Healthy MOM Act

I 116TH CONGRESS 1ST SESSION H. R. 2778 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 15, 2019 Mrs. WATSON COLEMAN (for herself, Ms. ADAMS, Ms. BARRAGA´N, Ms. BONAMICI, Ms. CLARK of Massachusetts, Ms. CLARKE of New York, Mr. COHEN, Mr. CONNOLLY, Ms. DELBENE, Mrs. DINGELL, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. ENGEL, Mr. ESPAILLAT, Mr. FOSTER, Ms. FRANKEL, Mr. GALLEGO, Mr. GRIJALVA, Ms. HAALAND, Mr. HAS- TINGS, Ms. JACKSON LEE, Ms. KELLY of Illinois, Mr. KHANNA, Mrs. KIRKPATRICK, Mr. LANGEVIN, Mrs. LAWRENCE, Ms. LEE of California, Mr. LEWIS, Ms. MCCOLLUM, Ms. MENG, Mr. SEAN PATRICK MALONEY of New York, Ms. MOORE, Mr. MOULTON, Mr. NADLER, Ms. NORTON, Mr. PASCRELL, Mr. RASKIN, Ms. ROYBAL-ALLARD, Mr. RYAN, Mr. SCHIFF, Mr. TONKO, Mr. TRONE, Ms. WILSON of Florida, Ms. WASSERMAN SCHULTZ, Ms. VELA´ZQUEZ, Mrs. BEATTY, Mr. VEASEY, Mr. VARGAS, Mr. BROWN of Maryland, Ms. BASS, Mr. THOMPSON of Mis- sissippi, and Mr. RICHMOND) introduced the following bill; which was re- ferred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Reform, and Edu- cation and Labor, 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. VerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 2 •HR 2778 IH 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 (1) Pregnancy is a significant life event for mil- 8 lions of women in the United States each year. 9 (2) For more than 30 years, our Nation, 10 through the Medicaid program, has recognized that 11 pregnant women need immediate access to afford- 12 able care, and has allowed women who meet income- 13 eligibility requirements to enroll in Medicaid cov- 14 erage when they become pregnant. 15 (3) Congress recognized the central importance 16 of maternity coverage by classifying maternity and 17 newborn care as one of the ten essential health bene- 18 fits that must now be covered on most individual 19 and small group health insurance plans under sec- 20 tion 1302(b)(1) of the Patient Protection and Af- 21 fordable Care Act (42 U.S.C. 18022(b)(1)). 22 (4) Congress has also recognized the significant 23 challenge of maternal mortality and the need to 24 eliminate disparities in maternal health outcomes for 25 VerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 3 •HR 2778 IH pregnancy-related and pregnancy-associated deaths, 1 and to improve health outcomes for both mothers 2 and babies through passage of the Preventing Ma- 3 ternal Deaths Act of 2018 (Public Law 115–344). 4 (5) Access to comprehensive maternity coverage 5 allows women to access important pregnancy-related 6 care, which is demonstrated to improve health out- 7 comes for women and newborns and reduce financial 8 costs for both consumers and insurers. 9 (6) Uninsured women, women with grand- 10 fathered and transitional health plans, self-funded 11 student health plans, and catastrophic and high-de- 12 ductible health plans may lack access to comprehen- 13 sive and affordable maternity coverage. 14 (7) Employer health plans that exclude depend- 15 ent daughters from maternity coverage leave young 16 women without coverage for their pregnancy, even 17 though Federal law has long held that treating preg- 18 nancy differently than other conditions is sex-based 19 discrimination. 20 (8) A special enrollment period is especially im- 21 portant for young adults, who are at high risk for 22 unintended pregnancies, yet young adults are fre- 23 quently enrolled in catastrophic coverage, which 24 VerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 4 •HR 2778 IH often has fewer benefits, more restrictions, and high- 1 er deductibles. 2 (9) This coverage would be an equalizer for 3 communities of color. The maternal mortality rate 4 varies drastically by race and ethnicity, and where a 5 woman lives. The rising maternal mortality rate in 6 the United States is driven predominantly by the 7 disproportionately high African-American maternal 8 mortality rate, which is four times more than the 9 rate for White women. 10 (10) According to the Centers for Disease Con- 11 trol and Prevention, about 700 women die each year 12 in the United States from pregnancy-related com- 13 plications. Black and American Indian/Alaska Native 14 women are about three times more likely to die from 15 a pregnancy-related cause than White women. 16 (11) Data demonstrates that 3 in 5 pregnancy 17 related deaths could be prevented. Improving access 18 to care is one way to help prevent deaths, regardless 19 of race or ethnicity. 20 (12) Timely maternity care improves the health 21 of pregnant women, as well as birth outcomes and 22 the health of babies throughout their lifetimes. Preg- 23 nancy-related maternal mortality is three to four 24 times higher among women who receive no maternity 25 VerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 5 •HR 2778 IH care compared to women who do. Regular maternity 1 care can detect or mitigate serious pregnancy-related 2 health complications, including preeclampsia, pla- 3 cental abruption, complications from diabetes, com- 4 plications from heart disease, and Graves’ disease, 5 all of which can result in morbidity or mortality for 6 the mother or newborn. 7 (13) The Centers for Disease Control and Pre- 8 vention reports that more than half of all maternal 9 deaths occur at delivery or in the first postpartum 10 year, whereas just more than one-third of preg- 11 nancy-related or pregnancy-associated deaths occur 12 while a person is still pregnant. Yet, for women eligi- 13 ble for the Medicaid program on the basis of preg- 14 nancy, such Medicaid coverage lapses at the end of 15 the month on which the 60th postpartum day lands. 16 (14) Timely maternity care and adequate 17 postpartum care can reduce short- and long-term 18 health care costs. If a woman does not have access 19 to affordable maternity care during her pregnancy, 20 and she or her newborn experiences pregnancy com- 21 plications that result in health problems after birth, 22 their insurer may end up paying much higher costs 23 than if the insurer had covered the woman’s mater- 24 nity care during her pregnancy. Intensive maternity 25 VerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 6 •HR 2778 IH care can reduce hospital and neonatal intensive care 1 unit admissions among infants, resulting in cost sav- 2 ings of $1,768 to $5,560 per birth. For women with 3 high-risk pregnancies, intensive maternity care saves 4 $1.37 for every $1 invested in maternity care. 5 (b) PURPOSE.—The purpose of this Act is to protect 6 the health of women and newborns by ensuring that all 7 women eligible for coverage through the Exchanges estab- 8 lished under title I of the Patient Protection and Afford- 9 able Care Act (Public Law 111–148) and women eligible 10 for other individual or group health plan coverage can ac- 11 cess affordable health coverage during their pregnancy. 12 SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 13 FOR PREGNANT INDIVIDUALS. 14 (a) PUBLIC HEALTH SERVICE ACT.—Section 15 2702(b)(2) of the Public Health Service Act (42 U.S.C. 16 300gg–1(b)(2)) is amended by inserting ‘‘including a spe- 17 cial enrollment period for pregnant individuals, beginning 18 on the date on which the pregnancy is reported to the 19 health insurance issuer’’ before the period at the end. 20 (b) PATIENT PROTECTION AND AFFORDABLE CARE 21 ACT.—Section 1311(c)(6) of the Patient Protection and 22 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend- 23 ed— 24 VerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 7 •HR 2778 IH (1) in subparagraph (C), by striking ‘‘and’’ at 1 the end; 2 (2) by redesignating subparagraph (D) as sub- 3 paragraph (E); and 4 (3) by inserting after subparagraph (C) the fol- 5 lowing new subparagraph: 6 ‘‘(D) a special enrollment period for preg- 7 nant individuals, beginning on the date on 8 which the pregnancy is reported to the Ex- 9 change; and’’. 10 (c) SPECIAL ENROLLMENT PERIODS.— 11 (1) INTERNAL REVENUE CODE.—Section 12 9801(f) of the Internal Revenue Code of 1986 (26 13 U.S.C. 9801(f)) is amended by adding at the end 14 the following new paragraph: 15 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 16 ‘‘(A) A group health plan shall permit an 17 employee who is eligible, but not enrolled, for 18 coverage under the terms of the plan (or a de- 19 pendent of such an employee if the dependent 20 is eligible, but not enrolled, for coverage under 21 such terms) to enroll for coverage under the 22 terms of the plan upon pregnancy, with the spe- 23 cial enrollment period beginning on the date on 24 which the pregnancy is reported to the group 25 VerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 8 •HR 2778 IH health plan or the pregnancy is confirmed by a 1 health care provider. 2 ‘‘(B) The Secretary shall promulgate regu- 3 lations with respect to the special enrollment 4 period under subparagraph (A), including es- 5 tablishing a time period for pregnant individ- 6 uals to enroll in coverage and effective date of 7 such coverage.’’. 8 (2) ERISA.—Section 701(f) of the Employee 9 Retirement Income Security Act of 1974 (29 U.S.C. 10 1181(f)) is amended by adding at the end the fol- 11 lowing: 12 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 13 ‘‘(A) A group health plan or health insur- 14 ance issuer in connection with a group health 15 plan shall permit an employee who is eligible, 16 but not enrolled, for coverage under the terms 17 of the plan (or a dependent of such an employee 18 if the dependent is eligible, but not enrolled, for 19 coverage under such terms) to enroll for cov- 20 erage under the terms of the plan upon preg- 21 nancy, with the special enrollment period begin- 22 ning on the date on which the pregnancy is re- 23 ported to the group health plan or health insur- 24 VerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 9 •HR 2778 IH ance issuer or the pregnancy is confirmed by a 1 health care provider. 2 ‘‘(B) The Secretary shall promulgate regu- 3 lations with respect to the special enrollment 4 period under subparagraph (A), including es- 5 tablishing a time period for pregnant individ- 6 uals to enroll in coverage and effective date of 7 such coverage.’’. 8 (d) EFFECTIVE DATE.—The amendments made by 9 this section shall apply with respect to plan years begin- 10 ning after the 2019 plan year. 11 SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT 12 CHILDREN. 13 Section 2719A of the Public Health Service Act (42 14 U.S.C. 300gg–19a) is amended by adding at the end the 15 following: 16 ‘‘(e) 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 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 10 •HR 2778 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 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778 pbinns on DSK79D2C42PROD with BILLS 11 •HR 2778 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 end and inserting ‘‘, and’’; and 18 (C) by adding at the end the f [Text truncated for display. Full text available on Congress.gov.]