Sec. 3. Maternity care home demonstration project
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Title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq.) is amended by inserting the following new section after section 1946: Not later than 1 year after the date of the enactment of this section, the Secretary shall establish a demonstration project (in this section referred to as the demonstration project ) under which the Secretary shall provide grants to States to enter into arrangements with eligible entities to implement or expand a maternity care home model for eligible individuals.
In this section: The term eligible entity means an entity or organization that provides medically accurate, comprehensive maternity services to individuals who are eligible for medical assistance under a State plan under this title or a waiver of such a plan, and may include: A freestanding birth center. An entity or organization receiving assistance under section 330 of the Public Health Service Act. A federally qualified health center. A rural health clinic. A health facility operated by an Indian tribe or tribal organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act).
The term eligible individual means a pregnant woman or a formerly pregnant woman during the 365-day period beginning on the last day of her pregnancy who is— enrolled in a State plan under this title, a waiver of such a plan, or a State child health plan under title XXI; and a patient of an eligible entity which has entered into an arrangement with a State under subsection (g). The goals of the demonstration project are the following: To improve— maternity and infant care outcomes; health equity; communication by maternity, infant care, and social services providers; integration of perinatal support services, including community health workers, doulas, social workers, public health nurses, peer lactation counselors, childbirth educators, and others, into health care entities and organizations; care coordination between maternity, infant care, oral health care, and social services providers within the community; the quality and safety of maternity and infant care; the experience of women receiving maternity care, including by increasing the ability of a woman to develop and follow her own birthing plan; and access to adequate prenatal and postpartum care, including— prenatal care that is initiated in a timely manner; not fewer than 2 post-pregnancy visits to a maternity care provider; and interpregnancy care.
To provide coordinated, evidence-based maternity care management. To decrease— severe maternal morbidity and maternal mortality; overall health care spending; unnecessary emergency department visits; disparities in maternal and infant care outcomes, including racial, economic, and geographical disparities; racial bias among health care professionals; the rate of cesarean deliveries for low-risk pregnancies; the rate of preterm births and infants born with low birth weight; and the rate of avoidable maternal and newborn hospitalizations and admissions to intensive care units.
In designing and implementing the demonstration project the Secretary shall consult with stakeholders, including— States; organizations representing relevant health care professionals, including oral health care professionals; organizations representing consumers, including consumers that are disproportionately impacted by poor maternal health outcomes; representatives with experience implementing other maternity care home models, including representatives from the Center for Medicare and Medicaid Innovation; community-based health care professionals, including doulas, and other stakeholders; and experts in promoting health equity and combating racial bias in health care settings.
A State seeking to participate in the demonstration project shall submit an application to the Secretary at such time and in such manner as the Secretary shall require. The Secretary may select 15 States to participate in the demonstration project. In selecting States to participate in the demonstration project, the Secretary shall— ensure that there is geographic diversity in the areas in which activities will be carried out under the project; and ensure that States with significant disparities in maternal and infant health outcomes, including severe maternal morbidity, and other disparities based on race, income, or access to maternity care, are included.
From amounts appropriated under subsection (l), the Secretary shall award 1 grant for each year of the demonstration project to each State that is selected to participate in the demonstration project. A State may use funds received under this section to— award grants or make payments to eligible entities as part of an arrangement described in subsection (g)(2); provide financial incentives to health care professionals, including community health workers and community-based doulas, who participate in the State's maternity care home model; provide adequate training for health care professionals, including community health workers, doulas, and care coordinators, who participate in the State's maternity care home model, which may include training for cultural competency, racial bias, health equity, reproductive and birth justice, home visiting skills, and respectful communication and listening skills, particularly in regards to maternal health; pay for personnel and administrative expenses associated with designing, implementing, and operating the State's maternity care home model; pay for items and services that are furnished under the State's maternity care home model and for which payment is otherwise unavailable under this title; and pay for other costs related to the State's maternity care home model, as determined by the Secretary.
From the amounts appropriated under subsection (l), prior to awarding any grants under paragraph (1), the Secretary shall enter into a contract with a national external entity to create a single, uniform process to— ensure that States that receive grants under paragraph
(1)comply with the requirements of this section; and evaluate the outcomes of the demonstration project in each participating State. The contract described in subparagraph
(A)shall require the national external entity to submit to the Secretary— a yearly evaluation report for each year of the demonstration project; and a final impact report after the demonstration project has concluded. Nothing in this paragraph shall prevent the Secretary from making a determination that a State is not in compliance with the requirements of this section without the national external entity making such a determination. As a condition of receiving a grant under this section, a State shall enter into an arrangement with one or more eligible entities that meets the requirements of paragraph (2). Under an arrangement between a State and an eligible entity under this subsection, the eligible entity shall perform the following functions, with respect to eligible individuals enrolled with the entity under the State's maternity care home model— provide culturally competent care, which may include prenatal care, family planning services, medical care, mental and behavioral care, postpartum care, and oral health care to such eligible individuals through a team of health care professionals, which may include obstetrician-gynecologists, maternal-fetal medicine specialists, family physicians, primary care providers, oral health providers, physician assistants, advanced practice registered nurses such as nurse practitioners and certified nurse midwives, certified midwives, certified professional midwives, social workers, traditional and community-based doulas, lactation consultants, childbirth educators, community health workers, and other health care professionals; conduct a risk assessment of each such eligible individual to determine if her pregnancy is high or low risk, and establish a tailored pregnancy care plan, which takes into consideration the individual's own preferences and pregnancy care and birthing plans and determines the appropriate support services to reduce the individual's medical, social, and environmental risk factors, for each such eligible individual based on the results of such risk assessment; assign each such eligible individual to a care coordinator, which may be a nurse, social worker, traditional or community-based doula, community health worker, midwife, or other health care provider, who is responsible for ensuring that such eligible individual receives the necessary medical care and connections to essential support services; provide, or arrange for the provision of, essential support services, such as services that address— nutrition and exercise; smoking cessation; substance use disorder and addiction treatment; anxiety, depression, and other mental and behavioral health issues; breast feeding initiation, continuation, and duration; housing; transportation; intimate partner violence; home visiting services; childbirth education; oral health education; continuous labor support; and group prenatal care; as appropriate, facilitate connections to a usual primary care provider, which may be a women's health provider; refer to guidelines and opinions of medical associations when determining whether an elective delivery should be performed on an eligible individual before 39 weeks of gestation; provide such eligible individuals with evidence-based education and resources to identify potential warning signs of pregnancy and postpartum complications and when and how to obtain medical attention; provide, or arrange for the provision of, pregnancy and postpartum health services, including family planning counseling and services, to eligible individuals; track and report birth outcomes of such eligible individuals and their children; ensure that care is patient-led, including by engaging eligible individuals in their own care, including through communication and education; and ensure adequate training for appropriately serving the population of individuals eligible for medical assistance under the State plan or waiver of such plan, including through reproductive and birth justice frameworks, race equity awareness, home visiting skills, and knowledge of social services. The Secretary shall conduct the demonstration project for a period of 5 years. To the extent that the Secretary determines necessary in order to carry out the demonstration project, the Secretary may waive section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability). The Secretary shall establish a process to provide technical assistance to States that are awarded grants under this section and to eligible entities and other providers participating in a State maternity care home model funded by such a grant. Not later than 18 months after the date of the enactment of this section and annually thereafter for each year of the demonstration project term, the Secretary shall submit a report to Congress on the results of the demonstration project. As part of the final report required under paragraph (1), the Secretary shall include— the results of the final report of the national external entity required under subsection (f)(3)(B)(ii); and recommendations on whether the model studied in the demonstration project should be continued or more widely adopted, including by private health plans. There are authorized to be appropriated to the Secretary, for each of fiscal years 2019 through 2026, such sums as may be necessary to carry out this section. .
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Sec. 3
Maternity care home demonstration project
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