Perinatal Care Alternative Payment Model Demonstration Project

(a)

In general

For the period of fiscal years 2027 through 2031, the Secretary of Health and Human Services (referred to in this section as the Secretary), acting through the Administrator of the Centers for Medicare & Medicaid Services, shall establish and implement, in accordance with the requirements of this section, a demonstration project, to be known as the Perinatal Care Alternative Payment Model Demonstration Project (referred to in this section as the Demonstration Project), for purposes of allowing States to test payment models under their State plans under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and State child health plans under title XXI of such Act (42 U.S.C. 1397aa et seq.) with respect to maternity care provided to pregnant and postpartum individuals enrolled in such State plans and State child health plans. (b)

Coordination

In establishing the Demonstration Project, the Secretary shall coordinate with stakeholders such as— (1)State Medicaid programs; (2)maternity care providers and organizations representing maternity care providers; (3)relevant organizations representing patients, with a particular focus on patients from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes; (4)relevant community-based organizations, particularly organizations that seek to improve maternal health outcomes for individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes; (5)perinatal health workers; (6)relevant health insurance issuers; (7) hospitals, health systems, midwifery practices, freestanding birth centers (as such term is defined in paragraph (3)(B) of section 1905(l) of the Social Security Act (42 U.S.C. 1396d(l))), Federally-qualified health centers (as such term is defined in paragraph (2)(B) of such section), and rural health clinics (as such term is defined in section 1861(aa) of such Act (42 U.S.C. 1395x(aa))); (8)researchers and policy experts in fields related to maternity care payment models; and (9)any other stakeholders as the Secretary determines appropriate, with a particular focus on stakeholders from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes. (c)

Considerations

In establishing the Demonstration Project, the Secretary shall consider any alternative payment model that— (1)is designed to improve maternal health outcomes for individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes; (2)includes methods for stratifying patients by pregnancy risk level and, as appropriate, adjusting payments under such model to take into account pregnancy risk level, including consideration of the appropriate transfer of patients by pregnancy risk level; (3)establishes evidence-based quality metrics for such payments; (4)includes consideration of nonhospital birth settings such as freestanding birth centers (as so defined); (5)includes consideration of social determinants of maternal health; (6)includes diverse maternity care teams that include— (A)maternity care providers, mental and behavioral health care providers acting in accordance with State law, and registered dietitians or nutrition professionals (as such term is defined in section 1395x(vv)(2) of title 42, United States Code)— (i)from racially, ethnically, and professionally diverse backgrounds; (ii)with experience practicing in racially and ethnically diverse communities; or (iii)who have undergone training on implicit bias and racism; and (B)perinatal health workers; or (7)includes consideration of maternal mental health conditions and substance use disorders. (d)

Eligibility

To be eligible to participate in the Demonstration Project, a State shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. (e)

Evaluation

The Secretary shall conduct an evaluation of the Demonstration Project to determine the impact of the Demonstration Project on— (1)maternal health outcomes, with data stratified by race, ethnicity, primary language, socioeconomic status, geography, insurance type, and other factors as the Secretary determines appropriate; (2)spending on maternity care by States participating in the Demonstration Project; (3)to the extent practicable, qualitative and quantitative measures of patient experience; and (4)any other areas of assessment that the Secretary determines relevant. (f)

Report

Not later than one year after the completion or termination date of the Demonstration Project, the Secretary shall submit to the Congress, and make publicly available, a report containing— (1)the results of any evaluation conducted under subsection (e); and (2)a recommendation regarding whether the Demonstration Project should be continued after fiscal year 2031 and expanded on a national basis. (g)

Definitions

In this section: (1)

Alternative payment model

The term alternative payment model has the meaning given such term in section 1833(z)(3)(C) of the Social Security Act (42 U.S.C. 1395l(z)(3)(C)). (2)

Maternal mortality

The term maternal mortality means a death occurring during or within a 1-year period after pregnancy, caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications. (3)

Maternity care provider

The term maternity care provider means a health care provider who— (A)is a physician, a physician assistant, a midwife who meets, at a minimum, the international definition of a midwife and global standards for midwifery education as established by the International Confederation of Midwives, an advanced practice registered nurse, a doula accredited by a State to receive reimbursement for doula services under a State plan (or a waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or a lactation consultant certified by the International Board of Lactation Consultant Examiners; and (B)has a focus on maternal or perinatal health. (4)

Perinatal

The term perinatal means the period beginning on the day an individual becomes pregnant and ending on the last day of the 1-year period beginning on the last day of such individual’s pregnancy. (5)

Perinatal health worker

The term perinatal health worker means a nonclinical health worker focused on maternal or perinatal health, such as a doula, community health worker, peer supporter, lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, patient navigator or coordinator, or language interpreter. (6)

Postpartum and postpartum period

The terms postpartum and postpartum period refer to the 1-year period beginning on the last day of the pregnancy of an individual. (7)

Severe maternal morbidity

The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant. (8)

Social determinants of maternal health

The term social determinants of maternal health means nonclinical factors that impact maternal health outcomes. (h)

Authorization of appropriations

There are authorized to be appropriated such sums as are necessary to carry out this section.