Optimizing Postpartum Outcomes Act of 2023

To direct the Secretary of Health and Human Services to issue guidance on coverage under the Medicaid program under title XIX of the Social Security Act of certain pelvic health services furnished during the postpartum period, and for other purposes. 1. Short title This Act may be cited as the Optimizing Postpartum Outcomes Act of 2023 2. CMS guidance (a) In general Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue guidance on coverage under State plans (or waivers of such plans) under the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. 42 U.S.C. 1397aa et seq. (1) best practices from States with respect to innovative or evidenced-based payment models to increase access to covered pelvic health services; (2) recommendations for States on available financing options under— (A) the Medicaid program under title XIX of such Act ( 42 U.S.C. 1396 et seq. (B) the Children’s Health Insurance Program under title XXI of such Act ( 42 U.S.C. 1397aa et seq. (3) guidance and technical assistance to State agencies responsible for administering State plans (or waivers of such plans) under the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. (4) guidance regarding suggested terminology and diagnosis codes, such as the International Classification of Diseases code set, to identify women with pelvic floor dysfunction and disorders. (b) GAO study Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study on, and submit to Congress a report that addresses, gaps in coverage for— (1) covered pelvic health services under State plans (or waivers of such plans) under the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. (2) other services for postpartum women who received medical assistance under a State plan (or a waiver of such plan) under the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. (c) Definitions In this section: (1) The term postpartum period (2) The term covered pelvic health services (A) (B) pelvic health physical therapy (as defined in such section 317L–2). 3. Postpartum pelvic health education campaign Part B of title III of the Public Health Service Act ( 42 U.S.C. 243 et seq. 42 U.S.C. 247b–13a 317L–2. Postpartum pelvic health education campaign (a) In general The Secretary, acting through the Director of the Centers for Disease Control and Prevention, in collaboration with the Administrator of the Health Resources and Services Administration and the heads of other agencies, and in consultation with appropriate health professional associations, shall develop and carry out a program— (1) to educate and train health professionals on pelvic floor examinations and the benefits of pelvic health physical therapy; and (2) to educate postpartum women on— (A) with respect to pelvic floor examinations— (i) the importance of such examinations during the postpartum period; (ii) how to obtain such an examination, including information relating to obtaining referrals; and (iii) what is involved in such an examination; and (B) with respect to pelvic health physical therapy— (i) the benefits of, and availability of such physical therapy; and (ii) how to obtain a referral for such physical therapy. (b) Definitions In this section: (1) The term pelvic floor examination (A) an external evaluation that includes analysis of posture, joint integrity, muscle performance, quality of movement, and palpation and observation of the pelvic floor; and (B) if deemed necessary based on the health care professional’s clinical reasoning, an internal vaginal or rectal examination, or both, to gather relevant information about the tone, strength, control, ability to contract and relax the muscles of the pelvic floor individually and together, the condition of the surrounding fascia, and the position of the organs. (2) The term pelvic health physical therapy (3) The term pelvic health related condition (c) Authorization of appropriations There are authorized to be appropriated to carry out this section $2,000,000 for each of fiscal years 2024 through 2028. .

Summary: Optimizing Postpartum Outcomes Act of 2023 This bill requires (1) the Centers for Medicare & Medicaid Services to issue guidance to support coverage of prenatal and postpartum pelvic health services under Medicaid and the Children's Health Insurance Program (CHIP), (2) the Government Accountability Office to study gaps in Medicaid coverage of these and other services for postpartum women, and (3) the Centers for Disease Control and Prevention to educate health professionals and postpartum women on pelvic health services.