Improving Coverage and Care for Mothers Act

II 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 lacta- tion 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Improving Coverage 4 and Care for Mothers Act’’. 5 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 2 •S 3443 IS SEC. 2. EXTENDING MEDICAID ELIGIBILITY TO ALL PREG- 1 NANT WOMEN. 2 (a) IN GENERAL.—Section 1905(n)(1) of the Social 3 Security Act (42 U.S.C. 1396d(n)(1)) is amended to read 4 as follows: 5 ‘‘(1) a woman who is pregnant and through the 6 end of the month in which the 365-day period (be- 7 ginning on the last day of her pregnancy) ends; 8 and’’. 9 (b) CONFORMING AMENDMENTS.—Title XIX of the 10 Social Security Act (42 U.S.C. 1396 et seq.) is amended— 11 (1) in section 1902— 12 (A) in subsection (a)(10)(C)— 13 (i) in clause (ii), by striking ‘‘must 14 make available medical assistance—’’ and 15 all that follows through ‘‘individual de- 16 scribed in subparagraph (A)’’ and inserting 17 ‘‘must make available medical assistance to 18 individuals under the age of 18 who (but 19 for income and resources) would be eligible 20 for medical assistance as an individual de- 21 scribed in subparagraph (A)(i)’’; 22 (ii) in clause (iii)— 23 (I) by striking ‘‘must include (I) 24 with respect to’’ and inserting ‘‘must 25 include, with respect to’’; and 26 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 3 •S 3443 IS (II) by striking ‘‘; and (II)’’ and 1 all that follows through ‘‘delivery serv- 2 ices’’; 3 (B) in subsection (e), by striking para- 4 graph (6); 5 (C) in subsection (l)(1)(A), by inserting 6 ‘‘before January 1, 2020,’’ before ‘‘women dur- 7 ing pregnancy’’; and 8 (D) in subsection (ii)(1)(A), by inserting 9 ‘‘that was in effect as of January 1, 2020’’ 10 after ‘‘pregnant women’’; 11 (2) in section 1920(b)(1)(A), by striking ‘‘that 12 the family income’’ and all that follows through ‘‘in- 13 come level of eligibility’’ and inserting ‘‘that the 14 woman is eligible for medical assistance’’; and 15 (3) in section 1937(a)(2)(B), by amending 16 clause (i) to read as follows: 17 ‘‘(i) QUALIFIED PREGNANT WOMEN.— 18 The individual is a qualified pregnant 19 woman (as defined in section 20 1905(n)(1)).’’. 21 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 4 •S 3443 IS SEC. 3. EXTENDING CONTINUOUS MEDICAID AND CHIP 1 COVERAGE FOR PREGNANT AND POSTPAR- 2 TUM WOMEN. 3 (a) EXTENDING CONTINUOUS MEDICAID AND CHIP 4 COVERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 5 (1) MEDICAID.—Title XIX of the Social Secu- 6 rity Act (42 U.S.C. 1396 et seq.) is amended— 7 (A) in section 1902(e)(5), by striking ‘‘60- 8 day period’’ and inserting ‘‘365-day period’’; 9 (B) in section 1902(l)(1)(A), by striking 10 ‘‘60-day period’’ and inserting ‘‘365-day pe- 11 riod’’; 12 (C) in section 1903(v)(4)(A)(i), by striking 13 ‘‘60-day period’’ and inserting ‘‘365-day pe- 14 riod’’; and 15 (D) in section 1905(a), in the 4th sentence 16 in the matter following paragraph (30), by 17 striking ‘‘60-day period’’ and inserting ‘‘365- 18 day period’’. 19 (2) CHIP.—Section 2112 of the Social Security 20 Act (42 U.S.C. 1397ll) is amended by striking ‘‘60- 21 day period’’ each place it appears and inserting 22 ‘‘365-day period’’. 23 (3) CONFORMING AMENDMENT.—Section 24 1938(b)(2)(C) of the Social Security Act (42 U.S.C. 25 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 5 •S 3443 IS 1396u–8(b)(2)(C)) is amended by striking ‘‘previous 1 60 days’’ and inserting ‘‘previous 365 days’’. 2 (b) REQUIRING FULL BENEFITS FOR PREGNANT 3 AND POSTPARTUM WOMEN.— 4 (1) MEDICAID.— 5 (A) IN GENERAL.—Paragraph (5) of sec- 6 tion 1902(e) of the Social Security Act (24 7 U.S.C. 1396a(e)) is amended to read as follows: 8 ‘‘(5) Any woman who is eligible for medical as- 9 sistance under the State plan or a waiver of such 10 plan and who is, or who while so eligible becomes, 11 pregnant, shall continue to be eligible under the plan 12 or waiver for medical assistance through the end of 13 the month in which the 365-day period (beginning 14 on the last day of her pregnancy) ends, regardless 15 of the basis for the woman’s eligibility for medical 16 assistance, including if the woman’s eligibility for 17 medical assistance is on the basis of being preg- 18 nant.’’. 19 (B) CONFORMING AMENDMENT.—Section 20 1902(a)(10) of the Social Security Act (42 21 U.S.C. 1396a(a)(10)) is amended in the matter 22 following subparagraph (G) by striking ‘‘(VII) 23 the medical assistance’’ and all that follows 24 through ‘‘complicate pregnancy,’’. 25 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 6 •S 3443 IS (2) CHIP.— 1 (A) Section 2107(e)(1) of the Social Secu- 2 rity Act (42 U.S.C. 1397gg(e)(1)) is amend- 3 ed— 4 (i) by redesignating subparagraphs 5 (H) through (S) as subparagraphs (I) 6 through (T), respectively; and 7 (ii) by inserting after subparagraph 8 (G), the following: 9 ‘‘(H) Section 1902(e)(5) (requiring 365- 10 day continuous coverage for pregnant and 11 postpartum women).’’. 12 (B) Section 2112 of the Social Security 13 Act (42 U.S.C. 1397ll) is amended, in sub- 14 sections (d)(2) and (f)(2), by striking ‘‘60-day 15 period’’ each place it appears and inserting 16 ‘‘365-day period’’. 17 SEC. 4. MEDICAID COVERAGE OF SERVICES PROVIDED BY 18 DOULAS, MIDWIVES, AND LACTATION CON- 19 SULTANTS. 20 (a) IN GENERAL.—Section 1905 of the Social Secu- 21 rity Act (42 U.S.C. 1396d) is amended— 22 (1) in subsection (a)— 23 (A) in paragraph (29), by striking ‘‘and’’ 24 at the end; 25 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 7 •S 3443 IS (B) by redesignating paragraph (30) as 1 paragraph (31); and 2 (C) by inserting after paragraph (29) the 3 following new paragraph: 4 ‘‘(30) services, including— 5 ‘‘(A) prenatal, delivery, postpartum, and 6 lactation consulting services, provided by 7 doulas, midwives, and lactation consultants (as 8 those terms are defined in subsection (gg)) to 9 the extent authorized under State law; and 10 ‘‘(B) services included in the components 11 of postpartum care identified by the American 12 College of Obstetricians and Gynecologists in 13 Committee Opinion Number 736 published in 14 May of 2018 (or any successor opinion or publi- 15 cation); and’’; and 16 (2) by adding at the end the following new sub- 17 section: 18 ‘‘(gg) DOULAS AND MIDWIVES DEFINED.—For pur- 19 poses of subsection (a)(30): 20 ‘‘(1) DOULAS DEFINED.—The term ‘doula’ 21 means an individual who— 22 ‘‘(A) is certified by an organization, which 23 has been established for not less than 5 years 24 and which requires the completion of continuing 25 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 8 •S 3443 IS education to maintain such certification, to pro- 1 vide non-medical advice, information, emotional 2 support, and physical comfort to an individual 3 during such individual’s pregnancy, childbirth, 4 and postpartum period; and 5 ‘‘(B) maintains such certification by com- 6 pleting such required continuing education. 7 ‘‘(2) MIDWIVES DEFINED.— 8 ‘‘(A) IN GENERAL.—The term ‘midwife’ 9 means a certified midwife, certified professional 10 midwife, and Tribal-recognized midwife. 11 ‘‘(B) CERTIFIED MIDWIFE.—For purposes 12 of subparagraph (A), the term ‘certified mid- 13 wife’ means an individual who is certified by the 14 American Midwifery Certification Board to 15 practice midwifery. 16 ‘‘(C) CERTIFIED PROFESSIONAL MID- 17 WIFE.—For purposes of subparagraph (A), the 18 term ‘certified professional midwife’ means an 19 individual who— 20 ‘‘(i) is certified by the North Amer- 21 ican Registry of Midwives to practice mid- 22 wifery for normal, low-risk pregnancies and 23 childbirths; 24 ‘‘(ii) completes— 25 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 9 •S 3443 IS ‘‘(I) a midwifery education pro- 1 gram accredited by the Midwifery 2 Education and Accreditation Council 3 or any other entity recognized by the 4 Department of Education; or 5 ‘‘(II) the requirements to obtain 6 a Midwifery Bridge Certificate from 7 the North American Registry of Mid- 8 wives; and 9 ‘‘(iii) maintains the certification de- 10 scribed in clause (i) by completing any re- 11 quired continuing education for such cer- 12 tification. 13 ‘‘(D) TRIBAL-RECOGNIZED MIDWIFE.—For 14 purposes of subparagraph (A), the term ‘Tribal- 15 recognized midwife’ means an individual who is 16 recognized by an Indian tribe (as defined in 17 section 4 of the Indian Health Care Improve- 18 ment Act) to practice midwifery for such tribe. 19 ‘‘(3) LACTATION CONSULTANT DEFINED.—The 20 term ‘lactation consultant’ means an individual who 21 is a specialist who— 22 ‘‘(A) is trained to— 23 ‘‘(i) focus on the needs and concerns 24 of a breastfeeding mother and baby; and 25 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 10 •S 3443 IS ‘‘(ii) prevent, recognize, and solve 1 breastfeeding difficulties; 2 ‘‘(B) is certified by an organization, which 3 has been established for not less than 5 years 4 and which requires the completion of continuing 5 education to maintain such certification, to pro- 6 vide lactation consulting services; and 7 ‘‘(C) maintains such certification by com- 8 pleting such required continuing education.’’. 9 (b) REQUIRING MANDATORY COVERAGE UNDER 10 STATE PLAN.—Section 1902(a)(10)(A) of the Social Se- 11 curity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the 12 matter preceding clause (i), by striking ‘‘and (29)’’ and 13 inserting ‘‘(29), and (30)’’. 14 SEC. 5. INCREASED FMAP FOR ADDITIONAL EXPENDI- 15 TURES. 16 Section 1905 of the Social Security Act (42 U.S.C. 17 1396d), as amended by section 4, is further amended— 18 (1) in subsection (b), by striking ‘‘and (ff)’’ and 19 inserting ‘‘(ff), and (hh)’’; and 20 (2) by adding at the end the following: 21 ‘‘(hh) INCREASED FMAP FOR ADDITIONAL EXPEND- 22 ITURES FOR MEDICAL ASSISTANCE TO PREGNANT AND 23 POSTPARTUM WOMEN.—For calendar quarters beginning 24 on or after January 1, 2021, notwithstanding subsection 25 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 11 •S 3443 IS (b), the Federal medical assistance percentage for a State, 1 with respect to the additional amounts expended by such 2 State for medical assistance under the State plan under 3 this title or a waiver of such plan that are attributable 4 to requirements imposed by the amendments made by the 5 Improving Coverage and Care for Mothers Act (as deter- 6 mined by the Secretary), shall be equal to 100 percent.’’. 7 SEC. 6. EFFECTIVE DATE. 8 (a) IN GENERAL.—Subject to subsection (b), the 9 amendments made by this Act shall apply with respect to 10 medical assistance furnished on or after January 1, 2021. 11 (b) EXCEPTION FOR STATE LEGISLATION.—In the 12 case of a State plan under title XIX of the Social Security 13 Act (42 U.S.C. 1396 et seq.) that the Secretary of Health 14 and Human Services determines requires State legislation 15 in order for the respective plan to meet any requirement 16 imposed by amendments made by this section, the respec- 17 tive plan shall not be regarded as failing to comply with 18 the requirements of such title solely on the basis of its 19 failure to meet such an additional requirement before the 20 first day of the first calendar quarter beginning after the 21 close of the first regular session of the State legislature 22 that begins after the date of the enactment of this Act. 23 For purposes of the previous sentence, in the case of a 24 State that has a 2-year legislative session, each year of 25 VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS 12 •S 3443 IS the session shall be considered to be a separate regular 1 session of the State legislature. 2 Æ VerDate Sep 11 2014 02:00 Mar 22, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\S3443.IS S3443 kjohnson on DSK79L0C42PROD with BILLS