(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 Maximizing Outcomes 
for Moms through Medicaid Improvement and 
Enhancement of Services 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; 
(2) by striking ‘‘For purposes of subsection 
(a)(13)(C)’’ and inserting the following: 
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‘‘(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— 
‘‘(i) a physician that satisfies the cri-
teria specified in subparagraph (A); 
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‘‘(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)) or a certified 
professional midwife who is working in ac-
cordance with State law. 
‘‘(C) A rural health clinic, federally quali-
fied health center, health center that receives 
funding under title X of the Public Health 
Service Act, or other health clinic that receives 
reimbursement on a fee schedule applicable 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. 
‘‘(E) A midwife who is working in accord-
ance with State law.’’. 
(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— 
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(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 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 
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to enable the State and the Secretary to ensure com-
pliance 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 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 SERVICES FOR MED-
ICAID 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 services under 
State Medicaid programs, which shall at a minimum 
include the following: 
(A) Information about coverage for doula 
services under State Medicaid programs that 
currently provide coverage for such care, includ-
ing the type of doula services offered (such as 
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prenatal, labor and delivery, postpartum sup-
port, and community-based and traditional 
doula services), credentialing and provider en-
rollment requirements for doulas under State 
Medicaid programs, additional forms of support 
contributing to doula enrollment and reimburse-
ment under State Medicaid programs, and data 
on outcomes with respect to doula services 
under each State Medicaid program, including 
the number of doulas registered under the State 
Medicaid program, the number of pregnant, 
birthing, and postpartum people served by 
doulas under the State Medicaid program, and 
the amount of time it takes for doulas to re-
ceive payment under the State Medicaid pro-
gram for services provided under the program. 
(B) An analysis of barriers to covering 
doula services under State Medicaid programs. 
(C) An identification of effective strategies 
to increase the use of doula services in order to 
provide better care and achieve better maternal 
and infant health outcomes, including strategies 
that States may use to recruit, train, sutain, 
and certify a diverse doula workforce, particu-
larly from underserved communities, commu-
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nities of color, and communities facing lin-
guistic or cultural barriers. 
(D) Recommendations for legislative and 
administrative actions to increase access to 
doula services in State Medicaid programs, in-
cluding actions that ensure doulas may earn a 
sustainable living wage that accounts for their 
time and costs associated with providing care 
and community-based doula program adminis-
tration and operation. 
(2) STAKEHOLDER CONSULTATION.—In devel-
oping the report required under paragraph (1), 
MACPAC shall consult with relevant stakeholders, 
including— 
(A) States; 
(B) organizations, especially reproductive 
justice and birth justice organizations led by 
people of color, representing consumers of ma-
ternal health care, including those that are dis-
proportionately impacted by poor maternal 
health outcomes; 
(C) organizations and individuals rep-
resenting doulas, including community-based 
doula programs and those who serve under-
served communities, including communities of 
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color, and communities facing linguistic or cul-
tural barriers; 
(D) organizations representing health care 
providers; and 
(E) Black, Indigenous, and other maternal 
health care consumers of color who have experi-
enced severe maternal morbidity. 
(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 services under Medicaid. Such guidance shall 
at a minimum include— 
(A) options for States to provide medical 
assistance for doula services under State Med-
icaid programs; 
(B) best practices for ensuring that doulas, 
including community-based doulas, receive reim-
bursement for doula 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 
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care and community-based doula program ad-
ministration; and 
(C) best practices for increasing access to 
doula services, including services provided by 
community-based doulas, under State Medicaid 
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 
of maternal health care, including those that 
are disproportionately impacted by poor mater-
nal health outcomes; 
(C) organizations representing doulas, in-
cluding community-based doulas and those who 
serve underserved communities, such as com-
munities of color and communities facing lin-
guistic or cultural barriers; 
(D) organizations representing medical 
professionals; and 
(E) maternal health advocacy organiza-
tions. 
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SEC. 6. GAO REPORT ON STATE MEDICAID PROGRAMS’ USE 
OF TELEHEALTH 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 telehealth to increase access to maternity 
care. Such report shall include the following: 
(1) The number of State Medicaid programs 
that utilize telehealth that increases access to mater-
nity care. 
(2) With respect to State Medicaid programs 
that utilize telehealth that increases access to mater-
nity care, information about— 
(A) common characteristics of such pro-
grams’ approaches to utilizing telehealth that 
increases access to maternity care; 
(B) differences in States’ approaches to 
utilizing telehealth to improve access to mater-
nity care, and the resulting differences in State 
maternal health outcomes, as determined by 
factors described in subsection (C); and 
(C) when compared to patients who receive 
maternity care in-person, what is known 
about— 
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(i) the demographic characteristics, 
such as race, ethnicity, sex, sexual orienta-
tion, gender identity, disability status, age, 
and preferred language of the individuals 
enrolled in such programs who use tele-
health to access maternity care; 
(ii) health outcomes for such individ-
uals, including frequency of mortality and 
severe morbidity, as compared to individ-
uals with similar characteristics who did 
not use telehealth to access maternity care; 
(iii) the services provided to individ-
uals through telehealth, including family 
planning services, mental health care serv-
ices, and oral health services; 
(iv) the devices and equipment pro-
vided to individuals for remote patient 
monitoring and telehealth, including blood 
pressure monitors and blood glucose mon-
itors; 
(v) the quality of maternity care pro-
vided through telehealth, including whether 
maternity care provided through telehealth 
is culturally and linguistically appropriate; 
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(vi) the level of patient satisfaction 
with an experience of maternity care pro-
vided through telehealth to individuals en-
rolled in State Medicaid programs; 
(vii) the impact of utilizing telehealth 
to increase access to maternity care on 
spending, cost savings, access to care, and 
utilization of care under State Medicaid 
programs; and 
(viii) the accessibility and effectiveness 
of telehealth for maternity care during the 
COVID–19 pandemic. 
(3) An identification and analysis of the bar-
riers to using telehealth to increase access to mater-
nity care under State Medicaid programs. 
(4) Recommendations for such legislative and 
administrative actions related to increasing access to 
telehealth maternity services under Medicaid as the 
Comptroller General deems appropriate. 
Æ 
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