[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1622 Introduced in Senate (IS)]

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117th CONGRESS
  1st Session
                                S. 1622

 To amend title XIX of the Social Security Act to provide States with 
the option to provide coordinated care through a pregnancy medical home 
         for high-risk pregnant women, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 13, 2021

  Mr. Portman (for himself and Ms. Stabenow) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XIX of the Social Security Act to provide States with 
the option to provide coordinated care through a pregnancy medical home 
         for high-risk pregnant women, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Harnessing Effective and Appropriate 
Long-Term Health for Moms On Medicaid Act of 2021'' or the ``HEALTH for 
MOM Act of 2021''.

SEC. 2. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH HOME 
              FOR PREGNANT AND POSTPARTUM WOMEN.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by inserting after section 1945A the following new section:

``SEC. 1945B. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH 
              HOME FOR PREGNANT AND POSTPARTUM WOMEN.

    ``(a) State Option.--
            ``(1) In general.--Notwithstanding section 1902(a)(1) 
        (relating to statewideness) and section 1902(a)(10)(B) 
        (relating to comparability), beginning April 1, 2023, a State, 
        at its option as a State plan amendment, may provide for 
        medical assistance under this title to an eligible woman who 
        chooses to--
                    ``(A) 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 woman's maternity 
                health home for purposes of providing the woman with 
                pregnancy and postpartum coordinated care services; or
                    ``(B) 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 women under this section.
            ``(2) Eligible woman defined.--
                    ``(A) In general.--In this section, the term 
                `eligible woman' means an individual who--
                            ``(i) 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 waiver) that are not less in 
                        amount, duration, or scope, or are determined 
                        by the Secretary to be substantially 
                        equivalent, to the medical assistance available 
                        for an individual described in subsection 
                        (a)(10)(A)(i); and
                            ``(ii) is pregnant.
                    ``(B) Continuation of eligibility.--An individual 
                described in subparagraph (A) shall be deemed to be 
                described in such subparagraph through the earlier of--
                            ``(i) the end of the month in which the 
                        individual's eligibility for medical assistance 
                        under the State plan (or waiver) ends; and
                            ``(ii) the last day of the 1-year period 
                        that begins on the last day of the individual's 
                        pregnancy.
                    ``(C) Exclusion of individuals eligible for a 
                limited pregnancy-related only benefit package.--Such 
                term does not include an individual who had a pregnancy 
                end within the last 365 days and whose eligibility 
                under such plan (or waiver) is limited to coverage for 
                a limited type of benefits and services.
    ``(b) Qualification Standards.--The Secretary shall establish 
standards for qualification as a maternity health home or as a 
designated provider, 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. Such standards 
shall include requiring designated providers, teams of health care 
professionals operating with such providers, and health teams 
(designated as a maternity health home) to demonstrate to the State the 
ability to do the following:
            ``(1) Coordinate prompt care and access to maternity and 
        postpartum care services, including services provided by 
        specialists, and programs for an eligible woman during 
        pregnancy and during the period for which she remains eligible 
        as described in subsection (a)(2)(B).
            ``(2) Develop an individualized, comprehensive, patient-
        centered care plan for each eligible woman that accommodates 
        patient preferences and, if applicable, reflects adjustments to 
        the payment methodology described in subsection (c)(2)(B).
            ``(3) Develop and incorporate into each eligible woman's 
        care plan, in a culturally and linguistically appropriate 
        manner consistent with the needs of the eligible woman, ongoing 
        home care, community-based primary care, inpatient care, social 
        support services, behavioral health services, local hospital 
        emergency care, and to the extent, applicable, care management 
        and planning related to a change in an eligible woman's 
        eligibility for medical assistance or a change in health 
        insurance coverage.
            ``(4) Coordinate with pediatric care providers, as 
        appropriate.
            ``(5) Collect and report information under subsection 
        (f)(1).
    ``(c) Payments.--
            ``(1) In general.--A State shall provide a designated 
        provider, a team of health care professionals operating with 
        such a provider, or a health team with payments for the 
        provision of pregnancy and postpartum coordinated care 
        services, to each eligible woman that selects such provider, 
        team of health care professionals, or health team as the 
        woman's maternity health home or care provider. Payments made 
        to a maternity health home or care provider for such services 
        shall be treated as medical assistance for purposes of section 
        1903(a), except that, during the first 2 fiscal year quarters 
        that the State plan amendment is in effect, the Federal medical 
        assistance percentage applicable to such payments shall be 
        increased by 15 percentage points, but in no case may exceed 90 
        percent.
            ``(2) Methodology.--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 to an 
        eligible woman. Such methodology for determining payment--
                    ``(A) may be based on--
                            ``(i) a per-member per-month basis for each 
                        eligible woman enrolled in the maternity health 
                        home;
                            ``(ii) a prospective payment model, in the 
                        case of payments to Federally qualified health 
                        centers or a rural health clinics; or
                            ``(iii) an alternate model of payment 
                        (which may include a model developed under a 
                        waiver under section 1115) proposed by the 
                        State and approved by the Secretary;
                    ``(B) may be adjusted to reflect, with respect to 
                each eligible woman--
                            ``(i) the severity of the risks associated 
                        with the woman's pregnancy;
                            ``(ii) the severity of the risks associated 
                        with the woman's postpartum health care needs; 
                        and
                            ``(iii) the level or amount of time of care 
                        coordination required with respect to the 
                        woman; and
                    ``(C) shall be established consistent with section 
                1902(a)(30)(A).
    ``(d) Coordinating Care.--
            ``(1) Hospital notification.--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 woman who seeks treatment in the emergency 
        department of such hospital for--
                    ``(A) providing the woman with culturally and 
                linguistically appropriate information on the 
                respective treatment models and opportunities for the 
                woman to access a maternity health home and its 
                associated benefits; and
                    ``(B) notifying the maternity health home in which 
                the woman is enrolled, or the designated provider, team 
                of health care professionals operating with such a 
                provider, or health team treating the woman, of the 
                woman's treatment in the emergency department and of 
                the protocols for the maternity health home, designated 
                provider, or team to be involved in the woman's 
                emergency care or post-discharge care.
            ``(2) Education with respect to availability of a maternity 
        health home.--
                    ``(A) In general.--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--
                            ``(i) educating providers participating in 
                        the State plan (or a waiver of such plan) on 
                        the availability of maternity health homes for 
                        eligible women, including the process by which 
                        such providers can participate in or refer 
                        eligible women to an approved maternity health 
                        home or a designated provider, team of health 
                        care professionals operating such a provider, 
                        or health team; and
                            ``(ii) educating eligible women, in a 
                        culturally and linguistically appropriate 
                        manner, on the availability of maternity health 
                        homes.
                    ``(B) Outreach.--The process established by the 
                State under subparagraph (A) shall include the 
                participation of relevant stakeholders 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).
            ``(3) Mental health coordination.--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 women.
            ``(4) Coordination of social and support services.--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 women receiving 
        pregnancy and postpartum care coordinated 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.
    ``(e) Monitoring.--A State shall include in the State plan 
amendment--
            ``(1) 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;
            ``(2) a proposal for use of health information technology 
        in providing an eligible woman with pregnancy and postpartum 
        coordinated care services as specified under this section and 
        improving service delivery and coordination across the care 
        continuum; and
            ``(3) a methodology for tracking prompt and timely access 
        to medically necessary care for eligible women from out-of-
        State providers.
    ``(f) Data Collection.--
            ``(1) Provider reporting requirements.--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, 
        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:
                    ``(A) 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 eligible women 
                who have selected such provider, team of health care 
                professionals, or health team as the women's maternity 
                health home.
                    ``(B) Information on all applicable measures for 
                determining the quality of services provided by such 
                provider, team of health care professionals, or health 
                team, including, to the extent applicable, maternal and 
                perinatal health quality measures under section 1139B.
                    ``(C) Such other information as the Secretary shall 
                specify in guidance.
            ``(2) State reporting requirements.--
                    ``(A) Comprehensive report.--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 frequency of every 12 months, and in 
                such form and manner determined by the Secretary to be 
                reasonable and minimally burdensome, including through 
                a health information exchange or other public health 
                data sharing entity, the following information:
                            ``(i) Information described in paragraph 
                        (1).
                            ``(ii) The number and, to the extent 
                        available and while maintaining all relevant 
                        protecting privacy and confidentially 
                        protections, disaggregated demographic 
                        information of eligible women who have enrolled 
                        in a maternity health home pursuant to this 
                        section.
                            ``(iii) The number of maternity health 
                        homes in the State.
                            ``(iv) The medical and behavioral health 
                        conditions or factors that contribute to severe 
                        maternal morbidity among eligible women 
                        enrolled in maternity health homes in the 
                        State.
                            ``(v) The extent to which such women 
                        receive health care items and services under 
                        the State plan before, during, and after the 
                        women's enrollment in such a maternity health 
                        home.
                            ``(vi) Where applicable, mortality data and 
                        data for the associated causes of death for 
                        eligible women 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.
                    ``(B) Implementation report.--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.
    ``(g) Confidentiality.--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 woman enrolled in a maternity health home or any 
maternal mortality case, and that all relevant confidentiality and 
privacy protections, including the requirements under 1902(a)(7)(A), 
are maintained.
    ``(h) Rule of Construction.--Nothing in this section shall be 
construed to require--
            ``(1) an eligible woman to enroll in a maternity health 
        home under this section; or
            ``(2) 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.
    ``(i) Planning Grants.--
            ``(1) In general.--Beginning October 1, 2022, 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, but 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 women. A planning grant awarded to a State under this 
        subsection shall remain available until expended.
            ``(2) Appropriation.--There are authorized to be 
        appropriated to the Secretary $50,000,000 for the period of 
        fiscal years 2021 through 2022, for the purposes of making 
        grants under this subsection, to remain available until 
        expended.
            ``(3) Limitation.--The total amount of payments made to 
        States under this subsection shall not exceed $50,000,000.
    ``(j) Additional Definitions.--In this section:
            ``(1) Designated provider.--The term `designated provider' 
        means a physician (including an obstetrician-gynecologist), 
        hospital, clinical practice or clinical group practice, a 
        medicaid managed care organization, as defined in section 
        1903(m)(1)(A), a prepaid inpatient health plan, as defined in 
        section 438.2 of title 42, Code of Federal Regulations (or any 
        successor regulation), a prepaid ambulatory health plan, as 
        defined in such section (or any successor regulation), rural 
        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 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.
            ``(2) Maternity health home.--The term `maternity health 
        home' means a designated provider (including a provider that 
        operates in coordination with a team of health care 
        professionals) or a health team is selected by an eligible 
        woman to provide pregnancy and postpartum coordinated care 
        services.
            ``(3) Health team.--The term `health team' has the meaning 
        given such term for purposes of section 3502 of Public Law 111-
        148.
            ``(4) Pregnancy and postpartum coordinated care services.--
                    ``(A) In general.--The term `pregnancy and 
                postpartum coordinated care services' 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 to an eligible woman 
                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).
                    ``(B) Services described.--
                            ``(i) In general.--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.
                            ``(ii) Other items and services.--In 
                        addition to medical assistance described in 
                        clause (i), the services described in this 
                        subparagraph shall include the following:
                                    ``(I) Comprehensive care 
                                management.
                                    ``(II) 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.
                                    ``(III) Comprehensive transitional 
                                care, including appropriate follow-up, 
                                from inpatient to other settings.
                                    ``(IV) Patient and family support 
                                (including authorized representatives).
                                    ``(V) Referrals to community and 
                                social support services, if relevant.
                                    ``(VI) Use of health information 
                                technology to link services, as 
                                feasible and appropriate.
            ``(5) Team of health care professionals.--The term `team of 
        health care professionals' means a team of health care 
        professionals (as described in the State plan amendment under 
        this section) that may--
                    ``(A) include--
                            ``(i) physicians, including gynecologist-
                        obstetricians, pediatricians, and other 
                        professionals such as physicians assistants, 
                        advance practice nurses, including certified 
                        nurse midwives, 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;
                            ``(ii) an entity or individual who is 
                        designated to coordinate such care delivered by 
                        the team; and
                            ``(iii) 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
                    ``(B) provide care at a facility that is 
                freestanding, virtual, or based at a hospital, 
                community health center, community mental health 
                center, rural 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.''.
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