§1396w–9 State studies and HHS report on costs of providing maternity, labor, and delivery services

Summary

States must study the cost of providing maternity, labor, and delivery care at certain hospitals and send the results to the Secretary of Health and Human Services. The first study is due within 30 months after February 3, 2026, and then every 5 years. Each study must estimate costs using a representative sample of hospitals from the two most recent years, include hospitals that stopped offering births in the last 5 years, look at how location, community makeup, and local economy affect costs, report what hospitals are paid by Medicare (parts A and B), Medicaid (fee-for-service and managed care), CHIP (fee-for-service and managed care), and private insurance, compare Medicaid fee-for-service rates to Medicare and (when data exist) to Medicaid managed care and private insurers, review different payment methods (like bundled payments or quality bonuses), and say whether each hospital is likely to see big changes in costs or reimbursements in the next 3 years. An “applicable hospital” means either a hospital where more than 50% of births in the last year were paid by Medicaid or CHIP, or a rural hospital that averages fewer than 300 births per year over the last two years and still provides labor and delivery. The law provides $10,000,000 for fiscal year 2026 to help small rural hospitals gather detailed data for the studies, and $3,000,000 for fiscal year 2026 to help carry out the law. After each State sends its data, the Secretary must publish a report within 18 months. The Secretary must also give Congress and the public a report on the first round of State studies by 3 years and 6 months after February 3, 2026, with recommendations to improve cost data.