[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5236 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 5236
To amend titles XIX and XXI of the Social Security Act to enhance
financial support for rural and safety net hospitals providing
maternity, labor, and delivery services to vulnerable populations, and
for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 25, 2024
Mr. Wyden (for himself, Ms. Hassan, Ms. Stabenow, Ms. Cantwell, Mr.
Carper, Mr. Cardin, Mr. Brown, Mr. Bennet, Mr. Casey, Mr. Warner, Mr.
Whitehouse, Ms. Cortez Masto, Ms. Warren, Mr. Helmy, Ms. Duckworth, Mr.
Booker, Mr. Merkley, and Mrs. Murray) 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 enhance
financial support for rural and safety net hospitals providing
maternity, labor, and delivery services to vulnerable populations, 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 ``Keeping Obstetrics
Local Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--ENHANCING FINANCIAL SUPPORT FOR RURAL AND SAFETY NET HOSPITALS
THAT PROVIDE OBSTETRIC SERVICES
Sec. 101. State studies and HHS report on costs of providing maternity,
labor, and delivery services.
Sec. 102. Requiring adequate payment rates under Medicaid for
maternity, labor, and delivery services at
eligible hospitals.
Sec. 103. Increased Federal financial participation for maternity,
labor, and delivery services furnished by
eligible hospitals.
Sec. 104. Labor and delivery services anchor payments.
Sec. 105. Application of adequate payment requirement and increased
Federal financial participation
requirements to CHIP.
Sec. 106. Disregarding increased and additional payments to hospitals
for purposes of other supplemental payments
and upper payment limits.
TITLE II--EXPAND COVERAGE OF MATERNAL HEALTH CARE
Sec. 201. Requiring 12-month continuous, full benefit coverage for
pregnant individuals under Medicaid and
CHIP.
Sec. 202. Health homes for pregnant and postpartum women.
Sec. 203. Guidance on supporting and improving access to Medicaid and
CHIP coverage of services provided by
doulas and certain maternal health
professionals.
Sec. 204. Medicaid and CHIP increased financial support for depression
and anxiety screening during the perinatal
and postpartum periods.
Sec. 205. Presumptive eligibility for pregnant individuals.
TITLE III--INVEST IN THE MATERNAL HEALTH CARE WORKFORCE
Sec. 301. Emergency obstetric workforce support.
Sec. 302. Streamlined screening and enrollment of providers of
maternity, labor, and delivery services in
neighboring States.
TITLE IV--REQUIRING PUBLIC COMMUNICATION OF OBSTETRICS DATA AND UNIT
CLOSURES
Sec. 401. Timely notifications of impending hospital obstetric unit
closures.
Sec. 402. Collection of data relating to hospital labor and delivery
services.
TITLE I--ENHANCING FINANCIAL SUPPORT FOR RURAL AND SAFETY NET HOSPITALS
THAT PROVIDE OBSTETRIC SERVICES
SEC. 101. STATE STUDIES AND HHS REPORT ON COSTS OF PROVIDING MATERNITY,
LABOR, AND DELIVERY SERVICES.
(a) State Study.--
(1) In general.--In order to meet the requirement of
section 1902(a)(6) of the Social Security Act (42 U.S.C.
1396a(a)(6)), not later than 1 year after the date of enactment
of this Act, and every 5 years thereafter, each State (as such
term is defined in section 1101(a)(1) of the Social Security
Act (42 U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI
of such Act) shall conduct a study on the costs of providing
maternity, labor, and delivery services in hospitals and submit
the results of such study to the Secretary of Health and Human
Services (referred to in this section as the ``Secretary'').
(2) Content of study.--A State study required under
paragraph (1) shall include the following information with
respect to maternity, labor, and delivery services furnished by
hospitals located in the State:
(A) An estimate of the cost of providing maternity,
labor, and delivery services at hospitals for which
more than 50 percent of births are financed by the
Medicaid program or the Children's Health Insurance
Program, based on the expenditures a representative
sample of such hospitals incurred for providing such
services during the 2 most recent years for which data
is available.
(B) An estimate of the full cost of providing
maternity, labor, and delivery services at independent
rural hospitals with less than 300 births per year,
based on the expenditures a representative sample of
such hospitals incurred for providing such services
during the 2 most recent years for which data are
available.
(C) An estimate of the cost of providing maternity
services at hospitals that ceased providing labor and
delivery services within the past 5 years, based on the
expenditures a representative sample of such hospitals
incurred for providing such services during the 2 most
recent years for which data is available.
(D) To the extent data allows, an analysis of the
extent to which factors such as geographic location and
community population affect the cost of providing
maternity, labor, and delivery services at hospitals,
including the cost of hospital services that support
the provision of maternity, labor, and delivery
services.
(E) The amounts hospitals are paid for maternity,
labor, and delivery services, by geographic location
and hospital size, under Medicare, the State Medicaid
program, the State CHIP plan, and private health
insurance, including, with respect to the State
Medicaid program, the State CHIP plan, and private
health insurance, payment amounts for such services
under fee-for-service payment arrangements and under
managed care (as applicable).
(F) A comparative payment rate analysis--
(i) comparing maternity, labor, and
delivery services payment rates under the State
Medicaid fee-for-service program to payment
rates for such services under Medicare (as
described in section 447.203(b)(3) of title 42,
Code of Federal Regulations), other federally-
funded or State-funded programs (including, to
the extent data is available, Medicaid managed
care rates), and to the payment rates, to the
extent data is available, of private health
insurers within geographic areas of the State;
and
(ii) analyzing different payment methods
for such services, such as the use of bundled
payments, quality incentives, and low-volume
adjustments.
(G) An evaluation of whether each hospital located
in the State that furnishes maternity, labor, and
delivery services is expected to experience in the next
3 years--
(i) significant changes in particular
expenditures or types of reimbursement for
maternity, labor, and delivery services; or
(ii) any other significant change that is
likely to affect the hospital's ability to
continue to provide such services.
(3) Assistance to small hospitals in compiling cost
information.--There is appropriated to the Secretary for each
fiscal year beginning with fiscal year 2025, $10,000,000 for
the purpose of providing grants and technical assistance to
small rural obstetric hospitals to enable such hospitals to
compile detailed information on expenses incurred for
maternity, labor, and delivery services for use in the State
studies required under paragraph (1), to remain available until
expended.
(4) HHS report on state studies.--For each year in which
State studies are required to be conducted under paragraph (1),
the Secretary shall issue a public report that compiles and
details the results of such studies and includes the
information described in paragraph (2).
(b) HHS Report and Proposed Legislation.--Not later than 2 years
after the date of enactment of this Act, the Secretary shall submit to
Congress and make publicly available a report analyzing the first
studies conducted by States under subsection (a)(1) that includes--
(1) recommendations for improving data collection on the
cost of providing maternity, labor, and delivery services;
(2) guidance to States on the collection of such data; and
(3) if the Secretary determines it appropriate based on the
findings made by the Secretary in such report, proposed
legislation or administrative action, including, to the extent
the Secretary determines appropriate, issuance of regulations,
to adjust the amounts paid for maternity, labor, and delivery
services under Medicare, State Medicaid plans, and other
federally-funded payers, to more accurately compensate eligible
hospitals (as such term is defined in subsection (uu) of
section 1902 of the Social Security Act (42 U.S.C. 1396a), as
added by section 102) for the cost of providing such services.
SEC. 102. REQUIRING ADEQUATE PAYMENT RATES UNDER MEDICAID FOR
MATERNITY, LABOR, AND DELIVERY SERVICES AT ELIGIBLE
HOSPITALS.
(a) Fee-for-Service Payments.--Section 1902 of the Social Security
Act (42 U.S.C. 1396a) is amended--
(1) in subsection (a)(13)--
(A) by striking ``and'' at the end of subparagraph
(B);
(B) by adding ``and'' at the end of subparagraph
(C); and
(C) by adding at the end the following new
subparagraph:
``(D) for each fiscal year beginning with fiscal
year 2026, payment for maternity, labor, and delivery
services (as defined in subsection (uu)) furnished
during such fiscal year in an eligible hospital (as
defined in such subsection) at a rate that is not less
than the minimum payment rate specified for the fiscal
year in paragraph (4) of such subsection;''; and
(2) by adding at the end the following new subsection:
``(uu) Maternity, Labor, and Delivery Services and Eligible
Hospitals Defined.--For purposes of subsection (a)(13)(D)--
``(1) Maternity, labor, and delivery services.--
``(A) In general.--The term `maternity, labor, and
delivery services' means such inpatient hospital
services and outpatient hospital services, including
behavioral health services, that are provided in
relation to maternity care or labor and delivery,
identified by appropriate ICD and CPT codes, as the
Secretary shall specify after consultation with
professional or medical societies with expertise in
pregnancy, childbirth, and postpartum care.
``(B) Scope.--Such term shall not be limited in
application, for any eligible hospital, only to
services that relate to a birth that occurs in the
hospital.
``(C) Rulemaking.--Not later than July 1, 2025, the
Secretary shall issue an interim final rule specifying
which services shall be considered maternity, labor,
and delivery services for purposes of this subsection
and subsection (a)(13)(D).
``(2) Eligible hospital.--
``(A) In general.--The term `eligible hospital'
means, with respect to a State and fiscal year--
``(i) a hospital that is located in a rural
area (as defined by the Federal Office of Rural
Health Policy for the purpose of rural health
grant programs administered by such Office);
``(ii) a critical access hospital (as
defined in section 1861(mm)(1));
``(iii) a hospital operated by the Indian
Health Service or an Indian Tribe under the
Indian Self-Determination and Education
Assistance Act;
``(iv) a hospital for which, in the most
recent 12-month period for which data is
available, at least 50 percent of all births
for which the hospital provided maternity,
labor, and delivery services during such fiscal
year were qualifying births; or
``(v) a hospital that is able to
demonstrate, through a process to be determined
by the Secretary, that, for the applicable
fiscal year, the hospital projects that at
least 50 percent of all births for which the
hospital will provide maternity, labor, and
delivery services during such fiscal year will
be qualifying births.
``(B) Identification of eligible hospitals.--Each
State, subject to the approval of the Secretary, shall
identify the hospitals in the State that are eligible
hospitals with respect to a fiscal year.
``(3) Qualifying birth.--For purposes of paragraph (2), the
term `qualifying birth' means a birth for which any maternity,
labor, and delivery services associated with the birth--
``(A) were paid for under a State plan under this
title (or under a waiver of such a plan) or under a
State child health plan under title XXI (or under a
waiver of such a plan);
``(B) were paid for under title XVIII;
``(C) were provided by the Indian Health Service or
a Native Hawaiian health care system (as defined in
section 12 of the Native Hawaiian Health Care
Improvement Act); or
``(D) were provided to a patient who does not have
minimum essential coverage (as defined in section
5000A(f) of the Internal Revenue Code of 1986) and were
not fully paid for by such patient.
``(4) Minimum payment rate specified.--The minimum payment
rate specified in this paragraph is, with respect to an
eligible hospital and maternal, labor, and delivery services--
``(A) for fiscal year 2026, 150 percent of the
payment rate that would apply for such services and
hospital under title XVIII; and
``(B) for each period of 5 fiscal years beginning
with fiscal years 2027 through 2031, a payment rate
that is determined for such period by the Secretary to
accurately reflect the costs incurred by eligible
hospitals in providing such services, informed by the
results of the most recent State studies submitted to
the Secretary under section 101(a) of the Keeping
Obstetrics Local Act.''.
(b) Under Medicaid Managed Care Plans.--Section 1932(f) of the
Social Security Act (42 U.S.C. 1396u-2(f)) is amended--
(1) in the heading, by inserting ``and Maternity, Labor,
and Delivery Services at Eligible Hospitals'' after
``Services''; and
(2) by striking ``described in section 1902(a)(13)(C)'' and
inserting ``described in subparagraph (C) of section
1902(a)(13) or maternity, labor, and delivery services
described in subparagraph (D) of such section that are
furnished by an eligible hospital (as defined in section
1905(uu))''.
SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION FOR MATERNITY,
LABOR, AND DELIVERY SERVICES FURNISHED BY ELIGIBLE
HOSPITALS.
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(1) in subsection (b), by striking ``and (ii)'' and
inserting ``(ii), and (kk)''; and
(2) by adding at the end the following new subsection:
``(kk) Maternity, Labor, and Delivery Services.--
``(1) In general.--Notwithstanding subsection (b), with
respect to State expenditures for medical assistance for
maternity, labor, and delivery services furnished by an
eligible hospital (as such terms are defined in section
1902(uu)) in a fiscal quarter that begins on or after October
1, 2025--
``(A) the Federal medical assistance percentage
applicable to the enhanced payment rate amount of such
expenditures (as determined for the State and quarter
under paragraph (2)(A)) shall be equal to 100 percent;
and
``(B) subject to paragraph (3), the Federal medical
assist