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 1947: 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 individual or a formerly pregnant individual during the 1-year period beginning on the last day of the pregnancy, or such longer period beginning on such day as a State may elect, 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; birth equity; health equity for— Black, Indigenous, and other people of color; lesbian, gay, bisexual, transgender, queer, non-binary, and gender nonconfirming individuals; people who live in regions with limited or no access to obstetric care; people with disabilities; and other underserved populations; communication by and between 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, lactation consultants, childbirth educators, peer mental health workers, and others, into health care entities and organizations; care coordination between maternity, infant care, oral health services, and social services providers within the community; the quality and safety of maternity and infant care; the experience of individuals receiving respectful maternity care, including by increasing the ability of an individual to develop and follow their own birthing plans; and access to adequate prenatal and postpartum care, including— prenatal care that is initiated in a timely manner; not fewer than 5 post-pregnancy visits to a maternity care provider for postpartum care and support; interpregnancy care; and support and treatment for perinatal mood and anxiety disorders.
To provide coordinated, evidence-based, respectful, culturally and linguistically appropriate, and person-centered maternity care management. To decrease— preventable and severe maternal morbidity and maternal mortality; overall health care spending; unnecessary emergency department visits; disparities in maternal and infant care outcomes, including racial, economic, disability, gender-based, and geographical disparities; racial, gender, economic, and other discrimination among among health care professionals; racism, discrimination, disrespect, trauma, and abuse in maternity care settings; the rate of cesarean deliveries for low-risk pregnancies; the rate of preterm births and infants born with low birth weight; the rate of avoidable maternal and newborn hospitalizations and admissions to intensive care units; the rate of perinatal mood and anxiety disorders.
In designing and implementing the demonstration project the Secretary shall consult with stakeholders, including— States; organizations representing relevant health care professionals, including oral health services professionals; organizations, particularly reproductive justice and birth justice organizations led by people of color, that represent consumers of maternal health care, including consumers of maternal health care who 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, lactation consultants, and other stakeholders; experts in promoting health equity and combating racial bias in health care settings; and Black, Indigenous, and other maternal health care consumers of color who have experienced severe maternal morbidity.
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 shall select at least 10 States to participate in the demonstration project. In selecting States to participate in the demonstration project, the Secretary shall— ensure that there is geographic and regional diversity in the areas in which activities will be carried out under the project; 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; and ensure that at least 1 territory is 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-based health care workers and community-based doulas, who participate in the State's maternity care home model; provide adequate training for health care professionals, including community-based health care workers, doulas, and care coordinators, who participate in the State's maternity care home model, which may include training for cultural humility and antiracism, racial bias, health equity, reproductive and birth justice, trauma-informed care, 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; pay for services and materials to ensure culturally and linguistically appropriate communication, including— language services such as interpreters and translation of written materials; and development of culturally and linguistically appropriate materials; and auxiliary aids and services; 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 and linguistically appropriate congruent care, which may include prenatal care, family planning services, medical care, mental and behavioral care, postpartum care, and oral health services 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, physical therapists, social workers, traditional and community-based doulas, lactation consultants, childbirth educators, community health workers, peer mental health supporters, and other health care professionals; conduct a risk assessment of each such eligible individual to determine if their 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 culturally and linguistically appropriate 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— food access, nutrition, and exercise; smoking cessation; substance use disorder and addiction treatment; anxiety, depression, trauma, and other mental and behavioral health issues; breast feeding, chestfeeding, or other infant feeding options supports, initiation, continuation, and duration; stable, affordable, safe, and healthy housing; transportation; intimate partner violence; community and police violence; home visiting services; childbirth and newborn care education; oral health education; continuous labor support; group prenatal care; family planning and contraceptive care and supplies; and affordable child care; as appropriate, facilitate connections to a usual primary care provider, which may be a reproductive health care 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 individual with evidence-based and culturally and linguistically appropriate 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, culturally and linguistically appropriate pregnancy and postpartum health services, including family planning counseling and services, to eligible individuals; track and report postpartum health and birth outcomes of such eligible individuals and their children; ensure that care is person-centered, culturally and linguistically appropriate, and 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 justice, birth justice, birth equity, and anti-racist frameworks, 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 2024 through 2031, 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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