119-hr3942

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3942 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3942

 To amend titles XIX and XXI of the Social Security Act to enhance 
 financial support for rural and safety net hospitals providing 
maternity, labor, and delivery services to vulnerable populations, and 
 for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 12, 2025

 Ms. Bonamici (for herself and Ms. Kelly of Illinois) introduced the 
 following bill; which was referred to the Committee on Energy and 
 Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
 committee concerned

_______________________________________________________________________

 A BILL

 To amend titles XIX and XXI of the Social Security Act to enhance 
 financial support for rural and safety net hospitals providing 
maternity, labor, and delivery services to vulnerable populations, 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; 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);
            (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

    (uu) ) furnished 
 during such fiscal year in an eligible hospital (as 
 defined in such subsection) at a rate that is not less 
 than the minimum payment rate specified for the fiscal 
 year in paragraph

    (4) of such subsection;''; and

    (2) by adding at the end the following new subsection:
 ``

    (uu) 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 1905

    (uu) )''.

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

    (kk) ''; and

    (2) by adding at the end the following new subsection:
 ``

    (kk) 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

    (uu) ) 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.--
 ``
            (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

    (uu) ) in 
 such fiscal quarter that is attributable to the 
 amount by which the minimum payment rate 
 required under 

section 1902

    (a)

    (13)
            (D) (or, by 
 application, 

section 1932

    (f) ) exceeds the base 
 payment rate applicable to such services, as 
 determined for the State, quarter, and services 
 under clause
            (ii) .
 ``
            (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

    (uu) ) 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

    (uu) ) 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

    (uu)

    (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 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
        (U) as 
 subparagraphs
            (C) through
            (V) , respectively; and

    (2) by inserting after subparagraph
        (A) the following new 
 subparagraph:
 ``
        (B) Section 1902

    (a)

    (13)
            (D) and 

section 1905

    (kk) (relating to the minimum payment rate required for 
 maternity, labor, and delivery services furnished by an 
 eligible hospital and Federal financial participation 
 for State expenditures for such services).''.

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

    (86) , by striking ``and'' at the 
 end;
            (C) in paragraph

    (87) , by striking the period at 
 the end and inserting ``; and''; and
            (D) by inserting after paragraph

    (87) the following 
 new paragraph:
 ``

    (88) 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
        (K) 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:
 ``
        (K) 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.

    (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
        (K) 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 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.
 ``

    (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:
 ``
        (W) 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
            (ll) ''; and

    (2) by adding at the end the following:
 ``
            (ll) 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
            (ll) (1) that are provided 
 under the plan (or waiver) to an individual who is eligible for 
 such assistance on the basis of being pregnant (including 
 pregnancy-related assistance provided to a targeted low-income 
 pregnant woman (as defined in 

section 2112
            (d) ), pregnancy-
 related assistance provided to an individual who is eligible 
 for such assistance through application of 

section 1903
            (v) (4)
        (A)
            (i) under 

section 2107

    (e)

    (1) , or any other 
 assistance under the plan (or waiver) provided to an individual 
 who is eligible for such assistance on the basis of being 
 pregnant) and during the 12-month period that begins on the 
 last day of the individual's pregnancy and ends on the last day 
 of the month in which such 12-month period ends (including any 
 such assistance provided during the month in which such period 
 ends).''.
            (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)
        (R) 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;
            (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:
 ``

    (10) 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

    (uu)

    (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)
        (G) 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)
        (G) 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--

    (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

    (87) , by striking ``and'' at the end;

    (2) in paragraph

    (88) , by striking the period at the end 
 and inserting ``; and''; and

    (3) by inserting after paragraph

    (88) the following new 
 paragraph:
 ``

    (89) 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.''.
 <all>