Healthy MOM Act

I 117TH CONGRESS 1ST SESSION H. R. 3126 To amend title XXVII of the Public Health Service Act to provide for a special enrollment period for pregnant women, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 11, 2021 Mrs. WATSON COLEMAN (for herself, Ms. ADAMS, Ms. BASS, Mrs. BEATTY, Mr. BISHOP of Georgia, Mr. BLUMENAUER, Ms. BONAMICI, Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. CARSON, Ms. CHU, Mr. COHEN, Mr. CONNOLLY, Mr. COOPER, Mr. ESPAILLAT, Mr. EVANS, Mr. FOSTER, Ms. LOIS FRANKEL of Florida, Mrs. HAYES, Mr. JOHNSON of Georgia, Mr. JONES, Mr. KILMER, Mr. LANGEVIN, Mr. LARSON of Con- necticut, Ms. LEE of California, Mr. LEVIN of California, Mrs. CAROLYN B. MALONEY of New York, Mr. MEEKS, Ms. MENG, Mr. MOULTON, Ms. NORTON, Mr. PAYNE, Mr. POCAN, Ms. ROSS, Ms. ROYBAL-ALLARD, Ms. SEWELL, Ms. SHERRILL, Mr. SMITH of Washington, Ms. STEVENS, Ms. STRICKLAND, Mr. SWALWELL, Ms. TLAIB, Mr. TORRES of New York, Ms. WASSERMAN SCHULTZ, Ms. WILSON of Florida, Mr. GARCI´A of Illi- nois, and Ms. CASTOR of Florida) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, and Over- sight and Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XXVII of the Public Health Service Act to provide for a special enrollment period for pregnant women, 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 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 3126 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Healthy Maternity and 2 Obstetric Medicine Act’’ or the ‘‘Healthy MOM Act’’. 3 SEC. 2. FINDINGS AND PURPOSE. 4 (a) FINDINGS.—Congress finds the following: 5 (1) Pregnancy is a significant life event for mil- 6 lions of women in the United States each year. 7 (2) For more than 30 years, our Nation, 8 through the Medicaid program, has recognized that 9 pregnant women need immediate access to afford- 10 able care, and has allowed women who meet income- 11 eligibility requirements to enroll in Medicaid cov- 12 erage when they become pregnant. 13 (3) Congress recognized the central importance 14 of maternity coverage by classifying maternity and 15 newborn care as one of the ten essential health bene- 16 fits that must now be covered on most individual 17 and small group health insurance plans under sec- 18 tion 1302(b)(1) of the Patient Protection and Af- 19 fordable Care Act (42 U.S.C. 18022(b)(1)). 20 (4) Congress has also recognized the significant 21 challenge of maternal mortality and the need to 22 eliminate disparities in maternal health outcomes for 23 pregnancy-related and pregnancy-associated deaths, 24 and to improve health outcomes for both mothers 25 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 3126 IH and babies through passage of the Preventing Ma- 1 ternal Deaths Act of 2018 (Public Law 115–344). 2 (5) Access to comprehensive maternity coverage 3 allows women to access important pregnancy-related 4 care, which is demonstrated to improve health out- 5 comes for women and newborns and reduce financial 6 costs for both consumers and insurers. 7 (6) Uninsured women, women with grand- 8 fathered and transitional health plans, self-funded 9 student health plans, and catastrophic and high-de- 10 ductible health plans may lack access to comprehen- 11 sive and affordable maternity coverage. 12 (7) Employer health plans that exclude depend- 13 ent daughters from maternity coverage leave young 14 women without coverage for their pregnancy, even 15 though Federal law has long held that treating preg- 16 nancy differently than other conditions is sex-based 17 discrimination. 18 (8) A special enrollment period is especially im- 19 portant for young adults, who are at high risk for 20 unintended pregnancies, yet young adults are fre- 21 quently enrolled in catastrophic coverage, which 22 often has fewer benefits, more restrictions, and high- 23 er deductibles. 24 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 3126 IH (9) This coverage would be an equalizer for 1 communities of color. The maternal mortality rate 2 varies drastically by race and ethnicity, and where a 3 woman lives. The rising maternal mortality rate in 4 the United States is driven predominantly by the 5 disproportionately high African-American maternal 6 mortality rate, which is four times more than the 7 rate for White women. 8 (10) According to the Centers for Disease Con- 9 trol and Prevention, about 700 women die each year 10 in the United States from pregnancy-related com- 11 plications. Black and American Indian/Alaska Native 12 women are about three times more likely to die from 13 a pregnancy-related cause than White women. 14 (11) Data demonstrates that 3 in 5 pregnancy 15 related deaths could be prevented. Improving access 16 to care is one way to help prevent deaths, regardless 17 of race or ethnicity. 18 (12) Timely maternity care improves the health 19 of pregnant women, as well as birth outcomes and 20 the health of babies throughout their lifetimes. Preg- 21 nancy-related maternal mortality is three to four 22 times higher among women who receive no maternity 23 care compared to women who do. Regular maternity 24 care can detect or mitigate serious pregnancy-related 25 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 3126 IH health complications, including preeclampsia, pla- 1 cental abruption, complications from diabetes, com- 2 plications from heart disease, and Graves’ disease, 3 all of which can result in morbidity or mortality for 4 the mother or newborn. 5 (13) The Centers for Disease Control and Pre- 6 vention reports that more than half of all maternal 7 deaths occur at delivery or in the first postpartum 8 year, whereas just more than one-third of preg- 9 nancy-related or pregnancy-associated deaths occur 10 while a person is still pregnant. Yet, for women eligi- 11 ble for the Medicaid program on the basis of preg- 12 nancy, such Medicaid coverage lapses at the end of 13 the month on which the 60th postpartum day lands. 14 (14) Timely maternity care and adequate 15 postpartum care can reduce short- and long-term 16 health care costs. If a woman does not have access 17 to affordable maternity care during her pregnancy, 18 and she or her newborn experiences pregnancy com- 19 plications that result in health problems after birth, 20 their insurer may end up paying much higher costs 21 than if the insurer had covered the woman’s mater- 22 nity care during her pregnancy. Intensive maternity 23 care can reduce hospital and neonatal intensive care 24 unit admissions among infants, resulting in cost sav- 25 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 3126 IH ings of $1,768 to $5,560 per birth. For women with 1 high-risk pregnancies, intensive maternity care saves 2 $1.37 for every $1 invested in maternity care. 3 (b) PURPOSE.—The purpose of this Act is to protect 4 the health of women and newborns by ensuring that all 5 women eligible for coverage through the Exchanges estab- 6 lished under title I of the Patient Protection and Afford- 7 able Care Act (Public Law 111–148) and women eligible 8 for other individual or group health plan coverage can ac- 9 cess affordable health coverage during their pregnancy. 10 SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 11 FOR PREGNANT INDIVIDUALS. 12 (a) PUBLIC HEALTH SERVICE ACT.—Section 13 2702(b)(2) of the Public Health Service Act (42 U.S.C. 14 300gg–1(b)(2)) is amended by inserting ‘‘including a spe- 15 cial enrollment period for pregnant individuals, beginning 16 on the date on which the pregnancy is reported to the 17 health insurance issuer’’ before the period at the end. 18 (b) PATIENT PROTECTION AND AFFORDABLE CARE 19 ACT.—Section 1311(c)(6) of the Patient Protection and 20 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend- 21 ed— 22 (1) in subparagraph (C), by striking ‘‘and’’ at 23 the end; 24 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 3126 IH (2) by redesignating subparagraph (D) as sub- 1 paragraph (E); and 2 (3) by inserting after subparagraph (C) the fol- 3 lowing new subparagraph: 4 ‘‘(D) a special enrollment period for preg- 5 nant individuals, beginning on the date on 6 which the pregnancy is reported to the Ex- 7 change; and’’. 8 (c) SPECIAL ENROLLMENT PERIODS.— 9 (1) INTERNAL REVENUE CODE.—Section 10 9801(f) of the Internal Revenue Code of 1986 (26 11 U.S.C. 9801(f)) is amended by adding at the end 12 the following new paragraph: 13 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 14 ‘‘(A) A group health plan shall permit an 15 employee who is eligible, but not enrolled, for 16 coverage under the terms of the plan (or a de- 17 pendent of such an employee if the dependent 18 is eligible, but not enrolled, for coverage under 19 such terms) to enroll for coverage under the 20 terms of the plan upon pregnancy, with the spe- 21 cial enrollment period beginning on the date on 22 which the pregnancy is reported to the group 23 health plan or the pregnancy is confirmed by a 24 health care provider. 25 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 3126 IH ‘‘(B) The Secretary shall promulgate regu- 1 lations with respect to the special enrollment 2 period under subparagraph (A), including es- 3 tablishing a time period for pregnant individ- 4 uals to enroll in coverage and effective date of 5 such coverage.’’. 6 (2) ERISA.—Section 701(f) of the Employee 7 Retirement Income Security Act of 1974 (29 U.S.C. 8 1181(f)) is amended by adding at the end the fol- 9 lowing: 10 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 11 ‘‘(A) A group health plan or health insur- 12 ance issuer in connection with a group health 13 plan shall permit an employee who is eligible, 14 but not enrolled, for coverage under the terms 15 of the plan (or a dependent of such an employee 16 if the dependent is eligible, but not enrolled, for 17 coverage under such terms) to enroll for cov- 18 erage under the terms of the plan upon preg- 19 nancy, with the special enrollment period begin- 20 ning on the date on which the pregnancy is re- 21 ported to the group health plan or health insur- 22 ance issuer or the pregnancy is confirmed by a 23 health care provider. 24 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 3126 IH ‘‘(B) The Secretary shall promulgate regu- 1 lations with respect to the special enrollment 2 period under subparagraph (A), including es- 3 tablishing a time period for pregnant individ- 4 uals to enroll in coverage and effective date of 5 such coverage.’’. 6 (d) EFFECTIVE DATE.—The amendments made by 7 this section shall apply with respect to plan years begin- 8 ning after the 2021 plan year. 9 SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT 10 CHILDREN. 11 Section 2719A of the Public Health Service Act (42 12 U.S.C. 300gg–19a) is amended— 13 (1) in subsection (e), by inserting ‘‘(other than 14 subsection (f))’’ after ‘‘this section’’; and 15 (2) by adding at the end the following: 16 ‘‘(f) COVERAGE OF MATERNITY CARE.—A group 17 health plan, or health insurance issuer offering group or 18 individual health insurance coverage, that provides cov- 19 erage for dependants shall ensure that such plan or cov- 20 erage includes coverage for maternity care associated with 21 pregnancy, childbirth, and postpartum care for all partici- 22 pants, beneficiaries, or enrollees, including dependants, in- 23 cluding coverage of labor and delivery. Such coverage shall 24 be provided to all pregnant dependents regardless of age.’’. 25 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 3126 IH SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 1 (a) COVERAGE OF PREGNANCY.— 2 (1) IN GENERAL.—The Director of the Office of 3 Personnel Management shall issue such regulations 4 as are necessary to ensure that pregnancy is consid- 5 ered a change in family status and a qualifying life 6 event for an individual who is eligible to enroll, but 7 is not enrolled, in a health benefit plan under chap- 8 ter 89 title 5, United States Code. 9 (2) EFFECTIVE DATE.—The requirement in 10 paragraph (1) shall apply with respect to any con- 11 tract entered into under section 8902 of such title 12 beginning 12 months after the date of enactment of 13 this Act. 14 (b) DESIGNATING CERTAIN FEHBP–RELATED 15 SERVICES AS EXCEPTED SERVICES UNDER THE ANTI- 16 DEFICIENCY ACT.— 17 (1) IN GENERAL.—Section 8905 of title 5, 18 United States Code, is amended by adding at the 19 end the following: 20 ‘‘(i) Any services by an officer or employee under this 21 chapter relating to enrolling individuals in a health bene- 22 fits plan under this chapter, or changing the enrollment 23 of an individual already so enrolled due to an event de- 24 scribed in section 5(a)(1) of the Healthy MOM Act, shall 25 be deemed, for purposes of section 1342 of title 31, serv- 26 VerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 3126 IH ices for emergencies involving the safety of human life or 1 the protection of property.’’. 2 (2) APPLICATION.—The amendment made by 3 paragraph (1) shall apply to any lapse in appropria- 4 tions beginning on or after the date of enactment of 5 this Act. 6 SEC. 6. CONTINUATION OF MEDICAID INCOME ELIGIBILITY 7 STANDARD FOR PREGNANT INDIVIDUALS 8 AND INFANTS. 9 Section 1902(l)(2)(A) of the Social Security Act (42 10 U.S.C. 1396a(l)(2)(A)) is amended— 11 (1) in clause (i), by striking ‘‘and not more 12 than 185 percent’’; 13 (2) in clause (ii)— 14 (A) in subclause (I), by striking ‘‘and’’ 15 after the comma; 16 (B) in subclause (II), by striking the pe- 17 riod at the e [Text truncated for display. Full text available on Congress.gov.]