Sec. 30722. State option to provide coordinated care through a maternal health home for pregnant and postpartum individuals
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Title XIX of the Social Security Act ( 42 U.S.C. 1396a ) is amended by inserting after section 1945A the following new section: Notwithstanding section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability), beginning 24 months after the date of enactment of this section, a State, at its option as a State plan amendment, may provide for medical assistance under this title to eligible individuals who choose to enroll in a maternal health home under this section and receive maternal health home services from a designated provider, a team of health professionals operating with such a provider, or a health team.
A maternal health home under this section shall demonstrate to the State the ability to do the following: Develop an individualized comprehensive care plan for each eligible individual, working in a culturally and linguistically appropriate manner with such individual to develop and incorporate such care plan in a manner consistent with such individual’s needs and choices, including— primary care; inpatient care; social support services; local hospital emergency care; care management and planning related to a change in an eligible individual’s eligibility for medical assistance or a change in health insurance coverage as needed; and behavioral health services.
Coordinate all necessary services to support prenatal, labor and delivery, and postpartum care for eligible individuals. Coordinate access to specialists, behavioral health providers, early intervention services, and pediatricians. Collect and report information under subsection (d). A State shall provide a designated provider, a team of health professionals operating with such a provider, or a health team with payments for the provision of maternal health home services to each eligible individual enrolled in a maternal health home.
Payments for maternal health home services made to a designated provider, a team of health professionals operating with such a provider, or a health team shall be treated as payments for medical assistance for purposes of section 1903(a), except that, during the first 8 fiscal quarters that the State plan amendment is in effect, the Federal medical assistance percentage otherwise applicable to such payments shall be increased by 15 percentage points, not to exceed 90 percent.
The State shall specify in the State plan amendment the methodology the State will use for determining payment for the provision of maternal health home services. Such methodology for determining payment— may be tiered or adjusted to reflect, with respect to each individual provided such services by a designated provider, a team of health care professionals operating with such a provider, or a health team, the acuity of each individual receiving care, or the specific capabilities of the provider, team of health care providers, or health team; and shall be established consistent with section 1902(a)(30)(A).
The methodology for determining payment for provision of maternal health home services under this section shall not be limited to a fee-for-service or per-member per-month payment model, and may provide for alternate models of payment that reflect the needs of a State, subject to the approval of the Secretary. Beginning 12 months after the date of enactment of this section, the Secretary may award planning grants to States for purposes of developing a State plan amendment under this section.
A planning grant awarded to a State under this paragraph shall remain available until expended. A State awarded a planning grant shall contribute an amount equal to the State percentage determined under section 1905(b) for each fiscal year for which the grant is awarded. In addition to amounts otherwise available, there is appropriated for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, to remain available until expended, to carry out this paragraph, $5,000,000 for awarding grants under this section.
In order to receive payments from a State under subsection (c), a designated provider, a team of health professionals operating with such a provider, or a health team shall report to the State, in accordance with such requirements as the Secretary shall specify, the following: With respect to each such designated provider, team of health professionals, or health team, the name, national provider identification number, address, and specific maternal health home services offered to be provided to eligible individuals who have selected such designated provider, team of health professionals, or health team as the maternal health home of such eligible individuals.
Information on all applicable measures for determining the quality of maternal health home services provided by such designated provider, team of health professionals, or health team, including, to the extent applicable, the core set of child health quality measures published under section 1139A, the core set of adult health quality measures for Medicaid eligible adults published under section 1139B, and maternal health quality measures. A designated provider, a team of health professionals operating with such a provider, or a health team shall use, to the extent practicable, health information technology to provide a State with the information required under subparagraph
(A)and to improve care coordination for eligible individuals, such as by— facilitating the review of person-centered care plans; monitoring service delivery and identifying gaps in treatment; and communicating with eligible individuals and with primary, behavioral health and specialty care providers. A State with a State plan amendment approved under this section shall collect and report to the Secretary, at such time and in such form and manner as required by the Secretary, the following information: The number of maternal health homes in a State in which individuals are enrolled pursuant to a State plan amendment under this section. The number of individuals served who selected a maternal health home, disaggregated by race and ethnicity, pursuant to a State plan amendment under this section. Information on the quality measures applicable for maternal health home services, including, to the extent applicable, the core set of child health quality measures published under section 1139A, and the core set of adult health quality measures for Medicaid eligible adults published under section 1139B, and maternal health quality measures. The type of delivery systems and payment models used to provide health home services to eligible individuals enrolled in a maternal health home under a State plan amendment under this section. The number and characteristics of designated providers, teams of health professionals, and health teams selected as maternal health homes pursuant to a State plan amendment under this section. Information on hospitalizations, morbidity, and mortality of eligible individuals and their infants enrolled in a maternal health home in such State alongside comparable data from a State’s maternal mortality review committee. A report on best practices for effective strategies in coordinating care to support access to comprehensive maternal health services. Information reported to the State under paragraph (1). A State plan amendment submitted pursuant to this section shall include— eligibility criteria for maternal health homes; services available to eligible individuals through the maternal health home; a description of providers that may provide care through a maternal health home, and that include how such State will ensure any provider arrangement offered includes a person-centered planning approach to determining necessary services and supports and providing the appropriate care coordination to meet clinical and non-clinical needs of eligible individuals; and reimbursement methodologies (as described in subsection (c)(2)). 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 a waiver of such plan) to establish procedures for, in the case of an individual who is enrolled in a maternal health home pursuant to this section and seeks treatment in the emergency department of such hospital, notifying the health home of such individual of such treatment. 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 educating providers participating in the State plan (or a waiver of such plan) on the availability of maternal health home services, including the process by which such providers can refer individuals to a designated provider, team of health care professionals operating such a provider, or health team for the purpose of establishing a maternal health home through which such individuals may receive such services; and a description of the State’s process for educating individuals on the availability of such services. A State with a State plan amendment approved under this section shall establish confidentiality protections to ensure, at a minimum, that the State does not disclose any identifying information with respect to any specific mortality case (including pursuant to the reporting of information required under subsection (d)(2)(F)). Nothing in this section shall be construed— to require an eligible individual to enroll in, or prohibit an eligible individual from disenrolling at any time from, a maternal health home under this section; or to require a designated provider, team of health professionals, or health team to act as a maternal health home and provide services in accordance with this section if the designated provider, team of health professionals, or health team does not voluntarily agree to act as a maternal health home. In this section: The term designated provider means a physician, clinical practice or clinical group practice, rural health clinic, freestanding birth center, community health center, obstetrician gynecologist, midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, or any other health care entity or provider determined by the State and approved by the Secretary to be qualified to act as a maternal health home. The term eligible individual means an individual eligible for medical assistance under the State plan or under a waiver of such plan who— is pregnant or in the postpartum period that begins on the last day of the pregnancy and ends on the last day of the month in which the 12-month period (beginning on the last day of the pregnancy of the individual) ends (or, if the State provides for a longer period of postpartum coverage period under such plan or waiver, on the last day of such longer period); and is not enrolled in a health home under section 1945 or 1945A. The term health team has the meaning given such term for purposes of section 3502 of Public Law 111–148 . The term maternal health home means a designated provider (including a provider that operates in coordination with a team of health care professionals), or a health team selected by a State to provide maternal health home services to pregnant and postpartum individuals. The term maternal health home services means comprehensive and timely high-quality services described in subparagraph
(B)that are provided by a designated provider, a team of health professionals operating with such a provider, or a health team. The services described in this subparagraph shall include— a standardized risk assessment for all participants to determine needs; comprehensive care management; care coordination and health promotion; comprehensive transitional care, including arranging appropriate follow-up, for individuals transitioning from inpatient care to other settings; individual and family support (including authorized representatives); making referrals to other medical, community, and social support services, if relevant; and the use of health information technology to link services and coordinate care, to the extent practicable. The term standardized risk assessment means an assessment to determine the needs of an eligible individual, and shall include an assessment of medical, obstetric, behavioral health, and social needs performed at the initial prenatal or postpartum visit. The term team of health professionals means a team of health professionals (as described in the State plan amendment under this section) that may— include physicians, midwives who meet at a minimum the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, nurses, nurse care coordinators, nutritionists, social workers, doulas, behavioral health professionals, community health workers, translators and interpreters, and other professionals determined to be appropriate by the State; a health care entity or individual who is designated to coordinate such a team; and provide care at a facility that is freestanding, virtual, or based at a hospital, freestanding birth center, community health center, community mental health center, rural clinic, clinical practice or clinical group practice, academic health center, children’s hospital, or any health care entity determined to be appropriate by the State and approved by the Secretary. .
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- Pub. L. 111-148
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Sec. 30722
State option to provide coordinated care through a maternal health home for pregnant and postpartum individuals
Pub. L.Pub. L. 111-148
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