Improving Coverage and Care for Mothers Act

II 117TH CONGRESS 1ST SESSION S. 1977 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 JUNE 8, 2021 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 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 1977 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 insert- 17 ing ‘‘must make available medical assist- 18 ance to individuals under the age of 18 19 who (but for income and resources) would 20 be eligible for medical assistance as an in- 21 dividual described in subparagraph 22 (A)(i);’’; and 23 (ii) in clause (iii)— 24 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 1977 IS (I) by striking ‘‘must include (I) 1 with respect to’’ and inserting ‘‘must 2 include, with respect to’’; and 3 (II) by striking ‘‘, and (II)’’ and 4 all that follows through ‘‘delivery serv- 5 ices’’; 6 (B) in subsection (e), by striking para- 7 graph (6); 8 (C) in subsection (l)(1)(A), by inserting 9 ‘‘before January 1, 2022,’’ before ‘‘women dur- 10 ing pregnancy’’; and 11 (D) in subsection (ii)(1)(A), by inserting 12 ‘‘that was in effect as of January 1, 2022’’ 13 after ‘‘pregnant women’’; 14 (2) in section 1920(b)(1)(A), by striking ‘‘that 15 the family income’’ and all that follows through ‘‘in- 16 come level of eligibility’’ and inserting ‘‘that the 17 woman is eligible for medical assistance’’; and 18 (3) in section 1937(a)(2)(B), by amending 19 clause (i) to read as follows: 20 ‘‘(i) QUALIFIED PREGNANT WOMEN.— 21 The individual is a qualified pregnant 22 woman (as defined in section 23 1905(n)(1)).’’. 24 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 1977 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)— 8 (i) in paragraph (5), by striking ‘‘60- 9 day period’’ and inserting ‘‘365-day pe- 10 riod’’; and 11 (ii) in paragraph (16), by striking ‘‘At 12 the option of the State’’ and inserting ‘‘Be- 13 fore January 1, 2022, at the option of the 14 State’’; 15 (B) in section 1902(l)(1)(A), by striking 16 ‘‘60-day period’’ and inserting ‘‘365-day pe- 17 riod’’; 18 (C) in section 1903(v)(4)(A)(i), by striking 19 ‘‘60-day period’’ and inserting ‘‘365-day pe- 20 riod’’; and 21 (D) in section 1905(a), in the 4th sentence 22 in the matter following paragraph (30)— 23 (i) by striking ‘‘60-day period’’ and 24 inserting ‘‘365-day period’’; and 25 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 1977 IS (ii) by striking ‘‘subdivision (B) fol- 1 lowing paragraph (30)’’ and inserting 2 ‘‘subdivision (B) following paragraph 3 (32)’’. 4 (2) CHIP.—Section 2112 of the Social Security 5 Act (42 U.S.C. 1397ll) is amended by striking ‘‘60- 6 day period’’ each place it appears and inserting 7 ‘‘365-day period’’. 8 (3) CONFORMING AMENDMENT.—Section 9 1938(b)(2)(C) of the Social Security Act (42 U.S.C. 10 1396u–8(b)(2)(C)) is amended by striking ‘‘previous 11 60 days’’ and inserting ‘‘previous 365 days’’. 12 (b) REQUIRING FULL BENEFITS FOR PREGNANT 13 AND POSTPARTUM WOMEN.— 14 (1) MEDICAID.— 15 (A) IN GENERAL.—Paragraph (5) of sec- 16 tion 1902(e) of the Social Security Act (24 17 U.S.C. 1396a(e)) is amended to read as follows: 18 ‘‘(5) Any woman who is eligible for medical as- 19 sistance under the State plan or a waiver of such 20 plan and who is, or who while so eligible becomes, 21 pregnant, shall continue to be eligible under the plan 22 or waiver for medical assistance through the end of 23 the month in which the 365-day period (beginning 24 on the last day of her pregnancy) ends, regardless 25 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 1977 IS of the basis for the woman’s eligibility for medical 1 assistance, including if the woman’s eligibility for 2 medical assistance is on the basis of being preg- 3 nant.’’. 4 (B) CONFORMING AMENDMENT.—Section 5 1902(a)(10) of the Social Security Act (42 6 U.S.C. 1396a(a)(10)) is amended in the matter 7 following subparagraph (G) by striking ‘‘(VII) 8 the medical assistance’’ and all that follows 9 through ‘‘complicate pregnancy,’’. 10 (2) CHIP.—Section 2107(e)(1)(J) of the Social 11 Security Act (42 U.S.C. 1397gg(e)(1)(J)) is amend- 12 ed— 13 (A) by inserting ‘‘, before January 1, 14 2022,’’ before ‘‘(16) of section 1902(e)’’; and 15 (B) by striking ‘‘(relating to’’ and all that 16 follows through the period and inserting ‘‘(re- 17 lating to the provision of medical assistance to 18 pregnant women during pregnancy and the 19 365-day postpartum period under title XIX).’’ 20 SEC. 4. MEDICAID COVERAGE OF SERVICES PROVIDED BY 21 DOULAS, MIDWIVES, AND LACTATION CON- 22 SULTANTS. 23 (a) IN GENERAL.—Section 1905 of the Social Secu- 24 rity Act (42 U.S.C. 1396d) is amended— 25 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 1977 IS (1) in subsection (a)— 1 (A) in paragraph (30), by striking ‘‘and’’ 2 at the end; 3 (B) by redesignating paragraph (31) as 4 paragraph (32); and 5 (C) by inserting after paragraph (30) the 6 following new paragraph: 7 ‘‘(31) services, including— 8 ‘‘(A) prenatal, delivery, postpartum, and 9 lactation consulting services, provided by 10 doulas, midwives, and lactation consultants (as 11 those terms are defined in subsection (jj)) to 12 the extent authorized under State law; and 13 ‘‘(B) services included in the components 14 of postpartum care identified by the American 15 College of Obstetricians and Gynecologists in 16 Committee Opinion Number 736 published in 17 May of 2018 (or any successor opinion or publi- 18 cation); and’’; and 19 (2) by adding at the end the following new sub- 20 section: 21 ‘‘(jj) DOULAS AND MIDWIVES DEFINED.—For pur- 22 poses of subsection (a)(31): 23 ‘‘(1) DOULAS DEFINED.—The term ‘doula’ 24 means an individual who— 25 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 1977 IS ‘‘(A) is certified by an organization, which 1 has been established for not less than 5 years 2 and which requires the completion of continuing 3 education to maintain such certification, to pro- 4 vide non-medical advice, information, emotional 5 support, and physical comfort to an individual 6 during such individual’s pregnancy, childbirth, 7 and postpartum period; and 8 ‘‘(B) maintains such certification by com- 9 pleting such required continuing education. 10 ‘‘(2) MIDWIVES DEFINED.— 11 ‘‘(A) IN GENERAL.—The term ‘midwife’ 12 means a certified midwife, certified professional 13 midwife, and Tribal-recognized midwife. 14 ‘‘(B) CERTIFIED MIDWIFE.—For purposes 15 of subparagraph (A), the term ‘certified mid- 16 wife’ means an individual who is certified by the 17 American Midwifery Certification Board to 18 practice midwifery. 19 ‘‘(C) CERTIFIED PROFESSIONAL MID- 20 WIFE.—For purposes of subparagraph (A), the 21 term ‘certified professional midwife’ means an 22 individual who— 23 ‘‘(i) is certified by the North Amer- 24 ican Registry of Midwives to practice mid- 25 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 1977 IS wifery for normal, low-risk pregnancies and 1 childbirths; 2 ‘‘(ii) completes— 3 ‘‘(I) a midwifery education pro- 4 gram accredited by the Midwifery 5 Education and Accreditation Council 6 or any other entity recognized by the 7 Department of Education; or 8 ‘‘(II) the requirements to obtain 9 a Midwifery Bridge Certificate from 10 the North American Registry of Mid- 11 wives; and 12 ‘‘(iii) maintains the certification de- 13 scribed in clause (i) by completing any re- 14 quired continuing education for such cer- 15 tification. 16 ‘‘(D) TRIBAL-RECOGNIZED MIDWIFE.—For 17 purposes of subparagraph (A), the term ‘Tribal- 18 recognized midwife’ means an individual who is 19 recognized by an Indian tribe (as defined in 20 section 4 of the Indian Health Care Improve- 21 ment Act) to practice midwifery for such tribe. 22 ‘‘(3) LACTATION CONSULTANT DEFINED.—The 23 term ‘lactation consultant’ means an individual who 24 is a specialist who— 25 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 1977 IS ‘‘(A) is trained to— 1 ‘‘(i) focus on the needs and concerns 2 of a breastfeeding mother and baby; and 3 ‘‘(ii) prevent, recognize, and solve 4 breastfeeding difficulties; 5 ‘‘(B) is certified by an organization, which 6 has been established for not less than 5 years 7 and which requires the completion of continuing 8 education to maintain such certification, to pro- 9 vide lactation consulting services; and 10 ‘‘(C) maintains such certification by com- 11 pleting such required continuing education.’’. 12 (b) REQUIRING MANDATORY COVERAGE UNDER 13 STATE PLAN.—Section 1902(a)(10)(A) of the Social Se- 14 curity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the 15 matter preceding clause (i), by striking ‘‘and (30)’’ and 16 inserting ‘‘(30), and (31)’’. 17 SEC. 5. INCREASED FMAP FOR ADDITIONAL EXPENDI- 18 TURES. 19 Section 1905 of the Social Security Act (42 U.S.C. 20 1396d), as amended by section 4, is further amended— 21 (1) in subsection (b), by striking ‘‘and (ii)’’ and 22 inserting ‘‘(ii), and (kk)’’; and 23 (2) by adding at the end the following: 24 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 1977 IS ‘‘(kk) INCREASED FMAP FOR ADDITIONAL EXPEND- 1 ITURES FOR MEDICAL ASSISTANCE TO PREGNANT AND 2 POSTPARTUM WOMEN.—For calendar quarters beginning 3 on or after January 1, 2022, notwithstanding subsection 4 (b), the Federal medical assistance percentage for a State, 5 with respect to the additional amounts expended by such 6 State for medical assistance under the State plan under 7 this title or a waiver of such plan that are attributable 8 to requirements imposed by the amendments made by the 9 Improving Coverage and Care for Mothers Act (as deter- 10 mined by the Secretary), shall be equal to 100 percent.’’. 11 SEC. 6. EFFECTIVE DATE. 12 (a) IN GENERAL.—Subject to subsection (b), the 13 amendments made by this Act shall apply with respect to 14 medical assistance furnished on or after January 1, 2022. 15 (b) EXCEPTION FOR STATE LEGISLATION.—In the 16 case of a State plan under title XIX of the Social Security 17 Act (42 U.S.C. 1396 et seq.) that the Secretary of Health 18 and Human Services determines requires State legislation 19 in order for the respective plan to meet any requirement 20 imposed by amendments made by this section, the respec- 21 tive plan shall not be regarded as failing to comply with 22 the requirements of such title solely on the basis of its 23 failure to meet such an additional requirement before the 24 first day of the first calendar quarter beginning after the 25 VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 1977 IS close of the first regular session of the State legislature 1 that begins after the date of the enactment of this Act. 2 For purposes of the previous sentence, in the case of a 3 State that has a 2-year legislative session, each year of 4 the session shall be considered to be a separate regular 5 session of the State legislature. 6 Æ VerDate Sep 11 2014 16:54 Jun 22, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\S1977.IS S1977 pamtmann on DSKBC07HB2PROD with BILLS