[Congressional Record Volume 172, Number 50 (Thursday, March 19, 2026)]
[Senate]
[Pages S1396-S1404]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 4688. Mr. WYDEN (for himself, Mr. Lujan, and Mr. Van Hollen)
submitted an amendment intended to be proposed by him to the bill S.
1383, to establish the Veterans Advisory Committee on Equal Access, and
for other purposes; which was ordered to lie on the table; as follows:
In lieu of the matter proposed to be inserted, insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Keeping
Obstetrics Local Act''.
(b) Table of Contents.--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 SERVICES
Sec. 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 CARE
Sec. 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 WORKFORCE
Sec. 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
CLOSURES
Sec. 401. Timely notifications of impending hospital obstetric unit
closures.
Sec. 402. Collection of data relating to hospital labor and delivery
services.
TITLE I--ENHANCING FINANCIAL SUPPORT FOR RURAL AND SAFETY NET HOSPITALS
THAT PROVIDE OBSTETRIC SERVICES
SEC. 101. STATE STUDIES AND HHS REPORT ON COSTS OF PROVIDING
MATERNITY, LABOR, AND DELIVERY SERVICES.
(a) State Study.--
(1) In general.--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 (42 U.S.C. 1301(a)(1)) 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
``Secretary'').
(2) Content of study.--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:
(A) 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.
(B) 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.
(C) 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.
(D) The amounts applicable hospitals are paid for
maternity, labor, and delivery services, by geographic
location and hospital size, under--
(i) Medicare;
(ii) the State Medicaid program, including payment amounts
for such services under fee-for-service payment arrangements
and under managed care (as applicable);
[[Page S1397]]
(iii) the State CHIP plan, including payment amounts for
such services under fee-for-service payment arrangements and
under managed care (as applicable); and
(iv) private health insurance.
(E) A comparative payment rate analysis--
(i) 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
(ii) analyzing different payment methods for such services,
such as the use of bundled payments, quality incentives, and
low-volume adjustments.
(F) 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.
(3) Applicable hospital defined.--For purposes of this
subsection, the term ``applicable hospital'' means any
hospital located in a State that meets either of the
following criteria:
(A) 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.
(B) The hospital--
(i) 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);
(ii) 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
(iii) provides labor and delivery services.
(4) Assistance to small hospitals in compiling cost
information.--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.
(5) HHS report on state studies.--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).
(b) HHS Report on National Data Collection Findings.--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.
(c) Implementation Funding.--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.
SEC. 102. REQUIRING ADEQUATE PAYMENT RATES UNDER MEDICAID FOR
MATERNITY, LABOR, AND DELIVERY SERVICES AT
ELIGIBLE HOSPITALS.
(a) Fee-for-Service Payments.--Section 1902 of the Social
Security Act (42 U.S.C. 1396a) is amended--
(1) in subsection (a)(13)--
(A) by striking ``and'' at the end of subparagraph (B);
(B) by adding ``and'' at the end of subparagraph (C); and
(C) by adding at the end the following new subparagraph:
``(D) for each fiscal year beginning with fiscal year 2027,
payment for maternity, labor, and delivery services (as
defined in subsection (zz)) 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;'';
and
(2) by adding at the end the following new subsection:
``(zz) Maternity, Labor, and Delivery Services and Eligible
Hospitals Defined.--For purposes of subsection (a)(13)(D)--
``(1) Maternity, labor, and delivery services.--
``(A) In general.--The term `maternity, labor, and delivery
services' 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.
``(B) Scope.--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.
``(C) Rulemaking.--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).
``(2) Eligible hospital.--
``(A) In general.--The term `eligible hospital' means, with
respect to a State and fiscal year--
``(i) 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);
``(ii) a critical access hospital (as defined in section
1861(mm)(1));
``(iii) a hospital operated by the Indian Health Service or
an Indian Tribe under the Indian Self-Determination and
Education Assistance Act;
``(iv) 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
``(v) 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.
``(B) Identification of eligible hospitals.--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.
``(3) Qualifying birth.--For purposes of paragraph (2), the
term `qualifying birth' means a birth for which any
maternity, labor, and delivery services associated with the
birth--
``(A) 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);
``(B) were paid for under title XVIII;
``(C) 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
``(D) were provided to a patient who does not have minimum
essential coverage (as defined in section 5000A(f) of the
Internal Revenue Code of 1986) and were not fully paid for by
such patient.
``(4) Minimum payment rate specified.--The minimum payment
rate specified in this paragraph is, with respect to an
eligible hospital and maternal, labor, and delivery
services--
``(A) for fiscal year 2027, 150 percent of the payment rate
that would apply for such services and hospital under title
XVIII; and
``(B) 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 Keeping Obstetrics Local Act.''.
(b) Under Medicaid Managed Care Plans.--Section 1932(f) of
the Social Security Act (42 U.S.C. 1396u-2(f)) is amended--
(1) in the heading, by inserting ``and Maternity, Labor,
and Delivery Services at Eligible Hospitals'' after
``Services''; and
(2) by striking ``described in section 1902(a)(13)(C)'' and
inserting ``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
1902(zz))''.
SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION FOR
MATERNITY, LABOR, AND DELIVERY SERVICES
FURNISHED BY ELIGIBLE HOSPITALS.
Section 1905 of the Social Security Act (42 U.S.C. 1396d)
is amended--
(1) in subsection (b), by striking ``and (ii)'' and
inserting ``(ii), and (ll)''; and
(2) by adding at the end the following new subsection:
``(ll) Maternity, Labor, and Delivery Services.--
``(1) In general.--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(zz)) in a fiscal quarter that begins on or after October
1, 2026--
``(A) 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
``(B) 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).
``(2) Determination of enhanced payment rate amount and
base payment rate amount.--
``(A) Enhanced payment rate amount.--
[[Page S1398]]
``(i) In general.--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(zz)) 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).
``(ii) Base payment rate.--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(zz)) shall be equal to--
``(I) 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
``(II) 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.
``(B) Base payment rate amount.--For purposes of paragraph
(1)(B), the base payment rate amount for a State and fiscal
quarter is equal to--
``(i) 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(zz)) in such fiscal quarter; minus
``(ii) the enhanced payment rate amount determined for the
State and fiscal quarter under subparagraph (A).
``(3) Application of higher match.--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.
``(4) Exclusion of expenditures from territorial caps.--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.''.
SEC. 104. LABOR AND DELIVERY SERVICES ANCHOR PAYMENTS.
(a) State Requirement.--Section 1902(a)(13)(A) of the
Social Security Act (42 U.S.C. 1396a(a)(13)(A)) is amended--
(1) in clause (iii), by striking ``and'' at the end;
(2) in clause (iv), by striking the semicolon at the end
and inserting ``, and''; and
(3) by adding at the end the following new clause:
``(v) 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);''.
(b) Requiring Anchor Payments for Low Volume Obstetric
Hospitals.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended by inserting the following after
section 1923:
``SEC. 1923A. ANCHOR PAYMENTS FOR LABOR AND DELIVERY SERVICES
PROVIDED BY LOW VOLUME OBSTETRIC HOSPITALS.
``(a) Implementation of Requirement.--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).
``(b) Definitions.--In this section:
``(1) Antenatal transfer.--The term `antenatal transfer'
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.
``(2) Delivery volume.--The term `delivery volume' 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.
``(3) Labor and delivery revenue floor.--The term `labor
and delivery revenue floor' means, with respect to a low
volume obstetric hospital and a fiscal year, the amount equal
to the sum of--
``(A) the product of--
``(i) the delivery volume for such hospital and fiscal
year; and
``(ii) the per delivery amount for such fiscal year; and
``(B) the standby capacity amount for such fiscal year.
``(4) Labor and delivery services.--The term `labor and
delivery services' 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.
``(5) Low volume obstetric hospital.--The term `low volume
obstetric hospital' means, with respect to a hospital and a
fiscal year, a hospital--
``(A) that is an eligible hospital (as defined in section
1902(zz)(2));
``(B) 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;
``(C) 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;
``(D) 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
``(E) 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.
``(6) Medicaid labor and delivery revenue floor.--The term
`Medicaid labor and delivery revenue floor' means, with
respect to a low volume obstetric hospital and a fiscal year,
the product of--
``(A) the labor and delivery revenue floor for such
hospital and fiscal year; and
``(B) 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).
``(7) Per delivery amount.--
``(A) In general.--The term `per delivery amount' 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.
``(B) Determination of per delivery amount.--
``(i) Fiscal year 2028.--For fiscal year 2028, the per
delivery amount shall be $10,000.
``(ii) Indexing.--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.
``(iii) Periodic revision of per delivery amount.--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.
``(8) Standby capacity amount.--
``(A) In general.--The term `standby capacity amount'
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.
``(B) Determination of standby capacity amount.--
``(i) Fiscal year 2028.--For fiscal year 2028, the standby
capacity amount shall be $1,200,000.
``(ii) Indexing.--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.
``(iii) Periodic revision of standby capacity amount.--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.
``(c) Anchor Payment for Low Volume Obstetric Hospitals.--
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--
``(1) the Medicaid labor and delivery revenue floor for the
hospital and fiscal year; exceeds
``(2) 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
[[Page S1399]]
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.
``(d) Requirements for Receipt of Payments.--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:
``(1) Skills maintenance and training activities.--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.
``(2) Continued provision of labor and delivery services.--
``(A) In general.--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--
``(i) 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
``(ii) 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.
``(B) Recovery of payment in the event of breach of
contract by hospital.--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.
``(3) Utilization of funds for labor and delivery
services.--
``(A) In general.--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.
``(B) Recovery of payment in the event of breach of
contract by hospital.--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.
``(e) Treatment of Payments; Recovery of Payments.--
``(1) In general.--Payments made by a State under this
section for a fiscal year--
``(A) 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
``(B) 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).
``(2) Payments recovered by a state.--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).''.
(c) Conforming Amendments.--Title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) is amended as follows:
(1) In section 1903--
(A) in subsection (d)(6)(B)--
(i) by striking ``related to the total amount'' and
inserting the following: ``related to--
``(i) the total amount'';
(ii) by striking the period at the end and inserting ``;
and''; and
(iii) by adding at the end the following new clause:
``(ii) the total amount of payments made to individual
providers (by provider) under section 1923A during such
fiscal year.''; and
(B) in subsection (bb)(2)(B)--
(i) in the header, by inserting ``and low volume obstetric
hospital'' after ``DSH''; and
(ii) by inserting ``or a payment made to a low volume
obstetric hospital under section 1923A'' before the period.
(2) In section 1905--
(A) in subsection (cc), by striking ``section 1923'' the
second place it appears and inserting ``section 1923 or
1923A''; and
(B) in subsection (ii)(2)(A), by inserting ``or payments to
low volume obstetric hospitals described in section 1923A''
before the semicolon.
SEC. 105. APPLICATION OF ADEQUATE PAYMENT REQUIREMENT AND
INCREASED FEDERAL FINANCIAL PARTICIPATION
REQUIREMENTS TO CHIP.
Section 2107(e)(1) of the Social Security Act (42 U.S.C.
1397gg(e)(1)) is amended--
(1) by redesignating subparagraphs (B) through (W) as
subparagraphs (C) through (X), respectively; and
(2) by inserting after subparagraph (A) the following new
subparagraph:
``(B) Section 1902(a)(13)(D) and section 1905(ll) (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).''.
SEC. 106. DISREGARDING INCREASED AND ADDITIONAL PAYMENTS TO
HOSPITALS FOR PURPOSES OF OTHER SUPPLEMENTAL
PAYMENTS AND UPPER PAYMENT LIMITS.
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 (42 U.S.C. 1395ww(d)(5)(F), 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.
TITLE II--EXPAND COVERAGE OF MATERNAL HEALTH CARE
SEC. 201. REQUIRING 12-MONTH CONTINUOUS, FULL BENEFIT
COVERAGE FOR PREGNANT INDIVIDUALS UNDER
MEDICAID AND CHIP.
(a) Medicaid.--Section 1902 of the Social Security Act (42
U.S.C. 1396a) is amended--
(1) in subsection (a)--
(A) in paragraph (10), in the matter following subparagraph
(G), by striking ``(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,'' and inserting ``(VII)
[Repealed],'';
(B) in paragraph (89), by striking ``and'' at the end;
(C) in paragraph (90), by striking the period at the end
and inserting ``; and''; and
(D) by inserting after paragraph (90) the following new
paragraph:
``(91) provide that the State plan is in compliance with
subsection (e)(16).''; and
(2) in subsection (e)(16)--
(A) in subparagraph (A), by striking ``At the option of the
State, the State plan (or waiver of such State plan) may
provide'' and inserting ``A State plan (or waiver of such
State plan) shall provide'';
(B) in subparagraph (B), in the matter preceding clause
(i), by striking ``by a State making an election under this
paragraph'' and inserting ``under a State plan (or a waiver
of such State plan)''; and
(C) in subparagraph (C)--
(i) by striking ``A State making an election under this
paragraph'' and inserting ``In the case of a State''; and
(ii) by striking ``shall also make the election'' and
inserting ``the State shall provide coverage''.
(b) CHIP.--
(1) In general.--Subparagraph (L) of section 2107(e)(1) of
the Social Security Act (42 U.S.C. 1397gg(e)(1)), as
redesignated by section 105, is amended to read as follows:
``(L) 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).''.
(2) Conforming amendment.--Section 2112(d)(2)(A) of the
Social Security Act (42 U.S.C. 1397ll(d)(2)(A)) is amended by
striking ``the month in which the 60-day period'' and all
that follows through ``pursuant to section 2107(e)(1),''.
(c) Effective Date.--
(1) In general.--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.
[[Page S1400]]
(2) Exception for state legislation.--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.
(3) State option for earlier effective date.--A State may
elect to have subsection (e)(16) of section 1902 of the
Social Security Act (42 U.S.C. 1396a) and subparagraph (L) of
section 2107(e)(1) of the Social Security Act (42 U.S.C.
1397gg(e)(1)), 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.
SEC. 202. HEALTH HOMES FOR PREGNANT AND POSTPARTUM WOMEN.
(a) Medicaid.--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 INDIVIDUALS.
``(a) State Option.--
``(1) In general.--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--
``(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 individual's maternity health home for purposes
of providing the individual 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
individuals under this section.
``(2) Eligible individual defined.--In this section, the
term `eligible individual' means an individual--
``(A) 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);
``(B) who is not enrolled in a health home under section
1945 or 1945A; and
``(C) either--
``(i) who is pregnant; or
``(ii) 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.
``(b) Qualification Standards.--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:
``(1) 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.
``(2) 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).
``(3) 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.
``(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 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.
``(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 during an
eligible individual's pregnancy and the 365-day period
beginning on the last day of such pregnancy. Such methodology
for determining payment--
``(A) may be based on--
``(i) a per-member per-month basis for each eligible
individual enrolled in a 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 proposed by the State
and approved by the Secretary;
``(B) may be adjusted to reflect, with respect to each
eligible individual--
``(i) the severity of the risks associated with the
individual's pregnancy;
``(ii) the severity of the risks associated with the
individual's postpartum health care needs; and
``(iii) the level or amount of time of care coordination
required with respect to the individual; 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 individual who seeks treatment in
the emergency department of such hospital for--
``(A) 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
``(B) 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.
``(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 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
``(ii) educating eligible individuals, 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 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).
``(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 individuals.
``(4) 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 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
[[Page S1401]]
330H or title X of the Public Health Service Act.
``(5) Coordination with grant program for integrated
services for pregnant and postpartum women.--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).
``(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 individual 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 individuals 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 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:
``(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 any
eligible individual who has selected such provider, team of
health care professionals, or health team as the eligible
individual's maternity health home.
``(B) Information on all other applicable measures for
determining the quality of services provided by such
provider, team of health care professionals, or health team.
``(C) 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.
``(D) 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 annually, and in such form and manner determined by
the Secretary to be reasonable and minimally burdensome, the
following information:
``(i) Information described in paragraph (1).
``(ii) 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.
``(iii) The number of maternity health homes in the State
designated under this section.
``(iv) The medical conditions or factors that contribute to
severe maternal morbidity among eligible individuals enrolled
in maternity health homes in the State.
``(v) 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.
``(vi) 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.
``(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 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.
``(h) Rule of Construction.--Nothing in this section shall
be construed to require--
``(1) an eligible individual 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 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.
``(2) Appropriation.--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.
``(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 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.
``(2) Health team.--The term `health team' has the meaning
given such term for purposes of section 3502 of Public Law
111-148.
``(3) 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 that is selected by an
eligible individual to provide pregnancy and postpartum
coordinated care services.
``(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 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) 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.
``(II) Comprehensive care management.
``(III) 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.
``(IV) Comprehensive transitional care, including
appropriate follow-up, from inpatient to other settings.
``(V) Patient and family support (including authorized
representatives).
``(VI) Referrals to community and social support services,
if relevant.
``(VII) Use of health information technology to link
services, as feasible and appropriate.
[[Page S1402]]
``(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,
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;
``(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 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.''.
(b) Applicability to CHIP.--Section 2107(e)(1) of the
Social Security Act (42 U.S.C. 1397gg(e)(1)), as amended by
section 105, is amended by adding at the end the following
new subparagraph:
``(Y) Section 1945B (relating to optional health homes for
pregnant and postpartum individuals).''.
SEC. 203. GUIDANCE ON SUPPORTING AND IMPROVING ACCESS TO
MEDICAID AND CHIP COVERAGE OF SERVICES PROVIDED
BY DOULAS AND CERTAIN MATERNAL HEALTH
PROFESSIONALS.
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 (42
U.S.C. 1396 et seq.) or under a waiver of such plan, and
under a State child health plan under title XXI of such Act
(42 U.S.C. 1397aa et seq.) 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)--
(1) in rural areas;
(2) across a continuum of care; and
(3) among varied provider settings and payment and care
models, including managed care.
SEC. 204. MEDICAID AND CHIP INCREASED FINANCIAL SUPPORT FOR
DEPRESSION AND ANXIETY SCREENING DURING THE
PERINATAL AND POSTPARTUM PERIODS.
(a) Medicaid.--Section 1905 of the Social Security Act (42
U.S.C. 1396d), as amended by section 103, is further
amended--
(1) in the first sentence of subsection (b), by striking
``subsection (a)(4)(D)'' and inserting ``subsections
(a)(4)(D) and (mm)''; and
(2) by adding at the end the following:
``(mm) Increased FMAP for Depression and Anxiety Screening
During the Perinatal and Postpartum Periods.--
``(1) In general.--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--
``(A) during the perinatal period, at least 1 screening for
depression and anxiety symptoms using a standardized,
validated tool; and
``(B) 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.
``(2) Exclusion from territorial caps.--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.''.
(b) CHIP.--Section 2105(c) of the Social Security Act (42
U.S.C. 1397ee(c)) is amended by adding at the end the
following new paragraph:
``(13) Enhanced payment for depression and anxiety
screening during the perinatal and postpartum periods.--
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(mm)(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).''.
(c) Effective Date.--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.
SEC. 205. PRESUMPTIVE ELIGIBILITY FOR PREGNANT INDIVIDUALS.
(a) In General.--
(1) Requirement.--Section 1920(a) of the Social Security
Act (42 U.S.C. 1396r-1(a)) is amended by striking ``may
provide'' and inserting ``shall provide''.
(2) Application.--Section 1920 of the Social Security Act
(42 U.S.C. 1396r-1) is amended by adding at the end the
following new subsection:
``(f) Application.--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.''.
(b) Conforming Amendments.--
(1) Section 1902(a)(47) of the Social Security Act (42
U.S.C. 1396a(a)(47)) is amended to read as follows:
``(47) provide--
``(A)(i) for making ambulatory prenatal care available to
pregnant women during a presumptive eligibility period in
accordance with section 1920; and
``(ii) at the option of the State--
``(I) 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;
``(II) 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
``(III) 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
``(B) 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;''.
(2) Section 1920(e) of the Social Security Act (42 U.S.C.
1396r-1(e)) is amended--
(A) by striking ``If the State has elected the option to
provide a presumptive eligibility period under this section
or section 1920A, the'' and inserting ``The''; and
(B) by striking ``1920A, subject to'' and inserting ``1920A
(if the State has elected the option), subject to''.
(3) Section 2107(e)(1)(U) of the Social Security Act (42
U.S.C. 1397gg(e)(1)(R)) is amended by inserting ``1920
(relating to presumptive eligibility for pregnant women and
section'' before ``1920A''.
(4) Section 2112(c) of the Social Security Act (42 U.S.C.
1397ll(c)) is amended--
(A) in the heading, by striking ``Option To Provide''; and
(B) by striking ``may elect'' and inserting ``shall
elect''.
TITLE III--INVEST IN THE MATERNAL HEALTH CARE WORKFORCE
SEC. 301. EMERGENCY OBSTETRIC WORKFORCE SUPPORT.
(a) In General.--Section 203A of the Public Health Service
Act (42 U.S.C. 204a) is amended--
(1) in subsection (a)--
(A) in paragraph (1), in the matter preceding subparagraph
(A), by inserting ``and urgent maternal health care needs''
after ``public health care needs'';
(B) in paragraph (3), by inserting ``or urgent maternal
health care need'' after ``public health care need'';
(C) in paragraph (5)--
(i) in subparagraph (C), by striking ``or'' at the end;
[[Page S1403]]
(ii) in subparagraph (D), by striking the period at the end
and inserting ``; or''; and
(iii) by adding at the end the following:
``(E) 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.''; and
(D) by adding at the end the following:
``(6) Urgent maternal health care need.--
``(A) In general.--For purposes of this section and section
214, the term `urgent maternal health care need', 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.
``(B) Considerations.--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.'';
(2) in subsection (b)--
(A) in paragraph (1), by inserting ``or urgent maternal
health care needs'' after ``public health care needs''; and
(B) in each of paragraphs (2) and (4)(B), by inserting ``or
urgent maternal health care need'' after ``public health care
need''; and
(3) in subsection (c), by inserting ``or urgent maternal
health care need'' after ``public health care need''.
(b) Detail of Personnel.--Section 214 of the Public Health
Service Act (42 U.S.C. 215) is amended--
(1) by redesignating subsection (e) as subsection (f);
(2) by inserting after subsection (d) the following:
``(e)(1) 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.
``(2)(A) Personnel detailed under paragraph (1) shall be
paid from applicable appropriations of the Service.
``(B) 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.
``(C) 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.
``(3) 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--
``(A) in the case of an imminent closure or a loss of
workers, as determined by the Secretary--
``(i) 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
``(ii) 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;
``(B) 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
``(C) commit to an assessment by the Secretary of the
workplace practices of such eligible entity concerned, if
applicable.
``(4) In this subsection--
``(A) the term `eligible entity' means--
``(i) a State;
``(ii) a political subdivision of a State; or
``(iii) a Tribal, nonprofit, or other health care entity;
and
``(B) the term `personnel' means an employee or officer of
the Commissioned Corps.''; and
(3) in subsection (f) (as so redesignated), by inserting
``or an urgent maternal health care need'' before the period
at the end.
(c) Funding for Commissioned Corps of the Public Health
Service.--Section 203 of the Public Health Service Act (42
U.S.C. 204) is amended by adding at the end the following:
``(e) Operations of the Commissioned Corps of the Public
Health Service.--
``(1) In general.--The Secretary shall carry out duties and
responsibilities relating to the operations of the
Commissioned Corps of the Service, including the following:
``(A) Enhance the processes and systems of the Service's
Headquarters operations.
``(B) 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.
``(C) Recruit and retain qualified professionals suited to
serving underserved and vulnerable communities by--
``(i) improving onboarding timelines, providing officer
placements to align with mission needs, ensuring adequate
officer morale and wellness resources, and incentivizing
recruiters and recruits; and
``(ii) 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.
``(D) Improve deployment processes and prepare mission
teams to execute routine and emergent public health events.
``(E) Establish a legislative liaison office to carry out
legislative affairs functions under the direction of the
Secretary.
``(2) Authorization of appropriations.--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.''.
SEC. 302. STREAMLINED SCREENING AND ENROLLMENT OF PROVIDERS
OF MATERNITY, LABOR, AND DELIVERY SERVICES IN
NEIGHBORING STATES.
(a) Application to Medicaid.--Section 1902(kk) of the
Social Security Act (42 U.S.C. 1396a(kk)) is amended by
adding at the end the following new paragraph:
``(11) Streamlined enrollment process for eligible out-of-
state providers of maternity, labor, and delivery services.--
``(A) In general.--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.
``(B) Eligible out-of-state provider.--In this paragraph,
the term `eligible out-of-State provider' means, with respect
to a State, a provider--
``(i) that furnishes maternity, labor, and delivery
services (as defined in subsection (zz)(1)), or provides
orders or referrals for such services, for which payment is
available under the State plan of the State;
``(ii) that is located in a neighboring State (as defined
by the Secretary);
``(iii) 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);
``(iv) 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
``(v) that has not been excluded from participation in the
Medicare program under such title or the Medicaid program
under this title.''.
(b) Conforming Amendments.--
(1) Section 1902(a)(77) of the Social Security Act (42
U.S.C. 1396a(a)(77)) is amended by inserting ``enrollment,''
after ``screening,''.
(2) Section 1902(kk) of such Act (42 U.S.C. 1396a(kk)), as
amended by subsection (a), is further amended--
(A) in the subsection heading, by inserting ``Enrollment,''
after ``Screening,''; and
(B) in paragraph (9), by striking ``Nothing'' and inserting
``Except as provided in paragraph (10), nothing''.
(c) Application to CHIP.--Section 2107(e)(1)(H) of such Act
(42 U.S.C. 1397gg(e)(1)(G)) is amended by inserting
``enrollment,'' after ``screening,''.
(d) Guidance on Screening and Enrolling Out-of-State
Providers of Maternity, Labor, and Delivery Services.--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 (42 U.S.C. 1396a(kk)) and section
2107(e)(1)(H) of such Act (42 U.S.C. 1397gg(e)(1)(G)) (as
added and amended by this section) and including best
practices for screening and enrolling out-of-State providers
in managed care plans.
(e) Effective Date.--The amendments made by this section
take effect on January 1, 2028.
TITLE IV--REQUIRING PUBLIC COMMUNICATION OF OBSTETRICS DATA AND UNIT
CLOSURES
SEC. 401. TIMELY NOTIFICATIONS OF IMPENDING HOSPITAL
OBSTETRIC UNIT CLOSURES.
(a) In General.--Section 1866(a)(1) of the Social Security
Act (42 U.S.C. 1395cc(a)(1)) is amended--
[[Page S1404]]
(1) in subparagraph (X), by striking ``and'' at the end;
(2) in subparagraph (Y)(ii)(V), by striking the period and
inserting ``, and''; and
(3) by inserting after subparagraph (Y) the following new
subparagraph:
``(Z) 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--
``(i) 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;
``(ii) steps the hospital will take to identify other
health care providers that can alleviate any service gaps as
a result of the closure;
``(iii) the cause of the closure of such obstetric unit;
``(iv) data regarding historic transportation costs related
to obstetric services in such community; and
``(v) any additional information as may be required by the
Secretary.''.
(b) State Requirement To Post Reports.--Section 1902(a) of
the Social Security Act (42 U.S.C. 1396a(a)), as amended by
section 201(a)(1), is further amended--
(1) in paragraph (90), by striking ``and'' at the end;
(2) in paragraph (91), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (91) the following new
paragraph:
``(92) 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).''; and
SEC. 402. COLLECTION OF DATA RELATING TO HOSPITAL LABOR AND
DELIVERY SERVICES.
Section 1866(a)(1) of the Social Security Act (42 U.S.C.
1395cc(a)(1)), as amended by section 401, is amended--
(1) in subparagraph (Y)(ii)(V), by striking ``and'' at the
end;
(2) in subparagraph (Z), by striking the period and
inserting ``, and''; and
(3) by adding at the end the following new subparagraph:
``(AA) 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--
``(i) the number of births that occurred at such hospital
during the cost reporting period, delineated by the number of
cesarean births and vaginal births;
``(ii) the number of antenatal and postpartum transfers
from the hospital to other hospitals;
``(iii) data on the number and characteristics of the staff
providing labor and delivery services at such hospital;
``(iv) the expenses the hospital incurred for providing
labor and delivery services at such hospital, including
nursing care, anesthesia, and operating room services;
``(v) the amount the hospital spent for on-call coverage
for labor and delivery services by physicians and midwives;
and
``(vi) the amount and sources of revenue received by such
hospital for labor and delivery services, including payments
received for--
``(I) items and services furnished to individuals eligible
for coverage under a State plan under title XIX (or a waiver
of such a plan);
``(II) items and services furnished to individuals with
other forms of health insurance or third-party coverage; and
``(III) items and services furnished to individuals without
health insurance or other source of third party coverage.''.
______