119-s2289

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2289 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2289

 To amend titles XIX and XXI of the Social Security Act to improve 
 maternal health coverage under Medicaid and CHIP, and for other 
 purposes.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 July 15, 2025

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

_______________________________________________________________________

 A BILL

 To amend titles XIX and XXI of the Social Security Act to improve 
 maternal health coverage under Medicaid and CHIP, 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 ``Healthy Moms and 
Babies Act''.

    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

Sec. 2. Definitions.

Sec. 3. Mandatory reporting by State Medicaid programs on adult health 
 care quality measures of maternal and 
 perinatal health.

Sec. 4. Medicaid quality improvement initiatives to reduce rates of 
 cesarean sections; Medicare requirement for 
 hospitals to report on data on cesarean 
 births.

Sec. 5. State option to provide coordinated care through a health home 
 for pregnant and postpartum women.

Sec. 6. Guidance on care coordination to support maternal health.

Sec. 7. National reskilling of the maternity care workforce.

Sec. 8. MACPAC study on doulas and community health workers; guidance 
 on increasing access to doula services 
 under Medicaid.

Sec. 9. Demonstration projects to improve the delivery of maternal 
 health care through telehealth.

Sec. 10. CMS report on coverage of remote physiologic monitoring 
 devices and impact on maternal and child 
 health outcomes under Medicaid.

Sec. 11. Guidance on community-based maternal health programs.

Sec. 12. Developing guidance on maternal mortality and severe morbidity 
 reduction for maternal care providers 
 receiving payment under the Medicaid 
 program.

Sec. 13. Program related to reducing cesarean births and increasing 
 rates of vaginal birth after cesarean.

Sec. 14. Collection of information related to social determinants of 
 the health of Medicaid and CHIP 
 beneficiaries.

Sec. 15. Report on payment methodologies for transferring pregnant 
 women between facilities before, during, 
 and after childbirth.

Sec. 16. Medicaid guidance on State options to address social 
 determinants of health for pregnant and 
 postpartum women.

Sec. 17. Payment error rate measurement

    (PERM) audit and improvement 
 requirements.

SEC. 2. DEFINITIONS.

 In this Act:

    (1) CHIP.--The term ``CHIP'' means the Children's Health 
 Insurance Program established under title XXI of the Social 
 Security Act (42 U.S.C. 1397aa et seq.).

    (2) Comptroller general.--The term ``Comptroller General'' 
 means the Comptroller General of the United States.

    (3) Group health plan; health insurance issuer, etc.--The 
 terms ``group health plan'', ``health insurance coverage'', 
 ``health insurance issuer'', ``group health insurance 
 coverage'', and ``individual health insurance coverage'' have 
 the meanings given such terms in 

section 2791 of the Public 
 Health Service Act (42 U.S.C. 300gg-91).

    (4) Medicaid.--The term ``Medicaid'' means the Medicaid 
 program established under title XIX of the Social Security Act 
 (42 U.S.C. 1396 et seq.).

    (5) Medicaid managed care organization.--The term 
 ``medicaid managed care organization'' has the meaning given 
 that term in 

section 1903
            (m) (1)
        (A) of the Social Security Act 
 (42 U.S.C. 1396b
            (m) (1)
        (A) ).

    (6) Secretary.--The term ``Secretary'' means the Secretary 
 of Health and Human Services.

    (7) State.--The term ``State'' has the meaning given that 
 term for purposes of titles V, XIX, and XXI of the Social 
 Security Act (42 U.S.C. 701 et seq., 1396 et seq., 1397aa et 
 seq.).

SEC. 3. MANDATORY REPORTING BY STATE MEDICAID PROGRAMS ON ADULT HEALTH 
 CARE QUALITY MEASURES OF MATERNAL AND PERINATAL HEALTH.

 

Section 1139B of the Social Security Act (42 U.S.C. 1320b-9b) is 
amended--

    (1) in subsection

    (b) --
        (A) in paragraph

    (3)
        (B) --
            (i) in the subparagraph heading, by 
 inserting ``and maternal and perinatal health'' 
 after ``behavioral health'';
            (ii) by striking ``all behavioral health'' 
 and inserting ``all behavioral health and 
 maternal and perinatal health''; and
            (iii) by inserting ``and of maternal and 
 perinatal health care for Medicaid eligible 
 adults'' after ``Medicaid eligible adults''; 
 and
        (B) in paragraph

    (5)
            (C) --
            (i) in the subparagraph heading, by 
 inserting ``and maternal and perinatal health'' 
 after ``behavioral health''; and
            (ii) by inserting ``and, with respect to 
 Medicaid eligible adults, maternal and 
 perinatal health measures'' after ``behavioral 
 health measures''; and

    (2) in subsection
            (d) (1)
        (A) , by inserting ``and maternal 
 and perinatal health'' after ``behavioral health''.

SEC. 4. MEDICAID QUALITY IMPROVEMENT INITIATIVES TO REDUCE RATES OF 
 CESAREAN SECTIONS; MEDICARE REQUIREMENT FOR HOSPITALS TO 
 REPORT ON DATA ON CESAREAN BIRTHS.

    (a) Medicaid State Plan Amendment.--

Section 1902

    (a) of the Social 
Security Act (42 U.S.C. 1396a

    (a) ) is amended--

    (1) in paragraph

    (86) , by striking ``and'' after the 
 semicolon;

    (2) in paragraph

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

    (3) by inserting after paragraph

    (87) the following:
 ``

    (88) provide that, not later than January 1, 2027, and 
 annually thereafter through January 1, 2037, the State shall 
 submit a report to the Secretary, that shall be made publicly 
 available, which contains with respect to the preceding 
 calendar year--
 ``
        (A) the rate of low-risk cesarean delivery, as 
 defined by the Secretary in consultation with relevant 
 stakeholders, for pregnant women eligible for medical 
 assistance under the State plan or a waiver of such 
 plan in the State, as compared to the overall rate of 
 cesarean delivery in the State;
 ``
        (B) a description of the State's quality 
 improvement activities to safely reduce the rate of 
 low-risk cesarean delivery (as so defined) for pregnant 
 women eligible for medical assistance under the State 
 plan or a waiver of such plan in the State reported 
 under subparagraph
        (A) , including initiatives aimed at 
 reducing racial and ethnic health disparities, 
 hospital-level quality improvement initiatives, taking 
 into account hospital type and the patient population 
 served, and, if applicable, partnerships with State or 
 regional perinatal quality collaboratives;
 ``
            (C) for each report submitted after January 1, 
 2027, the percentage change (if any) in the rate of 
 low-risk cesarean delivery (as so defined) for pregnant 
 women eligible for medical assistance under the State 
 plan or a waiver of such plan in the State reported 
 under subparagraph
        (A) from the rate reported for the 
 most recent previous report; and
 ``
            (D) such other relevant data and information as 
 determined by the Secretary, and in consultation with 
 relevant stakeholders, such as State initiatives and 
 evaluations of quality improvement activities, cesarean 
 delivery rates, and health outcomes.''.

    (b) GAO Study Regarding Medicaid Payment Rates Cesarean Births.--

    (1) Study.--The Comptroller General shall conduct a study 
 regarding payment rates for cesarean births and vaginal births 
 under State Medicaid programs. To the extent feasible and data 
 are available, the study shall include analyses of the 
 following:
        (A) Payment rates for cesarean births and vaginal 
 births paid by fee-for-service Medicaid programs and by 
 Medicaid programs that contract with Medicaid managed 
 care organizations to furnish medical assistance under 
 such programs;
        (B) What is known about how Medicaid payment rates 
 have changed over time;
            (C) What is known about how payment rates for 
 cesarean and vaginal births by Medicaid programs 
 compare with the payment rates for such births by other 
 sources of insurance coverage; and
            (D) Such other factors related to payment rates for 
 cesarean and vaginal births under Medicaid as the 
 Comptroller General determines appropriate.

    (2) Report.--Not later than 18 months after the date of 
 enactment of this Act, the Comptroller General shall submit to 
 Congress a report containing the results of the study conducted 
 under paragraph

    (1) , together with recommendations for such 
 legislation and administrative action as the Comptroller 
 General determines appropriate.
            (c) GAO Study on Racial Disparities in Cesarean Births.--

    (1) In general.--The Comptroller General shall conduct a 
 study on racial disparities in the frequency of cesarean 
 births. To the extent feasible and data are available, the 
 study shall compare such information on low- and high-risk 
 cesarean births, differences by payer (such as Medicaid and 
 private payers), and hospital characteristics (such as location 
 or hospital type). Such study may consider other factors 
 related to racial disparities in maternal health as the 
 Comptroller General deems appropriate.

    (2) Report.--Not later than 2 years after the date of 
 enactment of this Act, the Comptroller General shall submit to 
 Congress a report containing the results of the study conducted 
 under paragraph

    (1) , together with recommendations for such 
 legislation and administrative action as the Comptroller 
 General determines appropriate.
            (d) Medicare Requirement for Hospitals To Report Data on Cesarean 
Births.--

    (1) Requirement.--

Section 1866

    (a)

    (1) of the Social Security 
 Act (42 U.S.C. 1395cc

    (a)

    (1) ) is amended--
        (A) by moving the indentation of subparagraph
        (W) 2 
 ems to the left;
        (B) in subparagraph
            (X) --
            (i) by moving the indentation 2 ems to the 
 left; and
            (ii) by striking ``and'' at the end;
            (C) in subparagraph
        (Y) , by striking the period at 
 the end and inserting ``; and''; and
            (D) by inserting after subparagraph
        (Y) the 
 following new subparagraph:
 ``
        (Z) in the case of a hospital, to submit, in a form and 
 manner, and at a time, specified by the Secretary, data on the 
 Nulliparous, Term, Singleton, Vertex Cesarean section (NTSV C-
 section) rate with respect to the hospital for the preceding 
 year.''.

    (2) Incorporation into hospital quality reporting.--

Section 1886

    (b)

    (3)
        (B)
            (viii) of the Social Security Act (42 U.S.C. 
 1395ww

    (b)

    (3)
        (B)
            (viii) ) is amended by adding at the end the 
 following new subclause:
 ``
            (XIII) Effective for payments beginning with fiscal year 2027, in 
expanding the number of measures under subclause
            (III) , the Secretary 
shall adopt a measure relating to the Nulliparous, Term, Singleton, 
Vertex Cesarean section (NTSV C-section) rate for hospitals in 
inpatient settings. Not later than 2027, the Secretary shall 
incorporate such measure into the designation of maternity care quality 
hospitals, as described in the final rule entitled `Medicare Program; 
Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals 
and the Long Term Care Hospital Prospective Payment System and Policy 
Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare 
Promoting Interoperability Program Requirements for Eligible Hospitals 
and Critical Access Hospitals; Costs Incurred for Qualified and Non-
Qualified Deferred Compensation Plans; and Changes to Hospital and 
Critical Access Hospital Conditions of Participation' (87 Fed. Reg. 
48780 (August 10, 2022)).''.

SEC. 5. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH HOME 
 FOR PREGNANT AND POSTPARTUM WOMEN.

 Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by inserting after 

section 1945A the following new section:

``

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

 ``

    (a) State Option.--
 ``

    (1) In general.--Notwithstanding 

section 1902

    (a)

    (1) (relating to statewideness) and 

section 1902

    (a)

    (10)
        (B) (relating to comparability), beginning April 1, 2028, a State, 
 at its option as a State plan amendment, may provide for 
 medical assistance under this title to an eligible woman who 
 chooses to--
 ``
        (A) enroll in a maternity health home under this 
 section by selecting a designated provider, a team of 
 health care professionals operating with such a 
 provider, or a health team as the woman's maternity 
 health home for purposes of providing the woman with 
 pregnancy and postpartum coordinated care services; or
 ``
        (B) receive such services from a designated 
 provider, a team of health care professionals operating 
 with such a provider, or a health team that has 
 voluntarily opted to participate in a maternity health 
 home for eligible women under this section.
 ``

    (2) Eligible woman defined.--In this section, the term 
 `eligible woman' 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 
 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
 ``
        (B) who--
 ``
            (i) is pregnant; or
 ``
            (ii) had a pregnancy end within the last 
 365 days.
 ``

    (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. 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 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 necessary 
 maternity care services, including services provided by 
 specialists, and programs for an eligible woman during her 
 pregnancy and the 365-day period beginning on the last day of 
 her pregnancy.
 ``

    (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, 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 woman losing eligibility for medical assistance under 
 the State plan or waiver, care management and planning related 
 to a change in the eligible woman'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 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) .
 ``

    (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 woman's pregnancy and the 365-day period beginning on 
 the last day of her pregnancy. Such methodology for determining 
 payment--
 ``
        (A) may be based on--
 ``
            (i) a per-member per-month basis for each 
 eligible woman enrolled in the maternity health 
 home;
 ``
            (ii) a prospective payment model, in the 
 case of payments to Federally qualified health 
 centers or a rural health clinics; or
 ``
            (iii) an alternate model of payment 
 (which may include a model developed under a 
 waiver under 

section 1115) proposed by the 
 State and approved by the Secretary;
 ``
        (B) may be adjusted to reflect, with respect to 
 each eligible woman--
 ``
            (i) the severity of the risks associated 
 with the woman's pregnancy;
 ``
            (ii) the severity of the risks associated 
 with the woman's postpartum health care needs; 
 and
 ``
            (iii) the level or amount of time of care 
 coordination required with respect to the 
 woman; and
 ``
            (C) shall be established consistent with 

section 1902

    (a)

    (30)
        (A) .
 ``
            (d) Coordinating Care.--
 ``

    (1) Hospital notification.--A State with a State plan 
 amendment approved under this section shall require each 
 hospital that is a participating provider under the State plan 
 (or under a waiver of such plan) to establish procedures in the 
 case of an eligible woman who seeks treatment in the emergency 
 department of such hospital for--
 ``
        (A) providing the woman with culturally and 
 linguistically appropriate information on the 
 respective treatment models and opportunities for the 
 woman to access a maternity health home and its 
 associated benefits; and
 ``
        (B) notifying the maternity health home in which 
 the woman is enrolled, or the designated provider, team 
 of health care professionals operating with such a 
 provider, or health team treating the woman, of the 
 woman's treatment in the emergency department and of 
 the protocols for the maternity health home, designated 
 provider, or team to be involved in the woman's 
 emergency care or post-discharge care.
 ``

    (2) Education with respect to availability of a maternity 
 health home.--
 ``
        (A) In general.--In order for a State plan 
 amendment to be approved under this section, a State 
 shall include in the State plan amendment a description 
 of the State's process for--
 ``
            (i) educating providers participating in 
 the State plan (or a waiver of such plan) on 
 the availability of maternity health homes for 
 eligible women, including the process by which 
 such providers can participate in or refer 
 eligible women to an approved maternity health 
 home or a designated provider, team of health 
 care professionals operating such a provider, 
 or health team; and
 ``
            (ii) educating eligible women, in a 
 culturally and linguistically appropriate 
 manner, on the availability of maternity health 
 homes.
 ``
        (B) Outreach.--The process established by the 
 State under subparagraph
        (A) shall include the 
 participation of 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 women.
 ``

    (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 women 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.
 ``

    (e) Monitoring.--A State shall include in the State plan 
amendment--
 ``

    (1) a methodology for tracking reductions in inpatient 
 days and reductions in the total cost of care resulting from 
 improved care coordination and management under this section;
 ``

    (2) a proposal for use of health information technology 
 in providing an eligible woman with pregnancy and postpartum 
 coordinated care services as specified under this section and 
 improving service delivery and coordination across the care 
 continuum; and
 ``

    (3) a methodology for tracking prompt and timely access 
 to medically necessary care for eligible women from out-of-
 State providers.
 ``

    (f) Data Collection.--
 ``

    (1) Provider reporting requirements.--In order to receive 
 payments from a State under subsection
            (c) , a maternity health 
 home, or a designated provider, a team of health care 
 professionals operating with such a provider, or a health team, 
 shall report to the State, at such time and in such form and 
 manner as may be required by the State, including through a 
 health information exchange or other public health data sharing 
 entity, the following information:
 ``
        (A) With respect to each such designated 
 provider, team of health care professionals operating 
 with such a provider, and health team (designated as a 
 maternity health home), the name, National Provider 
 Identification number, address, and specific health 
 care services offered to be provided to eligible women 
 who have selected such provider, team of health care 
 professionals, or health team as the women's maternity 
 health home.
 ``
        (B) Information on measures from the core sets of 
 child health quality measures and adult health quality 
 measures under sections 1139A and 1139B that are 
 identified by the Secretary as being relevant to 
 maternal, perinatal, or infant health.
 ``
            (C) Information on all other applicable measures 
 for determining the quality of services provided by 
 such provider, team of health care professionals, or 
 health team.
 ``
            (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 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 conditions or factors 
 that contribute to severe maternal morbidity 
 among eligible women enrolled in maternity 
 health homes in the State.
 ``
            (v) The extent to which such women 
 receive health care items and services under 
 the State plan before, during, and after the 
 women's enrollment in such a maternity health 
 home.
 ``
            (vi) Where applicable, mortality data and 
 data for the associated causes of death for 
 eligible women enrolled in a maternity health 
 home under this section, in accordance with 
 subsection

    (g) . For deaths occurring 
 postpartum, such data shall distinguish between 
 deaths occurring up to 42 days postpartum and 
 deaths occurring between 43 days to up to 1 
 year postpartum. Where applicable, data 
 reported under this clause shall be reported 
 alongside comparable data from a State's 
 maternal mortality review committee, as 
 established in accordance with 

section 317K
            (d) of the Public Health Service Act, for purposes 
 of further identifying and comparing statewide 
 trends in maternal mortality among populations 
 participating in the maternity health home 
 under this section.
 ``
        (B) Implementation report.--Not later than 18 
 months after a State has a State plan amendment 
 approved under this section, the State shall submit to 
 the Secretary, and make publicly available on the 
 appropriate State website, a report on how the State is 
 implementing the option established under this section, 
 including through any best practices adopted by the 
 State.
 ``

    (g) Confidentiality.--A State with a State plan amendment under 
this section shall establish confidentiality protections for the 
purposes of subsection

    (f)

    (2)
        (A) to ensure, at a minimum, that there is 
no disclosure by the State of any identifying information about any 
specific eligible woman enrolled in a maternity health home or any 
maternal mortality case, and that all relevant confidentiality and 
privacy protections, including the requirements under 1902

    (a)

    (7)
        (A) , 
are maintained.
 ``

    (h) Rule of Construction.--Nothing in this section shall be 
construed to require--
 ``

    (1) an eligible woman to enroll in a maternity health 
 home under this section; or
 ``

    (2) a designated provider or health team to act as a 
 maternity health home and provide services in accordance with 
 this section if the provider or health team does not 
 voluntarily agree to act as a maternity health home.
 ``
            (i) Planning Grants.--
 ``

    (1) In general.--Beginning October 1, 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, but the Secretary may determine 
 the amount of the grant based on the merits of the application 
 and the goal of the State to prioritize health outcomes for 
 eligible women. A planning grant awarded to a State under this 
 subsection shall remain available until expended.
 ``

    (2) Appropriation.--There are authorized to be 
 appropriated to the Secretary $50,000,000 for the period of 
 fiscal years 2026 through 2028, for the purposes of making 
 grants under this subsection, to remain available until 
 expended.
 ``

    (3) Limitation.--The total amount of payments made to 
 States under this subsection shall not exceed $50,000,000.
 ``

    (j) Additional 

=== Definitions. ===
-In this section:
 ``

    (1) Designated provider.--The term `designated provider' 
 means a physician (including an obstetrician-gynecologist), 
 hospital, clinical practice or clinical group practice, a 
 medicaid managed care organization, as defined in 

section 1903
            (m) (1)
        (A) , a prepaid inpatient health plan, as defined in 
 

section 438.2 of title 42, Code of Federal Regulations (or any 
 successor regulation), a prepaid ambulatory health plan, as 
 defined in such section (or any successor regulation), rural 
 clinic, community health center, community mental health 
 center, or any other entity or provider that is determined by 
 the State and approved by the Secretary to be qualified to be a 
 maternity health home on the basis of documentation evidencing 
 that the entity has the systems, expertise, and infrastructure 
 in place to provide pregnancy and postpartum coordinated care 
 services. Such term may include providers who are employed by, 
 or affiliated with, a hospital.
 ``

    (2) Maternity health home.--The term `maternity health 
 home' means a designated provider (including a provider that 
 operates in coordination with a team of health care 
 professionals) or a health team is selected by an eligible 
 woman to provide pregnancy and postpartum coordinated care 
 services.
 ``

    (3) Health team.--The term `health team' has the meaning 
 given such term for purposes of 

section 3502 of Public Law 111-
 148.
 ``

    (4) Pregnancy and postpartum coordinated care services.--
 ``
        (A) In general.--The term `pregnancy and 
 postpartum coordinated care services' means items and 
 services related to the coordination of care for 
 comprehensive and timely high-quality, culturally and 
 linguistically appropriate, services described in 
 subparagraph
        (B) that are provided 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 a woman during the woman's 
 pregnancy and the 1-year period 
 beginning on the last day of her 
 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, pediatricians, and other 
 professionals such as physicians assistants, 
 advance practice nurses, including certified 
 nurse midwives, nurses, nurse care 
 coordinators, dietitians, nutritionists, social 
 workers, behavioral health professionals, 
 physical counselors, physical therapists, 
 occupational therapists, or any professionals 
 that assist in prenatal care, delivery, or 
 postpartum care for which medical assistance is 
 available under the State plan or a waiver of 
 such plan and determined to be appropriate by 
 the State and approved by the Secretary;
 ``
            (ii) an entity or individual who is 
 designated to coordinate such care delivered by 
 the team; and
 ``
            (iii) when appropriate and if otherwise 
 eligible to furnish items and services that are 
 reimbursable as medical assistance under the 
 State plan or under a waiver of such plan, 
 doulas, community health workers, translators 
 and interpreters, and other individuals with 
 culturally appropriate and trauma-informed 
 expertise; and
 ``
        (B) provide care at a facility that is 
 freestanding, virtual, or based at a hospital, 
 community health center, community mental health 
 center, rural clinic, clinical practice or clinical 
 group practice, academic health center, or any entity 
 determined to be appropriate by the State and approved 
 by the Secretary.''.

SEC. 6. GUIDANCE ON CARE COORDINATION TO SUPPORT MATERNAL HEALTH.

 Not later than 2 years after the date of enactment of this Act, the 
Secretary shall issue guidance for State Medicaid programs on improved 
care coordination, continuity of care, and clinical integration to 
support the needs of pregnant and postpartum women for services 
eligible for Medicaid payment. Such guidance shall identify best 
practices for care coordination for such women, both with respect to 
fee-for-service State Medicaid programs and State Medicaid programs 
that contract with Medicaid managed care organizations or other 
specified entities to furnish medical assistance for such women, and 
shall illustrate strategies for--

    (1) enhancing primary care and maternity care coordination 
 with specialists, including cardiologists, specialists in 
 gestational diabetes, dentists, lactation specialists, genetic 
 counselors, and behavioral health providers;

    (2) integrating behavioral health providers to provide 
 screening, assessment, treatment, and referral for behavioral 
 health needs, including substance use disorders, maternal 
 depression, anxiety, intimate partner violence, and other 
 trauma;

    (3) integrating into care teams or coordinating with 
 nonclinical professionals, including (if licensed or 
 credentialed by a State or State-authorized organization) 
 doulas, peer support specialists, and community health workers, 
 and how these services provided by such professionals may be 
 eligible for Federal financial participation under Medicaid;

    (4) screening pregnant and postpartum women for social 
 needs and coordinating related services during the prenatal and 
 postpartum periods to ensure social and physical supports are 
 provided for such women during such periods and for their 
 children;

    (5) supporting women who have had a stillbirth;

    (6) screening for maternal health, behavioral health, and 
 social needs during well-child and pediatric care visits; and

    (7) streamlining and reducing duplication in care 
 coordination efforts across and among providers, plans, and 
 other entities for such women.

SEC. 7. NATIONAL RESKILLING OF THE MATERNITY CARE WORKFORCE.

 Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after 

section 317L-1 the following:

``

SEC. 317L-2. NATIONAL RESKILLING OF THE MATERNITY CARE WORKFORCE.

 ``

    (a) Establishment of National Expert Group.--
 ``

    (1) In general.--The Secretary shall establish a national 
 expert group to evaluate national education on, and practice 
 of, best birthing practices.
 ``

    (2) Members.--
 ``
        (A) In general.--The group established under 
 paragraph

    (1) shall be composed of such members as the 
 Secretary appoints, including--
 ``
            (i) obstetricians and gynecologists, 
 family medicine physicians, midwifes, and 
 nursing leaders;
 ``
            (ii) hospital administrators;
 ``
            (iii) graduate medical education leaders;
 ``
            (iv) doula leaders;
 ``
            (v) individuals with experience in 
 community birth settings;
 ``
            (vi) patients;
 ``
            (vii) high-risk birth experts; and
 ``
            (viii) quality improvement leaders.
 ``
        (B) Geographic diversity.--In appointing members 
 under subparagraph
        (A) , the Secretary shall ensure a 
 balance of members representing rural areas and members 
 representing urban areas.
 ``

    (b) Duties.--The group established under subsection

    (a) shall--
 ``

    (1) examine evidence, trends, and differential use or 
 access by income, geographic area, and race and ethnicity 
 associated with birthing practices that include--
 ``
        (A) cesarean sections, repeat cesarean, and 
 vaginal birth after cesarean;
 ``
        (B) electronic fetal monitoring and intermittent 
 auscultation;
 ``
            (C) birth positions, including upright 
 positioning and ambulation;
 ``
            (D) labor with doula support;
 ``
        (E) evaluating indications for cesarean delivery, 
 including cervical dilation and duration of pushing;
 ``
        (F) operative vaginal deliveries;
 ``
        (G) manual fetal rotation;
 ``
        (H) amnioinfusion and scalp stimulation; and
 ``
            (I) cervical ripening methods;
 ``

    (2) assess the role of the culture of care, maternity 
 care financing, and health education with respect to the trends 
 under paragraph

    (1) ; and
 ``

    (3) identify case studies of the provision of exemplary 
 birthing care.
 ``
            (c) Recommendations.--The group established under subsection

    (a) shall, not later than 1 year after such establishment, issue--
 ``

    (1) best practices for--
 ``
        (A) evaluating birthing skills;
 ``
        (B) improving curricula for health professionals 
 engaged in birthing; and
 ``
            (C) the incorporation of midwives and doulas into 
 residency curricula for obstetricians; and
 ``

    (2) recommendations for policies and practices to improve 
 maternity care overall.''.

SEC. 8. MACPAC STUDY ON DOULAS AND COMMUNITY HEALTH WORKERS; GUIDANCE 
 ON INCREASING ACCESS TO DOULA SERVICES UNDER MEDICAID.

    (a) MACPAC Study on Doulas and Community Health Workers.--

    (1) In general.--As part of the first report required under 
 

section 1900

    (b)

    (1) of the Social Security Act (42 U.S.C. 
 1396

    (b)

    (1) ) after the date that is 1 year after the date of 
 enactment of this Act, the Medicaid and CHIP Payment and Access 
 Commission (referred to in this section as ``MACPAC'') shall 
 include with such report a report on the coverage of doula 
 services and the role of community health workers under State 
 Medicaid programs, which shall include the following:
        (A) Information about coverage for doula services 
 and community health worker services under State 
 Medicaid programs that currently provide coverage for 
 such services, including the type of doula services 
 offered (such as prenatal, labor and delivery, 
 postpartum support, and traditional doula services) and 
 information on the prevalence of doulas that care for 
 individuals in their own communities.
        (B) An analysis of strategies to facilitate the 
 appropriate use of doula services in order to provide 
 better care and achieve better maternal and infant 
 health outcomes, including strategies that States may 
 use to assist with services for which Federal financial 
 participation is eligible under a State Medicaid plan 
 or a waiver of such a plan by recruiting, training, and 
 certifying a diverse doula workforce, particularly from 
 underserved communities, communities of color, and 
 communities facing linguistic or cultural barriers.
            (C) Provide examples of community health worker 
 access in State Medicaid programs and strategies 
 employed by States to encourage a broad care team to 
 manage Medicaid patients.
            (D) An assessment of the impact of the involvement 
 of doulas and community health workers on maternal 
 health outcomes.
        (E) Recommendations, as MACPAC deems appropriate, 
 for legislative and administrative actions to increase 
 access to services that improve maternal health.

    (2) Stakeholder consultation.--In developing the report 
 required under paragraph

    (1) , MACPAC shall consult with 
 relevant stakeholders.

    (b) Guidance on Increasing Access to Doula Services Under 
Medicaid.--

    (1) In general.--Not later than 1 year after the date that 
 MACPAC publishes the report required under subsection

    (a) , the 
 Secretary shall issue guidance to States on increasing access 
 to doula services under Medicaid. Such guidance shall at a 
 minimum include--
        (A) options for States to provide medical 
 assistance for doula services under State Medicaid 
 programs;
        (B) best practices for ensuring that doulas, 
 including community-based doulas, receive reimbursement 
 for doula services provided under a State Medicaid 
 program, at a level that allows doulas to earn a living 
 wage that accounts for their time and costs associated 
 with providing care and community-based doula program 
 administration; and
            (C) best practices for increasing access to doula 
 services, including services provided by community-
 based doulas, under State Medicaid programs.

    (2) Stakeholder consultation.--In developing the report 
 required under paragraph

    (1) , the Secretary shall consult with 
 relevant stakeholders.
            (c) Relevant Stakeholders.--For purposes of subsections

    (a)

    (2) and

    (b)

    (2) , relevant stakeholders shall include--

    (1) States;

    (2) organizations representing consumers, including those 
 that are disproportionately impacted by poor maternal health 
 outcomes;

    (3) organizations and individuals representing doula 
 services providers and community health workers, including 
 community-based doula programs and those who serve underserved 
 communities, communities of color and communities facing 
 linguistic or cultural barriers; and

    (4) organizations representing health care providers.

SEC. 9. DEMONSTRATION PROJECTS TO IMPROVE THE DELIVERY OF MATERNAL 
 HEALTH CARE THROUGH TELEHEALTH.

    (a) In General.--Not later than 18 months after the date of 
enactment of this Act, the Secretary shall award grants to States to 
conduct demonstration projects under this section that are designed to 
expand the use of telehealth in State Medicaid programs for the 
delivery of health care to eligible pregnant or postpartum women.

    (b) Eligible Pregnant or Postpartum Woman Defined.--

    (1) In general.--In this section, the term ``eligible 
 pregnant or postpartum woman'' means a woman who is eligible 
 for and receiving medical assistance under a State Medicaid 
 plan (or waiver of such plan) and who is or becomes pregnant.

    (2) Postpartum women.--Such term includes a woman described 
 in paragraph

    (1) through the end of the month in which the 365-
 day period beginning on the last day of the woman's pregnancy 
 ends, without regard to any change in income of the family of 
 which she is a member.
            (c) Application; Selection of States; Duration.--

    (1) Application.--
        (A) In general.--To conduct a demonstration project 
 under this section, a State shall submit an application 
 to the Secretary at such time and in such manner as the 
 Secretary shall require. Under the demonstration 
 project, a State may include multiple proposed uses of 
 grant funds, and propose to focus on multiple 
 populations, as otherwise allowable under this section, 
 within a single application.
        (B) Required information.--A State application to 
 conduct a demonstration project under this section 
 shall include the following:
            (i) The population (such as individuals 
 residing in rural or medically underserved 
 areas) that the demonstration project will 
 target.
            (ii) A description of how the State 
 proposes to use funds awarded under this 
 section to conduct the demonstration project to 
 integrate or increase the integration of 
 telehealth into the State Medicaid program's 
 existing delivery system for furnishing medical 
 assistance to and improving the health care 
 outcomes of eligible pregnant or postpartum 
 women.
            (iii) A description of how the State will 
 use funds to address racial or ethnic 
 disparities in access to maternal health 
 services or maternal health outcomes, barriers 
 to care, including in rural or medically 
 underserved communities, other barriers to 
 using telehealth, such as those experienced by 
 individuals with disabilities and individuals 
 with limited English proficiency, and as 
 applicable, barriers to the use of telehealth 
 in tribal communities.
            (iv) A certification that the application 
 meets the requirements of subparagraph
            (C) .
            (v) Such other information as the Secretary 
 shall require.
            (C) Consultation with health care stakeholders.--
 Prior to the submission of an application to conduct a 
 demonstration project under this section, a State shall 
 consult with health care systems and providers, health 
 plans (if relevant), consumer organizations and 
 beneficiary advocates, and community-based 
 organizations or other stakeholders in the area that 
 the demonstration project will target to ensure that 
 the proposed project addresses the health care needs of 
 eligible pregnant or postpartum women in such area.

    (2) Selection of states and duration of projects.--
        (A) In general.--The Secretary shall award grants 
 to States that apply and meet the application 
 requirements to conduct 4-year demonstration projects 
 under this section. A State may request, and the 
 Secretary shall determine the appropriateness of, an 
 application of up to $10,000,000.
        (B) Selection of projects.--In selecting a State to 
 conduct a demonstration project under this section, the 
 Secretary shall ensure that the State is aware of the 
 4-year duration of the project and shall determine the 
 State has satisfied the application requirements.

    (3) Waiver of statewideness and comparability 
 requirement.--The Secretary shall waive compliance with 

section 1902

    (a)

    (1) of the Social Security Act (42 U.S.C. 1396a

    (a)

    (1) ) 
 (relating to statewideness) and 

section 1902

    (a)

    (10)
        (B) of such 
 Act (42 U.S.C. 1396a

    (a)

    (10)
        (B) ) (relating to comparability) to 
 the extent necessary to allow selected States to conduct 
 demonstration projects under this section.
            (d) Use of Grant Funds.--A State may use funds from a grant awarded 
under this section to connect eligible pregnant or postpartum women to 
telehealth services delivered via telehealth that are furnished by--

    (1) primary and maternity care providers;

    (2) health care specialists;

    (3) behavioral health providers; and

    (4) other categories of health care providers identified by 
 the Secretary.

    (e) Reports.--

    (1) State reports.--Each State that is awarded a grant to 
 conduct a demonstration project under this section shall submit 
 the following reports to the Secretary:
        (A) Initial report.--An initial report on the first 
 18 months during which the demonstration project is 
 conducted, not later than the last day of the 19th 
 month of the demonstration project, as described in 
 subparagraph
        (B) .
        (B) Final report.--Not later than 6 months after 
 the date on which the State's demonstration project 
 ends, a final report that includes the following:
            (i) The number of eligible pregnant or 
 postpartum women served under the demonstration 
 project.
            (ii) The activities and services funded 
 under the demonstration project, including the 
 providers that received funds under the 
 demonstration project.
            (iii) Demographic information about the 
 eligible pregnant or postpartum women served 
 under the demonstration project, if available.
            (iv) A description of the types of models 
 or programs developed under the demonstration 
 project.
            (v) How such models or programs impacted 
 access to, and utilization of, telehealth 
 services by eligible pregnant or postpartum 
 women, including a description of how such 
 models or programs addressed racial or ethnic 
 disparities in access or utilization.
            (vi) Qualitative information on beneficiary 
 experience.
            (vii) Challenges faced and lessons learned 
 by the State in integrating (or increasing the 
 integration of) telehealth into the delivery 
 system for furnishing medical assistance to 
 eligible pregnant or postpartum women in the 
 areas targeted under the demonstration project.

    (2) Reports to congress.--
        (A) Initial report.--Not later than 2 years after 
 the date of enactment of this Act, the Secretary shall 
 submit a report to Congress summarizing the information 
 reported by States under paragraph

    (1)
        (A) .
        (B) Final report.--Not later than 5 years after the 
 date of enactment of this Act, the Secretary shall 
 submit a report to Congress summarizing the information 
 reported by States under paragraph

    (1)
        (B) .

SEC. 10. CMS REPORT ON COVERAGE OF REMOTE PHYSIOLOGIC MONITORING 
 DEVICES AND IMPACT ON MATERNAL AND CHILD HEALTH OUTCOMES 
 UNDER MEDICAID.

    (a) In General.--Not later than 18 months after the date of 
enactment of this Act, the Secretary shall submit to Congress a report 
containing information on authorities and State practices for covering 
remote physiological monitoring devices, including limitations and 
barriers to such coverage and the impact on maternal health outcomes, 
and to the extent appropriate, recommendations on how to address such 
limitations or barriers related to coverage of remote physiologic 
devices under State Medicaid programs, including, but not limited to, 
pulse oximeters, blood pressure cuffs, scales, and blood glucose 
monitors, with the goal of improving maternal and child health outcomes 
for pregnant and postpartum women enrolled in State Medicaid programs.

    (b) State Resources.--Not later than 6 months after the submission 
of the report required by subsection

    (a) , the Secretary shall update 
resources for State Medicaid programs, such as State Medicaid 
telehealth toolkits, to be consistent with the recommendations provided 
in such report.

SEC. 11. GUIDANCE ON COMMUNITY-BASED MATERNAL HEALTH PROGRAMS.

 Not later than 3 years after the date of enactment of this Act, the 
Secretary shall issue guidance to State Medicaid programs to support 
the use of evidence-based community-based maternal health programs, 
including programs that offer group prenatal care, home visiting 
services, childbirth and parenting education, peer supports, stillbirth 
prevention activities, and substance use disorder and recovery 
supports, under such programs, and any other programs as determined by 
the Secretary.

SEC. 12. DEVELOPING GUIDANCE ON MATERNAL MORTALITY AND SEVERE MORBIDITY 
 REDUCTION FOR MATERNAL CARE PROVIDERS RECEIVING PAYMENT 
 UNDER THE MEDICAID PROGRAM.

    (a) In General.--Subject to the availability of appropriations, not 
later than 36 months after the date of enactment of this Act, the 
Secretary shall, in consultation with the Advisory Committee on 
Reducing Maternal Deaths established under subsection
            (c) and the Task 
Force on Maternal Mental Health established under 

section 1113 of 
division FF of the Consolidated Appropriations Act, 2023 (Public Law 
117-328), publish on a public website of the Centers for Medicare & 
Medicaid Services guidance for States on resources and strategies for 
hospitals, freestanding birth centers (as defined in 

section 1905
            (l) (3)
        (B) of the Social Security Act (42 U.S.C. 1396d
            (l) (3)
        (B) )), 
and other maternal care providers as determined by the Secretary for 
reducing maternal mortality and severe morbidity in individuals who are 
eligible for and receiving medical assistance under Medicaid or CHIP.

    (b) Updates.--The Secretary shall, in consultation with the 
Advisory Committee on Reducing Maternal Deaths established under 
subsection
            (c) and the Task Force on Maternal Mental Health established 
under 

section 1113 of division FF of the Consolidated Appropriations 
Act, 2023 (Public Law 117-328), update the guidance and resources 
described in subsection

    (a) at least once every 3 years.
            (c) Consultation With Advisory Committee.--

    (1) Establishment.--Subject to the availability of 
 appropriations, not later than 18 months after the date of 
 enactment of this Act, the Secretary shall establish an 
 advisory committee to be known as the ``National Advisory 
 Committee on Reducing Maternal Deaths'' (referred to in this 
 section as the ``Advisory Committee'').

    (2) Duties.--The Advisory Committee shall provide consensus 
 advice and guidance to the Secretary on the development and 
 compilation of the guidance described in subsection

    (a) (and 
 any updates to such guidance).

    (3) Membership.--
        (A) In general.--The Secretary, in consultation 
 with such other heads of agencies, as the Secretary 
 deems appropriate and in accordance with this 
 paragraph, shall appoint not more than 41 members to 
 the Advisory Committee. In appointing such members, the 
 Secretary shall ensure that--
            (i) the total number of members of the 
 Advisory Committee is an odd number; and
            (ii) the total number of voting members who 
 are not Federal officials does not exceed the 
 total number of voting Federal members who are 
 Federal officials.
        (B) Required members.--
            (i) Federal officials.--The Advisory 
 Committee shall include as voting members the 
 following Federal officials, or their 
 designees:
            (I) The Secretary.
            (II) The Administrator of the 
 Centers for Medicare & Medicaid 
 Services.
            (III) The Director of the Centers 
 for Disease Control and Prevention.
            (IV) The Associate Administrator of 
 the Maternal and Child Health Bureau of 
 the Health Resources and Services 
 Administration.
            (V) The Director of the Agency for 
 Healthcare Research and Quality.
            (VI) The National Coordinator for 
 Health Information Technology.
            (VII) The Director of the National 
 Institutes of Health.
            (VIII) The Secretary of Veterans 
 Affairs.
            (IX) The Director of the Indian 
 Health Service.
            (X) The Deputy Assistant Secretary 
 for Minority Health.
            (XI) The Administrator of the 
 Substance Abuse and Mental Health 
 Services Administration.
            (XII) The Deputy Assistant 
 Secretary for Women's Health.
            (XIII) Such other Federal officials 
 or their designees as the Secretary 
 determines appropriate.
            (ii) Non-federal officials.--
            (I) In general.--The Advisory 
 Committee shall include the following 
 as voting members:

    (aa) At least 1 
 representative from a 
 professional organization 
 representing hospitals and 
 health systems.

    (bb) At least 1 
 representative from a medical 
 professional organization 
 representing primary care 
 providers.
            (cc) At least 1 
 representative from a medical 
 professional organization 
 representing general 
 obstetrician-gynecologists.
            (dd) At least 1 
 representative from a medical 
 professional organization 
 representing certified nurse-
 midwives.

    (ee) At least 1 
 representative from a medical 
 professional organization 
 representing other maternal 
 fetal medicine providers.

    (ff) At least 1 
 representative from a medical 
 professional organization 
 representing anesthesiologists.

    (gg) At least 1 
 representative from a medical 
 professional organization 
 representing emergency medicine 
 physicians and urgent care 
 providers.

    (hh) At least 1 
 representative from a medical 
 professional organization 
 representing nurses.
            (ii) At least 1 
 representative from a 
 professional organization 
 representing community health 
 workers.

    (jj) At least 1 
 representative from a 
 professional organization 
 representing doulas.

    (kk) At least 1 
 representative from a 
 professional organization 
 representing perinatal 
 psychiatrists.
            (ll) At least 1 
 representative from State-
 affiliated programs or existing 
 collaboratives with 
 demonstrated expertise or 
 success in improving maternal 
 health.
            (mm) At least 1 director of 
 a State Medicaid agency that 
 has had demonstrated success in 
 improving maternal health.

    (nn) At least 1 
 representative from an 
 accrediting organization for 
 maternal health quality and 
 safety standards.

    (oo) At least 1 
 representative from a maternal 
 patient advocacy organization 
 with lived experience of severe 
 maternal morbidity.

    (pp) At least 1 medical 
 professional who is an expert 
 in the treatment of pregnant 
 women with substance use 
 disorder.
            (II) Requirements.--Each individual 
 selected to be a member under this 
 clause shall--

    (aa) have expertise in 
 maternal health;

    (bb) not be a Federal 
 official; and
            (cc) have experience 
 working with populations that 
 are at higher risk for maternal 
 mortality or severe morbidity, 
 such as populations that 
 experience racial, ethnic, and 
 geographic health disparities, 
 pregnant and postpartum women 
 experiencing a mental health 
 disorder, or pregnant or 
 postpartum women with other 
 comorbidities such as substance 
 use disorders, hypertension, 
 thyroid disorders, and sickle 
 cell disease.
            (C) Additional members.--
            (i) In general.--In addition to the members 
 required to be appointed under subparagraph
        (B) , the Secretary may appoint as non-voting 
 members to the Advisory Committee such other 
 individuals with relevant expertise or 
 experience as the Secretary shall determine 
 appropriate, which may include, but is not 
 limited to, individuals described in clause
            (ii) .
            (ii) Suggested additional members.--The 
 individuals described in this clause are the 
 following:
            (I) Representatives from State 
 maternal mortality review committees 
 and perinatal quality collaboratives.
            (II) Medical providers who care for 
 women and infants during pregnancy and 
 the postpartum period, such as family 
 practice physicians, cardiologists, 
 pulmonology critical care specialists, 
 endocrinologists, pediatricians, and 
 neonatologists.
            (III) Representatives from State 
 and local public health departments, 
 including State Medicaid Agencies.
            (IV) Subject matter experts in 
 conducting outreach to women who are 
 African-American or belong to another 
 minority group.
            (V) Directors of State agencies 
 responsible for administering a State's 
 maternal and child health services 
 program under title V of the Social 
 Security Act (42 U.S.C. 701 et seq.).
            (VI) Experts in medical education 
 or physician training.
            (VII) Representatives from Medicaid 
 managed care organizations.

    (4) Applicability of faca.--Chapter 10 of title 5, United 
 States Code, shall apply to the committee established under 
 this subsection.
            (d) Contents.--The guidance described in subsection

    (a) shall 
include, with respect to hospitals, freestanding birth centers, and 
other maternal care providers, the following:

    (1) Best practices regarding evidence-based screening and 
 clinician education initiatives relating to screening and 
 treatment protocols for individuals who are at risk of 
 experiencing complications related to pregnancy, with an 
 emphasis on individuals with preconditions directly linked to 
 pregnancy complications and maternal mortality and severe 
 morbidity, including--
        (A) methods to identify individuals who are at risk 
 of maternal mortality or severe morbidity, including 
 risk stratification;
        (B) evidence-based risk factors associated with 
 maternal mortality or severe morbidity and racial, 
 ethnic, and geographic health disparities;
            (C) evidence-based strategies to reduce risk 
 factors associated with maternal mortality or severe 
 morbidity through services which may be covered under 
 Medicaid or CHIP, including, but not limited to, 
 activities by community health workers (as such term is 
 defined in 

section 2113 of the Social Security Act (42 
 U.S.C. 1397mm)) that are funded by a grant awarded 
 under such section;
            (D) resources available to such individuals, such 
 as nutrition assistance and education, home visitation, 
 mental health and substance use disorder services, 
 smoking cessation programs, prenatal care, and other 
 evidence-based maternal mortality or severe morbidity 
 reduction programs;
        (E) examples of educational materials used by 
 providers of obstetrics services;
        (F) methods for improving community centralized 
 care, including providing telehealth services or home 
 visits to increase and facilitate access to and 
 engagement in prenatal and postpartum care and 
 collaboration with home health agencies, community 
 health centers, local public health departments, or 
 clinics;
        (G) guidance on medical record diagnosis codes 
 linked to maternal mortality and severe morbidity, 
 including, if applicable, codes related to social risk 
 factors, and methods for educating clinicians on the 
 proper use of such codes;
        (H) risk appropriate transfer protocols during 
 pregnancy, childbirth, and the postpartum period; and
            (I) any other information related to prevention and 
 treatment of at-risk individuals determined appropriate 
 by the Secretary.

    (2) Guidance on monitoring programs for individuals who 
 have been identified as at risk of complications related to 
 pregnancy.

    (3) Best practices for such hospitals, freestanding birth 
 centers, and providers to make pregnant women aware of the 
 complications related to pregnancy.

    (4) A fact sheet for providing pregnant women who are 
 receiving care on an outpatient basis with a notice during the 
 prenatal stage of pregnancy that--
        (A) explains the risks associated with pregnancy, 
 birth, and the postpartum period (including the risks 
 of hemorrhage, preterm birth, sepsis, eclampsia, 
 obstructed labor), chronic conditions (including high 
 blood pressure, diabetes, heart disease, depression, 
 and obesity) correlated with adverse pregnancy 
 outcomes, risks associated with advanced maternal age, 
 and the importance of adhering to a personalized plan 
 of care;
        (B) highlights multimodal and evidence-based 
 prevention and treatment techniques;
            (C) highlights evidence-based programs and 
 activities to reduce the incidence of stillbirth 
 (including tracking and awareness of fetal movements, 
 improvement of birth timing for pregnancies with risk 
 factors, initiatives that encourage safe sleeping 
 positions during pregnancy, screening and surveillance 
 for fetal growth restriction, efforts to achieve 
 smoking cessation during pregnancy, community-based 
 programs that provide home visits or other types of 
 support, and any other research or evidence-based 
 programming to prevent stillbirths);
            (D) provides for a method (through signature or 
 otherwise) for such an individual, or a person acting 
 on such individual's behalf, to acknowledge receipt of 
 such fact sheet;
        (E) is worded in an easily understandable manner 
 and made available in multiple languages and accessible 
 formats determined appropriate by the Secretary; and
        (F) includes any other information determined 
 appropriate by the Secretary.

    (5) A template for a voluntary clinician checklist that 
 outlines the minimum responsibilities that clinicians, such as 
 physicians, certified nurse-midwives, emergency room and urgent 
 care providers, nurses and others, are expected to meet in 
 order to promote quality and safety in the provision of 
 obstetric services.

    (6) A template for a voluntary checklist that outlines the 
 minimum responsibilities that hospital leadership responsible 
 for direct patient care, such as the institution's president, 
 chief medical officer, chief nursing officer, or other hospital 
 leadership that directly report to the president or chief 
 executive officer of the institution, should meet to promote 
 hospital-wide initiatives that improve quality and safety in 
 the provision of obstetric services.

    (7) Information on multi-stakeholder quality improvement 
 initiatives, such as the Alliance for Innovation on Maternal 
 Health, State perinatal quality improvement initiatives, and 
 other similar initiatives determined appropriate by the 
 Secretary, including--
        (A) information about such improvement initiatives 
 and how to join;
        (B) information about public maternal data 
 collection centers;
            (C) information about quality metrics used and 
 outcomes achieved by such improvement initiatives;
            (D) information about data sharing techniques used 
 by such improvement initiatives;
        (E) information about data sources used by such 
 improvement initiatives to identify maternal mortality 
 and severe morbidity risks;
        (F) information about interventions used by such 
 improvement initiatives to mitigate risks of maternal 
 mortality and severe morbidity;
        (G) information about data collection techniques on 
 race, ethnicity, geography, age, income, and other 
 demographic information used by such improvement 
 initiatives; and
        (H) any other information determined appropriate by 
 the Secretary.

    (e) Inclusion of Best Practices.--Not later than 18 months after 
the date of the publication of the guidance required under subsection

    (a) , the Secretary shall update such guidance to include best practices 
identified by the Secretary for such hospitals, freestanding birth 
centers, and providers to track maternal mortality and severe morbidity 
trends by clinicians at such hospitals, freestanding birth centers, and 
providers including--

    (1) ways to establish scoring systems, which may include 
 quality triggers and safety and quality metrics to score case 
 and patient outcome metrics, for such clinicians;

    (2) methods to identify, educate, and improve such 
 clinicians who may have higher rates of maternal mortality or 
 severe morbidity compared to their regional or State peers 
 (taking into account differences in patient risk for adverse 
 outcomes, which may include social risk factors);

    (3) methods for using such data and tracking to enhance 
 research efforts focused on maternal health, while also 
 improving patient outcomes, clinician education and training, 
 and coordination of care; and

    (4) any other information determined appropriate by the 
 Secretary.

    (f) Cultural and Linguistic Appropriateness.--To the extent 
practicable, the Secretary should develop the guidance, best practices, 
fact sheets, templates, and other materials that are required under 
this section in a trauma-informed, culturally and linguistically 
appropriate manner.

SEC. 13. PROGRAM RELATED TO REDUCING CESAREAN BIRTHS AND INCREASING 
 RATES OF VAGINAL BIRTH AFTER CESAREAN.

 

Section 317K

    (a) of the Public Health Service Act (42 U.S.C. 247b-
12

    (a) ) is amended--

    (1) in paragraph

    (1) --
        (A) by striking ``and to develop or support'' and 
 inserting ``to develop or support''; and
        (B) by inserting ``, and to establish a grant 
 program, or extend the Alliance for Innovation on 
 Maternal Health, for the establishment of perinatal 
 quality collaboratives to reduce cesarean section rates 
 and increase vaginal birth after cesarean rates'' 
 before the period at the end; and

    (2) in paragraph

    (2) , by adding at the end the following:
 ``
        (E) The Secretary may establish a competitive 
 grant program, or extend existing programs, including 
 the Alliance for Innovation on Maternal Health, for the 
 establishment or support of perinatal quality 
 collaboratives, with a focus on maternity care health 
 professional target areas and other areas with limited 
 birthing resources, to reduce cesarean birth rates and 
 increase vaginal birth after cesarean rates, including 
 through--
 ``
            (i) coordination with hospitals, clinical 
 teams, obstetricians and gynecologists, 
 birthing centers and community-based maternal 
 health organizations, public health agencies, 
 midwives, doulas, patients and families, and 
 other relevant entities;
 ``
            (ii) providing support and training to 
 hospital and clinical teams for quality 
 improvement, as appropriate;
 ``
            (iii) employing strategies that provide 
 opportunities for health care professionals and 
 clinical teams to collaborate across health 
 care settings and disciplines, including 
 midwifery care, doula support, the integration 
 of primary care and mental health, and blended 
 case payment rates;
 ``
            (iv) using data, disaggregated by race 
 and ethnicity, to provide timely feedback 
 across hospital and clinical teams, document 
 baseline cesarean and vaginal birth rates, and 
 measure progress; and
 ``
            (v) promotion of existing evidence on the 
 best practices for the safe reduction of 
 primary cesarean births.''.

SEC. 14. COLLECTION OF INFORMATION RELATED TO SOCIAL DETERMINANTS OF 
 THE HEALTH OF MEDICAID AND CHIP BENEFICIARIES.

    (a) Implementation Assessment Report to Congress.--

    (1) In general.--Not later than 2 years after the date of 
 enactment of this Act, the Secretary shall submit a report to 
 Congress that includes a description of whether and how 
 information related to the social determinants of health for 
 individuals eligible for medical assistance under Medicaid or 
 child health assistance or pregnancy-related assistance under 
 CHIP may be captured under the data systems for such programs 
 as in effect on the date such report is submitted, including--
        (A) a description of whether and how ICD-10 codes 
 (or successor codes) may be used to identify social 
 determinants of health in programs such as Medicaid and 
 CHIP, and whether other claims file or demographic 
 information may be employed; and
        (B) a description of whether existing data systems 
 under Medicaid and CHIP could be employed to capture 
 such information, whether program or system changes 
 would be required, how privacy and confidentiality as 
 required under applicable law and regulations would be 
 maintained, and the resources and timeframes at the 
 Federal and State levels that would be needed to make 
 such changes.

    (2) Guidance for states.--The Secretary shall issue 
 detailed guidance for States concurrent with the submission of 
 the report to Congress under paragraph

    (1) . Such guidance shall 
 address--
        (A) whether and how information related to the 
 social determinants of health for individuals eligible 
 for medical assistance under Medicaid or child health 
 assistance or pregnancy-related assistance under CHIP 
 could be captured employing existing systems under such 
 programs; and
        (B) implementation considerations for capturing 
 such information, including whether program or system 
 changes would be required, whether additional steps 
 would be needed to maintain privacy and confidentiality 
 as required under relevant laws and regulations, and 
 the resources and timeframes at that would be needed to 
 make such changes.

    (3) Stakeholder input.--The Secretary shall develop the 
 report required under paragraph

    (1) and the guidance required 
 under paragraph

    (2) with the input of relevant stakeholders, 
 such as State Medicaid directors, Medicaid managed care 
 organizations, and other relevant Federal agencies such as the 
 Centers for Disease Control and Prevention, the Health 
 Resources Services Administration, and the Agency for 
 Healthcare Research and Quality.

    (4) Action plan report.--
        (A) In general.--If the Secretary determines in the 
 report required under paragraph

    (1) that information 
 related to the social determinants of health for 
 individuals eligible for medical assistance under 
 Medicaid or child health assistance or pregnancy-
 related assistance under CHIP cannot be captured under 
 the data systems for such programs as in effect on the 
 date such report is submitted, then, not later than 6 
 months after such date, the Secretary shall submit a 
 second report to Congress that contains an action plan 
 for implementing the program or data systems changes 
 needed in order for such information to be collected 
 while maintaining privacy and confidentiality as 
 required under relevant laws and regulations. The 
 action plan should be prepared so as to be implemented 
 by the Federal Government and States not later than 2 
 years after the date on which the report required under 
 this paragraph is submitted to Congress.
        (B) Revised guidance for states.--The Secretary 
 shall revise and reissue the guidance for States 
 required under paragraph

    (2) to take into account the 
 action plan included in the report submitted to 
 Congress under subparagraph
        (A) .

    (5) Authorization of appropriations.--
        (A) Federal costs.--There are authorized to be 
 appropriated to the Secretary, $40,000,000 for purposes 
 of preparing the reports required under this subsection 
 and implementing the collection of information related 
 to the social determinants of health for individuals 
 eligible for medical assistance under Medicaid or child 
 health assistance or pregnancy-related assistance under 
 CHIP.
        (B) State costs.--There are authorized to be 
 appropriated to the Secretary, $50,000,000 for purposes 
 of making payments to States in accordance with a 
 methodology established by the Secretary for State 
 expenditures attributable to planning for and 
 implementing the collection of such information in 
 accordance with subsection
            (d) of 

section 1946 of the 
 Social Security Act (42 U.S.C. 1396w-5) (as added by 
 subsection

    (b) ).

    (b) Application to States.--

Section 1946 of the Social Security Act 
(42 U.S.C. 1396w-5) is amended by adding at the end the following:
 ``
            (d) Collection of Information Related to Social Determinants of 
Health.--
 ``

    (1) Development of collection methods.--
 ``
        (A) In general.--Subject to paragraph

    (5) , the 
 Secretary, in consultation with the States, shall 
 develop a method for collecting standardized and 
 aggregated State-level information related to social 
 determinants that may factor into the health of 
 beneficiaries under this title and beneficiaries under 
 title XXI which the States, notwithstanding 

section 1902

    (a)

    (7) and as a condition for meeting the 
 requirements of 

section 1902

    (a)

    (6) and 

section 2107

    (b)

    (1) , shall use to annually report such 
 information:
 ``
            (i) A model uniform reporting field 
 through the transformed Medicaid Statistical 
 Information System (T-MSIS) (or a successor 
 system) or another appropriate reporting 
 platform, as approved by the Secretary.
 ``
            (ii) A model uniform questionnaire or 
 survey (which may be included as part of an 
 existing survey, questionnaire, or form 
 administered by the Secretary), for purposes of 
 the State or the Secretary collecting such 
 information by administering regularly but not 
 less than annually a questionnaire or survey of 
 beneficiaries under this title and 
 beneficiaries under title XXI.
 ``
            (iii) A model uniform form to be adapted 
 for inclusion in the Medicaid and CHIP 
 Scorecard developed by the Centers for Medicare 
 & Medicaid Services, for purposes of the 
 Secretary collecting such information.
 ``
            (iv) An alternative method identified by 
 the Secretary for collecting such information.
 ``
        (B) Implementation.--In carrying out the 
 requirements of subparagraph
        (A) , the Secretary shall--
 ``
            (i) for purposes of the method described 
 in clause
            (i) of such subparagraph, determine 
 the appropriate providers and frequency with 
 which such providers shall complete the 
 reporting field identified and report the 
 information to the State;
 ``
            (ii) for purposes of the method described 
 in clause
            (ii) of such subparagraph, identify 
 the means and frequency (which shall be no less 
 frequent than once per year) with which a 
 questionnaire or survey of beneficiaries is to 
 be conducted;
 ``
            (iii) with respect to any method 
 described in such subparagraph, issue guidance 
 for ensuring compliance with applicable laws 
 regarding beneficiary informed consent, 
 privacy, and anonymity with respect to the 
 information collected under such method;
 ``
            (iv) with respect to the collection of 
 information relating to beneficiaries who are 
 children, issue guidance on the collection of 
 such information from a parent, legal guardian, 
 or any other person who is legally authorized 
 to share such information on behalf of the 
 child when the direct collection of such 
 information from children may not otherwise be 
 feasible or appropriate; and
 ``
            (v) regularly evaluate the method under 
 such subparagraph and the information reported 
 using such method, and, as needed, make updates 
 to the method and the information reported.
 ``

    (2) Social determinants of health.--The information 
 collected in accordance with the method made available under 
 paragraph

    (1) shall, to the extent practicable, include 
 standardized definitions for identifying social determinants of 
 health needs identified in the ICD-10 diagnostic codes Z55 
 through Z65 (or any such successor diagnostic codes), as 
 defined by the Healthy People 2020 and related initiatives of 
 the Office of Disease Prevention and Health Promotion of the 
 Department of Health and Human Services, or any other 
 standardized set of definitions for social determinants of 
 health identified by the Secretary. Such definitions shall 
 incorporate measures for quantifying the relative severity of 
 any such social determinant of health need identified in an 
 individual.
 ``

    (3) Federal privacy requirements.--Nothing in this 
 subsection shall be construed to supersede any Federal privacy 
 or confidentiality requirement, including the regulations 
 promulgated under 

section 264
            (c) of the Health Insurance 
 Portability and Accountability Act of 1996 and 

section 543 of 
 the Public Health Service Act and any regulations promulgated 
 thereunder.
 ``

    (4) Application to territories.--
 ``
        (A) In general.--To the extent that the Secretary 
 determines that it is not practicable for a State 
 specified in subparagraph
        (B) to report information in 
 accordance with the method made available under 
 paragraph

    (1) , this subsection shall not apply with 
 respect to such State.
 ``
        (B) Territories specified.--The States specified 
 in this subparagraph are Puerto Rico, the Virgin 
 Islands, Guam, American Samoa, and the Northern Mariana 
 Islands.
 ``

    (5) Application.--
 ``
        (A) In general.--Subject to subparagraph
        (B) , the 
 requirement for a State to collect information in 
 accordance with the method made available under 
 paragraph

    (1) shall not apply to the State before the 
 date that is 4 years after the date of enactment of 
 this subsection.
 ``
        (B) Alternative date.--If an action plan is 
 submitted to Congress under 

section 14

    (a)

    (4) of the 
 Healthy Moms and Babies Act, in lieu of the date 
 described in subparagraph
        (A) , the requirement for a 
 State to collect information in accordance with the 
 method made available under paragraph

    (1) shall not 
 apply to the State before the date specified in such 
 action plan.
 ``

    (6) Appropriation.--There is appropriated to the 
 Secretary for fiscal year 2026 and each fiscal year thereafter 
 $1,000,000 to carry out the provisions of this section and 
 subsection

    (b)

    (2)
        (B) .''.
            (c) Report on Data Analyses.--

Section 1946

    (b)

    (2) of such Act (42 
U.S.C. 1396w-5

    (b)

    (2) ) is amended--

    (1) by striking ``Not later than'' and inserting the 
 following:
 ``
        (A) Initial reports.--Not later than''; and

    (2) by adding at the end the following:
 ``
        (B) Reports on collection of information related 
 to social determinants of health.--
 ``
            (i) In general.--Not later than 5 years 
 after the date on which the requirement to 
 collect information under subsection
            (d) is 
 first applicable to States, the Secretary shall 
 submit to Congress a report that includes 
 aggregate findings and trends across respective 
 beneficiary populations for improving the 
 identification of social determinants of health 
 for beneficiaries under this title and 
 beneficiaries under title XXI based on analyses 
 of the data collected under subsection
            (d) .
 ``
            (ii) Interim report.--Not later than 3 
 years after the date of enactment of this 
 subparagraph, the Secretary shall submit to 
 Congress an interim report on progress in 
 developing, implementing, and utilizing the 
 method selected by the Secretary under 
 subsection
            (d) (1) along with any available, 
 preliminary information that has been collected 
 using such method.''.
            (d) Conforming Amendment.--

Section 2107

    (e)

    (1) of the Social 
Security Act (42 U.S.C. 1397gg

    (e)

    (1) ) is amended by adding at the end 
the following:
 ``
            (V) Section 1946 (relating to addressing health 
 care disparities).''.

SEC. 15. REPORT ON PAYMENT METHODOLOGIES FOR TRANSFERRING PREGNANT 
 WOMEN BETWEEN FACILITIES BEFORE, DURING, AND AFTER 
 CHILDBIRTH.

    (a) In General.--Subject to the availability of appropriations, not 
later than 36 months after the date of enactment of this Act, the 
Secretary shall submit to Congress a report on the payment 
methodologies under Medicaid for the antepartum, intrapartum, and 
postpartum transfer of pregnant women from one health care facility to 
another, including any potential disincentives or regulatory barriers 
to such transfers.

    (b) Consultation.--In developing the report required under 
subsection

    (a) , the Secretary shall consult with the advisory committee 
established under 

section 12
            (c) .

SEC. 16. MEDICAID GUIDANCE ON STATE OPTIONS TO ADDRESS SOCIAL 
 DETERMINANTS OF HEALTH FOR PREGNANT AND POSTPARTUM WOMEN.

    (a) In General.--Not later than 2 years after the date of enactment 
of this Act, the Secretary shall issue guidance to States and conduct 
one or more learning collaboratives to promote cross-state learning 
regarding options States may employ to address social determinants of 
health, as defined by the Healthy People 2030 and related initiatives 
of the Office of Disease Prevention and Health Promotion of the 
Department of Health and Human Services, including for pregnant and 
postpartum women.

    (b) Guidance Requirements.--The guidance required under subsection

    (a) shall, at a minimum, describe the authorities that States may 
leverage to support addressing the social determinants of health for 
pregnant and postpartum women and outline best practices for such 
efforts.
            (c) Learning Collaborative Requirements.--The learning 
collaboratives required under subsection

    (a) shall, at a minimum, 
include opportunities for States and other stakeholders to share 
innovative practices and approaches as they are being considered and 
developed, share solutions related to challenges that multiple urban 
and rural States face, and promote the uptake of approved, effective 
interventions addressing social needs and determinants covered by the 
Medicaid program.

SEC. 17. PAYMENT ERROR RATE MEASUREMENT

    (PERM) AUDIT AND IMPROVEMENT 
 REQUIREMENTS.

    (a) Biennial PERM Audit Requirement.--Beginning with fiscal year 
2027, the Administrator shall conduct payment error rate measurement 
(``PERM'') audits of each State Medicaid program on a biennial basis.

    (b) PERM Error Rate Reduction Plan Requirement.--Beginning with 
fiscal year 2027, any State with an overall PERM error rate exceeding 
15 percent in a PERM audit conducted with respect to the State in the 
previous fiscal year shall publish a plan, in coordination with, and 
subject to the approval of, the Administrator, for how the State will 
reduce its PERM error rate below 15 percent in the current fiscal year.
            (c) Notification; Identification of Sources of Improper Payments.--

    (1) Notification.--Not later than 6 months after the date 
 of enactment of this Act, the Administrator shall notify the 
 contractor conducting PERM audits of the Administrator's intent 
 to modify contracts to require PERM audits not less than once 
 every other year in each State.

    (2) Identification of sources of improper payments.--The 
 Administrator shall direct the contractor conducting PERM 
 audits of State Medicaid programs to identify areas known to be 
 sources of improper payments under such programs to identify 
 program areas or components known to be sources of high risk 
 for improper payments under such programs.
            (d) State Medicaid Director Letter.--Not later than 12 months after 
the date of enactment of this Act, the Administrator shall issue a 
State Medicaid Director letter regarding State requirements under 
Federal law and regulations regarding avoiding and responding to 
improper payments under State Medicaid programs.

    (e) State Improper Payment Mitigation Plans.--

    (1) In general.--Not later than January 1, 2026, each State 
 Medicaid program shall submit to the Administrator a plan, 
 which shall include specific actions and timeframes for taking 
 such actions and achieving specified results, for mitigating 
 improper payments under such program.

    (2) Publication of state plans.--The Administrator shall 
 make State plans submitted under paragraph

    (1) available to the 
 public.

    (f) 

=== Definitions. ===
-In this section:

    (1) Administrator.--The term ``Administrator'' means the 
 Administrator of the Centers for Medicare & Medicaid Services.

    (2) State.--The term ``State'' has the meaning given such 
 term for purposes of title XIX of the Social Security Act (42 
 U.S.C. 1396 et seq.).

    (3) State medicaid program.--The term ``State Medicaid 
 program'' means a State plan under title XIX of the Social 
 Security Act (42 U.S.C. 1396 et seq.), and includes any waiver 
 of such a plan.
 <all>