[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3509 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 3509
To amend title XXVII of the Public Health Service Act to provide for a
special enrollment period for pregnant persons, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 13, 2023
Mr. Brown (for himself, Mr. King, Ms. Baldwin, Mr. Casey, Ms. Smith,
Mr. Blumenthal, Mr. Van Hollen, Mr. Merkley, Mr. Whitehouse, Ms. Cortez
Masto, Mr. Kaine, Ms. Klobuchar, and Mr. Booker) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act to provide for a
special enrollment period for pregnant persons, 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 ``Healthy Maternity and Obstetric
Medicine Act'' or the ``Healthy MOM Act''.
SEC. 2. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD FOR PREGNANT
INDIVIDUALS.
(a) Special Enrollment Periods.--
(1) Public health service act.--Section 2702(b)(2) of the
Public Health Service Act (42 U.S.C. 300gg-1(b)(2)) is amended
by inserting ``including a special enrollment period for
pregnant individuals, beginning on the date on which the
pregnancy is reported to the health insurance issuer'' before
the period at the end.
(2) Patient protection and affordable care act.--Section
1311(c)(6) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031(c)(6)) is amended--
(A) in subparagraph (C), by striking ``and'' at the
end;
(B) by redesignating subparagraph (D) as
subparagraph (E); and
(C) by inserting after subparagraph (C) the
following new subparagraph:
``(D) a special enrollment period for pregnant
individuals, beginning on the date on which the
pregnancy is reported to the Exchange; and''.
(3) Internal revenue code.--Section 9801(f) of the Internal
Revenue Code of 1986 (26 U.S.C. 9801(f)) is amended by adding
at the end the following new paragraph:
``(4) For pregnant individuals.--
``(A) In general.--A group health plan shall permit
an employee who is eligible, but not enrolled, for
coverage under the terms of the plan (or a dependent of
such an employee if the dependent is eligible, but not
enrolled, for coverage under such terms) to enroll for
coverage under the terms of the plan upon pregnancy,
with the special enrollment period beginning on the
date on which the pregnancy is reported to the group
health plan or the pregnancy is confirmed by a health
care provider.
``(B) Regulations.--The Secretary shall promulgate
regulations with respect to the special enrollment
period under subparagraph (A), including establishing a
time period for pregnant individuals to enroll in
coverage and effective date of such coverage.''.
(4) ERISA.--Section 701(f) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by
adding at the end the following:
``(4) For pregnant individuals.--
``(A) In general.--A group health plan or health
insurance issuer in connection with a group health plan
shall permit an employee who is eligible, but not
enrolled, for coverage under the terms of the plan (or
a dependent of such an employee if the dependent is
eligible, but not enrolled, for coverage under such
terms) to enroll for coverage under the terms of the
plan upon pregnancy, with the special enrollment period
beginning on the date on which the pregnancy is
reported to the group health plan or health insurance
issuer or the pregnancy is confirmed by a health care
provider.
``(B) Regulations.--The Secretary shall promulgate
regulations with respect to the special enrollment
period under subparagraph (A), including establishing a
time period for pregnant individuals to enroll in
coverage and effective date of such coverage.''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning after December 31, 2024.
SEC. 3. COVERAGE OF MATERNITY CARE FOR DEPENDENT CHILDREN.
Section 2719A of the Public Health Service Act (42 U.S.C. 300gg-
19a) is amended--
(1) in subsection (e), by inserting ``(other than
subsection (f))'' after ``this section''; and
(2) by adding at the end the following:
``(f) Coverage of Maternity Care.--A group health plan, or health
insurance issuer offering group or individual health insurance
coverage, that provides coverage for dependants shall ensure that such
plan or coverage includes coverage for maternity care associated with
pregnancy, childbirth, and postpartum care for all participants,
beneficiaries, or enrollees, including dependants, including coverage
of labor and delivery. Such coverage shall be provided to all pregnant
dependents regardless of age.''.
SEC. 4. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS.
(a) Coverage of Pregnancy.--The Director of the Office of Personnel
Management shall issue such regulations as are necessary to ensure that
pregnancy is considered a change in family status and a qualifying life
event for an individual who is eligible to enroll, but is not enrolled,
in a health benefit plan under chapter 89 of title 5, United States
Code.
(b) Effective Date.--The requirement in subsection (a) shall apply
with respect to any contract entered into under section 8902 of such
title beginning 12 months after the date of enactment of this Act.
SEC. 5. CONTINUATION OF MEDICAID INCOME ELIGIBILITY STANDARD FOR
PREGNANT INDIVIDUALS AND INFANTS.
Section 1902(l)(2)(A) of the Social Security Act (42 U.S.C.
1396a(l)(2)(A)) is amended--
(1) in clause (i), by striking ``and not more than 185
percent'';
(2) in clause (ii)--
(A) in subclause (I), by striking ``and'' after the
comma;
(B) in subclause (II), by striking the period at
the end and inserting ``, and''; and
(C) by adding at the end the following:
``(III) January 1, 2025, is the percentage provided under
clause (v).''; and
(3) by adding at the end the following new clause:
``(v) The percentage provided under clause (ii) for medical
assistance provided on or after January 1, 2025, with respect to
individuals described in subparagraph (A) or (B) of paragraph (1) shall
not be less than--
``(I) the percentage specified for such individuals by the
State in an amendment to its State plan (whether approved or
not) as of January 1, 2014; or
``(II) if no such percentage is specified as of January 1,
2014, the percentage established for such individuals under the
State's authorizing legislation or provided for under the
State's appropriations as of that date.''.
SEC. 6. REQUIRING 12-MONTH CONTINUOUS COVERAGE FOR PREGNANT AND
POSTPARTUM INDIVIDUALS UNDER MEDICAID AND CHIP.
(a) Medicaid.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)--
(A) in paragraph (86), by striking ``and'' at the
end;
(B) in paragraph (87), by striking the period at
the end and inserting ``; and''; and
(C) by inserting after paragraph (87) the following
new paragraph:
``(88) provide that the State plan is in compliance with
subsection (e)(16).''; and
(2) in subsection (e)(16)--
(A) in subparagraph (A), by striking ``At the
option of the State, the State plan (or waiver of such
State plan) may provide'' and inserting ``A State plan
(or waiver of such State plan) shall provide'';
(B) in subparagraph (B), in the matter preceding
clause (i), by striking ``by a State making an election
under this paragraph'' and inserting ``under a State
plan (or a waiver of such State plan)''; and
(C) by striking subparagraph (C).
(b) CHIP.--
(1) In general.--Section 2107(e)(1)(J) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)(J)) is amended to read as
follows:
``(J) Paragraphs (5) and (16) of section 1902(e)
(relating to the requirement to provide medical
assistance under the State plan or waiver consisting of
full benefits during pregnancy and throughout the 12-
month postpartum period under title XIX).''.
(2) Conforming.--Section 2112(d)(2)(A) of the Social
Security Act (42 U.S.C. 1397ll(d)(2)(A)) is amended by striking
``the month in which the 60-day period'' and all that follows
through the period and inserting ``the 12-month period
beginning on the last day of the pregnancy.''.
(c) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall take effect on the first day of the
first calendar quarter that begins on or after the date that is
1 year after the date of enactment of this Act.
(2) Exception for state legislation.--In the case of a
State plan under title XIX or XXI of the Social Security Act
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 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 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.
SEC. 7. RELATIONSHIP TO OTHER LAWS.
Nothing in this Act (or an amendment made by this Act) shall be
construed to invalidate or limit the remedies, rights, and procedures
of any Federal law or the law of any State or political subdivision of
any State or jurisdiction that provides greater or equal protection for
enrollees in a group health plan or group or individual health
insurance offered by a health insurance issuer.
<all>