Text of Senate Amendment 4688

Text of Senate Amendment 4688

Congressional Record, Volume 172 Issue 50 (Thursday, March 19, 2026) [Congressional Record Volume 172, Number 50 (Thursday, March 19, 2026)] [Senate] [Pages S1396-S1404] From the Congressional Record Online through the Government Publishing Office [ www.gpo.gov ] SA 4688. Mr. WYDEN (for himself, Mr. Lujan, and Mr. Van Hollen) submitted an amendment intended to be proposed by him to the bill S. 1383, to establish the Veterans Advisory Committee on Equal Access, and for other purposes; which was ordered to lie on the table; as follows: In lieu of the matter proposed to be inserted, insert the following: 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); [[Page S1397]] (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 (zz)) 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: ``(zz) 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 s