I 118TH CONGRESS 1ST SESSION H. R. 2480 To direct the Secretary of Health and Human Services to issue guidance on coverage under the Medicaid program under title XIX of the Social Security Act of certain pelvic health services furnished during the postpartum period, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 6, 2023 Mr. BACON (for himself, Ms. BLUNT ROCHESTER, Ms. SEWELL, Mrs. GONZA´LEZ-COLO´N, Ms. WILD, and Mr. FITZPATRICK) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce A BILL To direct the Secretary of Health and Human Services to issue guidance on coverage under the Medicaid program under title XIX of the Social Security Act of certain pelvic health services furnished during the postpartum period, 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 ‘‘Optimizing 4 Postpartum Outcomes Act of 2023’’. 5 VerDate Sep 11 2014 22:43 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2480.IH H2480 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 2480 IH SEC. 2. CMS GUIDANCE. 1 (a) IN GENERAL.—Not later than 1 year after the 2 date of the enactment of this Act, the Secretary of Health 3 and Human Services shall issue guidance on coverage 4 under State plans (or waivers of such plans) under the 5 Medicaid program under title XIX of the Social Security 6 Act (42 U.S.C. 1396 et seq.) or State child health plans 7 (or waivers of such plans) under the Children’s Health In- 8 surance Program under title XXI of such Act (42 U.S.C. 9 1397aa et seq.) of covered pelvic health services furnished 10 during the prenatal or postpartum period. Such guidance 11 shall include— 12 (1) best practices from States with respect to 13 innovative or evidenced-based payment models to in- 14 crease access to covered pelvic health services; 15 (2) recommendations for States on available fi- 16 nancing options under— 17 (A) the Medicaid program under title XIX 18 of such Act (42 U.S.C. 1396 et seq.); and 19 (B) the Children’s Health Insurance Pro- 20 gram under title XXI of such Act (42 U.S.C. 21 1397aa et seq.), specifically funds made avail- 22 able through a Children’s Health Insurance 23 Program Health Services Initiative; 24 (3) guidance and technical assistance to State 25 agencies responsible for administering State plans 26 VerDate Sep 11 2014 22:43 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2480.IH H2480 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 2480 IH (or waivers of such plans) under the Medicaid pro- 1 gram under title XIX of the Social Security Act (42 2 U.S.C. 1396 et seq.) regarding additional flexibilities 3 and incentives related to screening and referral for, 4 and access to, covered pelvic health services; and 5 (4) guidance regarding suggested terminology 6 and diagnosis codes, such as the International Clas- 7 sification of Diseases code set, to identify women 8 with pelvic floor dysfunction and disorders. 9 (b) GAO STUDY.—Not later than 1 year after the 10 date of the enactment of this Act, the Comptroller General 11 of the United States shall conduct a study on, and submit 12 to Congress a report that addresses, gaps in coverage 13 for— 14 (1) covered pelvic health services under State 15 plans (or waivers of such plans) under the Medicaid 16 program under title XIX of the Social Security Act 17 (42 U.S.C. 1396 et seq.) for postpartum women; 18 and 19 (2) other services for postpartum women who 20 received medical assistance under a State plan (or a 21 waiver of such plan) under the Medicaid program 22 under title XIX of the Social Security Act (42 23 U.S.C. 1396 et seq.) during their pregnancy. 24 (c) DEFINITIONS.—In this section: 25 VerDate Sep 11 2014 22:43 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2480.IH H2480 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 2480 IH (1) The term ‘‘postpartum period’’ means the 1 longer of the period of lactation or the 6-month pe- 2 riod beginning on the last day of a woman’s preg- 3 nancy. 4 (2) The term ‘‘covered pelvic health services’’ 5 means— 6 (A) pelvic floor examinations (as defined in 7 section 317L–2 of the Public Health Service 8 Act, as added by section 2 of this Act); and 9 (B) pelvic health physical therapy (as de- 10 fined in such section 317L–2). 11 SEC. 3. POSTPARTUM PELVIC HEALTH EDUCATION CAM- 12 PAIGN. 13 Part B of title III of the Public Health Service Act 14 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 15 tion 317L–1 (42 U.S.C. 247b–13a) the following: 16 ‘‘SEC. 317L–2. POSTPARTUM PELVIC HEALTH EDUCATION 17 CAMPAIGN. 18 ‘‘(a) IN GENERAL.—The Secretary, acting through 19 the Director of the Centers for Disease Control and Pre- 20 vention, in collaboration with the Administrator of the 21 Health Resources and Services Administration and the 22 heads of other agencies, and in consultation with appro- 23 priate health professional associations, shall develop and 24 carry out a program— 25 VerDate Sep 11 2014 22:43 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2480.IH H2480 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 2480 IH ‘‘(1) to educate and train health professionals 1 on pelvic floor examinations and the benefits of pel- 2 vic health physical therapy; and 3 ‘‘(2) to educate postpartum women on— 4 ‘‘(A) with respect to pelvic floor examina- 5 tions— 6 ‘‘(i) the importance of such examina- 7 tions during the postpartum period; 8 ‘‘(ii) how to obtain such an examina- 9 tion, including information relating to ob- 10 taining referrals; and 11 ‘‘(iii) what is involved in such an ex- 12 amination; and 13 ‘‘(B) with respect to pelvic health physical 14 therapy— 15 ‘‘(i) the benefits of, and availability of 16 such physical therapy; and 17 ‘‘(ii) how to obtain a referral for such 18 physical therapy. 19 ‘‘(b) DEFINITIONS.—In this section: 20 ‘‘(1) The term ‘pelvic floor examination’ means 21 an examination to assess a patient for pelvic health 22 related conditions that is composed of— 23 ‘‘(A) an external evaluation that includes 24 analysis of posture, joint integrity, muscle per- 25 VerDate Sep 11 2014 22:43 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2480.IH H2480 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 2480 IH formance, quality of movement, and palpation 1 and observation of the pelvic floor; and 2 ‘‘(B) if deemed necessary based on the 3 health care professional’s clinical reasoning, an 4 internal vaginal or rectal examination, or both, 5 to gather relevant information about the tone, 6 strength, control, ability to contract and relax 7 the muscles of the pelvic floor individually and 8 together, the condition of the surrounding fas- 9 cia, and the position of the organs. 10 ‘‘(2) The term ‘pelvic health physical therapy’ 11 means a personalized physical therapy plan imple- 12 mented by a pelvic health physical therapist, after 13 performing a pelvic floor examination and making a 14 diagnosis, that is based on best available evidence to 15 improve the patient condition, with respect to the 16 anatomy of the pelvic floor, improve mobility, re- 17 cover from injury, prevent future injury, and man- 18 age pain and chronic conditions. 19 ‘‘(3) The term ‘pelvic health related condition’ 20 includes urinary dysfunction, bowel dysfunction, 21 musculoskeletal dysfunction, sexual dysfunction, can- 22 cer-related rehabilitation, and the pre-partum state 23 and pre-partum conditions. 24 VerDate Sep 11 2014 22:43 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2480.IH H2480 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 2480 IH ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 $2,000,000 for each of fiscal years 2024 through 2028.’’. 3 Æ VerDate Sep 11 2014 22:43 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H2480.IH H2480 pbinns on DSKJLVW7X2PROD with $$_JOB