S.F. 35 DIVISION I 1 MEDICAID COVERAGE —— MATERNAL AND CHILD HEALTH IMPROVEMENTS 2 Section 1. Section 249A.3, subsection 1, paragraph h, Code 3 2021, is amended to read as follows: 4 h. Is a woman who, while pregnant, meets eligibility 5 requirements for assistance under the federal Social Security 6 Act, section 1902(l), and continues to meet the requirements 7 except for income. The woman is eligible to receive assistance 8 until sixty days twelve months after the date pregnancy ends. 9 Sec. 2. MEDICAID REIMBURSEMENT FOR MATERNAL HEALTH. Under 10 both fee-for-service and managed care administration of 11 Medicaid, the department of human services shall adopt rules 12 pursuant to chapter 17A, amend any contract with a managed 13 care organization, and apply for any Medicaid state plan 14 amendment or waiver as may be necessary to provide for all of 15 the following: 16 1. Reimbursement in an amount appropriate to cover the 17 entire standard of care costs for labor and delivery. 18 2. The same reimbursement for maternal-fetal medicine 19 services and comprehensive maternity care, including both 20 facility and professional fees, whether provided in person or 21 through the use of telehealth. 22 3. Continuous Medicaid eligibility for a woman for a 23 twelve-month postpartum period, if the woman applied for 24 Medicaid coverage before the end of the woman’s pregnancy, was 25 determined Medicaid eligible, and remains eligible for coverage 26 during the month in which the woman’s pregnancy ends. The 27 woman’s eligibility for coverage shall continue during the 28 twelve-month postpartum period beginning with the last day of 29 the woman’s pregnancy through the end of the month in which the 30 twelve-month period ends; shall continue without regard to the 31 basis for the woman’s eligibility or changes in family income 32 or resources; and shall continue in the same coverage group 33 under which the woman received Medicaid coverage while pregnant 34 unless the woman qualifies for Medicaid under another coverage 35 -1- LSB 1094XS (4) 89 pf/rh 1/ 6

S.F. 35 group once the pregnancy ends or unless the woman’s eligibility 1 is through the medically needy program. 2 4. Comprehensive maternity care, to include the basic 3 number of prenatal and postpartum visits recommended by the 4 American college of obstetricians and gynecologists; additional 5 prenatal and postpartum visits that are medically necessary; 6 necessary laboratory, nutritional assessment and counseling, 7 health education, personal counseling, managed care, outreach, 8 and follow-up services; treatment of conditions which may 9 complicate pregnancy; and doula care. For the purposes of this 10 subsection, “doula” means a trained professional who provides 11 continuous physical, emotional, and informational support to a 12 woman before, during, and after childbirth, to help the woman 13 achieve the healthiest, most satisfying experience possible. 14 5. Reimbursement for breast-feeding supports, counseling, 15 and supplies including the standard cost of breast pumps 16 including electric breast pumps and associated breast pump 17 supplies. 18 6. Reimbursement for transportation to all prenatal and 19 postpartum care appointments. 20 7. Reimbursement for all postpartum care products such as 21 breast pads, period pads, comfort products, pain relievers, and 22 other similar products. 23 DIVISION II 24 MATERNAL BEST PRACTICES OR SAFETY BUNDLES —— REQUIREMENTS FOR 25 HOSPITALS 26 Sec. 3. NEW SECTION . 135B.36 Maternal best practices or 27 safety bundles —— information. 28 A hospital licensed under this chapter that provides labor 29 and delivery services shall do all of the following: 30 1. Adopt and implement the current best practices or safety 31 bundles recommended by the American college of obstetricians 32 and gynecologists and the alliance for innovation on maternal 33 health including but not limited to action measures for 34 obstetrical hemorrhage, severe hypertension or preeclampsia, 35 -2- LSB 1094XS (4) 89 pf/rh 2/ 6

S.F. 35 prevention of venous thromboembolism, reduction of low-risk 1 primary cesarean births and support for intended vaginal 2 births, reduction of peripartum racial disparities, and 3 postpartum care access and standards. 4 2. Provide all of the following information to the public: 5 a. Maternity and neonatal level of care status and the 6 meaning of a maternity or neonatal level of care status. 7 b. Cesarean birth statistics. 8 c. Vaginal birth after cesarean statistics. 9 d. Vaginal birth after two cesarean statistics. 10 e. The rate of exclusive breastfeeding upon discharge from 11 a hospital. 12 3. Provide all women receiving labor and delivery services 13 with information and assistance in applying for services and 14 health care coverage available for women and infants including 15 but not limited to those available through Medicaid; area 16 education agencies; the federal women, infants, and children 17 program; home visiting programs; and other relevant programs 18 prior to discharge from the hospital. 19 4. Have in place a comprehensive labor and delivery unit 20 closure plan that includes a plan for future births and 21 pregnancies and the capacity of other providers to absorb the 22 services in case of unit closure. 23 DIVISION III 24 MATERNAL AND INFANT HOME VISITING PROGRAM 25 Sec. 4. MATERNAL AND INFANT HOME VISITING PROGRAM. The 26 department of human services shall engage in a cross-agency 27 collaboration with the department of public health and the 28 department of education to identify and leverage funding 29 sources and opportunities, including Medicaid, to expand home 30 visiting services for women and infants that promote healthy 31 pregnancies, positive birth outcomes, and healthy infant 32 growth and development. The departments shall involve key 33 stakeholders in designing a home visiting services approach 34 for the state that maximizes the coordination and integration 35 -3- LSB 1094XS (4) 89 pf/rh 3/ 6

S.F. 35 of programs and funding streams, reduces duplication of 1 efforts, and ensures that the services provided meet federal 2 evidence-based criteria. The approach shall ensure that home 3 visiting services shall be available to women prenatally, 4 throughout the pregnancy, and postpartum, and shall include 5 mental and physical health, social, educational, and other 6 services and interventions based upon the risk factors and 7 needs identified. The departments may conduct a feasibility 8 study to consider the various options available to increase 9 Medicaid coverage and funding of home visiting services, either 10 through a state plan amendment or waiver. The department of 11 human services shall seek federal approval of any Medicaid 12 state plan amendment or waiver necessary to administer this 13 section. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill relates to maternal and child health. 18 Division I of the bill relates to maternal and child health 19 improvements under the Medicaid program. The bill directs the 20 department of human services (DHS) under both fee-for-service 21 and managed care administration of Medicaid to adopt rules 22 pursuant to Code chapter 17A, amend any contract with a managed 23 care organization, and apply for any Medicaid state plan 24 amendment or waiver as may be necessary to provide all of the 25 following: 1) reimbursement in an amount appropriate to cover 26 the entire standard of care costs for labor and delivery, 2) 27 the same reimbursement for maternal-fetal medicine services 28 and comprehensive maternity care, including facility and 29 professional fees, whether provided in person or through the 30 use of telehealth, 3) continuous Medicaid eligibility for 31 a woman for a 12-month postpartum period, 4) comprehensive 32 maternity care, to include the basic number of prenatal and 33 postpartum visits recommended by the American college of 34 obstetricians and gynecologists; additional prenatal and 35 -4- LSB 1094XS (4) 89 pf/rh 4/ 6

S.F. 35 postpartum visits that are medically necessary; necessary 1 laboratory, nutritional assessment and counseling, health 2 education, personal counseling, managed care, outreach, 3 and follow-up services; treatment of conditions which may 4 complicate pregnancy; and doula care, 5) reimbursement for 5 breastfeeding supports, counseling, and supplies including 6 the standard cost of breast pumps including electric breast 7 pumps and associated breast pump supplies, 6) reimbursement 8 for transportation to all prenatal and postpartum care 9 appointments, and 7) reimbursement for all postpartum care 10 products such as breast pads, period pads, comfort products, 11 pain relievers, and other similar products. 12 Division II of the bill relates to maternal best practices or 13 safety bundle requirements for hospitals. The bill requires 14 a licensed hospital that provides labor and delivery services 15 to 1) adopt and implement the current best practices or safety 16 bundles recommended by the American college of obstetricians 17 and gynecologists and the alliance for innovation on maternal 18 health; 2) provide information to the public including but not 19 limited to maternity and neonatal level of care status and 20 the meaning of a maternity and neonatal level of care status, 21 cesarean births, vaginal births following cesarean births, 22 and exclusive breast-feeding statistics; 3) provide all women 23 receiving labor and delivery services with information and 24 assistance in applying for services and health care coverage 25 available for women and infants including but not limited to 26 those available through Medicaid; area education agencies; the 27 federal women, infants, and children program; home visiting 28 programs; and other programs prior to discharge from the 29 hospital; and 4) have in place a comprehensive labor and 30 delivery unit closure plan that includes a plan for future 31 births and pregnancies and the capacity of other providers to 32 absorb the services in case of unit closure. 33 Division III of the bill requires DHS to engage in a 34 cross-agency collaboration with the departments of public 35 -5- LSB 1094XS (4) 89 pf/rh 5/ 6

S.F. 35 health and education to identify and leverage funding 1 sources and opportunities, including Medicaid, to expand home 2 visiting services for women and infants that promote healthy 3 pregnancies, positive birth outcomes, and healthy infant 4 growth and development. The departments shall involve key 5 stakeholders in designing a home visiting services approach 6 for the state. Home visiting services shall be available to 7 women prenatally, throughout the pregnancy, and postpartum, and 8 shall include mental and physical health, social, educational, 9 and other services and interventions based upon the risk 10 factors and needs identified. The departments may conduct a 11 feasibility study to consider the various options available 12 to increase Medicaid coverage and funding of home visiting 13 services, either through a state plan amendment or waiver. 14 DHS shall seek federal approval of any Medicaid state plan 15 amendment or waiver necessary to administer this division of 16 the bill. 17 -6- LSB 1094XS (4) 89 pf/rh 6/ 6