" display-inline="no-display-inline" indent="up1" id="id1af0c5b674774aa48648247a58a52a0f"><enum>(ii)</enum><text>at the option of the State—</text><subclause commented="no" display-inline="no-display-inline" id="id451f2d66111e46da9aa79dd8e14f60c1"><enum>(I)</enum><text display-inline="yes-display-inline">for making medical assistance for items and services described in subsection (a) of section 1920A available to children during a presumptive eligibility period in accordance with such section;</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id4afa68f670e34d5c83509d5323fb7842"><enum>(II)</enum><text display-inline="yes-display-inline">for making medical assistance available to individuals described in subsection (a) of section 1920B during a presumptive eligibility period in accordance with such section; and</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id55362d1c0e9d4ce18641f39936c9a23b"><enum>(III)</enum><text display-inline="yes-display-inline">for making medical assistance available to individuals described in subsection (a) of section 1920C during a presumptive eligibility period in accordance with such section; and</text></subclause></clause></subparagraph><subparagraph id="ID5000941DE8844920A8388B697E4762A4"><enum>(B)</enum><text>that any hospital that is a participating provider under the State plan may elect to be a qualified entity for purposes of determining, on the basis of preliminary information, whether any individual is eligible for medical assistance under the State plan or under a waiver of the plan for purposes of providing the individual with medical assistance during a presumptive eligibility period, in the same manner, and subject to the same requirements, as apply with respect to populations described in section 1920, 1920A, 1920B, or 1920C (without regard to whether the State has elected to provide for a presumptive eligibility period under sections 1920A, 1920B, or 1920C), subject to such guidance as the Secretary shall establish;</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="id8ba9c1edf1074a979a8f21700c6f46a0"><enum>(2)</enum><text>Section 1920(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-1">42 U.S.C. 1396r–1(e)</external-xref>) is amended—</text><subparagraph commented="no" display-inline="no-display-inline" id="id10425a6999d44a4488d1105dc4c55ac7"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote>If the State has elected the option to provide a presumptive eligibility period under this section or section 1920A, the</quote> and inserting <quote>The</quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idec41f0ba05f043d9b1dd648e96079f07"><enum>(B)</enum><text>by striking <quote>1920A, subject to</quote> and inserting <quote>1920A (if the State has elected the option), subject to</quote>.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0557e6c0cc344f188a422e3ff49a72c2"><enum>(3)</enum><text display-inline="yes-display-inline">Section 2107(e)(1)(R) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)(R)</external-xref>) is amended by inserting <quote>1920 (relating to presumptive eligibility for pregnant women and section</quote> before <quote>1920A</quote>.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6f1e615881d6490a8f39d06e8c07f5ef"><enum>(4)</enum><text>Section 2112(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397ll">42 U.S.C. 1397ll(c)</external-xref>) is amended—</text><subparagraph commented="no" display-inline="no-display-inline" id="id0c565ed9239b4c5a8f2dbbd6544dc25e"><enum>(A)</enum><text display-inline="yes-display-inline">in the heading, by striking <quote><header-in-text level="subsection" style="OLC">Option To Provide</header-in-text></quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id4998333479854347a255a07d7eae9976"><enum>(B)</enum><text display-inline="yes-display-inline">by striking <quote>may elect</quote> and inserting <quote>shall elect</quote>.</text></subparagraph></paragraph></subsection></section><enum>III</enum><header>Invest in the Maternal Health Care Workforce</header><section id="id303abe28bf2b4042a6b64c06b0505242"><enum>301.</enum><header>Emergency obstetric workforce support</header><subsection id="idc8dd521a8bef498793610da61065422c"><enum>(a)</enum><header>In general</header><text>Section 203A of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/204a">42 U.S.C. 204a</external-xref>) is amended—</text><paragraph id="id9e3b5968369c4fcaa9d153782f777c62"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="id98602b735d6445c0bc6ee23e6c488c74"><enum>(A)</enum><text>in paragraph (1), in the matter preceding subparagraph (A), by inserting <quote>and urgent maternal health care needs</quote> after <quote>public health care needs</quote>;</text></subparagraph><subparagraph id="id83ffc57a985c4c8d814f95d43a91bee6"><enum>(B)</enum><text>in paragraph (3), by inserting <quote>or urgent maternal health care need</quote> after <quote>public health care need</quote>;</text></subparagraph><subparagraph id="ide37b7a3007614015897a89762821a167"><enum>(C)</enum><text>in paragraph (5)—</text><clause id="idc0f95c249fe34445b594db218e0a3541"><enum>(i)</enum><text>in subparagraph (C), by striking <quote>or</quote> at the end;</text></clause><clause id="idbc11d22264924303983d72fe4af6ef87"><enum>(ii)</enum><text>in subparagraph (D), by striking the period at the end and inserting <quote>; or</quote>; and</text></clause><clause id="id573c797e3a0442dda52cf6f70d0da56d"><enum>(iii)</enum><text>by adding at the end the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id44d1fe036d76418397ddc112bc1cafa1"><subparagraph id="id5a4c8d2f83e9467fb8ff6ea9be663e4e"><enum>(E)</enum><text>any urgent need, not rising to the level of an emergency described in subparagraph (D), that, in the judgment of the Secretary, if not addressed, could result in an emergency that would be appropriate for the deployment of the Commissioned Corps.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="idc2983c4d582b4f9ead5cdb1255afedb8"><enum>(D)</enum><text>by adding at the end the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id0f15127a6746441091998c3cfb1f4f3e"><paragraph id="id78cded41d75740fd9304b017c1938c11"><enum>(6)</enum><header>Urgent maternal health care need</header><subparagraph id="idb809f7c4de3b48229ddadf9446d704a2"><enum>(A)</enum><header>In general</header><text>For purposes of this section and section 214, the term <term>urgent maternal health care need</term>, with respect to an area, means a maternal health care need, as determined by the Secretary, in consultation with the Attorney General, arising as a result of the closure or imminent closure of a hospital or other health care facility in such area, or the loss of workers employed by such hospital or health care facility who are trained to provide maternal health care services.</text></subparagraph><subparagraph id="ide883bcc1173d4cd28829e65e7bb02adf"><enum>(B)</enum><header>Considerations</header><text>In determining whether there is an urgent maternal health care need for purposes of subparagraph (A) with respect to an area, the Secretary shall consider whether such closure, imminent closure, or loss of workers has impacted access by individuals in such area to a full range of maternal health care services, including prenatal services, labor and delivery services, postnatal services, maternal and postpartum mental health services, behavioral health services, and reproductive health services.</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id8f9d2b7c300949e7af41091b327b8a94"><enum>(2)</enum><text>in subsection (b)—</text><subparagraph id="id6eb37d46348440828791d856920fab85"><enum>(A)</enum><text>in paragraph (1), by inserting <quote>or urgent maternal health care needs</quote> after <quote>public health care needs</quote>; and</text></subparagraph><subparagraph id="id30610335ae18486d87f6c793dfe77031"><enum>(B)</enum><text>in each of paragraphs (2) and (4)(B), by inserting <quote>or urgent maternal health care need</quote> after <quote>public health care need</quote>; and</text></subparagraph></paragraph><paragraph id="id84c11f8b944b4e00b1c6185bf46377e2"><enum>(3)</enum><text>in subsection (c), by inserting <quote>or urgent maternal health care need</quote> after <quote>public health care need</quote>.</text></paragraph></subsection><subsection id="id1900ae1a5e9e43ab87285de6036910e6"><enum>(b)</enum><header>Detail of personnel</header><text>Section 214 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/215">42 U.S.C. 215</external-xref>) is amended—</text><paragraph id="id5f6d12bd9b984914b6633f79362ec6bc"><enum>(1)</enum><text>by redesignating subsection (e) as subsection (f);</text></paragraph><paragraph id="id3c58089ff80e4a548654bd101dd0d747"><enum>(2)</enum><text>by inserting after subsection (d) the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idd178657b5cea4017a7da5e5091d6181e"><subsection id="id67d887e34f9f4ce6bfbc367b79ad5ba5"><enum>(e)</enum><paragraph commented="no" display-inline="yes-display-inline" id="idd11fd16d96e14b7ab2b8d6b46c1d2a2b"><enum>(1)</enum><text>Upon the request of an eligible entity with respect to a hospital or other health care facility the closure, imminent closure, or loss of workers of which led to an urgent maternal health care need in an area, personnel may be detailed by the Secretary for the purpose of assisting such eligible entity in work related to such urgent maternal health care need.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="iddd902201c9b04f93a8b4cfa16837b23d" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id9970eb20744541c1bc646cf80bd175c6"><enum>(A)</enum><text display-inline="yes-display-inline">Personnel detailed under paragraph (1) shall be paid from applicable appropriations of the Service. </text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" indent="up1" id="id98ec1986e43b4a3f97e44e9801bbd747"><enum>(B)</enum><text display-inline="yes-display-inline">In the case of detail of personnel under paragraph (1) to be paid from applicable Service appropriations, the Secretary may condition such detail on an agreement by the eligible entity concerned that such eligible entity concerned shall reimburse the United States for a portion of the amount of such payments made by the Service. </text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" indent="up1" id="idbc50a216a40349bd92893b701005ae74"><enum>(C)</enum><text display-inline="yes-display-inline">The services of personnel while detailed pursuant to this subsection shall be considered as having been performed in the Service for purposes of the computation of basic pay, promotion, retirement, compensation for injury or death, and the benefits provided by section 212.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" indent="up1" id="id2e1368b0522a4a04a4f9d947e0e15bd9"><enum>(3)</enum><text display-inline="yes-display-inline">The Secretary may condition a detail of personnel under paragraph (1) on an agreement by the eligible entity concerned that such eligible entity concerned shall—</text><subparagraph id="id5722874b78004418866798fb56fb1de7"><enum>(A)</enum><text>in the case of an imminent closure or a loss of workers, as determined by the Secretary—</text><clause id="ida9ac7314a64e4b3b8a02b62e13ae5936"><enum>(i)</enum><text>maintain the maternal health care services in the applicable area to the maximum extent practicable, including by hiring temporary workers, until the date on which the personnel are detailed to such area; and</text></clause><clause id="ide940558d46c240eea69a397dc375b06e"><enum>(ii)</enum><text>submit to the Secretary a plan for hiring and retaining health practitioners in the short- and long-term, both during periods in which personnel are detailed to such applicable area and periods in which personnel are not detailed to such applicable area;</text></clause></subparagraph><subparagraph id="iddae7cab0f22a411dac6d0a79007e0158"> <enum>(B)</enum> <text>in the case of a closure, submit to the Secretary a plan for working with, as applicable, State and local agencies and local stakeholders to transition patients to alternate sources of safe maternal health care services; and</text>
</subparagraph><subparagraph id="id325aef296eb0432db8c96a3cb6cd9bfd"><enum>(C)</enum><text>commit to an assessment by the Secretary of the workplace practices of such eligible entity concerned, if applicable.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" indent="up1" id="id24f7c03eae224dbaa1c20c4ef6da8885"><enum>(4)</enum><text>In this subsection—</text><subparagraph commented="no" display-inline="no-display-inline" id="ide88af073011d426b954c10f0111cfbb6"><enum>(A)</enum><text display-inline="yes-display-inline">the term <term>eligible entity</term> means—</text><clause commented="no" display-inline="no-display-inline" id="id30ecd2ee6636402bba16f0f7189132ed"><enum>(i)</enum><text display-inline="yes-display-inline">a State;</text></clause><clause commented="no" display-inline="no-display-inline" id="id26f438c317fb48ef8f49112a041ab3dd"><enum>(ii)</enum><text display-inline="yes-display-inline">a political subdivision of a State; or</text></clause><clause commented="no" display-inline="no-display-inline" id="id7a14bde9130e40cba50369818afef55f"><enum>(iii)</enum><text display-inline="yes-display-inline">a Tribal, nonprofit, or other health care entity; and</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id2c13997b409f484ba6931e2df0db499f"><enum>(B)</enum><text display-inline="yes-display-inline">the term <term>personnel</term> means an employee or officer of the Commissioned Corps.</text></subparagraph></paragraph></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="id8f77c6340044442e87c706ddbdfb8e8a"><enum>(3)</enum><text>in subsection (f) (as so redesignated), by inserting <quote>or an urgent maternal health care need</quote> before the period at the end.</text></paragraph></subsection><subsection id="idcd63e828f4ee42a8ab409d813f627f22"><enum>(c)</enum><header>Funding for commissioned corps of the public health service</header><text>Section 203 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/204">42 U.S.C. 204</external-xref>) is amended by adding at the end the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id78b4baffc6cf41d9a9e1f5a95a894eaa"><subsection id="id8ad72df003e74718a504fdd1fe71b687"><enum>(e)</enum><header>Operations of the Commissioned Corps of the Public Health Service</header><paragraph id="idab2fdf89dedc4643b4dcce7d55083b8d"><enum>(1)</enum><header>In general</header><text>The Secretary shall carry out duties and responsibilities relating to the operations of the Commissioned Corps of the Service, including the following:</text><subparagraph id="id7483513d9c794097a5824aa180c4725a"><enum>(A)</enum><text>Enhance the processes and systems of the Service’s Headquarters operations.</text></subparagraph><subparagraph id="idb487ead895014502a534cfee22d28466"><enum>(B)</enum><text>Maximize the force management, required training opportunities (as determined by the Secretary under section 203A(a)(1)), operational capacity, and mission readiness of the Regular Corps, the Ready Reserve Corps, and the Public Health Emergency Response Strike Teams, a subcomponent of the Regular Corps.</text></subparagraph><subparagraph id="id6204f987f0074e5b8e848587f16ac57d"><enum>(C)</enum><text>Recruit and retain qualified professionals suited to serving underserved and vulnerable communities by—</text><clause id="id9db4f601cba4413eb5f8359f29a917bd"><enum>(i)</enum><text>improving onboarding timelines, providing officer placements to align with mission needs, ensuring adequate officer morale and wellness resources, and incentivizing recruiters and recruits; and</text></clause><clause id="id77194b5b859248e487e1af8029fcfd71"><enum>(ii)</enum><text>expanding training opportunities, including training of personnel to deliver maternal health care services, providing credentialing support for high demand skill sets, and enriching leadership and research potential.</text></clause></subparagraph><subparagraph id="id16d4d913d6aa40719f64b869b5287b90"><enum>(D)</enum><text>Improve deployment processes and prepare mission teams to execute routine and emergent public health events.</text></subparagraph><subparagraph id="id3402d463daf14c71b66cac0b80526636"><enum>(E)</enum><text>Establish a legislative liaison office to carry out legislative affairs functions under the direction of the Secretary.</text></subparagraph></paragraph><paragraph id="idb9b477b0dfb3461da71340355e870bce"><enum>(2)</enum><header>Authorization of appropriations</header><text>In addition to amounts otherwise authorized to be appropriated for the Commissioned Corps of the Service, there is authorized to be appropriated to the Secretary to carry out paragraph (1) $150,000,000 for fiscal year 2027 and each fiscal year thereafter.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="id1391c6c342254004aa64c1363b5c069b"><enum>302.</enum><header>Streamlined screening and enrollment of providers of maternity, labor, and delivery services in neighboring States</header><subsection id="H80BD8FFC3B1847C99C9B78FAAFFF5F30"><enum>(a)</enum><header>Application to Medicaid</header><text>Section 1902(kk) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(kk)</external-xref>) is amended by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H888FC393ECA7403E87A5921C3AFD5FC2"><paragraph id="H1703DB4BACA14764A6289B52966D2086"><enum>(10)</enum><header>Streamlined enrollment process for eligible out-of-State providers of maternity, labor, and delivery services</header><subparagraph id="H88CAF8D5E7274D2BB20961F0885C7379"><enum>(A)</enum><header>In general</header><text>The State adopts and implements a process that enables an eligible out-of-State provider to enroll as a provider in the State plan without imposing any screening requirements that are in addition to the requirements imposed on in-State providers. An eligible out-of-State provider that enrolls in the State plan through such process shall be so enrolled for a 5-year period (unless the provider is terminated or excluded from participation during such period) and may revalidate such enrollment through such process for subsequent 5-year periods.</text></subparagraph><subparagraph id="HFF3A7D8C6FF4438BB2913235CAC35564"><enum>(B)</enum><header>Eligible out-of-State provider</header><text>In this paragraph, the term <term>eligible out-of-State provider</term> means, with respect to a State, a provider—</text><clause id="H6299C2E69F5A4BFAA55E126A22A30E6E"><enum>(i)</enum><text>that furnishes maternity, labor, and delivery services (as defined in subsection (uu)(1)), or provides orders or referrals for such services, for which payment is available under the State plan of the State;</text></clause><clause id="H006E1B3A51B24A8EA654401D7A7791D8"><enum>(ii)</enum><text>that is located in a neighboring State (as defined by the Secretary);</text></clause><clause id="HB5FE8B44BDE548F9B1E058D0772BE77E"><enum>(iii)</enum><text>with respect to which the Secretary has determined there is a limited risk of fraud, waste, or abuse for purposes of determining the level of screening to be conducted under section 1866(j)(2)(B);</text></clause><clause commented="no" id="HED24E916294141F49FEC18853B56BF0B"><enum>(iv)</enum><text>that has been screened under such section 1866(j)(2)(B) for purposes of enrolling in the Medicare program under title XVIII or the State plan of the State in which such provider is located; and</text></clause><clause commented="no" id="H919EA822716C44CD88E356CC7F42E6BF"><enum>(v)</enum><text>that has not been excluded from participation in the Medicare program under such title or the Medicaid program under this title.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H55B574A6861F4B629253872A830EC8EC"><enum>(b)</enum><header>Conforming amendments</header><paragraph id="H4AF6EFDEABF940BD8EA9A4CE8531EA3D"><enum>(1)</enum><text>Section 1902(a)(77) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(77)</external-xref>) is amended by inserting <quote>enrollment,</quote> after <quote>screening,</quote>.</text></paragraph><paragraph id="HF41A430485314E2DACFDA6D5CAA7AF57"><enum>(2)</enum><text>Section 1902(kk) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(kk)</external-xref>), as amended by subsection (a), is further amended—</text><subparagraph id="H14F0BF2D040F409B831F4E5B07A0FDE5"><enum>(A)</enum><text>in the subsection heading, by inserting <quote><header-in-text level="subsection" style="OLC">Enrollment,</header-in-text></quote> after <quote><header-in-text level="subsection" style="OLC">Screening,</header-in-text></quote>; and</text></subparagraph><subparagraph id="H6749D732A1914C9A9A9D61827BB7E326"><enum>(B)</enum><text>in paragraph (9), by striking <quote>Nothing</quote> and inserting <quote>Except as provided in paragraph (10), nothing</quote>.</text></subparagraph></paragraph></subsection><subsection commented="no" id="HD8D243AD540248159DEFA1BCD9D658CE"><enum>(c)</enum><header>Application to CHIP</header><text>Section 2107(e)(1)(G) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)(G)</external-xref>) is amended by inserting <quote>enrollment,</quote> after <quote>screening,</quote>.</text></subsection><subsection commented="no" id="HBF13790915F34E6CB04DFAB986F0285E"><enum>(d)</enum><header>Guidance on screening and enrolling out-of-State providers of maternity, labor, and delivery services</header><text>Not later than January 1, 2028, the Secretary of Health and Human Services shall issue (and update as the Secretary determines necessary) guidance to State Medicaid and CHIP directors on best practices for screening and enrolling out-of-State providers of maternity, labor, and delivery services in accordance with paragraph (10) of section 1902(kk) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(kk)</external-xref>) and section 2107(e)(1)(G) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)(G)</external-xref>) (as added and amended by this section) and including best practices for screening and enrolling out-of-State providers in managed care plans.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="idacbbf74ba4b54961bc891c052e4f1ecd"><enum>(e)</enum><header display-inline="yes-display-inline">Effective date</header><text>The amendments made by this section take effect on January 1, 2028.</text></subsection></section><enum>IV</enum><header>Requiring Public Communication of Obstetrics Data and Unit Closures</header><section id="idd1838f086d984dc6b30dc79a1f11ba9c"><enum>401.</enum><header>Timely notifications of impending hospital obstetric unit closures</header><subsection commented="no" display-inline="no-display-inline" id="idb8de0fbf79b045839a36a22c74f338fb"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Section 1866(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)(1)</external-xref>) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="idd74a9d20a48040d88d025557e916e5b1"><enum>(1)</enum><text>in subparagraph (X), by striking <quote>and</quote> at the end;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id7e76122c8af04cb399b5128a603e6159"><enum>(2)</enum><text>in subparagraph (Y)(ii)(V), by striking the period and inserting <quote>, and</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idc2e02c88ac5f423c831af4e920c60881"><enum>(3)</enum><text>by inserting after subparagraph (Y) the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idFDC27BD16A8A4BBA9E8A0B74E73F8665"><subparagraph id="idc4c9a0f3dbd8488e824f6dc80f2a9097"><enum>(Z)</enum><text>beginning 180 days after the date of the enactment of this subparagraph, in the case of a hospital, not less than 180 days prior to the closure of any obstetric unit of the hospital, to submit to the Secretary, any relevant local and State agencies, and the community a notification, which shall include—</text><clause commented="no" display-inline="no-display-inline" id="idfdca60ff69d04f5ebeb5bcfa89982da8"><enum>(i)</enum><text>a report analyzing the impact the closure will have on the community, including data on any adverse outcomes and increase in costs relating to obstetric services for such community;</text></clause><clause commented="no" display-inline="no-display-inline" id="id30b5aeddcdb84dfeb7d1a907fa9b189a"><enum>(ii)</enum><text>steps the hospital will take to identify other health care providers that can alleviate any service gaps as a result of the closure;</text></clause><clause commented="no" display-inline="no-display-inline" id="idab9492fde7404242ab9904f02765c01b"><enum>(iii)</enum><text display-inline="yes-display-inline">the cause of the closure of such obstetric unit;</text></clause><clause commented="no" display-inline="no-display-inline" id="idad801d66dd8448dda4337ddbae0727cc"><enum>(iv)</enum><text display-inline="yes-display-inline">data regarding historic transportation costs related to obstetric services in such community; and</text></clause><clause commented="no" display-inline="no-display-inline" id="id1955cff3964d469c87ba76435583e8e3"><enum>(v)</enum><text display-inline="yes-display-inline">any additional information as may be required by the Secretary.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id3e5c543d5b7340c4b792d5f97050805b"> <enum>(b)</enum> <header>State requirement To post reports</header> <text>Section 1902(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)</external-xref>), as amended by section 201(a)(1), is further amended—</text>
<paragraph id="idA1A749DBE95F4A41BB664A48C3948D4F">
<enum>(1)</enum>
<text>in paragraph (87), by striking <quote>and</quote> at the end;</text> </paragraph> <paragraph id="idC9479D39BB464DBE8371F8E9B4FBF29E"> <enum>(2)</enum> <text>in paragraph (88), by striking the period at the end and inserting <quote>; and</quote>; and</text>
</paragraph>
<paragraph id="idD2B29B6FA1F748C092A85B6DC7091B93">
<enum>(3)</enum>
<text>by inserting after paragraph (88) the following new paragraph:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="id31344F3072B94EA0B6D7499109A582F5"> <paragraph id="id4332BEEDB8D742BB88FC9A18E41CC76B"> <enum>(89)</enum> <text display-inline="yes-display-inline">provide that the State will make publicly available, on the website of any relevant State agency, any report received by the State from a hospital pursuant to section 1866(a)(1)(Z)(i).</text>
</paragraph>
<after-quoted-block>; and</after-quoted-block>
</quoted-block>
</paragraph>
</subsection></section><section id="id4d32f1899ae0408782366735c9392838"><enum>402.</enum><header>Collection of data relating to hospital labor and delivery services</header><text display-inline="no-display-inline">Section 1866(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)(1)</external-xref>), as amended by section 401, is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="id6ae81249392e4f80a251fd9b2687047b"><enum>(1)</enum><text>in subparagraph (Y)(ii)(V), by striking <quote>and</quote> at the end;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id18f229e847d348b8a174f4979e74335e"><enum>(2)</enum><text>in subparagraph (Z), by striking the period and inserting <quote>, and</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id877fd61703d049168fdf9ab00083e663"><enum>(3)</enum><text>by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id364E1C58912341BD9DDE4C1890D5E508"><subparagraph id="id201b80e6034e425db4ab4d12d6360c5e"><enum>(AA)</enum><text>in the case of a hospital, to include in cost reports submitted under this title for cost reporting periods beginning on or after July 1, 2026—</text><clause commented="no" display-inline="no-display-inline" id="idA59D511545E244CF966F96FE94D41C13"><enum>(i)</enum><text display-inline="yes-display-inline">the number of births that occurred at such hospital during the cost reporting period, delineated by the number of cesarean births and vaginal births;</text></clause><clause commented="no" display-inline="no-display-inline" id="id615b26698a42414ab687e99849bca8ec"><enum>(ii)</enum><text display-inline="yes-display-inline">the number of antenatal and postpartum transfers from the hospital to other hospitals;</text></clause><clause commented="no" display-inline="no-display-inline" id="id2da66b5830e3481b85e137ccc9ffbe51"><enum>(iii)</enum><text>data on the number and characteristics of the staff providing labor and delivery services at such hospital; </text></clause><clause commented="no" display-inline="no-display-inline" id="id435bc2ce820a45f89222c8e4da79d0b4"><enum>(iv)</enum><text display-inline="yes-display-inline">the expenses the hospital incurred for providing labor and delivery services at such hospital, including nursing care, anesthesia, and operating room services; </text></clause><clause commented="no" display-inline="no-display-inline" id="id682853a1a8cc454e8f21f4fd9e29c520"><enum>(v)</enum><text>the amount the hospital spent for on-call coverage for labor and delivery services by physicians and midwives; and</text></clause><clause commented="no" display-inline="no-display-inline" id="id5eaf5aa7dfca4bcbb99c0f4a71a10b95"><enum>(vi)</enum><text display-inline="yes-display-inline">the amount and sources of revenue received by such hospital for labor and delivery services, including payments received for—</text><subclause commented="no" display-inline="no-display-inline" id="id9fdaa0c2e2644c3c961389bfb627074f"><enum>(I)</enum><text display-inline="yes-display-inline">items and services furnished to individuals eligible for coverage under a State plan under title XIX (or a waiver of such a plan);</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id439bcd285dc94603807b5256405a7913"><enum>(II)</enum><text display-inline="yes-display-inline">items and services furnished to individuals with other forms of health insurance or third-party coverage; and</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id4b5f44146cd5428aa977412c0c5efa38"><enum>(III)</enum><text display-inline="yes-display-inline">items and services furnished to individuals without health insurance or other source of third party coverage.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>