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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4996 Engrossed in House (EH)]

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116th CONGRESS
  2d Session
                                H. R. 4996

_______________________________________________________________________

                                 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 individuals, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Helping Medicaid Offer Maternity 
Services Act of 2020'' or the ``Helping MOMS Act of 2020''.

SEC. 2. MODIFICATIONS TO CERTAIN COVERAGE UNDER MEDICAID AND CHIP FOR 
              PREGNANT AND POSTPARTUM WOMEN.

    (a) State Option.--Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended by adding at the end the following new 
paragraph:
            ``(16) Extending certain coverage for pregnant and 
        postpartum women.--At the option of the State, the State plan 
        (or waiver of such State plan) may provide that an individual 
        who, while pregnant, is eligible for and has received medical 
        assistance under the State plan approved under this title (or 
        waiver of such plan) (including during a period of retroactive 
        eligibility under subsection (a)(34)) shall, in addition to 
        remaining eligible under paragraph (5) for all pregnancy-
        related and postpartum medical assistance available under the 
        State plan (or wavier) through the last day of the month in 
        which the 60-day period (beginning on the last day of her 
        pregnancy) ends, remain eligible under the State plan (or 
        waiver) for medical assistance and such medical assistance 
        shall include all services covered under the State plan (or 
        waiver) that is not less in amount, duration, or scope, or is 
        determined by the Secretary to be substantially equivalent, to 
        the medical assistance available for an individual described in 
        subsection (a)(10)(A)(i) for the period beginning on the first 
        day occurring after the end of such 60-day period and ending on 
        the last day of the month in which the one-year period 
        (beginning on the last day of her pregnancy) ends.''.
    (b) Application to CHIP.--
            (1) In general.--Section 2107(e)(1) of the Social Security 
        Act (42 U.S.C. 1397gg(e)(1)) is amended--
                    (A) by redesignating subparagraphs (J) through (S) 
                as subparagraphs (K) through (T), respectively; and
                    (B) by inserting after subparagraph (I) the 
                following new subparagraph:
                    ``(J) In the case of a State that has elected to 
                apply the option under section 1902(e)(16) with respect 
                to coverage for pregnant and postpartum women under 
                title XIX, the provisions of such section with respect 
                to coverage of pregnant and postpartum women under this 
                title, except that such coverage shall be required and 
                not at the option of the State.''.
            (2) Optional coverage of targeted low-income pregnant 
        women.--Section 2112(d)(2)(A) of the Social Security Act (42 
        U.S.C. 1397ll(d)(2)(A)) is amended by inserting after ``60-day 
        period'' the following: ``, or, in the case that section 
        1902(e)(16) applies to the State child health plan (or waiver 
        of such plan) pursuant to section 2107(e)(1), the 1-year 
        period''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to State elections made under paragraph (16) of 
section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)), as 
added by subsection (a), under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) on or after the first day of the first fiscal year 
quarter beginning at least one year after the date of the enactment of 
this Act.

SEC. 3. MACPAC REPORT.

    (a) In General.--Not later than 1 year after the date of the 
enactment of this Act, the Medicaid and CHIP Payment and Access 
Commission (referred to in this section as ``MACPAC'') shall publish a 
report on the coverage of doula services under State Medicaid programs, 
which shall at a minimum include the following:
            (1) Information about coverage for doula services under 
        State Medicaid programs that currently provide coverage for 
        such services, including the type of doula services offered 
        (such as prenatal, labor and delivery, postpartum support, and 
        also community-based and traditional doula services).
            (2) An analysis of barriers to covering doula services 
        under State Medicaid programs.
            (3) An identification of effective strategies to increase 
        the use of doula services in order to provide better care and 
        achieve better maternal and infant health outcomes, including 
        strategies that States may use to recruit, train, and certify a 
        diverse doula workforce, particularly from underserved 
        communities, communities of color, and communities facing 
        linguistic or cultural barriers.
            (4) Recommendations for legislative and administrative 
        actions to increase access to doula services in State Medicaid 
        programs, including actions that ensure doulas may earn a 
        living wage that accounts for their time and costs associated 
        with providing care.
    (b) Stakeholder Consultation.--In developing the report required 
under subsection (a), MACPAC shall consult with relevant stakeholders, 
including--
            (1) States;
            (2) organizations representing consumers, including those 
        that are disproportionately impacted by poor maternal health 
        outcomes;
            (3) organizations and individuals representing doula 
        services providers, including community-based doula programs 
        and those who serve underserved communities, including 
        communities of color, and communities facing linguistic or 
        cultural barriers; and
            (4) organizations representing health care providers.

SEC. 4. GAO REPORT.

    (a) In General.--Not later than 2 years after the date of the 
enactment of this Act and every five years thereafter, the Comptroller 
General of the United States shall submit to Congress a report on the 
State adoption, under the Medicaid program under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.) and the Children's Health 
Insurance Program under title XXI of such Act, of extending coverage to 
365 days postpartum pursuant to the provisions of (and amendments made 
by this Act). Such report shall include the information and 
recommendations described in subsection (b) and shall also identify 
ongoing gaps in coverage for--
            (1) pregnant women under the Medicaid program and the 
        Children's Health Insurance Program; and
            (2) postpartum women under the Medicaid program and the 
        Children's Health Insurance Program who received assistance 
        under either such program during their pregnancy.
    (b) Content of Report.--The report under subsection (a) shall 
include the following:
            (1) Information regarding the extent to which States have 
        elected to extend coverage to 365 days postpartum pursuant to 
        the provisions of (and amendments made by this Act), including 
        which States make the election and when, impacts on perinatal 
        insurance churn in those States compared to States that did not 
        make such election, other health impacts of such election 
        including regarding maternal mortality and morbidity rates, and 
        impacts on State and Federal Medicaid spending.
            (2) Information about the abilities, successes, and 
        challenges of State Medicaid agencies in--
                    (A) transitioning their eligibility systems to 
                incorporate such an election by a State and in 
                determining whether pregnant and postpartum women are 
                eligible under another insurance affordability program; 
                and
                    (B) transitioning any such women who are so 
                eligible to coverage under such a program, pursuant to 
                section 1943(b)(3) of the Social Security Act (42 U.S.C 
                1396w-3(b)(3)).
            (3) Information on factors contributing to ongoing gaps in 
        coverage resulting from women transitioning from coverage under 
        the Medicaid program or Children's Health Insurance Program 
        that disproportionately impact underserved populations, 
        including low-income women, women of color, women who reside in 
        a health professional shortage area (as defined in section 
        332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 
        254e(a)(1)(A))), or who are members of a medically underserved 
        population (as defined by section 330(b)(3) of such Act (42 
        U.S.C. 254b(b)(3)(A))).
            (4) Recommendations for addressing and reducing such gaps 
        in coverage.
            (5) Such other information as the Comptroller General 
        determines appropriate.

SEC. 5. REPORT ON MEDICAID BUNDLED PAYMENTS FOR PREGNANCY-RELATED 
              SERVICES.

    Not later than 2 years after the date of the enactment of this Act, 
the Medicaid and CHIP Payment Advisory Commission shall submit to 
Congress a report containing an analysis of the use of bundled payments 
for reimbursing health care providers with respect to pregnancy-related 
services furnished under State plans (or waivers of such plans) under 
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

SEC. 6. SUNSET OF LIMIT ON MAXIMUM REBATE AMOUNT FOR SINGLE SOURCE 
              DRUGS AND INNOVATOR MULTIPLE SOURCE DRUGS.

    Section 1927(c)(2)(D) of the Social Security Act (42 U.S.C. 1396r-
8(c)(2)(D)) is amended by inserting after ``December 31, 2009,'' the 
following: ``and before January 1, 2023,''.

SEC. 7. MEDICAID IMPROVEMENT FUND.

    Section 1941(b)(3) of the Social Security Act (42 U.S.C 1396w-
1(b)(3)) is amended--
            (1) in subparagraph (A), by striking ``for fiscal year 2025 
        and thereafter, $1,960,000,000'' and inserting ``for fiscal 
        year 2022 and thereafter, $9,286,000,000''; and
            (2) in subparagraph (B), by striking ``fiscal year 2025'' 
        and inserting ``fiscal year 2022''.

SEC. 8. DETERMINATION OF BUDGETARY EFFECTS.

    The budgetary effects of this Act, for the purpose of complying 
with the Statutory Pay-As-You-Go Act of 2010, shall be determined by 
reference to the latest statement titled ``Budgetary Effects of PAYGO 
Legislation'' for this Act, submitted for printing in the Congressional 
Record by the Chairman of the House Budget Committee, provided that 
such statement has been submitted prior to the vote on passage.

            Passed the House of Representatives September 29, 2020.

            Attest:

                                                                 Clerk.
116th CONGRESS

  2d Session

                               H. R. 4996

_______________________________________________________________________

                                 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 individuals, and for other purposes.
```