Helping Medicaid Offer Maternity Services Act of 2020

IIB 116TH CONGRESS 2D SESSION H. R. 4996 IN THE SENATE OF THE UNITED STATES SEPTEMBER 30 (legislative day, SEPTEMBER 29), 2020 Received; read twice and referred to the Committee on Finance AN ACT To amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individ- uals, 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 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 2 HR 4996 RFS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Helping Medicaid 2 Offer Maternity Services Act of 2020’’ or the ‘‘Helping 3 MOMS Act of 2020’’. 4 SEC. 2. MODIFICATIONS TO CERTAIN COVERAGE UNDER 5 MEDICAID AND CHIP FOR PREGNANT AND 6 POSTPARTUM WOMEN. 7 (a) STATE OPTION.—Section 1902(e) of the Social 8 Security Act (42 U.S.C. 1396a(e)) is amended by adding 9 at the end the following new paragraph: 10 ‘‘(16) EXTENDING CERTAIN COVERAGE FOR 11 PREGNANT AND POSTPARTUM WOMEN.—At the op- 12 tion of the State, the State plan (or waiver of such 13 State plan) may provide that an individual who, 14 while pregnant, is eligible for and has received med- 15 ical assistance under the State plan approved under 16 this title (or waiver of such plan) (including during 17 a period of retroactive eligibility under subsection 18 (a)(34)) shall, in addition to remaining eligible 19 under paragraph (5) for all pregnancy-related and 20 postpartum medical assistance available under the 21 State plan (or wavier) through the last day of the 22 month in which the 60-day period (beginning on the 23 last day of her pregnancy) ends, remain eligible 24 under the State plan (or waiver) for medical assist- 25 ance and such medical assistance shall include all 26 VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 3 HR 4996 RFS services covered under the State plan (or waiver) 1 that is not less in amount, duration, or scope, or is 2 determined by the Secretary to be substantially 3 equivalent, to the medical assistance available for an 4 individual described in subsection (a)(10)(A)(i) for 5 the period beginning on the first day occurring after 6 the end of such 60-day period and ending on the last 7 day of the month in which the one-year period (be- 8 ginning on the last day of her pregnancy) ends.’’. 9 (b) APPLICATION TO CHIP.— 10 (1) IN GENERAL.—Section 2107(e)(1) of the 11 Social Security Act (42 U.S.C. 1397gg(e)(1)) is 12 amended— 13 (A) by redesignating subparagraphs (J) 14 through (S) as subparagraphs (K) through (T), 15 respectively; and 16 (B) by inserting after subparagraph (I) the 17 following new subparagraph: 18 ‘‘(J) In the case of a State that has elected 19 to apply the option under section 1902(e)(16) 20 with respect to coverage for pregnant and 21 postpartum women under title XIX, the provi- 22 sions of such section with respect to coverage of 23 pregnant and postpartum women under this 24 VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 4 HR 4996 RFS title, except that such coverage shall be required 1 and not at the option of the State.’’. 2 (2) OPTIONAL COVERAGE OF TARGETED LOW- 3 INCOME PREGNANT WOMEN.—Section 2112(d)(2)(A) 4 of the Social Security Act (42 U.S.C. 5 1397ll(d)(2)(A)) is amended by inserting after ‘‘60- 6 day period’’ the following: ‘‘, or, in the case that sec- 7 tion 1902(e)(16) applies to the State child health 8 plan (or waiver of such plan) pursuant to section 9 2107(e)(1), the 1-year period’’. 10 (c) EFFECTIVE DATE.—The amendments made by 11 this section shall apply with respect to State elections 12 made under paragraph (16) of section 1902(e) of the So- 13 cial Security Act (42 U.S.C. 1396a(e)), as added by sub- 14 section (a), under title XIX of the Social Security Act (42 15 U.S.C. 1396 et seq.) on or after the first day of the first 16 fiscal year quarter beginning at least one year after the 17 date of the enactment of this Act. 18 SEC. 3. MACPAC REPORT. 19 (a) IN GENERAL.—Not later than 1 year after the 20 date of the enactment of this Act, the Medicaid and CHIP 21 Payment and Access Commission (referred to in this sec- 22 tion as ‘‘MACPAC’’) shall publish a report on the coverage 23 of doula services under State Medicaid programs, which 24 shall at a minimum include the following: 25 VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 5 HR 4996 RFS (1) Information about coverage for doula serv- 1 ices under State Medicaid programs that currently 2 provide coverage for such services, including the type 3 of doula services offered (such as prenatal, labor and 4 delivery, postpartum support, and also community- 5 based and traditional doula services). 6 (2) An analysis of barriers to covering doula 7 services under State Medicaid programs. 8 (3) An identification of effective strategies to 9 increase the use of doula services in order to provide 10 better care and achieve better maternal and infant 11 health outcomes, including strategies that States 12 may use to recruit, train, and certify a diverse doula 13 workforce, particularly from underserved commu- 14 nities, communities of color, and communities facing 15 linguistic or cultural barriers. 16 (4) Recommendations for legislative and admin- 17 istrative actions to increase access to doula services 18 in State Medicaid programs, including actions that 19 ensure doulas may earn a living wage that accounts 20 for their time and costs associated with providing 21 care. 22 (b) STAKEHOLDER CONSULTATION.—In developing 23 the report required under subsection (a), MACPAC shall 24 consult with relevant stakeholders, including— 25 VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 6 HR 4996 RFS (1) States; 1 (2) organizations representing consumers, in- 2 cluding those that are disproportionately impacted 3 by poor maternal health outcomes; 4 (3) organizations and individuals representing 5 doula services providers, including community-based 6 doula programs and those who serve underserved 7 communities, including communities of color, and 8 communities facing linguistic or cultural barriers; 9 and 10 (4) organizations representing health care pro- 11 viders. 12 SEC. 4. GAO REPORT. 13 (a) IN GENERAL.—Not later than 2 years after the 14 date of the enactment of this Act and every five years 15 thereafter, the Comptroller General of the United States 16 shall submit to Congress a report on the State adoption, 17 under the Medicaid program under title XIX of the Social 18 Security Act (42 U.S.C. 1396 et seq.) and the Children’s 19 Health Insurance Program under title XXI of such Act, 20 of extending coverage to 365 days postpartum pursuant 21 to the provisions of (and amendments made by this Act). 22 Such report shall include the information and rec- 23 ommendations described in subsection (b) and shall also 24 identify ongoing gaps in coverage for— 25 VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 7 HR 4996 RFS (1) pregnant women under the Medicaid pro- 1 gram and the Children’s Health Insurance Program; 2 and 3 (2) postpartum women under the Medicaid pro- 4 gram and the Children’s Health Insurance Program 5 who received assistance under either such program 6 during their pregnancy. 7 (b) CONTENT OF REPORT.—The report under sub- 8 section (a) shall include the following: 9 (1) Information regarding the extent to which 10 States have elected to extend coverage to 365 days 11 postpartum pursuant to the provisions of (and 12 amendments made by this Act), including which 13 States make the election and when, impacts on 14 perinatal insurance churn in those States compared 15 to States that did not make such election, other 16 health impacts of such election including regarding 17 maternal mortality and morbidity rates, and impacts 18 on State and Federal Medicaid spending. 19 (2) Information about the abilities, successes, 20 and challenges of State Medicaid agencies in— 21 (A) transitioning their eligibility systems to 22 incorporate such an election by a State and in 23 determining whether pregnant and postpartum 24 VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 8 HR 4996 RFS women are eligible under another insurance af- 1 fordability program; and 2 (B) transitioning any such women who are 3 so eligible to coverage under such a program, 4 pursuant to section 1943(b)(3) of the Social Se- 5 curity Act (42 U.S.C 1396w–3(b)(3)). 6 (3) Information on factors contributing to ongo- 7 ing gaps in coverage resulting from women 8 transitioning from coverage under the Medicaid pro- 9 gram or Children’s Health Insurance Program that 10 disproportionately impact underserved populations, 11 including low-income women, women of color, women 12 who reside in a health professional shortage area (as 13 defined in section 332(a)(1)(A) of the Public Health 14 Service Act (42 U.S.C. 254e(a)(1)(A))), or who are 15 members of a medically underserved population (as 16 defined by section 330(b)(3) of such Act (42 U.S.C. 17 254b(b)(3)(A))). 18 (4) Recommendations for addressing and reduc- 19 ing such gaps in coverage. 20 (5) Such other information as the Comptroller 21 General determines appropriate. 22 VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 9 HR 4996 RFS SEC. 5. REPORT ON MEDICAID BUNDLED PAYMENTS FOR 1 PREGNANCY-RELATED SERVICES. 2 Not later than 2 years after the date of the enact- 3 ment of this Act, the Medicaid and CHIP Payment Advi- 4 sory Commission shall submit to Congress a report con- 5 taining an analysis of the use of bundled payments for 6 reimbursing health care providers with respect to preg- 7 nancy-related services furnished under State plans (or 8 waivers of such plans) under title XIX of the Social Secu- 9 rity Act (42 U.S.C. 1396 et seq.). 10 SEC. 6. SUNSET OF LIMIT ON MAXIMUM REBATE AMOUNT 11 FOR SINGLE SOURCE DRUGS AND INNO- 12 VATOR MULTIPLE SOURCE DRUGS. 13 Section 1927(c)(2)(D) of the Social Security Act (42 14 U.S.C. 1396r–8(c)(2)(D)) is amended by inserting after 15 ‘‘December 31, 2009,’’ the following: ‘‘and before January 16 1, 2023,’’. 17 SEC. 7. MEDICAID IMPROVEMENT FUND. 18 Section 1941(b)(3) of the Social Security Act (42 19 U.S.C 1396w–1(b)(3)) is amended— 20 (1) in subparagraph (A), by striking ‘‘for fiscal 21 year 2025 and thereafter, $1,960,000,000’’ and in- 22 serting ‘‘for fiscal year 2022 and thereafter, 23 $9,286,000,000’’; and 24 (2) in subparagraph (B), by striking ‘‘fiscal 25 year 2025’’ and inserting ‘‘fiscal year 2022’’. 26 VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS 10 HR 4996 RFS SEC. 8. DETERMINATION OF BUDGETARY EFFECTS. 1 The budgetary effects of this Act, for the purpose of 2 complying with the Statutory Pay-As-You-Go Act of 2010, 3 shall be determined by reference to the latest statement 4 titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 5 Act, submitted for printing in the Congressional Record 6 by the Chairman of the House Budget Committee, pro- 7 vided that such statement has been submitted prior to the 8 vote on passage. 9 Passed the House of Representatives September 29, 2020. Attest: CHERYL L. JOHNSON, Clerk. VerDate Sep 11 2014 05:55 Oct 01, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4996.RFS H4996 kjohnson on DSK79L0C42PROD with BILLS