---
kind: "section"
citation: "42 U.S.C. § 1396w–9"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1396w–9"
heading: "State studies and HHS report on costs of providing maternity, labor, and delivery services"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1396w-9"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XIX — Grants to States for Medical Assistance Programs"
---

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

- (a) **State study—**
  - (1) **In general—** Not later than 30 months after February 3, 2026, and every 5 years thereafter, each [State](/usc/42/619.md?p=5) (as such term is defined in [section 1301(a)(1) of this title](/usc/42/1301.md?p=a-1) for purposes of subchapters XIX and XXI of this chapter) shall conduct a study on the costs of providing maternity, labor, and delivery services in applicable [hospitals](/usc/42/300s–3.md?p=1) (as defined in [paragraph (3)](#a-3)) and submit the results of such study to the [Secretary](/usc/42/1301.md?p=a-6) of Health and Human Services (referred to in this section as the “[Secretary](/usc/42/1301.md?p=a-6)”) in such form and manner as the [Secretary](/usc/42/1301.md?p=a-6) requires.
  - (2) **Content of study—** A [State](/usc/42/619.md?p=5) study required under [paragraph (1)](#a-1) shall include the following information (to the extent practicable and as further defined by the [Secretary](/usc/42/1301.md?p=a-6)) with respect to maternity, labor, and delivery services furnished by applicable [hospitals](/usc/42/300s–3.md?p=1) located in the [State](/usc/42/619.md?p=5):
    - (A) An estimate of the cost of providing maternity, labor, and delivery services at applicable [hospitals](/usc/42/300s–3.md?p=1), based on the expenditures a representative sample of such [hospitals](/usc/42/300s–3.md?p=1) 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 [hospitals](/usc/42/300s–3.md?p=1) that would be applicable [hospitals](/usc/42/300s–3.md?p=1) (as defined in [paragraph (3)](#a-3)) if not for ceasing to provide labor and delivery services within the past 5 years, based on the expenditures a representative sample of such [hospitals](/usc/42/300s–3.md?p=1) incurred for providing such services during the 2 most recent years for which data is available.
    - (C) To the extent data allow, an analysis of the extent to which geographic location, community demographics, and local economic factors (as defined by the [Secretary](/usc/42/1301.md?p=a-6)) affect the cost of providing maternity, labor, and delivery services at applicable [hospitals](/usc/42/300s–3.md?p=1) described in subparagraphs [(A)](#a-2-A) and [(B)](#a-2-B), [including](/usc/42/1301.md?p=b) the cost of services that support the provision of maternity, labor, and delivery services.
    - (D) The amounts applicable [hospitals](/usc/42/300s–3.md?p=1) are paid for maternity, labor, and delivery services, by geographic location and [hospital](/usc/42/300s–3.md?p=1) size, under—
      - (i) parts A and B of the Medicare program;
      - (ii) the [State](/usc/42/619.md?p=5) Medicaid program, [including](/usc/42/1301.md?p=b) payment amounts for such services under fee-for-service payment arrangements and under managed care (as applicable);
      - (iii) the [State](/usc/42/619.md?p=5) CHIP plan, [including](/usc/42/1301.md?p=b) 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](/usc/42/300s–3.md?p=1) for furnishing maternity, labor, and delivery services) under the [State](/usc/42/619.md?p=5) Medicaid fee-for-service program to such payment rates for such services under Medicare ([including](/usc/42/1301.md?p=b) those described in paragraphs (2) and (3) of section 447.203(b) of title 42, Code of Federal Regulations), and, to the extent data is available, such payment rates for such services under Medicaid managed care and private health insurers within geographic areas of the [State](/usc/42/619.md?p=5); 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](/usc/42/1301.md?p=a-6), of whether each [hospital](/usc/42/300s–3.md?p=1) located in the [State](/usc/42/619.md?p=5) 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](/usc/42/300s–3.md?p=1)” means any [hospital](/usc/42/300s–3.md?p=1) located in a [State](/usc/42/619.md?p=5) that meets either of the following criteria:
    - (A) The [hospital](/usc/42/300s–3.md?p=1) provides labor and delivery services and more than 50 percent of the [hospital](/usc/42/300s–3.md?p=1)’s births (in the most recent year for which such data is available) are financed by the Medicaid program or CHIP.
    - (B) The [hospital](/usc/42/300s–3.md?p=1)—
      - (i) is located in a rural area (as defined by the Federal Office of Rural Health Policy for the purpose of rural health [grant](/usc/42/1397j.md?p=10) programs administered by such Office);
      - (ii) based on the most recent 2 years of data available (as determined by the [Secretary](/usc/42/1301.md?p=a-6)), 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](/usc/42/1301.md?p=a-6) for [fiscal year](/usc/42/619.md?p=3) 2026, $10,000,000 for the purpose of providing [grants](/usc/42/1397j.md?p=10) and technical assistance to a [hospital](/usc/42/300s–3.md?p=1) described in [paragraph (3)(B)](#a-3-B) to enable such [hospital](/usc/42/300s–3.md?p=1) to compile detailed information for use in the [State](/usc/42/619.md?p=5) studies required under [paragraph (1)](#a-1), to remain available until expended.
  - (5) **HHS report on State studies—** For each year in which a [State](/usc/42/619.md?p=5) is required to conduct a study under [paragraph (1)](#a-1), the [Secretary](/usc/42/1301.md?p=a-6) shall issue, not later than 18 months after the date on which the [State](/usc/42/619.md?p=5) submits to the [Secretary](/usc/42/1301.md?p=a-6) the data described in such paragraph, a publicly available report that compiles and details the results of such study and [includes](/usc/42/1301.md?p=b) the information described in [paragraph (2)](#a-2).
- (b) **HHS report on national data collection findings—** Not later than 3 years and 6 months after February 3, 2026, the [Secretary](/usc/42/1301.md?p=a-6) shall submit to Congress, and make publicly available, a report analyzing the first studies conducted by [States](/usc/42/619.md?p=5) under [subsection (a)(1)](#a-1), [including](/usc/42/1301.md?p=b) 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)](#a-4), there are appropriated, out of any funds in the Treasury not otherwise obligated, $3,000,000 for [fiscal year](/usc/42/619.md?p=3) 2026, to remain available until expended, to the [Secretary](/usc/42/1301.md?p=a-6) of Health and Human Services for purposes of implementing this section.

## Source credit

(Pub. L. 119–75, div. J, title I, § 6104, Feb. 3, 2026, 140 Stat. 640.)

## Notes

### Editorial Notes

### Codification

Section was enacted as part of the Consolidated Appropriations Act, 2026, and not as part of the Social Security Act which comprises this chapter.