119-hr3365

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3365 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3365

 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 HOUSE OF REPRESENTATIVES

 May 13, 2025

 Mr. Nunn of Iowa (for himself, Ms. Pressley, and Ms. Underwood) 
 introduced the following bill; which was referred to the Committee on 
 Energy and Commerce

_______________________________________________________________________

 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 2025'' or the ``HEALTH for 
MOM Act of 2025''.

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 2 years after the date 
 of the enactment of this section, a State, at its option as a 
 State plan amendment and after consultation with health care 
 providers and individuals enrolled under such plan who are or 
 have been pregnant, 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, oral health 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, community-
 based providers, behavioral health providers, social service 
 providers, local hospital and emergency care providers, oral 
 health providers, specialists, and providers of early 
 intervention services to ensure full implementation of the 
 client's care plan, 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 4 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 with 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, the Special Supplemental Nutrition Program 
 for Women, Infants, and Children, or under title V.
 ``

    (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 womens 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, 
 perinatal, and child 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.
 ``
            (vii) The type of delivery systems and 
 payment models used to provide health home 
 services to eligible individuals enrolled in a 
 maternal health home under such amendment.
 ``
            (viii) Information on hospitalizations, 
 morbidity, and mortality of eligible 
 individuals and their infants enrolled in a 
 maternal health home in such State alongside 
 comparable data from a State's maternal 
 mortality review committee.
 ``
        (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, 2025, 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 2-year period 
 beginning on the date of the enactment of this section, 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, 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, specialists, and 
 providers of early intervention 
 services, 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 
 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, or provide care at the home of an 
 individual with respect to a home birth.''.
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