[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6004 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 6004
To amend titles XIX and XXI of the Social Security Act to improve
Medicaid and the Children's Health Insurance Program for low-income
mothers.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 19, 2023
Ms. Pressley (for herself, Ms. Adams, Ms. Bush, Ms. Tlaib, Ms.
Underwood, Ms. Kelly of Illinois, Ms. Matsui, Ms. Jackson Lee, Mr.
Cohen, Ms. Norton, Ms. Velazquez, Mr. Johnson of Georgia, Mr. Lynch,
Ms. Crockett, Ms. Schakowsky, and Mrs. Watson Coleman) introduced the
following bill
October 25, 2023
Referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend titles XIX and XXI of the Social Security Act to improve
Medicaid and the Children's Health Insurance Program for low-income
mothers.
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 ``Maximizing Outcomes for Moms through
Medicaid Improvement and Enhancement of Services Act'' or the ``MOMMIES
Act''.
SEC. 2. ENHANCING MEDICAID AND CHIP BENEFITS FOR LOW-INCOME PREGNANT
INDIVIDUALS.
(a) Extending Continuous Medicaid and CHIP Coverage for Pregnant
and Postpartum Individuals.--
(1) Medicaid.--Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended--
(A) in section 1902(e)--
(i) in paragraph (6), by striking ``60-day
period (beginning on the last day of her
pregnancy)'' and inserting ``1-year period
beginning on the last day of the pregnancy (or
such longer period beginning on such day as the
State may elect)''; and
(ii) by striking paragraph (16);
(B) in section 1902(l)(1)(A), by striking ``60-day
period beginning on the last day of the pregnancy'' and
inserting ``1-year period beginning on the last day of
the pregnancy or such longer period beginning on such
day as the State may elect'';
(C) in section 1903(v)(4)(A)(i), by striking ``60-
day period beginning on the last day of the pregnancy''
and inserting ``1-year period beginning on the last day
of the pregnancy or such longer period beginning on
such day as the State may elect''; and
(D) in section 1905(a), in the 4th sentence in the
matter following the last numbered paragraph of such
section, by striking ``60-day period beginning on the
last day of her pregnancy'' and inserting ``1-year
period beginning on the last day of the pregnancy, or
such longer period beginning on such day as the State
may elect,''.
(2) CHIP.--Section 2112 of the Social Security Act (42
U.S.C. 1397ll) is amended--
(A) in subsection (d)(2)(A), by striking ``60-day
period'' and all that follows through the semicolon and
inserting ``1-year period beginning on the last day of
the pregnancy, or such longer period beginning on such
day as the State may elect, ends;''; and
(B) in subsection (f)(2), by striking ``60-day
period (beginning on the last day of the pregnancy)''
and inserting ``1-year period beginning on the last day
of the pregnancy, or such longer period beginning on
such day as the State may elect,''.
(b) Requiring Full Benefits for Pregnant and Postpartum
Individuals.--
(1) 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) Coverage of full benefits for at least 1 year for
pregnant and postpartum individuals.--
``(A) In general.--Any individual who, while
pregnant, is eligible for and has received medical
assistance under the State plan approved under this
title or a waiver of such plan (including during a
period of retroactive eligibility under subsection
(a)(34)) shall continue to be eligible under the plan
or waiver for medical assistance through the end of the
month in which the 1-year period beginning on the last
day of the pregnancy, or such longer period beginning
on such day as the State may elect, ends, regardless of
the basis for the individual's eligibility for medical
assistance, including if the individual's eligibility
for medical assistance is on the basis of being
pregnant.
``(B) Scope of benefits.--The medical assistance
provided for a pregnant or postpartum individual
described in subparagraph (A) shall--
``(i) include all items and services
covered under the State plan (or waiver) that
are not less in amount, duration, or scope, or
are determined by the Secretary to be
substantially equivalent, to the medical
assistance available for an individual
described in subsection (a)(10)(A)(i); and
``(ii) be provided for the individual while
pregnant and during the 1-year period that
begins on the last day of the pregnancy, or
such longer period beginning on such day as the
State may elect, and ends on the last day of
the month in which such period ends.''.
(2) Conforming amendments.--
(A) 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
``during the period described in such section,''.
(B) Section 2107(e)(1)(J) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)(J)) is amended--
(i) by striking ``Paragraphs (5) and (16)''
and inserting ``Paragraph (5)''; and
(ii) by striking ``(relating to'' and all
that follows through the period and inserting
``(relating to the provision of medical
assistance to pregnant individuals during and
following pregnancy under title XIX).''.
(c) Requiring Coverage of Oral Health Services for Pregnant and
Postpartum Individuals.--
(1) Medicaid.--Section 1905 of the Social Security Act (42
U.S.C. 1396d) is amended--
(A) in subsection (a)(4)--
(i) by striking ``; and (D)'' and inserting
``; (D)'';
(ii) by striking ``; and (E)'' and
inserting ``; (E)'';
(iii) by striking ``; and (F)'' and
inserting ``; (F)''; and
(iv) by inserting ``; and (G) oral health
services for pregnant and postpartum
individuals (as defined in subsection (jj))''
after ``(or waiver of such plan)''; and
(B) by adding at the end the following new
subsection:
``(jj) Oral Health Services for Pregnant and Postpartum
Individuals.--
``(1) In general.--For purposes of this title, the term
`oral health services for pregnant and postpartum individuals'
means dental services necessary to prevent disease and promote
oral health, restore oral structures to health and function,
and treat emergency conditions that are furnished to an
individual during pregnancy (or during the 1 year period that
begins on the last day of the pregnancy, or such longer period
beginning on such day as the State may elect).
``(2) Coverage requirements.--To satisfy the requirement to
provide oral health services for pregnant and postpartum
individuals, a State shall, at a minimum, provide coverage for
preventive, diagnostic, periodontal, and restorative care
consistent with recommendations for comprehensive perinatal
oral health services and dental services during pregnancy from
the American Academy of Pediatric Dentistry and the American
College of Obstetricians and Gynecologists.''.
(2) CHIP.--Section 2103(c)(6)(A) of the Social Security Act
(42 U.S.C. 1397cc(c)(6)(A)) is amended by inserting ``or a
targeted low-income pregnant individual'' after ``targeted low-
income child''.
(3) Technical amendment.--Section 2112(d)(2) of the Social
Security Act (42 U.S.C. 1397ll(d)(2)) is amended--
(A) in the paragraph header, by inserting ``;
targeted low-income pregnant individual'' after
``woman''; and
(B) by striking ``the term `targeted low-income
pregnant woman' means'' and inserting ``the terms
`targeted low-income pregnant woman' and `targeted low-
income pregnant individual' mean''.
(d) Maintenance of Effort.--
(1) Medicaid.--Section 1902 of the Social Security Act (42
U.S.C. 1396a) is amended--
(A) in paragraph (74), by striking ``subsection
(gg); and'' and inserting ``subsections (gg) and
(uu);''; and
(B) by adding at the end the following new
subsection:
``(uu) Maintenance of Effort Related to Low-Income Pregnant
Individuals.--For calendar quarters beginning on or after the date of
enactment of this subsection, and before January 1, 2025, no Federal
payment shall be made to a State under section 1903(a) for amounts
expended under a State plan under this title or a waiver of such plan
if the State--
``(1) has in effect under such plan eligibility standards,
methodologies, or procedures (including any enrollment cap or
other numerical limitation on enrollment, any waiting list, any
procedures designed to delay the consideration of applications
for enrollment, any income counting rules, or similar
limitation with respect to enrollment) for individuals
described in subsection (l)(1) who are eligible for medical
assistance under the State plan or waiver under subsection
(a)(10)(A)(ii)(IX) that are more restrictive than the
eligibility standards, methodologies, or procedures,
respectively, for such individuals under such plan or waiver
that are in effect on the date of the enactment of the
Maximizing Outcomes for Moms through Medicaid Improvement and
Enhancement of Services Act; or
``(2) reduces the amount, duration, or scope of medical
assistance available to individuals described in subsection
(l)(1) who are eligible for medical assistance under such plan
or waiver under subsection (a)(10)(A)(ii)(IX) from what the
State provided to such individuals under such plan or waiver on
the date of the enactment of the Maximizing Outcomes for Moms
through Medicaid Improvement and Enhancement of Services
Act.''.
(2) CHIP.--Section 2112 of the Social Security Act (42
U.S.C. 1397ll), as amended by subsection (a), is further
amended by adding at the end the following subsection:
``(g) Maintenance of Effort.--For calendar quarters beginning on or
after January 1, 2024, and before January 1, 2028, no payment may be
made under section 2105(a) with respect to a State child health plan if
the State--
``(1) has in effect under such plan eligibility standards,
methodologies, or procedures (including any enrollment cap or
other numerical limitation on enrollment, any waiting list, any
procedures designed to delay the consideration of applications
for enrollment, or similar limitation with respect to
enrollment) for targeted low-income pregnant individuals that
are more restrictive than the eligibility standards,
methodologies, or procedures, respectively, under such plan
that are in effect on the date of the enactment of the
Maximizing Outcomes for Moms through Medicaid Improvement and
Enhancement of Services Act; or
``(2) provides pregnancy-related assistance to targeted
low-income pregnant individuals under such plan at a level that
is less than the level at which the State provides such
assistance to such individuals under such plan on the date of
the enactment of the Maximizing Outcomes for Moms through
Medicaid Improvement and Enhancement of Services Act.''.
(e) Enhanced FMAP.--Section 1905 of the Social Security Act (42
U.S.C. 1396d), as amended by subsection (c), is further amended--
(1) in subsection (b), by striking ``and (ii)'' and
inserting ``(ii), and (kk)''; and
(2) by adding at the end the following new subsection:
``(kk) Increased FMAP for Additional Expenditures for Low-Income
Pregnant Individuals.--For calendar quarters beginning on or after
January 1, 2024, 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 Maximizing Outcomes
for Moms through Medicaid Improvement and Enhancement of Services Act
(as determined by the Secretary), shall be equal to 100 percent.''.
(f) GAO Study and Report.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to Congress a report on the gaps in
coverage for--
(A) pregnant individuals under the Medicaid program
under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) and the Children's Health Insurance
Program under title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.);
(B) postpartum individuals under the Medicaid
program and the Children's Health Insurance Program who
received assistance under either such program during
their pregnancy; and
(C) birthing people between the ages of 15 and 49
under the Medicaid program.
(2) Content of report.--The report required under this
subsection shall include the following:
(A) Information about the abilities and successes
of State Medicaid agencies in determining whether
pregnant and postpartum individuals are eligible under
another insurance affordability program, and in
transitioning any such individuals who are so eligible
to coverage under such a program at the end of their
period of eligibility for medical assistance, pursuant
to section 435.1200 of the title 42, Code of Federal
Regulations (as in effect on September 1, 2018).
(B) Information on factors contributing to gaps in
coverage that disproportionately impact underserved
populations, including low-income individuals, Black,
Indigenous, and other individuals of color, individuals
who reside in a health professional shortage area (as
defined in section 332(a)(1)(A) of the Public Health
Service Act (42 U.S.C. 254e(a)(1)(A))) or individuals
who are members of a medically underserved population
(as defined by section 330(b)(3) of such Act (42 U.S.C.
254b(b)(3)(A))).
(C) Recommendations for addressing and reducing
such gaps in coverage.
(D) Such other information as the Comptroller
General deems necessary.
(3) Data disaggregation.--To the greatest extent possible,
the Comptroller General shall dissagregate data presented in
the report, including by age, gender identity, race, ethnicity,
income level, and other demographic factors.
(g) Effective Date.--The amendments made by subsections (a) and (b)
shall take effect on January 1, 2024.
SEC. 3. MATERNITY CARE HOME DEMONSTRATION PROJECT.
Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is
amended by inserting the following new section after section 1947:
``SEC. 1948. MATERNITY CARE HOME DEMONSTRATION PROJECT.
``(a) In General.--Not later than 1 year after the date of the
enactment of this section, the Secretary shall establish a
demonstration project (in this section referred to as the
`demonstration project') under which the Secretary shall provide grants
to States to enter into arrangements with eligible entities to
implement or expand a maternity care home model for eligible
individuals.
``(b) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means an
entity or organization that provides medically accurate,
comprehensive maternity services to individuals who are
eligible for medical assistance under a State plan under this
title or a waiver of such a plan, and may include:
``(A) A freestanding birth center.
``(B) An entity or organization receiving
assistance under section 330 of the Public Health
Service Act.
``(C) A federally qualified health center.
``(D) A rural health clinic.
``(E) A health facility operated by an Indian tribe
or tribal organization (as those terms are defined in
section 4 of the Indian Health Care Improvement Act).
``(2) Eligible individual.--The term `eligible individual'
means a pregnant individual or a formerly pregnant individual
during the 1-year period beginning on the last day of the
pregnancy, or such longer period beginning on such day as a
State may elect, who is--
``(A) enrolled in a State plan under this title, a
waiver of such a plan, or a State child health plan
under title XXI; and
``(B) a patient of an eligible entity which has
entered into an arrangement with a State under
subsection (g).
``(c) Goals of Demonstration Project.--The goals of the
demonstration project are the following:
``(1) To improve--
``(A) maternity and infant care outcomes;
``(B) birth equity;
``(C) health equity for--
``(i) Black, Indigenous, and other people
of color;
``(ii) lesbian, gay, bisexual, transgender,
queer, non-binary, and gender nonconfirming
individuals;
``(iii) people who live in regions with
limited or no access to obstetric care;
``(iv) people with disabilities; and
``(v) other underserved populations;
``(D) communication by and between maternity,
infant care, and social services providers;
``(E) integration of perinatal support services,
including community health workers, doulas, social
workers, public health nurses, peer lactation
counselors, lactation consultants, childbirth
educators, peer mental health workers, and others, into
health care entities and organizations;
``(F) care coordination between maternity, infant
care, oral health services, and social services
providers within the community;
``(G) the quality and safety of maternity and
infant care;
``(H) the experience of individuals receiving
respectful maternity care, including by increasing the
ability of an individual to develop and follow their
own birthing plans; and
``(I) access to adequate prenatal and postpartum
care, including--
``(i) prenatal care that is initiated in a
timely manner;
``(ii) not fewer than 5 post-pregnancy
visits to a maternity care provider for
postpartum care and support;
``(iii) interpregnancy care; and
``(iv) support and treatment for perinatal
mood and anxiety disorders.
``(2) To provide coordinated, evidence-based, respectful,
culturally and linguistically appropriate, and person-centered
maternity care management.
``(3) To decrease--
``(A) preventable and severe maternal morbidity and
maternal mortality;
``(B) overall health care spending;
``(C) unnecessary emergency department visits;
``(D) disparities in maternal and infant care
outcomes, including racial, economic, disability,
gender-based, and geographical disparities;
``(E) racial, gender, economic, and other
discrimination among among health care professionals;
``(F) racism, discrimination, disrespect, trauma,
and abuse in maternity care settings;
``(G) the rate of cesarean deliveries for low-risk
pregnancies;
``(H) the rate of preterm births and infants born
with low birth weight;
``(I) the rate of avoidable maternal and newborn
hospitalizations and admissions to intensive care
units; and
``(J) the rate of perinatal mood and anxiety
disorders.
``(d) Consultation.--In designing and implementing the
demonstration project the Secretary shall consult with stakeholders,
including--
``(1) States;
``(2) organizations representing relevant health care
professionals, including oral health services professionals;
``(3) organizations, particularly reproductive justice and
birth justice organizations led by people of color, that
represent consumers of maternal health care, including
consumers of maternal health care who are disproportionately
impacted by poor maternal health outcomes;
``(4) representatives with experience implementing other
maternity care home models, including representatives from the
Center for Medicare and Medicaid Innovation;
``(5) community-based health care professionals, including
doulas, lactation consultants, and other stakeholders;
``(6) experts in promoting health equity and combating
racial bias in health care settings; and
``(7) Black, Indigenous, and other maternal health care
consumers of color who have experienced severe maternal
morbidity.
``(e) Application and Selection of States.--
``(1) In general.--A State seeking to participate in the
demonstration project shall submit an application to the
Secretary at such time and in such manner as the Secretary
shall require.
``(2) Selection of states.--
``(A) In general.--The Secretary shall select at
least 10 States to participate in the demonstration
project.
``(B) Selection requirements.--In selecting States
to participate in the demonstration project, the
Secretary shall--
``(i) ensure that there is geographic and
regional diversity in the areas in which
activities will be carried out under the
project;
``(ii) ensure that States with significant
disparities in maternal and infant health
outcomes, including severe maternal morbidity,
and other disparities based on race, income, or
access to maternity care, are included; and
``(iii) ensure that at least 1 territory is
included.
``(f) Grants.--
``(1) In general.--From amounts appropriated under
subsection (l), the Secretary shall award 1 grant for each year
of the demonstration project to each State that is selected to
participate in the demonstration project.
``(2) Use of grant funds.--A State may use funds received
under this section to--
``(A) award grants or make payments to eligible
entities as part of an arrangement described in
subsection (g)(2);
``(B) provide financial incentives to health care
professionals, including community-based health care
workers and community-based doulas, who participate in
the State's maternity care home model;
``(C) provide adequate training for health care
professionals, including community-based health care
workers, doulas, and care coordinators, who participate
in the State's maternity care home model, which may
include training for cultural humility and antiracism,
racial bias, health equity, reproductive and birth
justice, trauma-informed care, home visiting skills,
and respectful communication and listening skills,
particularly in regards to maternal health;
``(D) pay for personnel and administrative expenses
associated with designing, implementing, and operating
the State's maternity care home model;
``(E) pay for items and services that are furnished
under the State's maternity care home model and for
which payment is otherwise unavailable under this
title;
``(F) pay for services and materials to ensure
culturally and linguistically appropriate
communication, including--
``(i) language services such as
interpreters and translation of written
materials; and
``(ii) development of culturally and
linguistically appropriate materials; and
auxiliary aids and services; and
``(G) pay for other costs related to the State's
maternity care home model, as determined by the
Secretary.
``(3) Grant for national independent evaluator.--
``(A) In general.--From the amounts appropriated
under subsection (l), prior to awarding any grants
under paragraph (1), the Secretary shall enter into a
contract with a national external entity to create a
single, uniform process to--
``(i) ensure that States that receive
grants under paragraph (1) comply with the
requirements of this section; and
``(ii) evaluate the outcomes of the
demonstration project in each participating
State.
``(B) Annual report.--The contract described in
subparagraph (A) shall require the national external
entity to submit to the Secretary--
``(i) a yearly evaluation report for each
year of the demonstration project; and
``(ii) a final impact report after the
demonstration project has concluded.
``(C) Secretary's authority.--Nothing in this
paragraph shall prevent the Secretary from making a
determination that a State is not in compliance with
the requirements of this section without the national
external entity making such a determination.
``(g) Partnership With Eligible Entities.--
``(1) In general.--As a condition of receiving a grant
under this section, a State shall enter into an arrangement
with one or more eligible entities that meets the requirements
of paragraph (2).
``(2) Arrangements with eligible entities.--Under an
arrangement between a State and an eligible entity under this
subsection, the eligible entity shall perform the following
functions, with respect to eligible individuals enrolled with
the entity under the State's maternity care home model--
``(A) provide culturally and linguistically
appropriate congruent care, which may include prenatal
care, family planning services, medical care, mental
and behavioral care, postpartum care, and oral health
services to such eligible individuals through a team of
health care professionals, which may include
obstetrician-gynecologists, maternal-fetal medicine
specialists, family physicians, primary care providers,
oral health providers, physician assistants, advanced
practice registered nurses such as nurse practitioners
and certified nurse midwives, certified midwives,
certified professional midwives, physical therapists,
social workers, traditional and community-based doulas,
lactation consultants, childbirth educators, community
health workers, peer mental health supporters, and
other health care professionals;
``(B) conduct a risk assessment of each such
eligible individual to determine if their pregnancy is
high or low risk, and establish a tailored pregnancy
care plan, which takes into consideration the
individual's own preferences and pregnancy care and
birthing plans and determines the appropriate support
services to reduce the individual's medical, social,
and environmental risk factors, for each such eligible
individual based on the results of such risk
assessment;
``(C) assign each such eligible individual to a
culturally and linguistically appropriate care
coordinator, which may be a nurse, social worker,
traditional or community-based doula, community health
worker, midwife, or other health care provider, who is
responsible for ensuring that such eligible individual
receives the necessary medical care and connections to
essential support services;
``(D) provide, or arrange for the provision of,
essential support services, such as services that
address--
``(i) food access, nutrition, and exercise;
``(ii) smoking cessation;
``(iii) substance use disorder and
addiction treatment;
``(iv) anxiety, depression, trauma, and
other mental and behavioral health issues;
``(v) breast feeding, chestfeeding, or
other infant feeding options supports,
initiation, continuation, and duration;
``(vi) stable, affordable, safe, and
healthy housing;
``(vii) transportation;
``(viii) intimate partner violence;
``(ix) community and police violence;
``(x) home visiting services;
``(xi) childbirth and newborn care
education;
``(xii) oral health education;
``(xiii) continuous labor support;
``(xiv) group prenatal care;
``(xv) family planning and contraceptive
care and supplies; and
``(xvi) affordable child care;
``(E) as appropriate, facilitate connections to a
usual primary care provider, which may be a
reproductive health care provider;
``(F) refer to guidelines and opinions of medical
associations when determining whether an elective
delivery should be performed on an eligible individual
before 39 weeks of gestation;
``(G) provide such eligible individual with
evidence-based and culturally and linguistically
appropriate education and resources to identify
potential warning signs of pregnancy and postpartum
complications and when and how to obtain medical
attention;
``(H) provide, or arrange for the provision of,
culturally and linguistically appropriate pregnancy and
postpartum health services, including family planning
counseling and services, to eligible individuals;
``(I) track and report postpartum health and birth
outcomes of such eligible individuals and their
children;
``(J) ensure that care is person-centered,
culturally and linguistically appropriate, and patient-
led, including by engaging eligible individuals in
their own care, including through communication and
education; and
``(K) ensure adequate training for appropriately
serving the population of individuals eligible for
medical assistance under the State plan or waiver of
such plan, including through reproductive justice,
birth justice, birth equity, and anti-racist
frameworks, home visiting skills, and knowledge of
social services.
``(h) Term of Demonstration Project.--The Secretary shall conduct
the demonstration project for a period of 5 years.
``(i) Waiver Authority.--To the extent that the Secretary
determines necessary in order to carry out the demonstration project,
the Secretary may waive section 1902(a)(1) (relating to statewideness)
and section 1902(a)(10)(B) (relating to comparability).
``(j) Technical Assistance.--The Secretary shall establish a
process to provide technical assistance to States that are awarded
grants under this section and to eligible entities and other providers
participating in a State maternity care home model funded by such a
grant.
``(k) Report.--
``(1) In general.--Not later than 18 months after the date
of the enactment of this section and annually thereafter for
each year of the demonstration project term, the Secretary
shall submit a report to Congress on the results of the
demonstration project.
``(2) Final report.--As part of the final report required
under paragraph (1), the Secretary shall include--
``(A) the results of the final report of the
national external entity required under subsection
(f)(3)(B)(ii); and
``(B) recommendations on whether the model studied
in the demonstration project should be continued or
more widely adopted, including by private health plans.
``(l) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary, for each of fiscal years 2024 through
2031, such sums as may be necessary to carry out this section.''.
SEC. 4. REAPPLICATION OF MEDICARE PAYMENT RATE FLOOR TO PRIMARY CARE
SERVICES FURNISHED UNDER MEDICAID AND INCLUSION OF
ADDITIONAL PROVIDERS.
(a) Reapplication of Payment Floor; Additional Providers.--
(1) In general.--Section 1902(a)(13) of the Social Security
Act (42 U.S.C. 1396a(a)(13)) is amended--
(A) in subparagraph (B), by striking ``; and'' and
inserting a semicolon;
(B) in subparagraph (C), by striking the semicolon
and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(D) payment for primary care services (as defined
in subsection (jj)(1)) furnished in the period that
begins on the first day of the first month that begins
after the date of enactment of the Maximizing Outcomes
for Moms through Medicaid Improvement and Enhancement
of Services Act by a provider described in subsection
(jj)(2)--
``(i) at a rate that is not less than 100
percent of the payment rate that applies to
such services and the provider of such services
under part B of title XVIII (or, if greater,
the payment rate that would be applicable under
such part if the conversion factor under
section 1848(d) for the year were the
conversion factor under such section for 2009);
``(ii) in the case of items and services
that are not items and services provided under
such part, at a rate to be established by the
Secretary; and
``(iii) in the case of items and services
that are furnished in rural areas (as defined
in section 1886(d)(2)(D)), health professional
shortage areas (as defined in section
332(a)(1)(A) of the Public Health Service Act
(42 U.S.C. 254e(a)(1)(A))), or medically
underserved areas (according to a designation
under section 330(b)(3)(A) of the Public Health
Service Act (42 U.S.C. 254b(b)(3)(A))), at the
rate otherwise applicable to such items or
services under clause (i) or (ii) increased, at
the Secretary's discretion, by not more than 25
percent;''.
(2) Conforming amendments.--
(A) Section 1902(a)(13)(C) of the Social Security
Act (42 U.S.C. 1396a(a)(13)(C)) is amended by striking
``subsection (jj)'' and inserting ``subsection
(jj)(1)''.
(B) Section 1905(dd) of the Social Security Act (42
U.S.C. 1396d(dd)) is amended--
(i) by striking ``Notwithstanding'' and
inserting the following:
``(1) In general.--Notwithstanding'';
(ii) by striking ``section 1902(a)(13)(C)''
and inserting ``subparagraph (C) of section
1902(a)(13)'';
(iii) by inserting ``or for services
described in subparagraph (D) of section
1902(a)(13) furnished during an additional
period specified in paragraph (2),'' after
``2015,'';
(iv) by striking ``under such section'' and
inserting ``under subparagraph (C) or (D) of
section 1902(a)(13), as applicable''; and
(v) by adding at the end the following:
``(2) Additional periods.--For purposes of paragraph (1),
the following are additional periods:
``(A) The period that begins on the first day of
the first month that begins after the date of enactment
of the Maximizing Outcomes for Moms through Medicaid
Improvement and Enhancement of Services Act.''.
(b) Improved Targeting of Primary Care.--Section 1902(jj) of the
Social Security Act (42 U.S.C. 1396a(jj)) is amended--
(1) by redesignating paragraphs (1) and (2) as clauses (i)
and (ii), respectively and realigning the left margins
accordingly;
(2) by striking ``For purposes of subsection (a)(13)(C)''
and inserting the following:
``(1) In general.--
``(A) Definition.--For purposes of subparagraphs
(C) and (D) of subsection (a)(13)''; and
(3) by inserting after clause (ii) (as so redesignated) the
following:
``(B) Exclusions.--Such term does not include any
services described in subparagraph (A) or (B) of
paragraph (1) if such services are provided in an
emergency department of a hospital.
``(2) Additional providers.--For purposes of subparagraph
(D) of subsection (a)(13), a provider described in this
paragraph is any of the following:
``(A) A physician with a primary specialty
designation of family medicine, general internal
medicine, or pediatric medicine, or obstetrics and
gynecology.
``(B) An advanced practice clinician, as defined by
the Secretary, that works under the supervision of--
``(i) a physician that satisfies the
criteria specified in subparagraph (A);
``(ii) a nurse practitioner or a physician
assistant (as such terms are defined in section
1861(aa)(5)(A)) who is working in accordance
with State law; or
``(iii) or a certified nurse-midwife (as
defined in section 1861(gg)) or a certified
professional midwife who is working in
accordance with State law.
``(C) A rural health clinic, federally qualified
health center, health center that receives funding
under title X of the Public Health Service Act, or
other health clinic that receives reimbursement on a
fee schedule applicable to a physician.
``(D) An advanced practice clinician supervised by
a physician described in subparagraph (A), another
advanced practice clinician, or a certified nurse-
midwife.
``(E) A midwife who is working in accordance with
State law.''.
(c) Ensuring Payment by Managed Care Entities.--
(1) In general.--Section 1903(m)(2)(A) of the Social
Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
(A) in clause (xii), by striking ``and'' after the
semicolon;
(B) by realigning the left margin of clause (xiii)
so as to align with the left margin of clause (xii) and
by striking the period at the end of clause (xiii) and
inserting ``; and''; and
(C) by inserting after clause (xiii) the following:
``(xiv) such contract provides that (I) payments to
providers specified in section 1902(a)(13)(D) for primary care
services defined in section 1902(jj) that are furnished during
a year or period specified in section 1902(a)(13)(D) and
section 1905(dd) are at least equal to the amounts set forth
and required by the Secretary by regulation, (II) the entity
shall, upon request, provide documentation to the State,
sufficient to enable the State and the Secretary to ensure
compliance with subclause (I), and (III) the Secretary shall
approve payments described in subclause (I) that are furnished
through an agreed upon capitation, partial capitation, or other
value-based payment arrangement if the capitation, partial
capitation, or other value-based payment arrangement is based
on a reasonable methodology and the entity provides
documentation to the State sufficient to enable the State and
the Secretary to ensure compliance with subclause (I).''.
(2) Conforming amendment.--Section 1932(f) of the Social
Security Act (42 U.S.C. 1396u-2(f)) is amended--
(A) by striking ``section 1902(a)(13)(C)'' and
inserting ``subsections (C) and (D) of section
1902(a)(13)''; and
(B) by inserting ``and clause (xiv) of section
1903(m)(2)(A)'' before the period.
SEC. 5. MACPAC REPORT AND CMS GUIDANCE ON INCREASING ACCESS TO DOULA
SERVICES FOR MEDICAID BENEFICIARIES.
(a) MACPAC Report.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, the Medicaid and CHIP Payment and
Access Commission (referred to in this section as ``MACPAC'')
shall publish a report on the coverage of doula services under
State Medicaid programs, which shall at a minimum include the
following:
(A) Information about coverage for doula services
under State Medicaid programs that currently provide
coverage for such care, including the type of doula
services offered (such as prenatal, labor and delivery,
postpartum support, and community-based and traditional
doula services), credentialing and provider enrollment
requirements for doulas under State Medicaid programs,
additional forms of support contributing to doula
enrollment and reimbursement under State Medicaid
programs, and data on outcomes with respect to doula
services under each State Medicaid program, including
the number of doulas registered under the State
Medicaid program, the number of pregnant, birthing, and
postpartum people served by doulas under the State
Medicaid program, and the amount of time it takes for
doulas to receive payment under the State Medicaid
program for services provided under the program.
(B) An analysis of barriers to covering doula
services under State Medicaid programs.
(C) An identification of effective strategies to
increase the use of doula services in order to provide
better care and achieve better maternal and infant
health outcomes, including strategies that States may
use to recruit, train, sutain, and certify a diverse
doula workforce, particularly from underserved
communities, communities of color, and communities
facing linguistic or cultural barriers.
(D) Recommendations for legislative and
administrative actions to increase access to doula
services in State Medicaid programs, including actions
that ensure doulas may earn a sustainable living wage
that accounts for their time and costs associated with
providing care and community-based doula program
administration and operation.
(2) Stakeholder consultation.--In developing the report
required under paragraph (1), MACPAC shall consult with
relevant stakeholders, including--
(A) States;
(B) organizations, especially reproductive justice
and birth justice organizations led by people of color,
representing consumers of maternal health care,
including those that are disproportionately impacted by
poor maternal health outcomes;
(C) organizations and individuals representing
doulas, including community-based doula programs and
those who serve underserved communities, including
communities of color, and communities facing linguistic
or cultural barriers;
(D) organizations representing health care
providers; and
(E) Black, Indigenous, and other maternal health
care consumers of color who have experienced severe
maternal morbidity.
(b) CMS Guidance.--
(1) In general.--Not later than 1 year after the date that
MACPAC publishes the report required under subsection (a)(1),
the Administrator of the Centers for Medicare & Medicaid
Services shall issue guidance to States on increasing access to
doula services under Medicaid. Such guidance shall at a minimum
include--
(A) options for States to provide medical
assistance for doula services under State Medicaid
programs;
(B) best practices for ensuring that doulas,
including community-based doulas, receive reimbursement
for doula services provided under a State Medicaid
program, at a level that allows doulas to earn a living
wage that accounts for their time and costs associated
with providing care and community-based doula program
administration; and
(C) best practices for increasing access to doula
services, including services provided by community-
based doulas, under State Medicaid programs.
(2) Stakeholder consultation.--In developing the guidance
required under paragraph (1), the Administrator of the Centers
for Medicare & Medicaid Services shall consult with MACPAC and
other relevant stakeholders, including--
(A) State Medicaid officials;
(B) organizations representing consumers of
maternal health care, including those that are
disproportionately impacted by poor maternal health
outcomes;
(C) organizations representing doulas, including
community-based doulas and those who serve underserved
communities, such as communities of color and
communities facing linguistic or cultural barriers;
(D) organizations representing medical
professionals; and
(E) maternal health advocacy organizations.
SEC. 6. GAO REPORT ON STATE MEDICAID PROGRAMS' USE OF TELEHEALTH TO
INCREASE ACCESS TO MATERNITY CARE.
Not later than 1 year after the date of the enactment of this Act,
the Comptroller General of the United States shall submit a report to
Congress on State Medicaid programs' use of telehealth to increase
access to maternity care. Such report shall include the following:
(1) The number of State Medicaid programs that utilize
telehealth that increases access to maternity care.
(2) With respect to State Medicaid programs that utilize
telehealth that increases access to maternity care, information
about--
(A) common characteristics of such programs'
approaches to utilizing telehealth that increases
access to maternity care;
(B) differences in States' approaches to utilizing
telehealth to improve access to maternity care, and the
resulting differences in State maternal health
outcomes, as determined by factors described in
subsection (C); and
(C) when compared to patients who receive maternity
care in-person, what is known about--
(i) the demographic characteristics, such
as race, ethnicity, sex, sexual orientation,
gender identity, disability status, age, and
preferred language of the individuals enrolled
in such programs who use telehealth to access
maternity care;
(ii) health outcomes for such individuals,
including frequency of mortality and severe
morbidity, as compared to individuals with
similar characteristics who did not use
telehealth to access maternity care;
(iii) the services provided to individuals
through telehealth, including family planning
services, mental health care services, and oral
health services;
(iv) the devices and equipment provided to
individuals for remote patient monitoring and
telehealth, including blood pressure monitors
and blood glucose monitors;
(v) the quality of maternity care provided
through telehealth, including whether maternity
care provided through telehealth is culturally
and linguistically appropriate;
(vi) the level of patient satisfaction with
an experience of maternity care provided
through telehealth to individuals enrolled in
State Medicaid programs;
(vii) the impact of utilizing telehealth to
increase access to maternity care on spending,
cost savings, access to care, and utilization
of care under State Medicaid programs; and
(viii) the accessibility and effectiveness
of telehealth for maternity care during the
COVID-19 pandemic.
(3) An identification and analysis of the barriers to using
telehealth to increase access to maternity care under State
Medicaid programs.
(4) Recommendations for such legislative and administrative
actions related to increasing access to telehealth maternity
services under Medicaid as the Comptroller General deems
appropriate.
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