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H.R. 8907: Innovative Maternal Payment and Coverage To Save Moms Act

This bill, known as the Innovative Maternal Payment and Coverage To Save Moms Act, aims to improve maternity care for pregnant and postpartum individuals by establishing a demonstration project called the Perinatal Care Alternative Payment Model Demonstration Project. Here’s a breakdown of what the bill intends to do:

Overview of the Demonstration Project

From fiscal years 2027 through 2031, the Secretary of Health and Human Services, through the Administrator of the Centers for Medicare & Medicaid Services (CMS), will implement this demonstration project. The goal is to allow states to test new payment models specifically designed for maternity care under the Medicaid program and child health plans. The key objectives include:

Testing different payment models for maternity care.
Evaluating how these models can improve maternal health outcomes.

Stakeholder Coordination

The Secretary will collaborate with various stakeholders to set up the demonstration project. This includes:

State Medicaid programs.
Maternity care providers and their representative organizations.
Organizations that focus on patient advocacy, especially for demographic groups facing higher rates of maternal mortality and severe maternal illness.
Community organizations working to enhance maternal health.
Perinatal health workers.
Health insurance providers.
Hospitals, health systems, midwifery practices, and rural health clinics.
Researchers and policy experts.
Any other relevant stakeholders identified by the Secretary.

Considerations for Payment Models

When establishing the demonstration project, the Secretary will consider payment models that:

Focus on improving health outcomes for groups with high maternal mortality and morbidity rates.
Account for varying risk levels in pregnancy when making payment decisions.
Use evidence-based quality metrics for payment determinations.
Include non-hospital birth settings in their strategies, like freestanding birth centers.
Address social determinants affecting maternal health.
Utilize diverse maternity care teams inclusive of various health professionals.
Account for maternal mental health and substance use disorders.

State Participation and Evaluation

States interested in participating in the project must apply to the Secretary with necessary information. The impact of the project will be evaluated based on:

Maternal health outcomes, focusing on demographic factors.
State spending on maternity care under the project.
Qualitative and quantitative measures of patient experiences.
Any additional relevant assessments that the Secretary deems important.

Reporting Findings

One year after the completion or termination of the demonstration project, the Secretary will submit a report to Congress detailing:

The evaluation results of the demonstration project.
Recommendations on whether the project should continue and expand nationally after fiscal year 2031.

Definitions of Key Terms

The bill provides definitions for several key terms, including:

Alternative payment model: A specific payment strategy designed to improve care.
Maternal mortality: Death related to pregnancy or childbirth complications.
Maternity care provider: Includes physicians, midwives, doulas, and others focused on maternal health.
Perinatal: The period from the start of pregnancy to one year postpartum.
Severe maternal morbidity: Health conditions stemming from pregnancy that significantly impact the individual’s health.
Social determinants of maternal health: Nonclinical factors influencing maternal health outcomes.