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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1343 Introduced in Senate (IS)]

<DOC>

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.

    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 ``Maximizing Outcomes for Moms through 
Medicaid Improvement and Enhancement of Services Act'', or the 
``MOMMIES Act''.

SEC. 2. ENHANCING MEDICAID AND CHIP BENEFITS FOR LOW-INCOME PREGNANT 
              WOMEN.

    (a) Extending Continuous Medicaid and CHIP Coverage for Pregnant 
and Postpartum Women.--
            (1) Medicaid.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended--
                    (A) in section 1902(l)(1)(A), by striking ``60-day 
                period'' and inserting ``365-day period'';
                    (B) in section 1902(e)(6), by striking ``60-day 
                period'' and inserting ``365-day period'';
                    (C) in section 1903(v)(4)(A)(i), by striking ``60-
                day period'' and inserting ``365-day period''; and
                    (D) in section 1905(a), in the 4th sentence in the 
                matter following paragraph (30), by striking ``60-day 
                period'' and inserting ``365-day period''.
            (2) CHIP.--Section 2112 of the Social Security Act (42 
        U.S.C. 1397ll) is amended by striking ``60-day period'' each 
        place it appears and inserting ``365-day period''.
    (b) Requiring Full Benefits for Pregnant and Postpartum Women.--
            (1) Medicaid.--
                    (A) In general.--Paragraph (5) of section 1902(e) 
                of the Social Security Act (24 U.S.C. 1396a(e)) is 
                amended to read as follows:
            ``(5) Any woman who is eligible for medical assistance 
        under the State plan or a waiver of such plan and who is, or 
        who while so eligible becomes, pregnant, shall continue to be 
        eligible under the plan or waiver for medical assistance 
        through the end of the month in which the 365-day period 
        (beginning on the last day of her pregnancy) ends, regardless 
        of the basis for the woman's eligibility for medical 
        assistance, including if the woman's eligibility for medical 
        assistance is on the basis of being pregnant.''.
                    (B) Conforming amendment.--Section 1902(a)(10) of 
                the Social Security Act (42 U.S.C. 1396a(a)(10)) is 
                amended in the matter following subparagraph (G) by 
                striking ``(VII) the medical assistance'' and all that 
                follows through ``complicate pregnancy,''.
            (2) CHIP.--Section 2107(e)(1) of the Social Security Act 
        (42 U.S.C. 1397gg(e)(1)) is amended--
                    (A) by redesignating subparagraphs (H) through (S) 
                as subparagraphs (I) through (T), respectively; and
                    (B) by inserting after subparagraph (G), the 
                following:
                    ``(H) Section 1902(e)(5) (requiring 365-day 
                continuous coverage for pregnant and postpartum 
                women).''.
    (c) Requiring Coverage of Oral Health Services for Pregnant and 
Postpartum Women.--
            (1) Medicaid.--Section 1905 of the Social Security Act (42 
        U.S.C. 1396d) is amended--
                    (A) in subsection (a)(4)--
                            (i) by striking ``; and (D)'' and inserting 
                        ``; (D)''; and
                            (ii) by inserting ``; and (E) oral health 
                        services for pregnant and postpartum women (as 
                        defined in subsection (ff))'' after 
                        ``subsection (bb))''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(ff) Oral Health Services for Pregnant and Postpartum Women.--
            ``(1) In general.--For purposes of this title, the term 
        `oral health services for pregnant and postpartum women' means 
        dental services necessary to prevent disease and promote oral 
        health, restore oral structures to health and function, and 
        treat emergency conditions that are furnished to a woman during 
        pregnancy (or during the 365-day period beginning on the last 
        day of the pregnancy).
            ``(2) Coverage requirements.--To satisfy the requirement to 
        provide oral health services for pregnant and postpartum women, 
        a State shall, at a minimum, provide coverage for preventive, 
        diagnostic, periodontal, and restorative care consistent with 
        recommendations for perinatal oral health care and dental care 
        during pregnancy from the American Academy of Pediatric 
        Dentistry and the American College of Obstetricians and 
        Gynecologists.''.
            (2) CHIP.--Section 2103(c)(5)(A) of the Social Security Act 
        (42 U.S.C. 1397cc(c)(5)(A)) is amended by inserting ``or a 
        targeted low-income pregnant woman'' after ``targeted low-
        income child''.
    (d) Maintenance of Effort.--
            (1) Medicaid.--Section 1902 of the Social Security Act (42 
        U.S.C. 1396a) is amended--
                    (A) in paragraph (74), by striking ``subsection 
                (gg); and'' and inserting ``subsections (gg) and 
                (qq);''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(qq) Maintenance of Effort Related to Low-Income Pregnant 
Women.--For calendar quarters beginning on or after the date of 
enactment of this subsection, and before January 1, 2023, no Federal 
payment shall be made to a State under section 1903(a) for amounts 
expended under a State plan under this title or a waiver of such plan 
if the State--
            ``(1) has in effect under such plan eligibility standards, 
        methodologies, or procedures (including any enrollment cap or 
        other numerical limitation on enrollment, any waiting list, any 
        procedures designed to delay the consideration of applications 
        for enrollment, or similar limitation with respect to 
        enrollment) for individuals described in subsection (l)(1) who 
        are eligible for medical assistance under the State plan or 
        waiver under subsection (a)(10)(A)(ii)(IX) that are more 
        restrictive than the eligibility standards, methodologies, or 
        procedures, respectively, for such individuals under such plan 
        or waiver that are in effect on the date of the enactment of 
        the Maximizing Outcomes for Moms through Medicaid Improvement 
        and Enhancement of Services Act; or
            ``(2) provides medical assistance to individuals described 
        in subsection (l)(1) who are eligible for medical assistance 
        under such plan or waiver under subsection (a)(10)(A)(ii)(IX) 
        at a level that is less than the level at which the State 
        provides such assistance to such individuals under such plan or 
        waiver on the date of the enactment of the Maximizing Outcomes 
        for Moms through Medicaid Improvement and Enhancement of 
        Services Act.''.
            (2) CHIP.--Section 2112 of the Social Security Act (42 
        U.S.C. 1397ll), as amended by subsection (b), is further 
        amended by adding at the end the following subsection:
    ``(g) Maintenance of Effort.--For calendar quarters beginning on or 
after January 1, 2020, and before January 1, 2023, no payment may be 
made under section 2105(a) with respect to a State child health plan if 
the State--
            ``(1) has in effect under such plan eligibility standards, 
        methodologies, or procedures (including any enrollment cap or 
        other numerical limitation on enrollment, any waiting list, any 
        procedures designed to delay the consideration of applications 
        for enrollment, or similar limitation with respect to 
        enrollment) for targeted low-income pregnant women that are 
        more restrictive than the eligibility standards, methodologies, 
        or procedures, respectively, under such plan that are in effect 
        on the date of the enactment of the Maximizing Outcomes for 
        Moms through Medicaid Improvement and Enhancement of Services 
        Act; or
            ``(2) provides pregnancy-related assistance to targeted 
        low-income pregnant women under such plan at a level that is 
        less than the level at which the State provides such assistance 
        to such women under such plan on the date of the enactment of 
        the Maximizing Outcomes for Moms through Medicaid Improvement 
        and Enhancement of Services Act.''.
    (e) Enhanced FMAP.--Section 1905 of the Social Security Act (42 
U.S.C. 1396d), as amended by subsection (c), is further amended--
            (1) in subsection (b), by striking ``and (aa)'' and 
        inserting ``(aa), and (gg)''; and
            (2) by adding at the end the following:
    ``(gg) Increased FMAP for Additional Expenditures for Low-Income 
Pregnant Women.--For calendar quarters beginning on or after January 1, 
2020, notwithstanding subsection (b), the Federal medical assistance 
percentage for a State, with respect to the additional amounts expended 
by such State for medical assistance under the State plan under this 
title or a waiver of such plan that are attributable to requirements 
imposed by the amendments made by the Maximizing Outcomes for Moms 
through Medicaid Improvement and Enhancement of Services Act (as 
determined by the Secretary), shall be equal to 100 percent.''.
    (f) GAO Study and Report.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States shall submit to Congress a report on the gaps in 
        coverage for--
                    (A) pregnant women 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 the Social Security Act (42 U.S.C. 1397aa 
                et seq.); and
                    (B) postpartum women under the Medicaid program and 
                the Children's Health Insurance Program who received 
                assistance under either such program during their 
                pregnancy.
            (2) Content of report.--The report required under this 
        subsection shall include the following:
                    (A) Information about the abilities and successes 
                of State Medicaid agencies in determining whether 
                pregnant and postpartum women are eligible under 
                another insurance affordability program, and in 
                transitioning any such women who are so eligible to 
                coverage under such a program, pursuant to section 
                435.1200 of the title 42, Code of Federal Regulations 
                (as in effect on September 1, 2018).
                    (B) Information on factors contributing to gaps in 
                coverage 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))).
                    (C) Recommendations for addressing and reducing 
                such gaps in coverage.
                    (D) Such other information as the Comptroller 
                General deems necessary.
    (g) Effective Date.--The amendments made by subsections (a) and (b) 
shall take effect January 1, 2020.

SEC. 3. MATERNITY CARE HOME DEMONSTRATION PROJECT.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by inserting the following new section after section 1946:

              ``maternity care home demonstration project

    ``Sec. 1947.  (a) In General.--Not later than 1 year after the date 
of the enactment of this section, the Secretary shall establish a 
demonstration project (in this section referred to as the 
`demonstration project') under which the Secretary shall provide grants 
to States to enter into arrangements with eligible entities to 
implement or expand a maternity care home model for eligible 
individuals.
    ``(b) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means an 
        entity or organization that provides medically accurate, 
        comprehensive maternity services to individuals who are 
        eligible for medical assistance under a State plan under this 
        title or a waiver of such a plan, and may include:
                    ``(A) A freestanding birth center.
                    ``(B) An entity or organization receiving 
                assistance under section 330 of the Public Health 
                Service Act.
                    ``(C) A federally qualified health center.
                    ``(D) A rural health clinic.
                    ``(E) A health facility operated by an Indian tribe 
                or tribal organization (as those terms are defined in 
                section 4 of the Indian Health Care Improvement Act).
            ``(2) Eligible individual.--The term `eligible individual' 
        means a pregnant woman or a formerly pregnant woman during the 
        365-day period beginning on the last day of her pregnancy who 
        is--
                    ``(A) enrolled in a State plan under this title, a 
                waiver of such a plan, or a State child health plan 
                under title XXI; and
                    ``(B) a patient of an eligible entity which has 
                entered into an arrangement with a State under 
                subsection (g).
    ``(c) Goals of Demonstration Project.--The goals of the 
demonstration project are the following:
            ``(1) To improve--
                    ``(A) maternity and infant care outcomes;
                    ``(B) health equity;
                    ``(C) communication by maternity, infant care, and 
                social services providers;
                    ``(D) integration of perinatal support services, 
                including community health workers, doulas, social 
                workers, public health nurses, peer lactation 
                counselors, childbirth educators, and others, into 
                health care entities and organizations;
                    ``(E) care coordination between maternity, infant 
                care, oral health care, and social services providers 
                within the community;
                    ``(F) the quality and safety of maternity and 
                infant care;
                    ``(G) the experience of women receiving maternity 
                care, including by increasing the ability of a woman to 
                develop and follow her own birthing plan; and
                    ``(H) access to adequate prenatal and postpartum 
                care, including--
                            ``(i) prenatal care that is initiated in a 
                        timely manner;
                            ``(ii) not fewer than 2 post-pregnancy 
                        visits to a maternity care provider; and
                            ``(iii) interpregnancy care.
            ``(2) To provide coordinated, evidence-based maternity care 
        management.
            ``(3) To decrease--
                    ``(A) severe maternal morbidity and maternal 
                mortality;
                    ``(B) overall health care spending;
                    ``(C) unnecessary emergency department visits;
                    ``(D) disparities in maternal and infant care 
                outcomes, including racial, economic, and geographical 
                disparities;
                    ``(E) racial bias among health care professionals;
                    ``(F) the rate of cesarean deliveries for low-risk 
                pregnancies;
                    ``(G) the rate of preterm births and infants born 
                with low birth weight; and
                    ``(H) the rate of avoidable maternal and newborn 
                hospitalizations and admissions to intensive care 
                units.
    ``(d) Consultation.--In designing and implementing the 
demonstration project the Secretary shall consult with stakeholders, 
including--
            ``(1) States;
            ``(2) organizations representing relevant health care 
        professionals, including oral health care professionals;
            ``(3) organizations representing consumers, including 
        consumers that are disproportionately impacted by poor maternal 
        health outcomes;
            ``(4) representatives with experience implementing other 
        maternity care home models, including representatives from the 
        Center for Medicare and Medicaid Innovation;
            ``(5) community-based health care professionals, including 
        doulas, and other stakeholders; and
            ``(6) experts in promoting health equity and combating 
        racial bias in health care settings.
    ``(e) Application and Selection of States.--
            ``(1) In general.--A State seeking to participate in the 
        demonstration project shall submit an application to the 
        Secretary at such time and in such manner as the Secretary 
        shall require.
            ``(2) Selection of states.--
                    ``(A) In general.--The Secretary may select 15 
                States to participate in the demonstration project.
                    ``(B) Selection requirements.--In selecting States 
                to participate in the demonstration project, the 
                Secretary shall--
                            ``(i) ensure that there is geographic 
                        diversity in the areas in which activities will 
                        be carried out under the project; and
                            ``(ii) ensure that States with significant 
                        disparities in maternal and infant health 
                        outcomes, including severe maternal morbidity, 
                        and other disparities based on race, income, or 
                        access to maternity care, are included.
    ``(f) Grants.--
            ``(1) In general.--From amounts appropriated under 
        subsection (l), the Secretary shall award 1 grant for each year 
        of the demonstration project to each State that is selected to 
        participate in the demonstration project.
            ``(2) Use of grant funds.--A State may use funds received 
        under this section to--
                    ``(A) award grants or make payments to eligible 
                entities as part of an arrangement described in 
                subsection (g)(2);
                    ``(B) provide financial incentives to health care 
                professionals, including community health workers and 
                community-based doulas, who participate in the State's 
                maternity care home model;
                    ``(C) provide adequate training for health care 
                professionals, including community health workers, 
                doulas, and care coordinators, who participate in the 
                State's maternity care home model, which may include 
                training for cultural competency, racial bias, health 
                equity, reproductive and birth justice, home visiting 
                skills, and respectful communication and listening 
                skills, particularly in regards to maternal health;
                    ``(D) pay for personnel and administrative expenses 
                associated with designing, implementing, and operating 
                the State's maternity care home model;
                    ``(E) pay for items and services that are furnished 
                under the State's maternity care home model and for 
                which payment is otherwise unavailable under this 
                title; and
                    ``(F) pay for other costs related to the State's 
                maternity care home model, as determined by the 
                Secretary.
            ``(3) Grant for national independent evaluator.--
                    ``(A) In general.--From the amounts appropriated 
                under subsection (l), prior to awarding any grants 
                under paragraph (1), the Secretary shall enter into a 
                contract with a national external entity to create a 
                single, uniform process to--
                            ``(i) ensure that States that receive 
                        grants under paragraph (1) comply with the 
                        requirements of this section; and
                            ``(ii) evaluate the outcomes of the 
                        demonstration project in each participating 
                        State.
                    ``(B) Annual report.--The contract described in 
                subparagraph (A) shall require the national external 
                entity to submit to the Secretary--
                            ``(i) a yearly evaluation report for each 
                        year of the demonstration project; and
                            ``(ii) a final impact report after the 
                        demonstration project has concluded.
                    ``(C) Secretary's authority.--Nothing in this 
                paragraph shall prevent the Secretary from making a 
                determination that a State is not in compliance with 
                the requirements of this section without the national 
                external entity making such a determination.
    ``(g) Partnership With Eligible Entities.--
            ``(1) In general.--As a condition of receiving a grant 
        under this section, a State shall enter into an arrangement 
        with one or more eligible entities that meets the requirements 
        of paragraph (2).
            ``(2) Arrangements with eligible entities.--Under an 
        arrangement between a State and an eligible entity under this 
        subsection, the eligible entity shall perform the following 
        functions, with respect to eligible individuals enrolled with 
        the entity under the State's maternity care home model--
                    ``(A) provide culturally competent care, which may 
                include prenatal care, family planning services, 
                medical care, mental and behavioral care, postpartum 
                care, and oral health care to such eligible individuals 
                through a team of health care professionals, which may 
                include obstetrician-gynecologists, maternal-fetal 
                medicine specialists, family physicians, primary care 
                providers, oral health providers, physician assistants, 
                advanced practice registered nurses such as nurse 
                practitioners and certified nurse midwives, certified 
                midwives, certified professional midwives, social 
                workers, traditional and community-based doulas, 
                lactation consultants, childbirth educators, community 
                health workers, and other health care professionals;
                    ``(B) conduct a risk assessment of each such 
                eligible individual to determine if her pregnancy is 
                high or low risk, and establish a tailored pregnancy 
                care plan, which takes into consideration the 
                individual's own preferences and pregnancy care and 
                birthing plans and determines the appropriate support 
                services to reduce the individual's medical, social, 
                and environmental risk factors, for each such eligible 
                individual based on the results of such risk 
                assessment;
                    ``(C) assign each such eligible individual to a 
                care coordinator, which may be a nurse, social worker, 
                traditional or community-based doula, community health 
                worker, midwife, or other health care provider, who is 
                responsible for ensuring that such eligible individual 
                receives the necessary medical care and connections to 
                essential support services;
                    ``(D) provide, or arrange for the provision of, 
                essential support services, such as services that 
                address--
                            ``(i) nutrition and exercise;
                            ``(ii) smoking cessation;
                            ``(iii) substance use disorder and 
                        addiction treatment;
                            ``(iv) anxiety, depression, and other 
                        mental and behavioral health issues;
                            ``(v) breast feeding initiation, 
                        continuation, and duration;
                            ``(vi) housing;
                            ``(vii) transportation;
                            ``(viii) intimate partner violence;
                            ``(ix) home visiting services;
                            ``(x) childbirth education;
                            ``(xi) oral health education;
                            ``(xii) continuous labor support; and
                            ``(xiii) group prenatal care;
                    ``(E) as appropriate, facilitate connections to a 
                usual primary care provider, which may be a women's 
                health provider;
                    ``(F) refer to guidelines and opinions of medical 
                associations when determining whether an elective 
                delivery should be performed on an eligible individual 
                before 39 weeks of gestation;
                    ``(G) provide such eligible individuals with 
                evidence-based education and resources to identify 
                potential warning signs of pregnancy and postpartum 
                complications and when and how to obtain medical 
                attention;
                    ``(H) provide, or arrange for the provision of, 
                pregnancy and postpartum health services, including 
                family planning counseling and services, to eligible 
                individuals;
                    ``(I) track and report birth outcomes of such 
                eligible individuals and their children;
                    ``(J) ensure that care is patient-led, including by 
                engaging eligible individuals in their own care, 
                including through communication and education; and
                    ``(K) ensure adequate training for appropriately 
                serving the population of individuals eligible for 
                medical assistance under the State plan or waiver of 
                such plan, including through reproductive and birth 
                justice frameworks, race equity awareness, home 
                visiting skills, and knowledge of social services.
    ``(h) Term of Demonstration Project.--The Secretary shall conduct 
the demonstration project for a period of 5 years.
    ``(i) Waiver Authority.--To the extent that the Secretary 
determines necessary in order to carry out the demonstration project, 
the Secretary may waive section 1902(a)(1) (relating to statewideness) 
and section 1902(a)(10)(B) (relating to comparability).
    ``(j) Technical Assistance.--The Secretary shall establish a 
process to provide technical assistance to States that are awarded 
grants under this section and to eligible entities and other providers 
participating in a State maternity care home model funded by such a 
grant.
    ``(k) Report.--
            ``(1) In general.--Not later than 18 months after the date 
        of the enactment of this section and annually thereafter for 
        each year of the demonstration project term, the Secretary 
        shall submit a report to Congress on the results of the 
        demonstration project.
            ``(2) Final report.--As part of the final report required 
        under paragraph (1), the Secretary shall include--
                    ``(A) the results of the final report of the 
                national external entity required under subsection 
                (f)(3)(B)(ii); and
                    ``(B) recommendations on whether the model studied 
                in the demonstration project should be continued or 
                more widely adopted, including by private health plans.
    ``(l) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary, for each of fiscal years 2019 through 
2026, such sums as may be necessary to carry out this section.''.

SEC. 4. REAPPLICATION OF MEDICARE PAYMENT RATE FLOOR TO PRIMARY CARE 
              SERVICES FURNISHED UNDER MEDICAID AND INCLUSION OF 
              ADDITIONAL PROVIDERS.

    (a) Reapplication of Payment Floor; Additional Providers.--
            (1) In general.--Section 1902(a)(13) of the Social Security 
        Act (42 U.S.C. 1396a(a)(13)) is amended--
                    (A) in subparagraph (B), by striking ``; and'' and 
                inserting a semicolon;
                    (B) in subparagraph (C), by striking the semicolon 
                and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) payment for primary care services (as defined 
                in subsection (jj)(1)) furnished in the period that 
                begins on the first day of the first month that begins 
                after the date of enactment of the Maximizing Outcomes 
                for Moms through Medicaid Improvement and Enhancement 
                of Services Act by a provider described in subsection 
                (jj)(2)--
                            ``(i) at a rate that is not less than 100 
                        percent of the payment rate that applies to 
                        such services and the provider of such services 
                        under part B of title XVIII (or, if greater, 
                        the payment rate that would be applicable under 
                        such part if the conversion factor under 
                        section 1848(d) for the year were the 
                        conversion factor under such section for 2009);
                            ``(ii) in the case of items and services 
                        that are not items and services provided under 
                        such part, at a rate to be established by the 
                        Secretary; and
                            ``(iii) in the case of items and services 
                        that are furnished in rural areas (as defined 
                        in section 1886(d)(2)(D)), health professional 
                        shortage areas (as defined in section 
                        332(a)(1)(A) of the Public Health Service Act 
                        (42 U.S.C. 254e(a)(1)(A))), or medically 
                        underserved areas (according to a designation 
                        under section 330(b)(3)(A) of the Public Health 
                        Service Act (42 U.S.C. 254b(b)(3)(A))), at the 
                        rate otherwise applicable to such items or 
                        services under clause (i) or (ii) increased, at 
                        the Secretary's discretion, by not more than 25 
                        percent;''.
            (2) Conforming amendments.--
                    (A) Section 1902(a)(13)(C) of the Social Security 
                Act (42 U.S.C. 1396a(a)(13)(C)) is amended by striking 
                ``subsection (jj)'' and inserting ``subsection 
                (jj)(1)''.
                    (B) Section 1905(dd) of the Social Security Act (42 
                U.S.C. 1396d(dd)) is amended--
                            (i) by striking ``Notwithstanding'' and 
                        inserting the following:
            ``(1) In general.--Notwithstanding'';
                            (ii) by striking ``section 1902(a)(13)(C)'' 
                        and inserting ``subparagraph (C) of section 
                        1902(a)(13)'';
                            (iii) by inserting ``or for services 
                        described in subparagraph (D) of section 
                        1902(a)(13) furnished during an additional 
                        period specified in paragraph (2),'' after 
                        ``2015,'';
                            (iv) by striking ``under such section'' and 
                        inserting ``under subparagraph (C) or (D) of 
                        section 1902(a)(13), as applicable''; and
                            (v) by adding at the end the following:
            ``(2) Additional periods.--For purposes of paragraph (1), 
        the following are additional periods:
                    ``(A) The period that begins on the first day of 
                the first month that begins after the date of enactment 
                of the Maximizing Outcomes for Moms through Medicaid 
                Improvement and Enhancement of Services Act.''.
    (b) Improved Targeting of Primary Care.--Section 1902(jj) of the 
Social Security Act (42 U.S.C. 1396a(jj)) is amended--
            (1) by redesignating paragraphs (1) and (2) as clauses (i) 
        and (ii), respectively and realigning the left margins 
        accordingly;
            (2) by striking ``For purposes of subsection (a)(13)(C)'' 
        and inserting the following:
            ``(1) In general.--
                    ``(A) Definition.--For purposes of subparagraphs 
                (C) and (D) of subsection (a)(13)''; and
            (3) by inserting after clause (ii) (as so redesignated) the 
        following:
                    ``(B) Exclusions.--Such term does not include any 
                services described in subparagraph (A) or (B) of 
                paragraph (1) if such services are provided in an 
                emergency department of a hospital.
            ``(2) Additional providers.--For purposes of subparagraph 
        (D) of subsection (a)(13), a provider described in this 
        paragraph is any of the following:
                    ``(A) A physician with a primary specialty 
                designation of family medicine, general internal 
                medicine, or pediatric medicine, or obstetrics and 
                gynecology.
                    ``(B) An advanced practice clinician, as defined by 
                the Secretary, that works under the supervision of--
                            ``(i) a physician that satisfies the 
                        criteria specified in subparagraph (A);
                            ``(ii) a nurse practitioner or a physician 
                        assistant (as such terms are defined in section 
                        1861(aa)(5)(A)) who is working in accordance 
                        with State law; or
                            ``(iii) or a certified nurse-midwife (as 
                        defined in section 1861(gg)) who is working in 
                        accordance with State law.
                    ``(C) A rural health clinic, federally qualified 
                health center, or other health clinic that receives 
                reimbursement on a fee schedule applicable to a 
                physician.
                    ``(D) An advanced practice clinician supervised by 
                a physician described in subparagraph (A), another 
                advanced practice clinician, or a certified nurse-
                midwife.''.
    (c) Ensuring Payment by Managed Care Entities.--
            (1) In general.--Section 1903(m)(2)(A) of the Social 
        Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
                    (A) in clause (xii), by striking ``and'' after the 
                semicolon;
                    (B) by realigning the left margin of clause (xiii) 
                so as to align with the left margin of clause (xii) and 
                by striking the period at the end of clause (xiii) and 
                inserting ``; and''; and
                    (C) by inserting after clause (xiii) the following:
            ``(xiv) such contract provides that (I) payments to 
        providers specified in section 1902(a)(13)(D) for primary care 
        services defined in section 1902(jj) that are furnished during 
        a year or period specified in section 1902(a)(13)(D) and 
        section 1905(dd) are at least equal to the amounts set forth 
        and required by the Secretary by regulation, (II) the entity 
        shall, upon request, provide documentation to the State, 
        sufficient to enable the State and the Secretary to ensure 
        compliance with subclause (I), and (III) the Secretary shall 
        approve payments described in subclause (I) that are furnished 
        through an agreed upon capitation, partial capitation, or other 
        value-based payment arrangement if the capitation, partial 
        capitation, or other value-based payment arrangement is based 
        on a reasonable methodology and the entity provides 
        documentation to the State sufficient to enable the State and 
        the Secretary to ensure compliance with subclause (I).''.
            (2) Conforming amendment.--Section 1932(f) of the Social 
        Security Act (42 U.S.C. 1396u-2(f)) is amended--
                    (A) by striking ``section 1902(a)(13)(C)'' and 
                inserting ``subsections (C) and (D) of section 
                1902(a)(13)''; and
                    (B) by inserting ``and clause (xiv) of section 
                1903(m)(2)(A)'' before the period.

SEC. 5. MACPAC REPORT AND CMS GUIDANCE ON INCREASING ACCESS TO DOULA 
              CARE FOR MEDICAID BENEFICIARIES.

    (a) MACPAC Report.--
            (1) 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 care under 
        State Medicaid programs, which shall at a minimum include the 
        following:
                    (A) Information about coverage for doula care under 
                State Medicaid programs that currently provide coverage 
                for such care, including the type of doula care offered 
                (such as prenatal, labor and delivery, postpartum 
                support, and also community-based and traditional doula 
                care).
                    (B) An analysis of barriers to covering doula care 
                under State Medicaid programs.
                    (C) An identification of effective strategies to 
                increase the use of doula care 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.
                    (D) Recommendations for legislative and 
                administrative actions to increase access to doula care 
                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.
            (2) Stakeholder consultation.--In developing the report 
        required under paragraph (1), MACPAC shall consult with 
        relevant stakeholders, including--
                    (A) States;
                    (B) organizations representing consumers, including 
                those that are disproportionately impacted by poor 
                maternal health outcomes;
                    (C) organizations and individuals representing 
                doula care providers, including community-based doula 
                programs and those who serve underserved communities, 
                including communities of color, and communities facing 
                linguistic or cultural barriers; and
                    (D) organizations representing health care 
                providers.
    (b) CMS Guidance.--
            (1) In general.--Not later than 1 year after the date that 
        MACPAC publishes the report required under subsection (a)(1), 
        the Administrator of the Centers for Medicare & Medicaid 
        Services shall issue guidance to States on increasing access to 
        doula care under Medicaid. Such guidance shall at a minimum 
        include--
                    (A) options for States to provide medical 
                assistance for doula care services under State Medicaid 
                programs;
                    (B) best practices for ensuring that doulas, 
                including community-based doulas, receive reimbursement 
                for doula care services provided under a State Medicaid 
                program, at a level that allows doulas to earn a living 
                wage that accounts for their time and costs associated 
                with providing care; and
                    (C) best practices for increasing access to doula 
                care services, including services provided by 
                community-based doulas, under State Medicaid programs.
            (2) Stakeholder consultation.--In developing the guidance 
        required under paragraph (1), the Administrator of the Centers 
        for Medicare & Medicaid Services shall consult with MACPAC and 
        other relevant stakeholders, including--
                    (A) State Medicaid officials;
                    (B) organizations representing consumers, including 
                those that are disproportionately impacted by poor 
                maternal health outcomes;
                    (C) organizations representing doula care 
                providers, including community-based doulas and those 
                who serve underserved communities, such as communities 
                of color and communities facing linguistic or cultural 
                barriers; and
                    (D) organizations representing health care 
                professionals.

SEC. 6. GAO REPORT ON STATE MEDICAID PROGRAMS' USE OF TELEMEDICINE TO 
              INCREASE ACCESS TO MATERNITY CARE.

    Not later than 1 year after the date of the enactment of this Act, 
the Comptroller General of the United States shall submit a report to 
Congress on State Medicaid programs' use of telemedicine to increase 
access to maternity care. Such report shall include the following:
            (1) The number of State Medicaid programs that utilize 
        telemedicine to increase access to maternity care.
            (2) With respect to State Medicaid programs that utilize 
        telemedicine to increase access to maternity care, information 
        about--
                    (A) common characteristics of such programs' 
                approaches to utilizing telemedicine to increase access 
                to maternity care; and
                    (B) what is known about--
                            (i) the demographic characteristics of the 
                        individuals enrolled in such programs who use 
                        telemedicine to access maternity care;
                            (ii) health outcomes for such individuals 
                        as compared to individuals with similar 
                        characteristics who did not use telemedicine to 
                        access maternity care;
                            (iii) the services provided to individuals 
                        through telemedicine, including family planning 
                        services and oral health services;
                            (iv) the quality of maternity care provided 
                        through telemedicine, including whether 
                        maternity care provided through telemedicine is 
                        culturally competent;
                            (v) the level of patient satisfaction with 
                        maternity care provided through telemedicine to 
                        individuals enrolled in State Medicaid 
                        programs; and
                            (vi) the impact of utilizing telemedicine 
                        to increase access to maternity care on 
                        spending, cost savings, access to care, and 
                        utilization of care under State Medicaid 
                        programs.
            (3) An identification and analysis of the barriers to using 
        telemedicine to increase access to maternity care under State 
        Medicaid programs.
            (4) Recommendations for such legislative and administrative 
        actions related to increasing access to telemedicine maternity 
        services under Medicaid as the Comptroller General deems 
        appropriate.
                                 <all>
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