[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3443 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
2d Session
S. 3443
To amend title XIX of the Social Security Act to provide Medicaid
coverage for all pregnant and postpartum women, to provide coverage
under the Medicaid program for services provided by doulas, midwives,
and lactation consultants, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 11, 2020
Mr. Casey introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide Medicaid
coverage for all pregnant and postpartum women, to provide coverage
under the Medicaid program for services provided by doulas, midwives,
and lactation consultants, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Coverage and Care for
Mothers Act''.
SEC. 2. EXTENDING MEDICAID ELIGIBILITY TO ALL PREGNANT WOMEN.
(a) In General.--Section 1905(n)(1) of the Social Security Act (42
U.S.C. 1396d(n)(1)) is amended to read as follows:
``(1) a woman who is pregnant and through the end of the
month in which the 365-day period (beginning on the last day of
her pregnancy) ends; and''.
(b) Conforming Amendments.--Title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) is amended--
(1) in section 1902--
(A) in subsection (a)(10)(C)--
(i) in clause (ii), by striking ``must make
available medical assistance--'' and all that
follows through ``individual described in
subparagraph (A)'' and inserting ``must make
available medical assistance to individuals
under the age of 18 who (but for income and
resources) would be eligible for medical
assistance as an individual described in
subparagraph (A)(i)'';
(ii) in clause (iii)--
(I) by striking ``must include (I)
with respect to'' and inserting ``must
include, with respect to''; and
(II) by striking ``; and (II)'' and
all that follows through ``delivery
services'';
(B) in subsection (e), by striking paragraph (6);
(C) in subsection (l)(1)(A), by inserting ``before
January 1, 2020,'' before ``women during pregnancy'';
and
(D) in subsection (ii)(1)(A), by inserting ``that
was in effect as of January 1, 2020'' after ``pregnant
women'';
(2) in section 1920(b)(1)(A), by striking ``that the family
income'' and all that follows through ``income level of
eligibility'' and inserting ``that the woman is eligible for
medical assistance''; and
(3) in section 1937(a)(2)(B), by amending clause (i) to
read as follows:
``(i) Qualified pregnant women.--The
individual is a qualified pregnant woman (as
defined in section 1905(n)(1)).''.
SEC. 3. EXTENDING CONTINUOUS MEDICAID AND CHIP COVERAGE FOR PREGNANT
AND POSTPARTUM WOMEN.
(a) Extending Continuous Medicaid and CHIP Coverage for Pregnant
and Postpartum Women.--
(1) Medicaid.--Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended--
(A) in section 1902(e)(5), by striking ``60-day
period'' and inserting ``365-day period'';
(B) in section 1902(l)(1)(A), by striking ``60-day
period'' and inserting ``365-day period'';
(C) in section 1903(v)(4)(A)(i), by striking ``60-
day period'' and inserting ``365-day period''; and
(D) in section 1905(a), in the 4th sentence in the
matter following paragraph (30), by striking ``60-day
period'' and inserting ``365-day period''.
(2) CHIP.--Section 2112 of the Social Security Act (42
U.S.C. 1397ll) is amended by striking ``60-day period'' each
place it appears and inserting ``365-day period''.
(3) Conforming amendment.--Section 1938(b)(2)(C) of the
Social Security Act (42 U.S.C. 1396u-8(b)(2)(C)) is amended by
striking ``previous 60 days'' and inserting ``previous 365
days''.
(b) Requiring Full Benefits for Pregnant and Postpartum Women.--
(1) Medicaid.--
(A) In general.--Paragraph (5) of section 1902(e)
of the Social Security Act (24 U.S.C. 1396a(e)) is
amended to read as follows:
``(5) Any woman who is eligible for medical assistance
under the State plan or a waiver of such plan and who is, or
who while so eligible becomes, pregnant, shall continue to be
eligible under the plan or waiver for medical assistance
through the end of the month in which the 365-day period
(beginning on the last day of her pregnancy) ends, regardless
of the basis for the woman's eligibility for medical
assistance, including if the woman's eligibility for medical
assistance is on the basis of being pregnant.''.
(B) Conforming amendment.--Section 1902(a)(10) of
the Social Security Act (42 U.S.C. 1396a(a)(10)) is
amended in the matter following subparagraph (G) by
striking ``(VII) the medical assistance'' and all that
follows through ``complicate pregnancy,''.
(2) CHIP.--
(A) Section 2107(e)(1) of the Social Security Act
(42 U.S.C. 1397gg(e)(1)) is amended--
(i) by redesignating subparagraphs (H)
through (S) as subparagraphs (I) through (T),
respectively; and
(ii) by inserting after subparagraph (G),
the following:
``(H) Section 1902(e)(5) (requiring 365-day
continuous coverage for pregnant and postpartum
women).''.
(B) Section 2112 of the Social Security Act (42
U.S.C. 1397ll) is amended, in subsections (d)(2) and
(f)(2), by striking ``60-day period'' each place it
appears and inserting ``365-day period''.
SEC. 4. MEDICAID COVERAGE OF SERVICES PROVIDED BY DOULAS, MIDWIVES, AND
LACTATION CONSULTANTS.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)--
(A) in paragraph (29), by striking ``and'' at the
end;
(B) by redesignating paragraph (30) as paragraph
(31); and
(C) by inserting after paragraph (29) the following
new paragraph:
``(30) services, including--
``(A) prenatal, delivery, postpartum, and lactation
consulting services, provided by doulas, midwives, and
lactation consultants (as those terms are defined in
subsection (gg)) to the extent authorized under State
law; and
``(B) services included in the components of
postpartum care identified by the American College of
Obstetricians and Gynecologists in Committee Opinion
Number 736 published in May of 2018 (or any successor
opinion or publication); and''; and
(2) by adding at the end the following new subsection:
``(gg) Doulas and Midwives Defined.--For purposes of subsection
(a)(30):
``(1) Doulas defined.--The term `doula' means an individual
who--
``(A) is certified by an organization, which has
been established for not less than 5 years and which
requires the completion of continuing education to
maintain such certification, to provide non-medical
advice, information, emotional support, and physical
comfort to an individual during such individual's
pregnancy, childbirth, and postpartum period; and
``(B) maintains such certification by completing
such required continuing education.
``(2) Midwives defined.--
``(A) In general.--The term `midwife' means a
certified midwife, certified professional midwife, and
Tribal-recognized midwife.
``(B) Certified midwife.--For purposes of
subparagraph (A), the term `certified midwife' means an
individual who is certified by the American Midwifery
Certification Board to practice midwifery.
``(C) Certified professional midwife.--For purposes
of subparagraph (A), the term `certified professional
midwife' means an individual who--
``(i) is certified by the North American
Registry of Midwives to practice midwifery for
normal, low-risk pregnancies and childbirths;
``(ii) completes--
``(I) a midwifery education program
accredited by the Midwifery Education
and Accreditation Council or any other
entity recognized by the Department of
Education; or
``(II) the requirements to obtain a
Midwifery Bridge Certificate from the
North American Registry of Midwives;
and
``(iii) maintains the certification
described in clause (i) by completing any
required continuing education for such
certification.
``(D) Tribal-recognized midwife.--For purposes of
subparagraph (A), the term `Tribal-recognized midwife'
means an individual who is recognized by an Indian
tribe (as defined in section 4 of the Indian Health
Care Improvement Act) to practice midwifery for such
tribe.
``(3) Lactation consultant defined.--The term `lactation
consultant' means an individual who is a specialist who--
``(A) is trained to--
``(i) focus on the needs and concerns of a
breastfeeding mother and baby; and
``(ii) prevent, recognize, and solve
breastfeeding difficulties;
``(B) is certified by an organization, which has
been established for not less than 5 years and which
requires the completion of continuing education to
maintain such certification, to provide lactation
consulting services; and
``(C) maintains such certification by completing
such required continuing education.''.
(b) Requiring Mandatory Coverage Under State Plan.--Section
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A))
is amended, in the matter preceding clause (i), by striking ``and
(29)'' and inserting ``(29), and (30)''.
SEC. 5. INCREASED FMAP FOR ADDITIONAL EXPENDITURES.
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as
amended by section 4, is further amended--
(1) in subsection (b), by striking ``and (ff)'' and
inserting ``(ff), and (hh)''; and
(2) by adding at the end the following:
``(hh) Increased FMAP for Additional Expenditures for Medical
Assistance to Pregnant and Postpartum Women.--For calendar quarters
beginning on or after January 1, 2021, notwithstanding subsection (b),
the Federal medical assistance percentage for a State, with respect to
the additional amounts expended by such State for medical assistance
under the State plan under this title or a waiver of such plan that are
attributable to requirements imposed by the amendments made by the
Improving Coverage and Care for Mothers Act (as determined by the
Secretary), shall be equal to 100 percent.''.
SEC. 6. EFFECTIVE DATE.
(a) In General.--Subject to subsection (b), the amendments made by
this Act shall apply with respect to medical assistance furnished on or
after January 1, 2021.
(b) Exception for State Legislation.--In the case of a State plan
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
that the Secretary of Health and Human Services determines requires
State legislation in order for the respective plan to meet any
requirement imposed by amendments made by this section, the respective
plan shall not be regarded as failing to comply with the requirements
of such title solely on the basis of its failure to meet such an
additional requirement before the first day of the first calendar
quarter beginning after the close of the first regular session of the
State legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of the session shall be
considered to be a separate regular session of the State legislature.
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