I 

116TH CONGRESS 

1ST SESSION H. R. 2602 

To amend titles XIX and XXI of the Social Security Act to improve Medicaid 

and the Children’s Health Insurance Program for low-income mothers. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 8, 2019 

Ms. PRESSLEY (for herself, Ms. ADAMS, and Ms. UNDERWOOD) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to improve Medicaid and the Children’s Health Insurance 

Program for low-income mothers. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Healthy MOMMIES 

5 Act’’. 

6 SEC. 2. ENHANCING MEDICAID AND CHIP BENEFITS FOR 

7 LOW-INCOME PREGNANT WOMEN. 

8 (a) EXTENDING CONTINUOUS MEDICAID AND CHIP 

9 COVERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 


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1 (1) MEDICAID.—Title XIX of the Social Secu2 rity Act (42 U.S.C. 1396 et seq.) is amended— 

3 (A) in section 1902(l)(1)(A), by striking 

4 ‘‘60-day period’’ and inserting ‘‘365-day pe5 riod’’; 

6 (B) in section 1902(e)(6), by striking ‘‘60- 

7 day period’’ and inserting ‘‘365-day period’’; 

8 (C) in section 1903(v)(4)(A)(i), by striking 

9 ‘‘60-day period’’ and inserting ‘‘365-day pe10 riod’’; and 

11 (D) in section 1905(a), in the 4th sentence 

12 in the matter following paragraph (30), by 

13 striking ‘‘60-day period’’ and inserting ‘‘365- 

14 day period’’. 

15 (2) CHIP.—Section 2112 of the Social Security 

16 Act (42 U.S.C. 1397ll) is amended by striking ‘‘60- 

17 day period’’ each place it appears and inserting 

18 ‘‘365-day period’’. 

19 (b) REQUIRING FULL BENEFITS FOR PREGNANT

20 AND POSTPARTUM WOMEN.— 

21 (1) MEDICAID.— 

22 (A) IN GENERAL.—Paragraph (5) of sec23 tion 1902(e) of the Social Security Act (24 

24 U.S.C. 1396a(e)) is amended to read as follows: 


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1 ‘‘(5) Any woman who is eligible for medical as2 sistance under the State plan or a waiver of such 

3 plan and who is, or who while so eligible becomes, 

4 pregnant, shall continue to be eligible under the plan 

5 or waiver for medical assistance through the end of 

6 the month in which the 365-day period (beginning 

7 on the last day of her pregnancy) ends, regardless 

8 of the basis for the woman’s eligibility for medical 

9 assistance, including if the woman’s eligibility for 

10 medical assistance is on the basis of being preg11 nant.’’. 

12 (B) CONFORMING AMENDMENT.—Section 

13 1902(a)(10) of the Social Security Act (42 

14 U.S.C. 1396a(a)(10)) is amended in the matter 

15 following subparagraph (G) by striking ‘‘(VII) 

16 the medical assistance’’ and all that follows 

17 through ‘‘complicate pregnancy,’’. 

18 (2) CHIP.—Section 2107(e)(1) of the Social 

19 Security Act (42 U.S.C. 1397gg(e)(1)) is amended— 

20 (A) by redesignating subparagraphs (H) 

21 through (S) as subparagraphs (I) through (T), 

22 respectively; and 

23 (B) by inserting after subparagraph (G), 

24 the following: 


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1 ‘‘(H) Section 1902(e)(5) (requiring 365- 

2 day continuous coverage for pregnant and 

3 postpartum women).’’. 

4 (c) REQUIRING COVERAGE OF ORAL HEALTH SERV5 ICES FOR PREGNANT AND POSTPARTUM WOMEN.— 

6 (1) MEDICAID.—Section 1905 of the Social Se7 curity Act (42 U.S.C. 1396d) is amended— 

8 (A) in subsection (a)(4)— 

9 (i) by striking ‘‘; and (D)’’ and insert10 ing ‘‘; (D)’’; and 

11 (ii) by inserting ‘‘; and (E) oral health 

12 services for pregnant and postpartum 

13 women (as defined in subsection (ff))’’ 

14 after ‘‘subsection (bb))’’; and 

15 (B) by adding at the end the following new 

16 subsection: 

17 ‘‘(ff) ORAL HEALTH SERVICES FOR PREGNANT AND

18 POSTPARTUM WOMEN.— 

19 ‘‘(1) IN GENERAL.—For purposes of this title, 

20 the term ‘oral health services for pregnant and 

21 postpartum women’ means dental services necessary 

22 to prevent disease and promote oral health, restore 

23 oral structures to health and function, and treat 

24 emergency conditions that are furnished to a woman 


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1 during pregnancy (or during the 365-day period be2 ginning on the last day of the pregnancy). 

3 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 

4 the requirement to provide oral health services for 

5 pregnant and postpartum women, a State shall, at 

6 a minimum, provide coverage for preventive, diag7 nostic, periodontal, and restorative care consistent 

8 with recommendations for perinatal oral health care 

9 and dental care during pregnancy from the Amer10 ican Academy of Pediatric Dentistry and the Amer11 ican College of Obstetricians and Gynecologists.’’. 

12 (2) CHIP.—Section 2103(c)(5)(A) of the Social 

13 Security Act (42 U.S.C. 1397cc(c)(5)(A)) is amend14 ed by inserting ‘‘or a targeted low-income pregnant 

15 woman’’ after ‘‘targeted low-income child’’. 

16 (d) MAINTENANCE OF EFFORT.— 

17 (1) MEDICAID.—Section 1902 of the Social Se18 curity Act (42 U.S.C. 1396a) is amended— 

19 (A) in paragraph (74), by striking ‘‘sub20 section (gg); and’’ and inserting ‘‘subsections 

21 (gg) and (qq);’’; and 

22 (B) by adding at the end the following new 

23 subsection: 

24 ‘‘(qq) MAINTENANCE OF EFFORT RELATED TO LOW25 INCOME PREGNANT WOMEN.—For calendar quarters beVerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602

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1 ginning on or after the date of enactment of this sub2 section, and before January 1, 2023, no Federal payment 

3 shall be made to a State under section 1903(a) for 

4 amounts expended under a State plan under this title or 

5 a waiver of such plan if the State— 

6 ‘‘(1) has in effect under such plan eligibility 

7 standards, methodologies, or procedures (including 

8 any enrollment cap or other numerical limitation on 

9 enrollment, any waiting list, any procedures designed 

10 to delay the consideration of applications for enroll11 ment, or similar limitation with respect to enroll12 ment) for individuals described in subsection (l)(1) 

13 who are eligible for medical assistance under the 

14 State plan or waiver under subsection 

15 (a)(10)(A)(ii)(IX) that are more restrictive than the 

16 eligibility standards, methodologies, or procedures, 

17 respectively, for such individuals under such plan or 

18 waiver that are in effect on the date of the enact19 ment of the Healthy MOMMIES Act; or 

20 ‘‘(2) provides medical assistance to individuals 

21 described in subsection (l)(1) who are eligible for 

22 medical assistance under such plan or waiver under 

23 subsection (a)(10)(A)(ii)(IX) at a level that is less 

24 than the level at which the State provides such as25 sistance to such individuals under such plan or waivVerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602

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1 er on the date of the enactment of the Healthy 

2 MOMMIES Act.’’. 

3 (2) CHIP.—Section 2112 of the Social Security 

4 Act (42 U.S.C. 1397ll), as amended by subsection 

5 (b), is further amended by adding at the end the fol6 lowing subsection: 

7 ‘‘(g) MAINTENANCE OF EFFORT.—For calendar 

8 quarters beginning on or after January 1, 2020, and be9 fore January 1, 2023, no payment may be made under 

10 section 2105(a) with respect to a State child health plan 

11 if the State— 

12 ‘‘(1) has in effect under such plan eligibility 

13 standards, methodologies, or procedures (including 

14 any enrollment cap or other numerical limitation on 

15 enrollment, any waiting list, any procedures designed 

16 to delay the consideration of applications for enroll17 ment, or similar limitation with respect to enroll18 ment) for targeted low-income pregnant women that 

19 are more restrictive than the eligibility standards, 

20 methodologies, or procedures, respectively, under 

21 such plan that are in effect on the date of the enact22 ment of the Healthy MOMMIES Act; or 

23 ‘‘(2) provides pregnancy-related assistance to 

24 targeted low-income pregnant women under such 

25 plan at a level that is less than the level at which 


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1 the State provides such assistance to such women 

2 under such plan on the date of the enactment of the 

3 Healthy MOMMIES Act.’’. 

4 (e) ENHANCED FMAP.—Section 1905 of the Social 

5 Security Act (42 U.S.C. 1396d), as amended by sub6 section (c), is further amended— 

7 (1) in subsection (b), by striking ‘‘and (aa)’’ 

8 and inserting ‘‘(aa), and (gg)’’; and 

9 (2) by adding at the end the following: 

10 ‘‘(gg) INCREASED FMAP FOR ADDITIONAL EXPEND11 ITURES FOR LOW-INCOME PREGNANT WOMEN.—For cal12 endar quarters beginning on or after January 1, 2020, 

13 notwithstanding subsection (b), the Federal medical as14 sistance percentage for a State, with respect to the addi15 tional amounts expended by such State for medical assist16 ance under the State plan under this title or a waiver of 

17 such plan that are attributable to requirements imposed 

18 by the amendments made by the Healthy MOMMIES Act 

19 (as determined by the Secretary), shall be equal to 100 

20 percent.’’. 

21 (f) GAO STUDY AND REPORT.— 

22 (1) IN GENERAL.—Not later than 1 year after 

23 the date of the enactment of this Act, the Comp24 troller General of the United States shall submit to 

25 Congress a report on the gaps in coverage for— 


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1 (A) pregnant women under the Medicaid 

2 program under title XIX of the Social Security 

3 Act (42 U.S.C. 1396 et seq.) and the Children’s 

4 Health Insurance Program under title XXI of 

5 the Social Security Act (42 U.S.C. 1397aa et 

6 seq.); and 

7 (B) postpartum women under the Medicaid 

8 program and the Children’s Health Insurance 

9 Program who received assistance under either 

10 such program during their pregnancy. 

11 (2) CONTENT OF REPORT.—The report re12 quired under this subsection shall include the fol13 lowing: 

14 (A) Information about the abilities and 

15 successes of State Medicaid agencies in deter16 mining whether pregnant and postpartum 

17 women are eligible under another insurance af18 fordability program, and in transitioning any 

19 such women who are so eligible to coverage 

20 under such a program, pursuant to section 

21 435.1200 of the title 42, Code of Federal Regu22 lations (as in effect on September 1, 2018). 

23 (B) Information on factors contributing to 

24 gaps in coverage that disproportionately impact 

25 underserved populations, including low-income 


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1 women, women of color, women who reside in a 

2 health professional shortage area (as defined in 

3 section 332(a)(1)(A) of the Public Health Serv4 ice Act (42 U.S.C. 254e(a)(1)(A))) or who are 

5 members of a medically underserved population 

6 (as defined by section 330(b)(3) of such Act 

7 (42 U.S.C. 254b(b)(3)(A))). 

8 (C) Recommendations for addressing and 

9 reducing such gaps in coverage. 

10 (D) Such other information as the Comp11 troller General deems necessary. 

12 (g) EFFECTIVE DATE.—The amendments made by 

13 subsections (a) and (b) shall take effect January 1, 2020. 

14 SEC. 3. MATERNITY CARE HOME DEMONSTRATION 

15 PROJECT. 

16 Title XIX of the Social Security Act (42 U.S.C. 1396 

17 et seq.) is amended by inserting the following new section 

18 after section 1946: 

19 ‘‘MATERNITY CARE HOME DEMONSTRATION PROJECT

20 ‘‘SEC. 1947. (a) IN GENERAL.—Not later than 1 year 

21 after the date of the enactment of this section, the Sec22 retary shall establish a demonstration project (in this sec23 tion referred to as the ‘demonstration project’) under 

24 which the Secretary shall provide grants to States to enter 

25 into arrangements with eligible entities to implement or 


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1 expand a maternity care home model for eligible individ2 uals. 

3 ‘‘(b) DEFINITIONS.—In this section: 

4 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en5 tity’ means an entity or organization that provides 

6 medically accurate, comprehensive maternity services 

7 to individuals who are eligible for medical assistance 

8 under a State plan under this title or a waiver of 

9 such a plan, and may include: 

10 ‘‘(A) A freestanding birth center. 

11 ‘‘(B) An entity or organization receiving 

12 assistance under section 330 of the Public 

13 Health Service Act. 

14 ‘‘(C) A federally qualified health center. 

15 ‘‘(D) A rural health clinic. 

16 ‘‘(E) A health facility operated by an In17 dian tribe or tribal organization (as those terms 

18 are defined in section 4 of the Indian Health 

19 Care Improvement Act). 

20 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

21 individual’ means a pregnant woman or a formerly 

22 pregnant woman during the 365-day period begin23 ning on the last day of her pregnancy who is— 


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1 ‘‘(A) enrolled in a State plan under this 

2 title, a waiver of such a plan, or a State child 

3 health plan under title XXI; and 

4 ‘‘(B) a patient of an eligible entity which 

5 has entered into an arrangement with a State 

6 under subsection (g). 

7 ‘‘(c) GOALS OF DEMONSTRATION PROJECT.—The 

8 goals of the demonstration project are the following: 

9 ‘‘(1) To improve— 

10 ‘‘(A) maternity and infant care outcomes; 

11 ‘‘(B) health equity; 

12 ‘‘(C) communication by maternity, infant 

13 care, and social services providers; 

14 ‘‘(D) integration of perinatal support serv15 ices, including community health workers, 

16 doulas, social workers, public health nurses, 

17 peer lactation counselors, childbirth educators, 

18 and others, into health care entities and organi19 zations; 

20 ‘‘(E) care coordination between maternity, 

21 infant care, oral health care, and social services 

22 providers within the community; 

23 ‘‘(F) the quality and safety of maternity 

24 and infant care; 


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1 ‘‘(G) the experience of women receiving 

2 maternity care, including by increasing the abil3 ity of a woman to develop and follow her own 

4 birthing plan; and 

5 ‘‘(H) access to adequate prenatal and 

6 postpartum care, including— 

7 ‘‘(i) prenatal care that is initiated in 

8 a timely manner; 

9 ‘‘(ii) not fewer than 2 post-pregnancy 

10 visits to a maternity care provider; and 

11 ‘‘(iii) interpregnancy care. 

12 ‘‘(2) To provide coordinated, evidence-based 

13 maternity care management. 

14 ‘‘(3) To decrease— 

15 ‘‘(A) severe maternal morbidity and mater16 nal mortality; 

17 ‘‘(B) overall health care spending; 

18 ‘‘(C) unnecessary emergency department 

19 visits; 

20 ‘‘(D) disparities in maternal and infant 

21 care outcomes, including racial, economic, and 

22 geographical disparities; 

23 ‘‘(E) racial bias among health care profes24 sionals; 


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1 ‘‘(F) the rate of cesarean deliveries for 

2 low-risk pregnancies; 

3 ‘‘(G) the rate of preterm births and infants 

4 born with low birth weight; and 

5 ‘‘(H) the rate of avoidable maternal and 

6 newborn hospitalizations and admissions to in7 tensive care units. 

8 ‘‘(d) CONSULTATION.—In designing and imple9 menting the demonstration project the Secretary shall 

10 consult with stakeholders, including— 

11 ‘‘(1) States; 

12 ‘‘(2) organizations representing relevant health 

13 care professionals, including oral health care profes14 sionals; 

15 ‘‘(3) organizations representing consumers, in16 cluding consumers that are disproportionately im17 pacted by poor maternal health outcomes; 

18 ‘‘(4) representatives with experience imple19 menting other maternity care home models, includ20 ing representatives from the Center for Medicare 

21 and Medicaid Innovation; 

22 ‘‘(5) community-based health care professionals, 

23 including doulas, and other stakeholders; and 

24 ‘‘(6) experts in promoting health equity and 

25 combating racial bias in health care settings. 


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1 ‘‘(e) APPLICATION AND SELECTION OF STATES.— 

2 ‘‘(1) IN GENERAL.—A State seeking to partici3 pate in the demonstration project shall submit an 

4 application to the Secretary at such time and in 

5 such manner as the Secretary shall require. 

6 ‘‘(2) SELECTION OF STATES.— 

7 ‘‘(A) IN GENERAL.—The Secretary may se8 lect 15 States to participate in the demonstra9 tion project. 

10 ‘‘(B) SELECTION REQUIREMENTS.—In se11 lecting States to participate in the demonstra12 tion project, the Secretary shall— 

13 ‘‘(i) ensure that there is geographic 

14 diversity in the areas in which activities 

15 will be carried out under the project; and 

16 ‘‘(ii) ensure that States with signifi17 cant disparities in maternal and infant 

18 health outcomes, including severe maternal 

19 morbidity, and other disparities based on 

20 race, income, or access to maternity care, 

21 are included. 

22 ‘‘(f) GRANTS.— 

23 ‘‘(1) IN GENERAL.—From amounts appro24 priated under subsection (l), the Secretary shall 

25 award 1 grant for each year of the demonstration 


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1 project to each State that is selected to participate 

2 in the demonstration project. 

3 ‘‘(2) USE OF GRANT FUNDS.—A State may use 

4 funds received under this section to— 

5 ‘‘(A) award grants or make payments to 

6 eligible entities as part of an arrangement de7 scribed in subsection (g)(2); 

8 ‘‘(B) provide financial incentives to health 

9 care professionals, including community health 

10 workers and community-based doulas, who par11 ticipate in the State’s maternity care home 

12 model; 

13 ‘‘(C) provide adequate training for health 

14 care professionals, including community health 

15 workers, doulas, and care coordinators, who 

16 participate in the State’s maternity care home 

17 model, which may include training for cultural 

18 competency, racial bias, health equity, reproduc19 tive and birth justice, home visiting skills, and 

20 respectful communication and listening skills, 

21 particularly in regards to maternal health; 

22 ‘‘(D) pay for personnel and administrative 

23 expenses associated with designing, imple24 menting, and operating the State’s maternity 

25 care home model; 


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1 ‘‘(E) pay for items and services that are 

2 furnished under the State’s maternity care 

3 home model and for which payment is otherwise 

4 unavailable under this title; and 

5 ‘‘(F) pay for other costs related to the 

6 State’s maternity care home model, as deter7 mined by the Secretary. 

8 ‘‘(3) GRANT FOR NATIONAL INDEPENDENT

9 EVALUATOR.— 

10 ‘‘(A) IN GENERAL.—From the amounts 

11 appropriated under subsection (l), prior to 

12 awarding any grants under paragraph (1), the 

13 Secretary shall enter into a contract with a na14 tional external entity to create a single, uniform 

15 process to— 

16 ‘‘(i) ensure that States that receive 

17 grants under paragraph (1) comply with 

18 the requirements of this section; and 

19 ‘‘(ii) evaluate the outcomes of the 

20 demonstration project in each participating 

21 State. 

22 ‘‘(B) ANNUAL REPORT.—The contract de23 scribed in subparagraph (A) shall require the 

24 national external entity to submit to the Sec25 retary— 


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1 ‘‘(i) a yearly evaluation report for 

2 each year of the demonstration project; 

3 and 

4 ‘‘(ii) a final impact report after the 

5 demonstration project has concluded. 

6 ‘‘(C) SECRETARY’S AUTHORITY.—Nothing 

7 in this paragraph shall prevent the Secretary 

8 from making a determination that a State is 

9 not in compliance with the requirements of this 

10 section without the national external entity 

11 making such a determination. 

12 ‘‘(g) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 

13 ‘‘(1) IN GENERAL.—As a condition of receiving 

14 a grant under this section, a State shall enter into 

15 an arrangement with one or more eligible entities 

16 that meets the requirements of paragraph (2). 

17 ‘‘(2) ARRANGEMENTS WITH ELIGIBLE ENTI18 TIES.—Under an arrangement between a State and 

19 an eligible entity under this subsection, the eligible 

20 entity shall perform the following functions, with re21 spect to eligible individuals enrolled with the entity 

22 under the State’s maternity care home model— 

23 ‘‘(A) provide culturally competent care, 

24 which may include prenatal care, family plan25 ning services, medical care, mental and behavVerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602

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1 ioral care, postpartum care, and oral health 

2 care to such eligible individuals through a team 

3 of health care professionals, which may include 

4 obstetrician-gynecologists, maternal-fetal medi5 cine specialists, family physicians, primary care 

6 providers, oral health providers, physician as7 sistants, advanced practice registered nurses 

8 such as nurse practitioners and certified nurse 

9 midwives, certified midwives, certified profes10 sional midwives, social workers, traditional and 

11 community-based doulas, lactation consultants, 

12 childbirth educators, community health workers, 

13 and other health care professionals; 

14 ‘‘(B) conduct a risk assessment of each 

15 such eligible individual to determine if her preg16 nancy is high or low risk, and establish a tai17 lored pregnancy care plan, which takes into 

18 consideration the individual’s own preferences 

19 and pregnancy care and birthing plans and de20 termines the appropriate support services to re21 duce the individual’s medical, social, and envi22 ronmental risk factors, for each such eligible in23 dividual based on the results of such risk as24 sessment; 


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1 ‘‘(C) assign each such eligible individual to 

2 a care coordinator, which may be a nurse, social 

3 worker, traditional or community-based doula, 

4 community health worker, midwife, or other 

5 health care provider, who is responsible for en6 suring that such eligible individual receives the 

7 necessary medical care and connections to es8 sential support services; 

9 ‘‘(D) provide, or arrange for the provision 

10 of, essential support services, such as services 

11 that address— 

12 ‘‘(i) nutrition and exercise; 

13 ‘‘(ii) smoking cessation; 

14 ‘‘(iii) substance use disorder and ad15 diction treatment; 

16 ‘‘(iv) anxiety, depression, and other 

17 mental and behavioral health issues; 

18 ‘‘(v) breast feeding initiation, continu19 ation, and duration; 

20 ‘‘(vi) housing; 

21 ‘‘(vii) transportation; 

22 ‘‘(viii) intimate partner violence; 

23 ‘‘(ix) home visiting services; 

24 ‘‘(x) childbirth education; 

25 ‘‘(xi) oral health education; 


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1 ‘‘(xii) continuous labor support; and 

2 ‘‘(xiii) group prenatal care; 

3 ‘‘(E) as appropriate, facilitate connections 

4 to a usual primary care provider, which may be 

5 a women’s health provider; 

6 ‘‘(F) refer to guidelines and opinions of 

7 medical associations when determining whether 

8 an elective delivery should be performed on an 

9 eligible individual before 39 weeks of gestation; 

10 ‘‘(G) provide such eligible individuals with 

11 evidence-based education and resources to iden12 tify potential warning signs of pregnancy and 

13 postpartum complications and when and how to 

14 obtain medical attention; 

15 ‘‘(H) provide, or arrange for the provision 

16 of, pregnancy and postpartum health services, 

17 including family planning counseling and serv18 ices, to eligible individuals; 

19 ‘‘(I) track and report birth outcomes of 

20 such eligible individuals and their children; 

21 ‘‘(J) ensure that care is patient-led, includ22 ing by engaging eligible individuals in their own 

23 care, including through communication and 

24 education; and 


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1 ‘‘(K) ensure adequate training for appro2 priately serving the population of individuals el3 igible for medical assistance under the State 

4 plan or waiver of such plan, including through 

5 reproductive and birth justice frameworks, race 

6 equity awareness, home visiting skills, and 

7 knowledge of social services. 

8 ‘‘(h) TERM OF DEMONSTRATION PROJECT.—The 

9 Secretary shall conduct the demonstration project for a 

10 period of 5 years. 

11 ‘‘(i) WAIVER AUTHORITY.—To the extent that the 

12 Secretary determines necessary in order to carry out the 

13 demonstration project, the Secretary may waive section 

14 1902(a)(1) (relating to statewideness) and section 

15 1902(a)(10)(B) (relating to comparability). 

16 ‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 

17 establish a process to provide technical assistance to 

18 States that are awarded grants under this section and to 

19 eligible entities and other providers participating in a 

20 State maternity care home model funded by such a grant. 

21 ‘‘(k) REPORT.— 

22 ‘‘(1) IN GENERAL.—Not later than 18 months 

23 after the date of the enactment of this section and 

24 annually thereafter for each year of the demonstra25 tion project term, the Secretary shall submit a reVerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602

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1 port to Congress on the results of the demonstration 

2 project. 

3 ‘‘(2) FINAL REPORT.—As part of the final re4 port required under paragraph (1), the Secretary 

5 shall include— 

6 ‘‘(A) the results of the final report of the 

7 national external entity required under sub8 section (f)(3)(B)(ii); and 

9 ‘‘(B) recommendations on whether the 

10 model studied in the demonstration project 

11 should be continued or more widely adopted, in12 cluding by private health plans. 

13 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to the Secretary, for 

15 each of fiscal years 2019 through 2026, such sums as may 

16 be necessary to carry out this section.’’. 

17 SEC. 4. REAPPLICATION OF MEDICARE PAYMENT RATE 

18 FLOOR TO PRIMARY CARE SERVICES FUR19 NISHED UNDER MEDICAID AND INCLUSION 

20 OF ADDITIONAL PROVIDERS. 

21 (a) REAPPLICATION OF PAYMENT FLOOR; ADDI22 TIONAL PROVIDERS.— 

23 (1) IN GENERAL.—Section 1902(a)(13) of the 

24 Social Security Act (42 U.S.C. 1396a(a)(13)) is 

25 amended— 


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1 (A) in subparagraph (B), by striking ‘‘; 

2 and’’ and inserting a semicolon; 

3 (B) in subparagraph (C), by striking the 

4 semicolon and inserting ‘‘; and’’; and 

5 (C) by adding at the end the following new 

6 subparagraph: 

7 ‘‘(D) payment for primary care services (as 

8 defined in subsection (jj)(1)) furnished in the 

9 period that begins on the first day of the first 

10 month that begins after the date of enactment 

11 of the Healthy MOMMIES Act by a provider 

12 described in subsection (jj)(2)— 

13 ‘‘(i) at a rate that is not less than 100 

14 percent of the payment rate that applies to 

15 such services and the provider of such 

16 services under part B of title XVIII (or, if 

17 greater, the payment rate that would be 

18 applicable under such part if the conver19 sion factor under section 1848(d) for the 

20 year were the conversion factor under such 

21 section for 2009); 

22 ‘‘(ii) in the case of items and services 

23 that are not items and services provided 

24 under such part, at a rate to be established 

25 by the Secretary; and 


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1 ‘‘(iii) in the case of items and services 

2 that are furnished in rural areas (as de3 fined in section 1886(d)(2)(D)), health 

4 professional shortage areas (as defined in 

5 section 332(a)(1)(A) of the Public Health 

6 Service Act (42 U.S.C. 254e(a)(1)(A))), or 

7 medically underserved areas (according to 

8 a designation under section 330(b)(3)(A) 

9 of the Public Health Service Act (42 

10 U.S.C. 254b(b)(3)(A))), at the rate other11 wise applicable to such items or services 

12 under clause (i) or (ii) increased, at the 

13 Secretary’s discretion, by not more than 25 

14 percent;’’. 

15 (2) CONFORMING AMENDMENTS.— 

16 (A) Section 1902(a)(13)(C) of the Social 

17 Security Act (42 U.S.C. 1396a(a)(13)(C)) is 

18 amended by striking ‘‘subsection (jj)’’ and in19 serting ‘‘subsection (jj)(1)’’. 

20 (B) Section 1905(dd) of the Social Secu21 rity Act (42 U.S.C. 1396d(dd)) is amended— 

22 (i) by striking ‘‘Notwithstanding’’ and 

23 inserting the following: 

24 ‘‘(1) IN GENERAL.—Notwithstanding’’; 


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1 (ii) by striking ‘‘section 

2 1902(a)(13)(C)’’ and inserting ‘‘subpara3 graph (C) of section 1902(a)(13)’’; 

4 (iii) by inserting ‘‘or for services de5 scribed in subparagraph (D) of section 

6 1902(a)(13) furnished during an additional 

7 period specified in paragraph (2),’’ after 

8 ‘‘2015,’’; 

9 (iv) by striking ‘‘under such section’’ 

10 and inserting ‘‘under subparagraph (C) or 

11 (D) of section 1902(a)(13), as applicable’’; 

12 and 

13 (v) by adding at the end the following: 

14 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 

15 paragraph (1), the following are additional periods: 

16 ‘‘(A) The period that begins on the first 

17 day of the first month that begins after the 

18 date of enactment of the Healthy MOMMIES 

19 Act.’’. 

20 (b) IMPROVED TARGETING OF PRIMARY CARE.—Sec21 tion 1902(jj) of the Social Security Act (42 U.S.C. 

22 1396a(jj)) is amended— 

23 (1) by redesignating paragraphs (1) and (2) as 

24 clauses (i) and (ii), respectively and realigning the 

25 left margins accordingly; 


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1 (2) by striking ‘‘For purposes of subsection 

2 (a)(13)(C)’’ and inserting the following: 

3 ‘‘(1) IN GENERAL.— 

4 ‘‘(A) DEFINITION.—For purposes of sub5 paragraphs (C) and (D) of subsection (a)(13)’’; 

6 and 

7 (3) by inserting after clause (ii) (as so redesig8 nated) the following: 

9 ‘‘(B) EXCLUSIONS.—Such term does not 

10 include any services described in subparagraph 

11 (A) or (B) of paragraph (1) if such services are 

12 provided in an emergency department of a hos13 pital. 

14 ‘‘(2) ADDITIONAL PROVIDERS.—For purposes 

15 of subparagraph (D) of subsection (a)(13), a pro16 vider described in this paragraph is any of the fol17 lowing: 

18 ‘‘(A) A physician with a primary specialty 

19 designation of family medicine, general internal 

20 medicine, or pediatric medicine, or obstetrics 

21 and gynecology. 

22 ‘‘(B) An advanced practice clinician, as de23 fined by the Secretary, that works under the 

24 supervision of— 


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1 ‘‘(i) a physician that satisfies the cri2 teria specified in subparagraph (A); 

3 ‘‘(ii) a nurse practitioner or a physi4 cian assistant (as such terms are defined 

5 in section 1861(aa)(5)(A)) who is working 

6 in accordance with State law; or 

7 ‘‘(iii) or a certified nurse-midwife (as 

8 defined in section 1861(gg)) who is work9 ing in accordance with State law. 

10 ‘‘(C) A rural health clinic, federally quali11 fied health center, or other health clinic that re12 ceives reimbursement on a fee schedule applica13 ble to a physician. 

14 ‘‘(D) An advanced practice clinician super15 vised by a physician described in subparagraph 

16 (A), another advanced practice clinician, or a 

17 certified nurse-midwife.’’. 

18 (c) ENSURING PAYMENT BY MANAGED CARE ENTI19 TIES.— 

20 (1) IN GENERAL.—Section 1903(m)(2)(A) of 

21 the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 

22 is amended— 

23 (A) in clause (xii), by striking ‘‘and’’ after 

24 the semicolon; 


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1 (B) by realigning the left margin of clause 

2 (xiii) so as to align with the left margin of 

3 clause (xii) and by striking the period at the 

4 end of clause (xiii) and inserting ‘‘; and’’; and 

5 (C) by inserting after clause (xiii) the fol6 lowing: 

7 ‘‘(xiv) such contract provides that (I) payments 

8 to providers specified in section 1902(a)(13)(D) for 

9 primary care services defined in section 1902(jj) 

10 that are furnished during a year or period specified 

11 in section 1902(a)(13)(D) and section 1905(dd) are 

12 at least equal to the amounts set forth and required 

13 by the Secretary by regulation, (II) the entity shall, 

14 upon request, provide documentation to the State, 

15 sufficient to enable the State and the Secretary to 

16 ensure compliance with subclause (I), and (III) the 

17 Secretary shall approve payments described in sub18 clause (I) that are furnished through an agreed 

19 upon capitation, partial capitation, or other value20 based payment arrangement if the capitation, partial 

21 capitation, or other value-based payment arrange22 ment is based on a reasonable methodology and the 

23 entity provides documentation to the State sufficient 

24 to enable the State and the Secretary to ensure com25 pliance with subclause (I).’’. 


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1 (2) CONFORMING AMENDMENT.—Section 

2 1932(f) of the Social Security Act (42 U.S.C. 

3 1396u–2(f)) is amended— 

4 (A) by striking ‘‘section 1902(a)(13)(C)’’ 

5 and inserting ‘‘subsections (C) and (D) of sec6 tion 1902(a)(13)’’; and 

7 (B) by inserting ‘‘and clause (xiv) of sec8 tion 1903(m)(2)(A)’’ before the period. 

9 SEC. 5. MACPAC REPORT AND CMS GUIDANCE ON INCREAS10 ING ACCESS TO DOULA CARE FOR MEDICAID 

11 BENEFICIARIES. 

12 (a) MACPAC REPORT.— 

13 (1) IN GENERAL.—Not later than 1 year after 

14 the date of the enactment of this Act, the Medicaid 

15 and CHIP Payment and Access Commission (re16 ferred to in this section as ‘‘MACPAC’’) shall pub17 lish a report on the coverage of doula care under 

18 State Medicaid programs, which shall at a minimum 

19 include the following: 

20 (A) Information about coverage for doula 

21 care under State Medicaid programs that cur22 rently provide coverage for such care, including 

23 the type of doula care offered (such as prenatal, 

24 labor and delivery, postpartum support, and 


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1 also community-based and traditional doula 

2 care). 

3 (B) An analysis of barriers to covering 

4 doula care under State Medicaid programs. 

5 (C) An identification of effective strategies 

6 to increase the use of doula care in order to 

7 provide better care and achieve better maternal 

8 and infant health outcomes, including strategies 

9 that States may use to recruit, train, and cer10 tify a diverse doula workforce, particularly from 

11 underserved communities, communities of color, 

12 and communities facing linguistic or cultural 

13 barriers. 

14 (D) Recommendations for legislative and 

15 administrative actions to increase access to 

16 doula care in State Medicaid programs, includ17 ing actions that ensure doulas may earn a living 

18 wage that accounts for their time and costs as19 sociated with providing care. 

20 (2) STAKEHOLDER CONSULTATION.—In devel21 oping the report required under paragraph (1), 

22 MACPAC shall consult with relevant stakeholders, 

23 including— 

24 (A) States; 


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1 (B) organizations representing consumers, 

2 including those that are disproportionately im3 pacted by poor maternal health outcomes; 

4 (C) organizations and individuals rep5 resenting doula care providers, including com6 munity-based doula programs and those who 

7 serve underserved communities, including com8 munities of color, and communities facing lin9 guistic or cultural barriers; and 

10 (D) organizations representing health care 

11 providers. 

12 (b) CMS GUIDANCE.— 

13 (1) IN GENERAL.—Not later than 1 year after 

14 the date that MACPAC publishes the report re15 quired under subsection (a)(1), the Administrator of 

16 the Centers for Medicare & Medicaid Services shall 

17 issue guidance to States on increasing access to 

18 doula care under Medicaid. Such guidance shall at 

19 a minimum include— 

20 (A) options for States to provide medical 

21 assistance for doula care services under State 

22 Medicaid programs; 

23 (B) best practices for ensuring that doulas, 

24 including community-based doulas, receive reim25 bursement for doula care services provided 


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1 under a State Medicaid program, at a level that 

2 allows doulas to earn a living wage that ac3 counts for their time and costs associated with 

4 providing care; and 

5 (C) best practices for increasing access to 

6 doula care services, including services provided 

7 by community-based doulas, under State Med8 icaid programs. 

9 (2) STAKEHOLDER CONSULTATION.—In devel10 oping the guidance required under paragraph (1), 

11 the Administrator of the Centers for Medicare & 

12 Medicaid Services shall consult with MACPAC and 

13 other relevant stakeholders, including— 

14 (A) State Medicaid officials; 

15 (B) organizations representing consumers, 

16 including those that are disproportionately im17 pacted by poor maternal health outcomes; 

18 (C) organizations representing doula care 

19 providers, including community-based doulas 

20 and those who serve underserved communities, 

21 such as communities of color and communities 

22 facing linguistic or cultural barriers; and 

23 (D) organizations representing health care 

24 professionals. 


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1 SEC. 6. GAO REPORT ON STATE MEDICAID PROGRAMS’ USE 

2 OF TELEMEDICINE TO INCREASE ACCESS TO 

3 MATERNITY CARE. 

4 Not later than 1 year after the date of the enactment 

5 of this Act, the Comptroller General of the United States 

6 shall submit a report to Congress on State Medicaid pro7 grams’ use of telemedicine to increase access to maternity 

8 care. Such report shall include the following: 

9 (1) The number of State Medicaid programs 

10 that utilize telemedicine to increase access to mater11 nity care. 

12 (2) With respect to State Medicaid programs 

13 that utilize telemedicine to increase access to mater14 nity care, information about— 

15 (A) common characteristics of such pro16 grams’ approaches to utilizing telemedicine to 

17 increase access to maternity care; and 

18 (B) what is known about— 

19 (i) the demographic characteristics of 

20 the individuals enrolled in such programs 

21 who use telemedicine to access maternity 

22 care; 

23 (ii) health outcomes for such individ24 uals as compared to individuals with simi25 lar characteristics who did not use tele26 medicine to access maternity care; 


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1 (iii) the services provided to individ2 uals through telemedicine, including family 

3 planning services and oral health services; 

4 (iv) the quality of maternity care pro5 vided through telemedicine, including 

6 whether maternity care provided through 

7 telemedicine is culturally competent; 

8 (v) the level of patient satisfaction 

9 with maternity care provided through tele10 medicine to individuals enrolled in State 

11 Medicaid programs; and 

12 (vi) the impact of utilizing telemedi13 cine to increase access to maternity care 

14 on spending, cost savings, access to care, 

15 and utilization of care under State Med16 icaid programs. 

17 (3) An identification and analysis of the bar18 riers to using telemedicine to increase access to ma19 ternity care under State Medicaid programs. 

20 (4) Recommendations for such legislative and 

21 administrative actions related to increasing access to 

22 telemedicine maternity services under Medicaid as 

23 the Comptroller General deems appropriate. 

Æ 


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