‘‘(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 iden-
tify 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 serv-
ices, to eligible individuals; 
‘‘(I) track and report birth outcomes of 
such eligible individuals and their children; 
‘‘(J) ensure that care is patient-led, includ-
ing by engaging eligible individuals in their own 
care, including through communication and 
education; and 
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‘‘(K) ensure adequate training for appro-
priately serving the population of individuals el-
igible 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 demonstra-
tion project term, the Secretary shall submit a re-
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port to Congress on the results of the demonstration 
project. 
‘‘(2) FINAL REPORT.—As part of the final re-
port required under paragraph (1), the Secretary 
shall include— 
‘‘(A) the results of the final report of the 
national external entity required under sub-
section (f)(3)(B)(ii); and 
‘‘(B) recommendations on whether the 
model studied in the demonstration project 
should be continued or more widely adopted, in-
cluding 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 FUR-
NISHED UNDER MEDICAID AND INCLUSION 
OF ADDITIONAL PROVIDERS. 
(a) REAPPLICATION
OF PAYMENT FLOOR; ADDI-
TIONAL PROVIDERS.— 
(1) IN GENERAL.—Section 1902(a)(13) of the 
Social Security Act (42 U.S.C. 1396a(a)(13)) is 
amended— 
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(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 Healthy MOMMIES 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 conver-
sion 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 
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‘‘(iii) in the case of items and services 
that are furnished in rural areas (as de-
fined 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 other-
wise 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 in-
serting ‘‘subsection (jj)(1)’’. 
(B) Section 1905(dd) of the Social Secu-
rity Act (42 U.S.C. 1396d(dd)) is amended— 
(i) by striking ‘‘Notwithstanding’’ and 
inserting the following: 
‘‘(1) IN GENERAL.—Notwithstanding’’; 
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(ii) 
by 
striking 
‘‘section 
1902(a)(13)(C)’’ and inserting ‘‘subpara-
graph (C) of section 1902(a)(13)’’; 
(iii) by inserting ‘‘or for services de-
scribed 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 Healthy MOMMIES 
Act.’’. 
(b) IMPROVED TARGETING OF PRIMARY CARE.—Sec-
tion 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; 
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(2) by striking ‘‘For purposes of subsection 
(a)(13)(C)’’ and inserting the following: 
‘‘(1) IN GENERAL.— 
‘‘(A) DEFINITION.—For purposes of sub-
paragraphs (C) and (D) of subsection (a)(13)’’; 
and 
(3) by inserting after clause (ii) (as so redesig-
nated) 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 hos-
pital. 
‘‘(2) ADDITIONAL
PROVIDERS.—For purposes 
of subparagraph (D) of subsection (a)(13), a pro-
vider described in this paragraph is any of the fol-
lowing: 
‘‘(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 de-
fined by the Secretary, that works under the 
supervision of— 
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‘‘(i) a physician that satisfies the cri-
teria specified in subparagraph (A); 
‘‘(ii) a nurse practitioner or a physi-
cian 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 work-
ing in accordance with State law. 
‘‘(C) A rural health clinic, federally quali-
fied health center, or other health clinic that re-
ceives reimbursement on a fee schedule applica-
ble to a physician. 
‘‘(D) An advanced practice clinician super-
vised by a physician described in subparagraph 
(A), another advanced practice clinician, or a 
certified nurse-midwife.’’. 
(c) ENSURING PAYMENT BY MANAGED CARE ENTI-
TIES.— 
(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; 
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(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 fol-
lowing: 
‘‘(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 sub-
clause (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 arrange-
ment is based on a reasonable methodology and the 
entity provides documentation to the State sufficient 
to enable the State and the Secretary to ensure com-
pliance with subclause (I).’’. 
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(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 sec-
tion 1902(a)(13)’’; and 
(B) by inserting ‘‘and clause (xiv) of sec-
tion 1903(m)(2)(A)’’ before the period. 
SEC. 5. MACPAC REPORT AND CMS GUIDANCE ON INCREAS-
ING 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 (re-
ferred to in this section as ‘‘MACPAC’’) shall pub-
lish 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 cur-
rently provide coverage for such care, including 
the type of doula care offered (such as prenatal, 
labor and delivery, postpartum support, and 
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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 cer-
tify 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, includ-
ing actions that ensure doulas may earn a living 
wage that accounts for their time and costs as-
sociated with providing care. 
(2) STAKEHOLDER CONSULTATION.—In devel-
oping the report required under paragraph (1), 
MACPAC shall consult with relevant stakeholders, 
including— 
(A) States; 
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(B) organizations representing consumers, 
including those that are disproportionately im-
pacted by poor maternal health outcomes; 
(C) organizations and individuals rep-
resenting doula care providers, including com-
munity-based doula programs and those who 
serve underserved communities, including com-
munities of color, and communities facing lin-
guistic 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 re-
quired 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 reim-
bursement for doula care services provided 
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under a State Medicaid program, at a level that 
allows doulas to earn a living wage that ac-
counts 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 Med-
icaid programs. 
(2) STAKEHOLDER CONSULTATION.—In devel-
oping 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 im-
pacted 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. 
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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 pro-
grams’ 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 mater-
nity care. 
(2) With respect to State Medicaid programs 
that utilize telemedicine to increase access to mater-
nity care, information about— 
(A) common characteristics of such pro-
grams’ 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 individ-
uals as compared to individuals with simi-
lar characteristics who did not use tele-
medicine to access maternity care; 
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(iii) the services provided to individ-
uals through telemedicine, including family 
planning services and oral health services; 
(iv) the quality of maternity care pro-
vided 
through 
telemedicine, 
including 
whether maternity care provided through 
telemedicine is culturally competent; 
(v) the level of patient satisfaction 
with maternity care provided through tele-
medicine to individuals enrolled in State 
Medicaid programs; and 
(vi) the impact of utilizing telemedi-
cine to increase access to maternity care 
on spending, cost savings, access to care, 
and utilization of care under State Med-
icaid programs. 
(3) An identification and analysis of the bar-
riers to using telemedicine to increase access to ma-
ternity 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. 
Æ 
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