II 

116TH CONGRESS 

1ST SESSION S. 1343 

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 SENATE OF THE UNITED STATES 

MAY 7, 2019 

Mr. BOOKER (for himself, Ms. BALDWIN, Ms. WARREN, Ms. HARRIS, Mrs. 

GILLIBRAND, Mr. BLUMENTHAL, and Ms. HIRONO) introduced the following bill; which was read twice and referred to the Committee on Finance 

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 ‘‘Maximizing Outcomes 

5 for Moms through Medicaid Improvement and Enhance6 ment of Services Act’’, or the ‘‘MOMMIES Act’’. 


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1 SEC. 2. ENHANCING MEDICAID AND CHIP BENEFITS FOR 

2 LOW-INCOME PREGNANT WOMEN. 

3 (a) EXTENDING CONTINUOUS MEDICAID AND CHIP 

4 COVERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 

5 (1) MEDICAID.—Title XIX of the Social Secu6 rity Act (42 U.S.C. 1396 et seq.) is amended— 

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

8 ‘‘60-day period’’ and inserting ‘‘365-day pe9 riod’’; 

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

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

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

13 ‘‘60-day period’’ and inserting ‘‘365-day pe14 riod’’; and 

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

16 in the matter following paragraph (30), by 

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

18 day period’’. 

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

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

21 day period’’ each place it appears and inserting 

22 ‘‘365-day period’’. 

23 (b) REQUIRING FULL BENEFITS FOR PREGNANT

24 AND POSTPARTUM WOMEN.— 

25 (1) MEDICAID.— 


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1 (A) IN GENERAL.—Paragraph (5) of sec2 tion 1902(e) of the Social Security Act (24 

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

4 ‘‘(5) Any woman who is eligible for medical as5 sistance under the State plan or a waiver of such 

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

7 pregnant, shall continue to be eligible under the plan 

8 or waiver for medical assistance through the end of 

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

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

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

12 assistance, including if the woman’s eligibility for 

13 medical assistance is on the basis of being preg14 nant.’’. 

15 (B) CONFORMING AMENDMENT.—Section 

16 1902(a)(10) of the Social Security Act (42 

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

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

19 the medical assistance’’ and all that follows 

20 through ‘‘complicate pregnancy,’’. 

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

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

23 (A) by redesignating subparagraphs (H) 

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

25 respectively; and 


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

2 the following: 

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

4 day continuous coverage for pregnant and 

5 postpartum women).’’. 

6 (c) REQUIRING COVERAGE OF ORAL HEALTH SERV7 ICES FOR PREGNANT AND POSTPARTUM WOMEN.— 

8 (1) MEDICAID.—Section 1905 of the Social Se9 curity Act (42 U.S.C. 1396d) is amended— 

10 (A) in subsection (a)(4)— 

11 (i) by striking ‘‘; and (D)’’ and insert12 ing ‘‘; (D)’’; and 

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

14 services for pregnant and postpartum 

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

16 after ‘‘subsection (bb))’’; and 

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

18 subsection: 

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

20 POSTPARTUM WOMEN.— 

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

22 the term ‘oral health services for pregnant and 

23 postpartum women’ means dental services necessary 

24 to prevent disease and promote oral health, restore 

25 oral structures to health and function, and treat 


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1 emergency conditions that are furnished to a woman 

2 during pregnancy (or during the 365-day period be3 ginning on the last day of the pregnancy). 

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

5 the requirement to provide oral health services for 

6 pregnant and postpartum women, a State shall, at 

7 a minimum, provide coverage for preventive, diag8 nostic, periodontal, and restorative care consistent 

9 with recommendations for perinatal oral health care 

10 and dental care during pregnancy from the Amer11 ican Academy of Pediatric Dentistry and the Amer12 ican College of Obstetricians and Gynecologists.’’. 

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

14 Security Act (42 U.S.C. 1397cc(c)(5)(A)) is amend15 ed by inserting ‘‘or a targeted low-income pregnant 

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

17 (d) MAINTENANCE OF EFFORT.— 

18 (1) MEDICAID.—Section 1902 of the Social Se19 curity Act (42 U.S.C. 1396a) is amended— 

20 (A) in paragraph (74), by striking ‘‘sub21 section (gg); and’’ and inserting ‘‘subsections 

22 (gg) and (qq);’’; and 

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

24 subsection: 


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1 ‘‘(qq) MAINTENANCE OF EFFORT RELATED TO LOW2 INCOME PREGNANT WOMEN.—For calendar quarters be3 ginning on or after the date of enactment of this sub4 section, and before January 1, 2023, no Federal payment 

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

6 amounts expended under a State plan under this title or 

7 a waiver of such plan if the State— 

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

9 standards, methodologies, or procedures (including 

10 any enrollment cap or other numerical limitation on 

11 enrollment, any waiting list, any procedures designed 

12 to delay the consideration of applications for enroll13 ment, or similar limitation with respect to enroll14 ment) for individuals described in subsection (l)(1) 

15 who are eligible for medical assistance under the 

16 State plan or waiver under subsection 

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

18 eligibility standards, methodologies, or procedures, 

19 respectively, for such individuals under such plan or 

20 waiver that are in effect on the date of the enact21 ment of the Maximizing Outcomes for Moms 

22 through Medicaid Improvement and Enhancement of 

23 Services Act; or 

24 ‘‘(2) provides medical assistance to individuals 

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


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1 medical assistance under such plan or waiver under 

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

3 than the level at which the State provides such as4 sistance to such individuals under such plan or waiv5 er on the date of the enactment of the Maximizing 

6 Outcomes for Moms through Medicaid Improvement 

7 and Enhancement of Services Act.’’. 

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

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

10 (b), is further amended by adding at the end the fol11 lowing subsection: 

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

13 quarters beginning on or after January 1, 2020, and be14 fore January 1, 2023, no payment may be made under 

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

16 if the State— 

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

18 standards, methodologies, or procedures (including 

19 any enrollment cap or other numerical limitation on 

20 enrollment, any waiting list, any procedures designed 

21 to delay the consideration of applications for enroll22 ment, or similar limitation with respect to enroll23 ment) for targeted low-income pregnant women that 

24 are more restrictive than the eligibility standards, 

25 methodologies, or procedures, respectively, under 


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1 such plan that are in effect on the date of the enact2 ment of the Maximizing Outcomes for Moms 

3 through Medicaid Improvement and Enhancement of 

4 Services Act; or 

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

6 targeted low-income pregnant women under such 

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

8 the State provides such assistance to such women 

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

10 Maximizing Outcomes for Moms through Medicaid 

11 Improvement and Enhancement of Services Act.’’. 

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

13 Security Act (42 U.S.C. 1396d), as amended by sub14 section (c), is further amended— 

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

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

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

18 ‘‘(gg) INCREASED FMAP FOR ADDITIONAL EXPEND19 ITURES FOR LOW-INCOME PREGNANT WOMEN.—For cal20 endar quarters beginning on or after January 1, 2020, 

21 notwithstanding subsection (b), the Federal medical as22 sistance percentage for a State, with respect to the addi23 tional amounts expended by such State for medical assist24 ance under the State plan under this title or a waiver of 

25 such plan that are attributable to requirements imposed 


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1 by the amendments made by the Maximizing Outcomes 

2 for Moms through Medicaid Improvement and Enhance3 ment of Services Act (as determined by the Secretary), 

4 shall be equal to 100 percent.’’. 

5 (f) GAO STUDY AND REPORT.— 

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

7 the date of the enactment of this Act, the Comp8 troller General of the United States shall submit to 

9 Congress a report on the gaps in coverage for— 

10 (A) pregnant women under the Medicaid 

11 program under title XIX of the Social Security 

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

13 Health Insurance Program under title XXI of 

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

15 seq.); and 

16 (B) postpartum women under the Medicaid 

17 program and the Children’s Health Insurance 

18 Program who received assistance under either 

19 such program during their pregnancy. 

20 (2) CONTENT OF REPORT.—The report re21 quired under this subsection shall include the fol22 lowing: 

23 (A) Information about the abilities and 

24 successes of State Medicaid agencies in deter25 mining whether pregnant and postpartum 


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1 women are eligible under another insurance af2 fordability program, and in transitioning any 

3 such women who are so eligible to coverage 

4 under such a program, pursuant to section 

5 435.1200 of the title 42, Code of Federal Regu6 lations (as in effect on September 1, 2018). 

7 (B) Information on factors contributing to 

8 gaps in coverage that disproportionately impact 

9 underserved populations, including low-income 

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

11 health professional shortage area (as defined in 

12 section 332(a)(1)(A) of the Public Health Serv13 ice Act (42 U.S.C. 254e(a)(1)(A))) or who are 

14 members of a medically underserved population 

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

16 (42 U.S.C. 254b(b)(3)(A))). 

17 (C) Recommendations for addressing and 

18 reducing such gaps in coverage. 

19 (D) Such other information as the Comp20 troller General deems necessary. 

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

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


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1 SEC. 3. MATERNITY CARE HOME DEMONSTRATION 

2 PROJECT. 

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

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

5 after section 1946: 

6 ‘‘MATERNITY CARE HOME DEMONSTRATION PROJECT

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

8 after the date of the enactment of this section, the Sec9 retary shall establish a demonstration project (in this sec10 tion referred to as the ‘demonstration project’) under 

11 which the Secretary shall provide grants to States to enter 

12 into arrangements with eligible entities to implement or 

13 expand a maternity care home model for eligible individ14 uals. 

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

16 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en17 tity’ means an entity or organization that provides 

18 medically accurate, comprehensive maternity services 

19 to individuals who are eligible for medical assistance 

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

21 such a plan, and may include: 

22 ‘‘(A) A freestanding birth center. 

23 ‘‘(B) An entity or organization receiving 

24 assistance under section 330 of the Public 

25 Health Service Act. 

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


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1 ‘‘(D) A rural health clinic. 

2 ‘‘(E) A health facility operated by an In3 dian tribe or tribal organization (as those terms 

4 are defined in section 4 of the Indian Health 

5 Care Improvement Act). 

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

7 individual’ means a pregnant woman or a formerly 

8 pregnant woman during the 365-day period begin9 ning on the last day of her pregnancy who is— 

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

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

12 health plan under title XXI; and 

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

14 has entered into an arrangement with a State 

15 under subsection (g). 

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

17 goals of the demonstration project are the following: 

18 ‘‘(1) To improve— 

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

20 ‘‘(B) health equity; 

21 ‘‘(C) communication by maternity, infant 

22 care, and social services providers; 

23 ‘‘(D) integration of perinatal support serv24 ices, including community health workers, 

25 doulas, social workers, public health nurses, 


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1 peer lactation counselors, childbirth educators, 

2 and others, into health care entities and organi3 zations; 

4 ‘‘(E) care coordination between maternity, 

5 infant care, oral health care, and social services 

6 providers within the community; 

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

8 and infant care; 

9 ‘‘(G) the experience of women receiving 

10 maternity care, including by increasing the abil11 ity of a woman to develop and follow her own 

12 birthing plan; and 

13 ‘‘(H) access to adequate prenatal and 

14 postpartum care, including— 

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

16 a timely manner; 

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

18 visits to a maternity care provider; and 

19 ‘‘(iii) interpregnancy care. 

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

21 maternity care management. 

22 ‘‘(3) To decrease— 

23 ‘‘(A) severe maternal morbidity and mater24 nal mortality; 

25 ‘‘(B) overall health care spending; 


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1 ‘‘(C) unnecessary emergency department 

2 visits; 

3 ‘‘(D) disparities in maternal and infant 

4 care outcomes, including racial, economic, and 

5 geographical disparities; 

6 ‘‘(E) racial bias among health care profes7 sionals; 

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

9 low-risk pregnancies; 

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

11 born with low birth weight; and 

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

13 newborn hospitalizations and admissions to in14 tensive care units. 

15 ‘‘(d) CONSULTATION.—In designing and imple16 menting the demonstration project the Secretary shall 

17 consult with stakeholders, including— 

18 ‘‘(1) States; 

19 ‘‘(2) organizations representing relevant health 

20 care professionals, including oral health care profes21 sionals; 

22 ‘‘(3) organizations representing consumers, in23 cluding consumers that are disproportionately im24 pacted by poor maternal health outcomes; 


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1 ‘‘(4) representatives with experience imple2 menting other maternity care home models, includ3 ing representatives from the Center for Medicare 

4 and Medicaid Innovation; 

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

6 including doulas, and other stakeholders; and 

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

8 combating racial bias in health care settings. 

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

10 ‘‘(1) IN GENERAL.—A State seeking to partici11 pate in the demonstration project shall submit an 

12 application to the Secretary at such time and in 

13 such manner as the Secretary shall require. 

14 ‘‘(2) SELECTION OF STATES.— 

15 ‘‘(A) IN GENERAL.—The Secretary may se16 lect 15 States to participate in the demonstra17 tion project. 

18 ‘‘(B) SELECTION REQUIREMENTS.—In se19 lecting States to participate in the demonstra20 tion project, the Secretary shall— 

21 ‘‘(i) ensure that there is geographic 

22 diversity in the areas in which activities 

23 will be carried out under the project; and 

24 ‘‘(ii) ensure that States with signifi25 cant disparities in maternal and infant 


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1 health outcomes, including severe maternal 

2 morbidity, and other disparities based on 

3 race, income, or access to maternity care, 

4 are included. 

5 ‘‘(f) GRANTS.— 

6 ‘‘(1) IN GENERAL.—From amounts appro7 priated under subsection (l), the Secretary shall 

8 award 1 grant for each year of the demonstration 

9 project to each State that is selected to participate 

10 in the demonstration project. 

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

12 funds received under this section to— 

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

14 eligible entities as part of an arrangement de15 scribed in subsection (g)(2); 

16 ‘‘(B) provide financial incentives to health 

17 care professionals, including community health 

18 workers and community-based doulas, who par19 ticipate in the State’s maternity care home 

20 model; 

21 ‘‘(C) provide adequate training for health 

22 care professionals, including community health 

23 workers, doulas, and care coordinators, who 

24 participate in the State’s maternity care home 

25 model, which may include training for cultural 


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1 competency, racial bias, health equity, reproduc2 tive and birth justice, home visiting skills, and 

3 respectful communication and listening skills, 

4 particularly in regards to maternal health; 

5 ‘‘(D) pay for personnel and administrative 

6 expenses associated with designing, imple7 menting, and operating the State’s maternity 

8 care home model; 

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

10 furnished under the State’s maternity care 

11 home model and for which payment is otherwise 

12 unavailable under this title; and 

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

14 State’s maternity care home model, as deter15 mined by the Secretary. 

16 ‘‘(3) GRANT FOR NATIONAL INDEPENDENT

17 EVALUATOR.— 

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

19 appropriated under subsection (l), prior to 

20 awarding any grants under paragraph (1), the 

21 Secretary shall enter into a contract with a na22 tional external entity to create a single, uniform 

23 process to— 


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1 ‘‘(i) ensure that States that receive 

2 grants under paragraph (1) comply with 

3 the requirements of this section; and 

4 ‘‘(ii) evaluate the outcomes of the 

5 demonstration project in each participating 

6 State. 

7 ‘‘(B) ANNUAL REPORT.—The contract de8 scribed in subparagraph (A) shall require the 

9 national external entity to submit to the Sec10 retary— 

11 ‘‘(i) a yearly evaluation report for 

12 each year of the demonstration project; 

13 and 

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

15 demonstration project has concluded. 

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

17 in this paragraph shall prevent the Secretary 

18 from making a determination that a State is 

19 not in compliance with the requirements of this 

20 section without the national external entity 

21 making such a determination. 

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

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

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


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1 an arrangement with one or more eligible entities 

2 that meets the requirements of paragraph (2). 

3 ‘‘(2) ARRANGEMENTS WITH ELIGIBLE ENTI4 TIES.—Under an arrangement between a State and 

5 an eligible entity under this subsection, the eligible 

6 entity shall perform the following functions, with re7 spect to eligible individuals enrolled with the entity 

8 under the State’s maternity care home model— 

9 ‘‘(A) provide culturally competent care, 

10 which may include prenatal care, family plan11 ning services, medical care, mental and behav12 ioral care, postpartum care, and oral health 

13 care to such eligible individuals through a team 

14 of health care professionals, which may include 

15 obstetrician-gynecologists, maternal-fetal medi16 cine specialists, family physicians, primary care 

17 providers, oral health providers, physician as18 sistants, advanced practice registered nurses 

19 such as nurse practitioners and certified nurse 

20 midwives, certified midwives, certified profes21 sional midwives, social workers, traditional and 

22 community-based doulas, lactation consultants, 

23 childbirth educators, community health workers, 

24 and other health care professionals; 


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

2 such eligible individual to determine if her preg3 nancy is high or low risk, and establish a tai4 lored pregnancy care plan, which takes into 

5 consideration the individual’s own preferences 

6 and pregnancy care and birthing plans and de7 termines the appropriate support services to re8 duce the individual’s medical, social, and envi9 ronmental risk factors, for each such eligible in10 dividual based on the results of such risk as11 sessment; 

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

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

14 worker, traditional or community-based doula, 

15 community health worker, midwife, or other 

16 health care provider, who is responsible for en17 suring that such eligible individual receives the 

18 necessary medical care and connections to es19 sential support services; 

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

21 of, essential support services, such as services 

22 that address— 

23 ‘‘(i) nutrition and exercise; 

24 ‘‘(ii) smoking cessation; 


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1 ‘‘(iii) substance use disorder and ad2 diction treatment; 

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

4 mental and behavioral health issues; 

5 ‘‘(v) breast feeding initiation, continu6 ation, and duration; 

7 ‘‘(vi) housing; 

8 ‘‘(vii) transportation; 

9 ‘‘(viii) intimate partner violence; 

10 ‘‘(ix) home visiting services; 

11 ‘‘(x) childbirth education; 

12 ‘‘(xi) oral health education; 

13 ‘‘(xii) continuous labor support; and 

14 ‘‘(xiii) group prenatal care; 

15 ‘‘(E) as appropriate, facilitate connections 

16 to a usual primary care provider, which may be 

17 a women’s health provider; 

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

19 medical associations when determining whether 

20 an elective delivery should be performed on an 

21 eligible individual before 39 weeks of gestation; 

22 ‘‘(G) provide such eligible individuals with 

23 evidence-based education and resources to iden24 tify potential warning signs of pregnancy and 


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1 postpartum complications and when and how to 

2 obtain medical attention; 

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

4 of, pregnancy and postpartum health services, 

5 including family planning counseling and serv6 ices, to eligible individuals; 

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

8 such eligible individuals and their children; 

9 ‘‘(J) ensure that care is patient-led, includ10 ing by engaging eligible individuals in their own 

11 care, including through communication and 

12 education; and 

13 ‘‘(K) ensure adequate training for appro14 priately serving the population of individuals el15 igible for medical assistance under the State 

16 plan or waiver of such plan, including through 

17 reproductive and birth justice frameworks, race 

18 equity awareness, home visiting skills, and 

19 knowledge of social services. 

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

21 Secretary shall conduct the demonstration project for a 

22 period of 5 years. 

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

24 Secretary determines necessary in order to carry out the 

25 demonstration project, the Secretary may waive section 


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

2 1902(a)(10)(B) (relating to comparability). 

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

4 establish a process to provide technical assistance to 

5 States that are awarded grants under this section and to 

6 eligible entities and other providers participating in a 

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

8 ‘‘(k) REPORT.— 

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

10 after the date of the enactment of this section and 

11 annually thereafter for each year of the demonstra12 tion project term, the Secretary shall submit a re13 port to Congress on the results of the demonstration 

14 project. 

15 ‘‘(2) FINAL REPORT.—As part of the final re16 port required under paragraph (1), the Secretary 

17 shall include— 

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

19 national external entity required under sub20 section (f)(3)(B)(ii); and 

21 ‘‘(B) recommendations on whether the 

22 model studied in the demonstration project 

23 should be continued or more widely adopted, in24 cluding by private health plans. 


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

2 are authorized to be appropriated to the Secretary, for 

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

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

5 SEC. 4. REAPPLICATION OF MEDICARE PAYMENT RATE 

6 FLOOR TO PRIMARY CARE SERVICES FUR7 NISHED UNDER MEDICAID AND INCLUSION 

8 OF ADDITIONAL PROVIDERS. 

9 (a) REAPPLICATION OF PAYMENT FLOOR; ADDI10 TIONAL PROVIDERS.— 

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

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

13 amended— 

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

15 and’’ and inserting a semicolon; 

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

17 semicolon and inserting ‘‘; and’’; and 

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

19 subparagraph: 

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

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

22 period that begins on the first day of the first 

23 month that begins after the date of enactment 

24 of the Maximizing Outcomes for Moms through 

25 Medicaid Improvement and Enhancement of 


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1 Services Act by a provider described in sub2 section (jj)(2)— 

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

4 percent of the payment rate that applies to 

5 such services and the provider of such 

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

7 greater, the payment rate that would be 

8 applicable under such part if the conver9 sion factor under section 1848(d) for the 

10 year were the conversion factor under such 

11 section for 2009); 

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

13 that are not items and services provided 

14 under such part, at a rate to be established 

15 by the Secretary; and 

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

17 that are furnished in rural areas (as de18 fined in section 1886(d)(2)(D)), health 

19 professional shortage areas (as defined in 

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

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

22 medically underserved areas (according to 

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

24 of the Public Health Service Act (42 

25 U.S.C. 254b(b)(3)(A))), at the rate otherVerDate Sep 11 2014 19:28 May 11, 2019 Jkt 089200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S1343.IS S1343

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1 wise applicable to such items or services 

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

3 Secretary’s discretion, by not more than 25 

4 percent;’’. 

5 (2) CONFORMING AMENDMENTS.— 

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

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

8 amended by striking ‘‘subsection (jj)’’ and in9 serting ‘‘subsection (jj)(1)’’. 

10 (B) Section 1905(dd) of the Social Secu11 rity Act (42 U.S.C. 1396d(dd)) is amended— 

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

13 inserting the following: 

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

15 (ii) by striking ‘‘section 

16 1902(a)(13)(C)’’ and inserting ‘‘subpara17 graph (C) of section 1902(a)(13)’’; 

18 (iii) by inserting ‘‘or for services de19 scribed in subparagraph (D) of section 

20 1902(a)(13) furnished during an additional 

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

22 ‘‘2015,’’; 

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

24 and inserting ‘‘under subparagraph (C) or 


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

2 and 

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

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

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

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

7 day of the first month that begins after the 

8 date of enactment of the Maximizing Outcomes 

9 for Moms through Medicaid Improvement and 

10 Enhancement of Services Act.’’. 

11 (b) IMPROVED TARGETING OF PRIMARY CARE.—Sec12 tion 1902(jj) of the Social Security Act (42 U.S.C. 

13 1396a(jj)) is amended— 

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

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

16 left margins accordingly; 

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

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

19 ‘‘(1) IN GENERAL.— 

20 ‘‘(A) DEFINITION.—For purposes of sub21 paragraphs (C) and (D) of subsection (a)(13)’’; 

22 and 

23 (3) by inserting after clause (ii) (as so redesig24 nated) the following: 


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

2 include any services described in subparagraph 

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

4 provided in an emergency department of a hos5 pital. 

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

7 of subparagraph (D) of subsection (a)(13), a pro8 vider described in this paragraph is any of the fol9 lowing: 

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

11 designation of family medicine, general internal 

12 medicine, or pediatric medicine, or obstetrics 

13 and gynecology. 

14 ‘‘(B) An advanced practice clinician, as de15 fined by the Secretary, that works under the 

16 supervision of— 

17 ‘‘(i) a physician that satisfies the cri18 teria specified in subparagraph (A); 

19 ‘‘(ii) a nurse practitioner or a physi20 cian assistant (as such terms are defined 

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

22 in accordance with State law; or 

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

24 defined in section 1861(gg)) who is work25 ing in accordance with State law. 


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1 ‘‘(C) A rural health clinic, federally quali2 fied health center, or other health clinic that re3 ceives reimbursement on a fee schedule applica4 ble to a physician. 

5 ‘‘(D) An advanced practice clinician super6 vised by a physician described in subparagraph 

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

8 certified nurse-midwife.’’. 

9 (c) ENSURING PAYMENT BY MANAGED CARE ENTI10 TIES.— 

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

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

13 is amended— 

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

15 the semicolon; 

16 (B) by realigning the left margin of clause 

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

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

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

20 (C) by inserting after clause (xiii) the fol21 lowing: 

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

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

24 primary care services defined in section 1902(jj) 

25 that are furnished during a year or period specified 


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

2 at least equal to the amounts set forth and required 

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

4 upon request, provide documentation to the State, 

5 sufficient to enable the State and the Secretary to 

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

7 Secretary shall approve payments described in sub8 clause (I) that are furnished through an agreed 

9 upon capitation, partial capitation, or other value10 based payment arrangement if the capitation, partial 

11 capitation, or other value-based payment arrange12 ment is based on a reasonable methodology and the 

13 entity provides documentation to the State sufficient 

14 to enable the State and the Secretary to ensure com15 pliance with subclause (I).’’. 

16 (2) CONFORMING AMENDMENT.—Section 

17 1932(f) of the Social Security Act (42 U.S.C. 

18 1396u–2(f)) is amended— 

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

20 and inserting ‘‘subsections (C) and (D) of sec21 tion 1902(a)(13)’’; and 

22 (B) by inserting ‘‘and clause (xiv) of sec23 tion 1903(m)(2)(A)’’ before the period. 


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1 SEC. 5. MACPAC REPORT AND CMS GUIDANCE ON INCREAS2 ING ACCESS TO DOULA CARE FOR MEDICAID 

3 BENEFICIARIES. 

4 (a) MACPAC REPORT.— 

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

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

7 and CHIP Payment and Access Commission (re8 ferred to in this section as ‘‘MACPAC’’) shall pub9 lish a report on the coverage of doula care under 

10 State Medicaid programs, which shall at a minimum 

11 include the following: 

12 (A) Information about coverage for doula 

13 care under State Medicaid programs that cur14 rently provide coverage for such care, including 

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

16 labor and delivery, postpartum support, and 

17 also community-based and traditional doula 

18 care). 

19 (B) An analysis of barriers to covering 

20 doula care under State Medicaid programs. 

21 (C) An identification of effective strategies 

22 to increase the use of doula care in order to 

23 provide better care and achieve better maternal 

24 and infant health outcomes, including strategies 

25 that States may use to recruit, train, and cer26 tify a diverse doula workforce, particularly from 


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1 underserved communities, communities of color, 

2 and communities facing linguistic or cultural 

3 barriers. 

4 (D) Recommendations for legislative and 

5 administrative actions to increase access to 

6 doula care in State Medicaid programs, includ7 ing actions that ensure doulas may earn a living 

8 wage that accounts for their time and costs as9 sociated with providing care. 

10 (2) STAKEHOLDER CONSULTATION.—In devel11 oping the report required under paragraph (1), 

12 MACPAC shall consult with relevant stakeholders, 

13 including— 

14 (A) States; 

15 (B) organizations representing consumers, 

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

18 (C) organizations and individuals rep19 resenting doula care providers, including com20 munity-based doula programs and those who 

21 serve underserved communities, including com22 munities of color, and communities facing lin23 guistic or cultural barriers; and 

24 (D) organizations representing health care 

25 providers. 


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1 (b) CMS GUIDANCE.— 

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

3 the date that MACPAC publishes the report re4 quired under subsection (a)(1), the Administrator of 

5 the Centers for Medicare & Medicaid Services shall 

6 issue guidance to States on increasing access to 

7 doula care under Medicaid. Such guidance shall at 

8 a minimum include— 

9 (A) options for States to provide medical 

10 assistance for doula care services under State 

11 Medicaid programs; 

12 (B) best practices for ensuring that doulas, 

13 including community-based doulas, receive reim14 bursement for doula care services provided 

15 under a State Medicaid program, at a level that 

16 allows doulas to earn a living wage that ac17 counts for their time and costs associated with 

18 providing care; and 

19 (C) best practices for increasing access to 

20 doula care services, including services provided 

21 by community-based doulas, under State Med22 icaid programs. 

23 (2) STAKEHOLDER CONSULTATION.—In devel24 oping the guidance required under paragraph (1), 

25 the Administrator of the Centers for Medicare & 


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1 Medicaid Services shall consult with MACPAC and 

2 other relevant stakeholders, including— 

3 (A) State Medicaid officials; 

4 (B) organizations representing consumers, 

5 including those that are disproportionately im6 pacted by poor maternal health outcomes; 

7 (C) organizations representing doula care 

8 providers, including community-based doulas 

9 and those who serve underserved communities, 

10 such as communities of color and communities 

11 facing linguistic or cultural barriers; and 

12 (D) organizations representing health care 

13 professionals. 

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

15 OF TELEMEDICINE TO INCREASE ACCESS TO 

16 MATERNITY CARE. 

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

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

19 shall submit a report to Congress on State Medicaid pro20 grams’ use of telemedicine to increase access to maternity 

21 care. Such report shall include the following: 

22 (1) The number of State Medicaid programs 

23 that utilize telemedicine to increase access to mater24 nity care. 


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1 (2) With respect to State Medicaid programs 

2 that utilize telemedicine to increase access to mater3 nity care, information about— 

4 (A) common characteristics of such pro5 grams’ approaches to utilizing telemedicine to 

6 increase access to maternity care; and 

7 (B) what is known about— 

8 (i) the demographic characteristics of 

9 the individuals enrolled in such programs 

10 who use telemedicine to access maternity 

11 care; 

12 (ii) health outcomes for such individ13 uals as compared to individuals with simi14 lar characteristics who did not use tele15 medicine to access maternity care; 

16 (iii) the services provided to individ17 uals through telemedicine, including family 

18 planning services and oral health services; 

19 (iv) the quality of maternity care pro20 vided through telemedicine, including 

21 whether maternity care provided through 

22 telemedicine is culturally competent; 

23 (v) the level of patient satisfaction 

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1 medicine to individuals enrolled in State 

2 Medicaid programs; and 

3 (vi) the impact of utilizing telemedi4 cine to increase access to maternity care 

5 on spending, cost savings, access to care, 

6 and utilization of care under State Med7 icaid programs. 

8 (3) An identification and analysis of the bar9 riers to using telemedicine to increase access to ma10 ternity care under State Medicaid programs. 

11 (4) Recommendations for such legislative and 

12 administrative actions related to increasing access to 

13 telemedicine maternity services under Medicaid as 

14 the Comptroller General deems appropriate. 

Æ 


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