S. 2289 — Healthy Moms and Babies Act

This section designates the Act as the “Healthy Moms and Babies Act” and sets forth its table of contents.

This section defines terms used in the Act, including "Medicaid" (i.e., the Medicaid program under title XIX of the Social Security Act), "CHIP" (i.e., the Children's Health Insurance Program under title XXI), "Secretary" (i.e., Secretary of Health and Human Services), "State" (i.e., as defined for titles V, XIX, and XXI of the Social Security Act), and "Medicaid managed care organization" (i.e., as defined in section 1903(m)(1)(A) of the Social Security Act).

This section expands mandatory reporting requirements for state Medicaid programs on specified adult health care quality measures under Section 1139B of the Social Security Act to include maternal and perinatal health measures, in addition to behavioral health measures, by amending subsections (b)(3)(B), (b)(5)(C), and (d)(1)(A). (As background, Section 1139B requires the Secretary of Health and Human Services to develop a core set of adult health quality measures applicable to Medicaid enrollees and requires states to annually report to the Secretary on state-specific performance on those measures.)

This section amends Medicaid state plan requirements to direct states to submit publicly available annual reports, beginning January 1, 2027, through January 1, 2037, on (1) low-risk cesarean delivery rates (as defined by the Secretary) for Medicaid-eligible pregnant women compared to the statewide rate; (2) state quality improvement activities to reduce such rates, including efforts to address racial and ethnic disparities, hospital-level initiatives, and perinatal quality collaboratives; (3) year-over-year percentage changes in such Medicaid rates; and (4) other data as specified by the Secretary. This section further directs the Comptroller General of the United States to conduct two studies—(1) on Medicaid payment rates for cesarean versus vaginal births under fee-for-service and managed care, historical changes, comparisons to other payers, and related factors, with a report to Congress containing recommendations due 18 months after enactment; and (2) on racial disparities in cesarean birth frequency by risk level, payer, and hospital characteristics, with a report to Congress containing recommendations due 2 years after enactment. This section also amends Medicare provider participation agreements to require hospitals to report their Nulliparous, Term, Singleton, Vertex (NTSV) cesarean section rates for the preceding year, in a form and manner specified by the Secretary; incorporates this measure into the hospital inpatient quality reporting program for payments beginning in FY2027; and directs its inclusion by 2027 in designations of maternity care quality hospitals.

This section establishes a new Medicaid state plan option, beginning April 1, 2028, under which states may provide coordinated pregnancy and postpartum care services (waiving statewideness and comparability requirements) to eligible women who enroll in a designated maternity health home (i.e., a designated provider, team of health care professionals, or health team meeting Secretary-established standards). Eligible women are those receiving full-scope Medicaid benefits who are pregnant or whose pregnancy ended within the last 365 days. The Secretary must establish qualification standards for maternity health homes, drawing on best practices from certain public health grants and requiring capabilities such as coordinating maternity care and community services (including behavioral health and social needs), developing individualized patient-centered care plans, coordinating with pediatric providers, and reporting data. States must pay maternity health homes using a specified methodology—such as per-member per-month amounts (potentially risk-adjusted for pregnancy/postpartum severity and care coordination needs), prospective payments to federally qualified health centers or rural health clinics, or an approved alternative—consistent with Medicaid economy and access requirements; such payments qualify as medical assistance eligible for federal matching. Participating hospitals must inform eligible women seeking emergency department treatment about maternity health homes and notify the woman's enrolled health home or provider.

This section directs the Secretary of Health and Human Services, not later than two years after enactment, to issue guidance for state Medicaid programs on improved care coordination, continuity of care, and clinical integration to support pregnant and postpartum women receiving Medicaid-eligible services. The guidance must identify best practices for such care coordination in both fee-for-service and managed care delivery systems and illustrate strategies for (1) enhancing coordination between primary and maternity care and specialists such as cardiologists, gestational diabetes specialists, dentists, lactation specialists, genetic counselors, and behavioral health providers; (2) integrating behavioral health providers for screening, assessment, treatment, and referral related to substance use disorders, maternal depression, anxiety, intimate partner violence, and trauma; (3) integrating or coordinating with nonclinical professionals such as doulas, peer support specialists, and community health workers (if state-licensed or credentialed) and clarifying Medicaid federal financial participation eligibility for their services; (4) screening for social needs and coordinating related services during prenatal and postpartum periods; (5) supporting women who have experienced stillbirth; (6) conducting maternal health, behavioral health, and social needs screenings during well-child and pediatric visits; and (7) streamlining care coordination to reduce duplication across providers, plans, and entities.

This section establishes a national expert group, appointed by the HHS Secretary, to evaluate national education on and practice of best birthing practices. The group includes obstetricians and gynecologists, family medicine physicians, midwives, nursing leaders, hospital administrators, graduate medical education leaders, doula leaders, community birth setting experts, patients, high-risk birth experts, and quality improvement leaders, with a balance of rural and urban representatives. The group shall (1) examine evidence, trends, and differential use or access by income, geography, race, and ethnicity for specified birthing practices (e.g., cesarean sections, electronic fetal monitoring, doula support, operative vaginal deliveries); (2) assess the role of care culture, maternity care financing, and health education in those trends; and (3) identify case studies of exemplary birthing care. Not later than one year after establishment, the group shall issue best practices for (1) evaluating birthing skills, (2) improving curricula for health professionals engaged in birthing, and (3) incorporating midwives and doulas into obstetric residency curricula, along with recommendations for policies and practices to improve maternity care overall.

This section directs the Medicaid and CHIP Payment and Access Commission (MACPAC) to include, as part of its first annual report due not later than March 15 after one year from enactment, a study on doula services coverage and the role of community health workers under state Medicaid programs. The study must cover (1) current state coverage details, including types of doula services (e.g., prenatal, labor and delivery, postpartum) and prevalence of community-based doulas; (2) strategies to promote doula use for better maternal and infant health, including recruiting and certifying diverse doulas from underserved communities; (3) community health worker access examples; (4) impacts on maternal health outcomes; and (5) recommendations for legislative and administrative actions, developed in consultation with stakeholders (i.e., states, consumer organizations, doula and community health worker representatives, and health care providers). This section further requires the Secretary of Health and Human Services, not later than one year after MACPAC's study, to issue guidance to states on increasing Medicaid access to doula services, including coverage options, reimbursement best practices to ensure a living wage for doulas (including community-based doulas), and strategies to expand access, developed in consultation with the same stakeholders.

This section directs the Secretary of Health and Human Services, not later than 18 months after enactment, to award grants to states for 4-year demonstration projects to expand telehealth in Medicaid (i.e., the joint federal-state program providing health coverage to low-income individuals, including pregnant women) for eligible pregnant or postpartum women (i.e., Medicaid-eligible women through the end of the month 365 days after pregnancy ends, regardless of income changes). States may request up to $10 million per project; applications must specify target populations (e.g., rural or medically underserved areas), telehealth integration plans, efforts to address racial/ethnic disparities and barriers (e.g., for those with disabilities, limited English proficiency, or in tribal communities), and evidence of stakeholder consultation. To enable the projects, the Secretary waives Medicaid requirements for statewideness (i.e., uniform statewide implementation) and comparability (i.e., uniform services across eligibility groups). (Thus, states may limit projects geographically or to specific populations.) Grant funds may connect eligible women to telehealth services from primary/maternity care providers, health care specialists, behavioral health providers, and other providers identified by the Secretary. States must submit an initial report after 18 months and a final report six months post-project detailing participants served, services funded, demographics, models developed, access/utilization impacts (including on disparities), beneficiary experiences, challenges, and lessons learned.

This section directs the Secretary of Health and Human Services to submit to Congress, not later than 18 months after enactment, a report on state Medicaid authorities and practices for covering remote physiologic monitoring devices (e.g., pulse oximeters, blood pressure cuffs, scales, blood glucose monitors), including limitations and barriers to such coverage, their impact on maternal health outcomes, and recommendations to address those barriers to improve maternal and child health outcomes for pregnant and postpartum women enrolled in Medicaid. Not later than six months after submitting the report, the Secretary must update resources for state Medicaid programs, such as telehealth toolkits, to reflect the report's recommendations.

This section directs the Secretary of Health and Human Services to issue guidance to state Medicaid programs, not later than three years after the date of enactment, to support the use of evidence-based community-based maternal health programs—including group prenatal care, home visiting services, childbirth and parenting education, peer supports, stillbirth prevention activities, and substance use disorder and recovery supports—under Medicaid and other programs as determined by the Secretary.

This section directs the HHS Secretary, subject to appropriations, to establish within 18 months of enactment the National Advisory Committee on Reducing Maternal Deaths to advise on guidance for reducing maternal mortality and severe morbidity (MM/SMM) among Medicaid and CHIP enrollees; and, within 36 months of enactment and in consultation with the committee and the Task Force on Maternal Mental Health, to publish on the CMS website guidance for states on resources and strategies for hospitals, freestanding birth centers, and other maternal care providers. The section requires the Secretary to update the guidance at least every three years, using the same consultations. The committee comprises up to 41 members (an odd total number), with non-federal voting members not exceeding federal voting members and including specified federal officials (e.g., HHS Secretary, CMS Administrator, CDC Director) and at least one non-federal representative from each of 16 categories (e.g., hospitals, OBGYNs, certified nurse-midwives, doulas, state Medicaid directors) who have maternal health expertise and experience with high-risk populations such as those facing racial/ethnic disparities or substance use disorders.

This section expands the purposes of grants under Section 317K(a)(1) of the Public Health Service Act (i.e., grants to support activities to reduce cesarean births and increase vaginal birth after cesarean rates) to authorize the Secretary to establish a grant program, or extend the Alliance for Innovation on Maternal Health, for perinatal quality collaboratives aimed at reducing cesarean section rates and increasing vaginal birth after cesarean rates. It further adds Section 317K(a)(2)(E) to specify grant activities, including (1) coordination with hospitals, clinicians, obstetricians, birthing centers, community organizations, public health agencies, midwives, doulas, patients, and families; (2) training for quality improvement; (3) cross-setting collaboration incorporating midwifery, doula support, primary and mental health care integration, and blended payment rates; (4) use of race- and ethnicity-disaggregated data for feedback, baselines, and progress measurement; and (5) promotion of evidence-based practices for safe primary cesarean reductions.

This section requires the Secretary of Health and Human Services, not later than two years after enactment, to submit to Congress a report assessing whether and how social determinants of health (SDOH) information for Medicaid and Children's Health Insurance Program (CHIP) enrollees can be captured in existing data systems (e.g., via ICD-10 codes, claims data, or demographics), including required program changes, privacy protections, and federal and state resources and timeframes. Concurrently, the Secretary must issue guidance to states on SDOH data capture using existing systems and issue revised guidance if needed; both the report and guidance must incorporate stakeholder input from state Medicaid directors, managed care organizations, and federal agencies such as CDC, HRSA, and AHRQ. If existing systems cannot capture SDOH data, the Secretary must submit a follow-up action plan report to Congress within six months proposing necessary changes for implementation by the federal government and states within two years. The section authorizes $40 million for federal costs to prepare the reports and implement SDOH data collection and $50 million for payments to states, per a Secretary-determined methodology, to cover state planning and implementation costs. This section further amends Section 1946 of the Social Security Act, which requires states to implement asset verification programs for Medicaid eligibility determinations and redeterminations (currently phased in through FY2013 for states generally and January 1, 2026, for Puerto Rico), by adding subsection (d). The new subsection requires states, notwithstanding certain Medicaid data privacy provisions and as a condition of Medicaid and CHIP data reporting requirements, to annually report standardized, aggregated state-level SDOH information for beneficiaries using Secretary-developed methods, including (1) a model uniform reporting field via the Transformed Medicaid Statistical Information System (T-MSIS) or successor; (2) a model uniform annual beneficiary questionnaire or survey; (3) a model uniform form for the Medicaid and CHIP Scorecard; or (4) an alternative method.

This section directs the Secretary, not later than 36 months after enactment and subject to the availability of appropriations, to submit to Congress a report on Medicaid payment methodologies for antepartum, intrapartum, and postpartum transfers of pregnant women between health care facilities, including any potential disincentives or regulatory barriers to such transfers. In developing the report, the Secretary must consult with the advisory committee established under section 12(c).

This section requires the Secretary of Health and Human Services, not later than two years after enactment, to issue guidance to states on options to address social determinants of health—as defined by Healthy People 2030 and related Department of Health and Human Services initiatives—for pregnant and postpartum women and to conduct one or more learning collaboratives to promote cross-state learning on such options. The guidance must describe state authorities available to support these efforts and outline best practices. The learning collaboratives must provide opportunities for states and stakeholders to share innovative practices and approaches, solutions to challenges faced by urban and rural states, and strategies to promote uptake of approved, effective Medicaid-covered interventions addressing social needs and determinants of health.

This section establishes a requirement for the Centers for Medicare & Medicaid Services (CMS) Administrator to conduct payment error rate measurement (PERM) audits—which measure improper payments (i.e., incorrect payments due to errors, fraud, abuse, or other factors)—of each state Medicaid program on a biennial basis beginning in FY2027 (previously annual). It further requires that, beginning in FY2027, any state with a PERM error rate exceeding 15% from the prior fiscal year's audit submit, for CMS approval, a plan to reduce its error rate below 15% in the current fiscal year. The section also directs the CMS Administrator to (1) notify PERM audit contractors within six months of enactment of the intent to modify contracts for biennial audits and to identify sources of improper payments and high-risk program areas; and (2) issue a State Medicaid Director letter within 12 months of enactment on federal requirements for avoiding and responding to improper payments. Finally, it requires each state Medicaid program to submit to CMS, by January 1, 2026, a public improper payment mitigation plan with specific actions, timeframes, and results.