Healthy MOM Act

II 116TH CONGRESS 1ST SESSION S. 1481 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 SENATE OF THE UNITED STATES MAY 15, 2019 Mr. BROWN (for himself, Ms. SMITH, Mrs. GILLIBRAND, Mr. MARKEY, Ms. KLOBUCHAR, Mr. TESTER, Ms. HASSAN, Mr. BLUMENTHAL, Ms. HAR- RIS, Mr. CASEY, Mr. WHITEHOUSE, Mr. BOOKER, Mr. MERKLEY, Mr. PETERS, Mr. KING, Ms. ROSEN, Mr. LEAHY, Ms. CORTEZ MASTO, Ms. BALDWIN, Mr. JONES, and Mr. KAINE) 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 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Healthy Maternity and 4 Obstetric Medicine Act’’ or the ‘‘Healthy MOM Act’’. 5 SEC. 2. FINDINGS AND PURPOSE. 6 (a) FINDINGS.—Congress finds the following: 7 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 2 •S 1481 IS (1) Pregnancy is a significant life event for mil- 1 lions of women in the United States each year. 2 (2) For more than 30 years, our Nation, 3 through the Medicaid program, has recognized that 4 pregnant women need immediate access to afford- 5 able care, and has allowed women who meet income- 6 eligibility requirements to enroll in Medicaid cov- 7 erage when they become pregnant. 8 (3) Congress recognized the central importance 9 of maternity coverage by classifying maternity and 10 newborn care as one of the ten essential health bene- 11 fits that must now be covered on most individual 12 and small group health insurance plans under sec- 13 tion 1302(b)(1) of the Patient Protection and Af- 14 fordable Care Act (42 U.S.C. 18022(b)(1)). 15 (4) Congress has also recognized the significant 16 challenge of maternal mortality and the need to 17 eliminate disparities in maternal health outcomes for 18 pregnancy-related and pregnancy-associated deaths, 19 and to improve health outcomes for both mothers 20 and babies through passage of the Preventing Ma- 21 ternal Deaths Act of 2018 (Public Law 115–344). 22 (5) Access to comprehensive maternity coverage 23 allows women to access important pregnancy-related 24 care, which is demonstrated to improve health out- 25 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 3 •S 1481 IS comes for women and newborns and reduce financial 1 costs for both consumers and insurers. 2 (6) Uninsured women, women with grand- 3 fathered and transitional health plans, self-funded 4 student health plans, and catastrophic and high-de- 5 ductible health plans may lack access to comprehen- 6 sive and affordable maternity coverage. 7 (7) Employer health plans that exclude depend- 8 ent daughters from maternity coverage leave young 9 women without coverage for their pregnancy, even 10 though Federal law has long held that treating preg- 11 nancy differently than other conditions is sex-based 12 discrimination. 13 (8) A special enrollment period is especially im- 14 portant for young adults, who are at high risk for 15 unintended pregnancies, yet young adults are fre- 16 quently enrolled in catastrophic coverage, which 17 often has fewer benefits, more restrictions, and high- 18 er deductibles. 19 (9) This coverage would be an equalizer for 20 communities of color. The maternal mortality rate 21 varies drastically by race and ethnicity, and where a 22 woman lives. The rising maternal mortality rate in 23 the United States is driven predominantly by the 24 disproportionately high African-American maternal 25 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 4 •S 1481 IS mortality rate, which is four times more than the 1 rate for White women. 2 (10) According to the Centers for Disease Con- 3 trol and Prevention, about 700 women die each year 4 in the United States from pregnancy-related com- 5 plications. Black and American Indian/Alaska Native 6 women are about three times more likely to die from 7 a pregnancy-related cause than White women. 8 (11) Data demonstrates that 3 in 5 pregnancy- 9 related deaths could be prevented. Improving access 10 to care is one way to help prevent deaths, regardless 11 of race or ethnicity. 12 (12) Timely maternity care improves the health 13 of pregnant women, as well as birth outcomes and 14 the health of babies throughout their lifetimes. Preg- 15 nancy-related maternal mortality is three to four 16 times higher among women who receive no maternity 17 care compared to women who do. Regular maternity 18 care can detect or mitigate serious pregnancy-related 19 health complications, including preeclampsia, pla- 20 cental abruption, complications from diabetes, com- 21 plications from heart disease, and Graves’ disease, 22 all of which can result in morbidity or mortality for 23 the mother or newborn. 24 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 5 •S 1481 IS (13) The Centers for Disease Control and Pre- 1 vention reports that more than half of all maternal 2 deaths occur at delivery or in the first postpartum 3 year, whereas just more than one-third of preg- 4 nancy-related or pregnancy-associated deaths occur 5 while a person is still pregnant. Yet, for women eligi- 6 ble for the Medicaid program on the basis of preg- 7 nancy, such Medicaid coverage lapses at the end of 8 the month on which the 60th postpartum day lands. 9 (14) Timely maternity care and adequate 10 postpartum care can reduce short- and long-term 11 health care costs. If a woman does not have access 12 to affordable maternity care during her pregnancy, 13 and she or her newborn experiences pregnancy com- 14 plications that result in health problems after birth, 15 their insurer may end up paying much higher costs 16 than if the insurer had covered the woman’s mater- 17 nity care during her pregnancy. Intensive maternity 18 care can reduce hospital and neonatal intensive care 19 unit admissions among infants, resulting in cost sav- 20 ings of $1,768 to $5,560 per birth. For women with 21 high-risk pregnancies, intensive maternity care saves 22 $1.37 for every $1 invested in maternity care. 23 (b) PURPOSE.—The purpose of this Act is to protect 24 the health of women and newborns by ensuring that all 25 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 6 •S 1481 IS women eligible for coverage through the Exchanges estab- 1 lished under title I of the Patient Protection and Afford- 2 able Care Act (Public Law 111–148) and women eligible 3 for other individual or group health plan coverage can ac- 4 cess affordable health coverage during their pregnancy. 5 SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 6 FOR PREGNANT INDIVIDUALS. 7 (a) PUBLIC HEALTH SERVICE ACT.—Section 8 2702(b)(2) of the Public Health Service Act (42 U.S.C. 9 300gg–1(b)(2)) is amended by inserting ‘‘including a spe- 10 cial enrollment period for pregnant individuals, beginning 11 on the date on which the pregnancy is reported to the 12 health insurance issuer’’ before the period at the end. 13 (b) PATIENT PROTECTION AND AFFORDABLE CARE 14 ACT.—Section 1311(c)(6) of the Patient Protection and 15 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend- 16 ed— 17 (1) in subparagraph (C), by striking ‘‘and’’ at 18 the end; 19 (2) by redesignating subparagraph (D) as sub- 20 paragraph (E); and 21 (3) by inserting after subparagraph (C) the fol- 22 lowing new subparagraph: 23 ‘‘(D) a special enrollment period for preg- 24 nant individuals, beginning on the date on 25 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 7 •S 1481 IS which the pregnancy is reported to the Ex- 1 change; and’’. 2 (c) SPECIAL ENROLLMENT PERIODS.— 3 (1) INTERNAL REVENUE CODE.—Section 4 9801(f) of the Internal Revenue Code of 1986 (26 5 U.S.C. 9801(f)) is amended by adding at the end 6 the following new paragraph: 7 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 8 ‘‘(A) A group health plan shall permit an 9 employee who is eligible, but not enrolled, for 10 coverage under the terms of the plan (or a de- 11 pendent of such an employee if the dependent 12 is eligible, but not enrolled, for coverage under 13 such terms) to enroll for coverage under the 14 terms of the plan upon pregnancy, with the spe- 15 cial enrollment period beginning on the date on 16 which the pregnancy is reported to the group 17 health plan or the pregnancy is confirmed by a 18 health care provider. 19 ‘‘(B) The Secretary shall promulgate regu- 20 lations with respect to the special enrollment 21 period under subparagraph (A), including es- 22 tablishing a time period for pregnant individ- 23 uals to enroll in coverage and effective date of 24 such coverage.’’. 25 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 8 •S 1481 IS (2) ERISA.—Section 701(f) of the Employee 1 Retirement Income Security Act of 1974 (29 U.S.C. 2 1181(f)) is amended by adding at the end the fol- 3 lowing: 4 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 5 ‘‘(A) A group health plan or health insur- 6 ance issuer in connection with a group health 7 plan shall permit an employee who is eligible, 8 but not enrolled, for coverage under the terms 9 of the plan (or a dependent of such an employee 10 if the dependent is eligible, but not enrolled, for 11 coverage under such terms) to enroll for cov- 12 erage under the terms of the plan upon preg- 13 nancy, with the special enrollment period begin- 14 ning on the date on which the pregnancy is re- 15 ported to the group health plan or health insur- 16 ance issuer or the pregnancy is confirmed by a 17 health care provider. 18 ‘‘(B) The Secretary shall promulgate regu- 19 lations with respect to the special enrollment 20 period under subparagraph (A), including es- 21 tablishing a time period for pregnant individ- 22 uals to enroll in coverage and effective date of 23 such coverage.’’. 24 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 9 •S 1481 IS (d) EFFECTIVE DATE.—The amendments made by 1 this section shall apply with respect to plan years begin- 2 ning after the 2019 plan year. 3 SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT 4 CHILDREN. 5 Section 2719A of the Public Health Service Act (42 6 U.S.C. 300gg–19a) is amended by adding at the end the 7 following: 8 ‘‘(e) COVERAGE OF MATERNITY CARE.—A group 9 health plan, or health insurance issuer offering group or 10 individual health insurance coverage, that provides cov- 11 erage for dependents shall ensure that such plan or cov- 12 erage includes coverage for maternity care associated with 13 pregnancy, childbirth, and postpartum care for all partici- 14 pants, beneficiaries, or enrollees, including dependents, in- 15 cluding coverage of labor and delivery. Such coverage shall 16 be provided to all pregnant dependents regardless of age.’’. 17 SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 18 (a) COVERAGE OF PREGNANCY.— 19 (1) IN GENERAL.—The Director of the Office of 20 Personnel Management shall issue such regulations 21 as are necessary to ensure that pregnancy is consid- 22 ered a change in family status and a qualifying life 23 event for an individual who is eligible to enroll, but 24 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 10 •S 1481 IS is not enrolled, in a health benefit plan under chap- 1 ter 89 title 5, United States Code. 2 (2) EFFECTIVE DATE.—The requirement in 3 paragraph (1) shall apply with respect to any con- 4 tract entered into under section 8902 of such title 5 beginning 12 months after the date of enactment of 6 this Act. 7 (b) DESIGNATING CERTAIN FEHBP-RELATED 8 SERVICES AS EXCEPTED SERVICES UNDER THE ANTI- 9 DEFICIENCY ACT.— 10 (1) IN GENERAL.—Section 8905 of title 5, 11 United States Code, is amended by adding at the 12 end the following: 13 ‘‘(i) Any services by an officer or employee under this 14 chapter relating to enrolling individuals in a health bene- 15 fits plan under this chapter, or changing the enrollment 16 of an individual already so enrolled due to an event de- 17 scribed in section 5(a)(1) of the Healthy MOM Act, shall 18 be deemed, for purposes of section 1342 of title 31, serv- 19 ices for emergencies involving the safety of human life or 20 the protection of property.’’. 21 (2) APPLICATION.—The amendment made by 22 paragraph (1) shall apply to any lapse in appropria- 23 tions beginning on or after the date of enactment of 24 this Act. 25 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 11 •S 1481 IS SEC. 6. CONTINUATION OF MEDICAID INCOME ELIGIBILITY 1 STANDARD FOR PREGNANT INDIVIDUALS 2 AND INFANTS. 3 Section 1902(l)(2)(A) of the Social Security Act (42 4 U.S.C. 1396a(l)(2)(A)) is amended— 5 (1) in clause (i), by striking ‘‘and not more 6 than 185 percent’’; 7 (2) in clause (ii)— 8 (A) in subclause (I), by striking ‘‘and’’ 9 after the comma; 10 (B) in subclause (II), by striking the pe- 11 riod at the end and inserting ‘‘, and’’; and 12 (C) by adding at the end the following: 13 ‘‘(III) January 1, 2020, is the percentage pro- 14 vided under clause (v).’’; and 15 (3) by adding at the end the following new 16 clause: 17 ‘‘(v) The percentage provided under clause (ii) for 18 medical assistance provided on or after January 1, 2020, 19 with respect to individuals described in subparagraph (A) 20 or (B) of paragraph (1) shall not be less than— 21 ‘‘(I) the percentage specified for such individ- 22 uals by the State in an amendment to its State plan 23 (whether approved or not) as of January 1, 2014; or 24 ‘‘(II) if no such percentage is specified as of 25 January 1, 2014, the percentage established for 26 VerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481 kjohnson on DSK79L0C42 with BILLS 12 •S 1481 IS such individuals under the State’s authorizi [Text truncated for display. 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