Mamas First Act

I 116TH CONGRESS 1ST SESSION H. R. 2751 To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services provided by doulas and midwives, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 15, 2019 Ms. MOORE (for herself, Ms. HAALAND, and Mrs. DINGELL) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services pro- vided by doulas and midwives, 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 ‘‘Mamas First Act’’. 4 SEC. 2. FINDINGS. 5 Congress finds the following: 6 (1) According to the Centers for Disease Con- 7 trol and Prevention, the maternal mortality rate var- 8 ies drastically for women by race and ethnicity. On 9 VerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2751.IH H2751 kjohnson on DSK79L0C42 with BILLS 2 •HR 2751 IH average, there are 12.7 deaths per 100,000 live 1 births for White women, 43.5 deaths per 100,000 2 live births for African-American women, 32.5 deaths 3 for American Indian and Alaskan Native women, 4 and 14.4 deaths per 100,000 live births for women 5 of other ethnicities. While maternal mortality dispar- 6 ately impacts African-American women and indige- 7 nous women, this urgent public health crisis tra- 8 verses race, ethnicity, socioeconomic status, edu- 9 cational background, and geography. 10 (2) United States maternal mortality rates are 11 the highest in the developed world and are increas- 12 ing rapidly. 13 (3) Many of these maternal deaths are likely 14 preventable. 15 (4) According to the National Institutes of 16 Health, doula-assisted mothers are four times less 17 likely to have a low-birth-weight baby, two times less 18 likely to experience a birth complication involving 19 themselves or their baby, and significantly more like- 20 ly to initiate breastfeeding. 21 (5) Midwife-led care is associated with cost sav- 22 ings, decreased rates of intervention, lower cesarean 23 rates, lower preterm birth rates, and healthier out- 24 comes for mothers and babies. 25 VerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2751.IH H2751 kjohnson on DSK79L0C42 with BILLS 3 •HR 2751 IH (6) Midwives may practice in any setting, in- 1 cluding the home, community, hospitals, clinics, or 2 health units. 3 SEC. 3. MEDICAID COVERAGE OF SERVICES PROVIDED BY 4 DOULAS AND MIDWIVES. 5 (a) IN GENERAL.—Section 1905 of the Social Secu- 6 rity Act (42 U.S.C. 1396d) is amended— 7 (1) in subsection (a)— 8 (A) in paragraph (29), by striking ‘‘and’’ 9 at the end; 10 (B) by redesignating paragraph (30) as 11 paragraph (31); and 12 (C) by inserting after paragraph (29) the 13 following new paragraph: 14 ‘‘(30) services, including prenatal, delivery, and 15 postpartum services, provided by doulas and mid- 16 wives (as those terms are defined in subsection (ff)) 17 to the extent authorized under State law; and’’; and 18 (2) by adding at the end the following new sub- 19 section: 20 ‘‘(ff) DOULAS AND MIDWIVES DEFINED.—For pur- 21 poses of subsection (a)(30): 22 ‘‘(1) DOULAS DEFINED.—The term ‘doula’ 23 means an individual who— 24 VerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2751.IH H2751 kjohnson on DSK79L0C42 with BILLS 4 •HR 2751 IH ‘‘(A) is certified by an organization, which 1 has been established for not less than five 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, licensed midwife, and Tribal-recog- 14 nized midwife. 15 ‘‘(B) CERTIFIED MIDWIFE.—For purposes 16 of subparagraph (A), the term ‘certified mid- 17 wife’ means an individual who is certified by the 18 American Midwifery Certification Board to 19 practice midwifery. 20 ‘‘(C) CERTIFIED PROFESSIONAL MID- 21 WIFE.—For purposes of subparagraph (A), the 22 term ‘certified professional midwife’ means an 23 individual who— 24 VerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2751.IH H2751 kjohnson on DSK79L0C42 with BILLS 5 •HR 2751 IH ‘‘(i) is certified by the North Amer- 1 ican Registry of Midwives to practice mid- 2 wifery for normal, low-risk pregnancies and 3 childbirths; 4 ‘‘(ii) completes— 5 ‘‘(I) a midwifery education pro- 6 gram accredited by the Midwifery 7 Education and Accreditation Council 8 or any other entity recognized by the 9 Department of Education; or 10 ‘‘(II) the requirements to obtain 11 a Midwifery Bridge Certificate from 12 the North American Registry of Mid- 13 wives; and 14 ‘‘(iii) maintains the certification de- 15 scribed in clause (i) by completing any re- 16 quired continuing education for such cer- 17 tification. 18 ‘‘(D) LICENSED MIDWIFE.—For purposes 19 of subparagraph (A), the term ‘licensed mid- 20 wife’ means, with respect to a State, an indi- 21 vidual who is licensed under State law to prac- 22 tice midwifery. 23 ‘‘(E) TRIBAL-RECOGNIZED MIDWIFE.—For 24 purposes of subparagraph (A), the term ‘Tribal- 25 VerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2751.IH H2751 kjohnson on DSK79L0C42 with BILLS 6 •HR 2751 IH recognized midwife’ means an individual who is 1 recognized by an Indian tribe (as defined in 2 section 4 of the Indian Health Care Improve- 3 ment Act) to practice midwifery for such 4 tribe.’’. 5 (b) REQUIRING MANDATORY COVERAGE UNDER 6 STATE PLAN.—Section 1902(a)(10)(A) of the Social Se- 7 curity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the 8 matter preceding clause (i), by striking ‘‘and (29)’’ and 9 inserting ‘‘(29), and (30)’’. 10 (c) EFFECTIVE DATE.— 11 (1) IN GENERAL.—Subject to paragraph (2), 12 the amendments made by this section shall apply 13 with respect to medical assistance furnished on or 14 after January 1, 2020. 15 (2) EXCEPTION FOR STATE LEGISLATION.—In 16 the case of a State plan under title XIX of the So- 17 cial Security Act (42 U.S.C. 1396 et seq.) that the 18 Secretary of Health and Human Services determines 19 requires State legislation in order for the respective 20 plan to meet any requirement imposed by amend- 21 ments made by this section, the respective plan shall 22 not be regarded as failing to comply with the re- 23 quirements of such title solely on the basis of its 24 failure to meet such an additional requirement be- 25 VerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2751.IH H2751 kjohnson on DSK79L0C42 with BILLS 7 •HR 2751 IH fore the first day of the first calendar quarter begin- 1 ning after the close of the first regular session of the 2 State legislature that begins after the date of the en- 3 actment of this Act. For purposes of the previous 4 sentence, in the case of a State that has a 2-year 5 legislative session, each year of the session shall be 6 considered to be a separate regular session of the 7 State legislature. 8 Æ VerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H2751.IH H2751 kjohnson on DSK79L0C42 with BILLS