[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2059 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 2059
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
June 12, 2025
Mr. Wyden (for himself, Ms. Hassan, Ms. Cantwell, Mr. Bennet, Mr.
Warner, Mr. Whitehouse, Ms. Cortez Masto, Ms. Warren, Mr. Sanders, Ms.
Smith, Mr. Lujan, Mr. Warnock, Mr. Welch, Ms. Duckworth, Mr. Booker,
Mr. Merkley, Mrs. Murray, and Mr. King) 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.--Not later than 24 months 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 applicable
hospitals (as defined in paragraph (3)) 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 (to the
extent practicable) with respect to maternity, labor, and
delivery services furnished by applicable hospitals located in
the State:
(A) An estimate of the cost of providing maternity,
labor, and delivery services at applicable hospitals,
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 cost of providing maternity,
labor, and delivery services at applicable 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.
(C) To the extent data allows, an analysis of the
extent to which geographic location, community
demographics, and local economic factors (as defined by
the Secretary) affect the cost of providing maternity,
labor, and delivery services at applicable hospitals,
including the cost of services that support the
provision of maternity, labor, and delivery services.
(D) The amounts applicable hospitals are paid for
maternity, labor, and delivery services, by geographic
location and hospital size, under--
(i) Medicare;
(ii) the State Medicaid program, including
payment amounts for such services under fee-
for-service payment arrangements and under
managed care (as applicable);
(iii) the State CHIP plan, including
payment amounts for such services under fee-
for-service payment arrangements and under
managed care (as applicable); and
(iv) private health insurance.
(E) A comparative payment rate analysis--
(i) comparing payment rates for maternity,
labor, and delivery services (inclusive of all
payments received by applicable hospitals for
furnishing maternity, labor, and delivery
services) under the State Medicaid fee-for-
service program to such 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 for such
services, 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.
(F) An evaluation, using such methodology and
parameters established by the Secretary, of whether
each hospital located in the State that furnishes
maternity, labor, and delivery services is expected to
experience in the next 3 years significant changes in
particular expenditures or types of reimbursement for
maternity, labor, and delivery services.
(3) Applicable hospital defined.--For purposes of this
subsection, the term ``applicable hospital'' means any hospital
located in a State that meets either of the following criteria:
(A) The hospital provides labor and delivery
services and more than 50 percent of the hospital's
births (in the most recent year for which such data is
available) are financed by the Medicaid program or
CHIP.
(B) The hospital--
(i) 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) based on the most recent 2 years of
data available (as determined by the
Secretary), furnished services for less than an
average of 300 births per year; and
(iii) provides labor and delivery services.
(4) Assistance to small hospitals in compiling cost
information.--There are appropriated to the Secretary for
fiscal year 2026, $10,000,000 for the purpose of providing
grants and technical assistance to a hospital described in
paragraph (3)(B) to enable such hospital to compile detailed
information for use in the State studies required under
paragraph (1), to remain available until expended.
(5) HHS report on state studies.--For each year in which a
State is required to conduct a study under paragraph (1), the
Secretary shall issue, not later than 12 months after the date
on which the State submits to the Secretary the data described
in such paragraph, a publicly available report that compiles
and details the results of such study and includes the
information described in paragraph (2).
(b) HHS Report on National Data Collection Findings.--Not later
than 3 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), including recommendations for improving data collection on the
cost of providing maternity, labor, and delivery services.
(c) Implementation Funding.--In addition to the amount appropriated
under subsection (a)(4), there are appropriated, out of any funds in
the Treasury not otherwise obligated, $3,000,000 for fiscal year 2026,
to remain available until expended, to the Secretary of Health and
Human Services for purposes of implementing this section.
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 2027, 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, 2026, 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 2027, 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 2028 through 2032, 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 d