Page 11

Page 11 – State Health Official

3) Decrease the rates of cesarean section births in low-risk pregnancies, defined as nulliparous (first-time pregnancies), term (37 or more weeks gestation), singleton (one fetus), vertex (head facing down in the birth canal) or “NTSV births.”

These three areas of focus were selected based on input from a stakeholder workgroup, which was charged with identifying areas where Medicaid and CHIP programs had the greatest capacity to influence improvement and where CMS and states could, collectively, have the greatest impact on maternal and infant health care and outcomes.

To support state Medicaid agencies and their partners in driving improvement in these areas, CMS designs and runs learning collaboratives, which combine webinars for all states featuring best practices and effective models of care with affinity groups that provide intensive quality improvement technical assistance to state teams committed to action in these areas. Two learning collaboratives began in 2021: Postpartum Care and Infant Well-Child Visits. The third learning collaborative, focused on low-risk cesarean section births, is scheduled to begin in 2022. CMS will continue to assess the quality measurement and improvement technical assistance needs of states and will develop future opportunities and resources to address the identified needs and to facilitate shared learning across states.

CMS publishes quality measures and other data and resource materials on Medicaid.gov for states to use in their quality improvement efforts. Currently available data and resources related to improving the quality of postpartum care are included in the Appendix of this letter. CMS anticipates adding additional resources as we learn more about states’ technical assistance needs and their successes and lessons learned from postpartum care quality improvement activities. Section 1115 Demonstrations

CMS has approved several state section 1115(a) demonstrations to implement initiatives in Medicaid and CHIP aimed at immediate extension of postpartum coverage. States that extended postpartum coverage through an approved section 1115 demonstration may choose to transition the authority for their extended postpartum coverage to the new SPA option. These states, as well as states with a pending 1115 demonstration application to extend postpartum coverage, should contact their demonstration project officer to discuss their options.

In addition, CMS has previously approved section 1115 demonstration projects providing coverage of family planning and related preventive health services, authorizing evidence-based home visiting services, and incentivizing providers to demonstrate specific quality improvements and beneficiary health outcomes for maternal health. CMS supports states in submitting section 1115 proposals to test approaches that address challenges associated with maternal mortality and morbidity and stands ready to work with states on such proposals. Closing

CMS appreciates the partnership with states to ensure Medicaid and CHIP drive improvements in health outcomes and promote health equity, and CMS remains committed to collaborating with states to improve access to coverage and maternal health outcomes. CMS is available to provide technical assistance to states as they extend postpartum coverage, implement innovative The contents of this document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract. This document is intended only to provide clarity to the public regarding existing requirements under the law.