Title: Healthy MOM Act
Policy area: Health

Summary:
Healthy Maternity and Obstetric Medicine Act or the Healthy MOM Act
This bill expands health insurance coverage availability for pregnant individuals. It requires health insurers, health insurance exchanges, and group health plans to offer a special enrollment period to pregnant individuals. The special enrollment period offered by an insurer or exchange must begin when the pregnancy is reported to the insurer or exchange. The special enrollment period offered by a group health plan must begin when the pregnancy is reported to the plan or is confirmed by a health care provider. The bill also makes pregnancy a qualifying life event for the purpose of enrolling in a federal employee health benefit plan.
Additionally, a group health plan or health insurer that covers dependents must provide coverage for maternity care to all covered individuals.
Any individual who is eligible for Medicaid and is, or becomes, pregnant maintains such eligibility for one year after the end of the pregnancy. The bill revises the range in which a state must establish a maximum level of family income for pregnant women and infants to be eligible for Medicaid. The upper limit of the range is eliminated and the lower limit is set to the level in place on January 1, 2014.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1481 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 1481

To amend title XXVII of the Public Health Service Act to provide for a 
 special enrollment period for pregnant women, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 15, 2019

  Mr. Brown (for himself, Ms. Smith, Mrs. Gillibrand, Mr. Markey, Ms. 
  Klobuchar, Mr. Tester, Ms. Hassan, Mr. Blumenthal, Ms. Harris, Mr. 
 Casey, Mr. Whitehouse, Mr. Booker, Mr. Merkley, Mr. Peters, Mr. King, 
Ms. Rosen, Mr. Leahy, Ms. Cortez Masto, Ms. Baldwin, Mr. Jones, and Mr. 
Kaine) introduced the following bill; which was read twice and referred 
                      to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XXVII of the Public Health Service Act to provide for a 
 special enrollment period for pregnant women, and for other purposes.

    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 ``Healthy Maternity and Obstetric 
Medicine Act'' or the ``Healthy MOM Act''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress finds the following:
            (1) Pregnancy is a significant life event for millions of 
        women in the United States each year.
            (2) For more than 30 years, our Nation, through the 
        Medicaid program, has recognized that pregnant women need 
        immediate access to affordable care, and has allowed women who 
        meet income-eligibility requirements to enroll in Medicaid 
        coverage when they become pregnant.
            (3) Congress recognized the central importance of maternity 
        coverage by classifying maternity and newborn care as one of 
        the ten essential health benefits that must now be covered on 
        most individual and small group health insurance plans under 
        section 1302(b)(1) of the Patient Protection and Affordable 
        Care Act (42 U.S.C. 18022(b)(1)).
            (4) Congress has also recognized the significant challenge 
        of maternal mortality and the need to eliminate disparities in 
        maternal health outcomes for pregnancy-related and pregnancy-
        associated deaths, and to improve health outcomes for both 
        mothers and babies through passage of the Preventing Maternal 
        Deaths Act of 2018 (Public Law 115-344).
            (5) Access to comprehensive maternity coverage allows women 
        to access important pregnancy-related care, which is 
        demonstrated to improve health outcomes for women and newborns 
        and reduce financial costs for both consumers and insurers.
            (6) Uninsured women, women with grandfathered and 
        transitional health plans, self-funded student health plans, 
        and catastrophic and high-deductible health plans may lack 
        access to comprehensive and affordable maternity coverage.
            (7) Employer health plans that exclude dependent daughters 
        from maternity coverage leave young women without coverage for 
        their pregnancy, even though Federal law has long held that 
        treating pregnancy differently than other conditions is sex-
        based discrimination.
            (8) A special enrollment period is especially important for 
        young adults, who are at high risk for unintended pregnancies, 
        yet young adults are frequently enrolled in catastrophic 
        coverage, which often has fewer benefits, more restrictions, 
        and higher deductibles.
            (9) This coverage would be an equalizer for communities of 
        color. The maternal mortality rate varies drastically by race 
        and ethnicity, and where a woman lives. The rising maternal 
        mortality rate in the United States is driven predominantly by 
        the disproportionately high African-American maternal mortality 
        rate, which is four times more than the rate for White women.
            (10) According to the Centers for Disease Control and 
        Prevention, about 700 women die each year in the United States 
        from pregnancy-related complications. Black and American 
        Indian/Alaska Native women are about three times more likely to 
        die from a pregnancy-related cause than White women.
            (11) Data demonstrates that 3 in 5 pregnancy-related deaths 
        could be prevented. Improving access to care is one way to help 
        prevent deaths, regardless of race or ethnicity.
            (12) Timely maternity care improves the health of pregnant 
        women, as well as birth outcomes and the health of babies 
        throughout their lifetimes. Pregnancy-related maternal 
        mortality is three to four times higher among women who receive 
        no maternity care compared to women who do. Regular maternity 
        care can detect or mitigate serious pregnancy-related health 
        complications, including preeclampsia, placental abruption, 
        complications from diabetes, complications from heart disease, 
        and Graves' disease, all of which can result in morbidity or 
        mortality for the mother or newborn.
            (13) The Centers for Disease Control and Prevention reports 
        that more than half of all maternal deaths occur at delivery or 
        in the first postpartum year, whereas just more than one-third 
        of pregnancy-related or pregnancy-associated deaths occur while 
        a person is still pregnant. Yet, for women eligible for the 
        Medicaid program on the basis of pregnancy, such Medicaid 
        coverage lapses at the end of the month on which the 60th 
        postpartum day lands.
            (14) Timely maternity care and adequate postpartum care can 
        reduce short- and long-term health care costs. If a woman does 
        not have access to affordable maternity care during her 
        pregnancy, and she or her newborn experiences pregnancy 
        complications that result in health problems after birth, their 
        insurer may end up paying much higher costs than if the insurer 
        had covered the woman's maternity care during her pregnancy. 
        Intensive maternity care can reduce hospital and neonatal 
        intensive care unit admissions among infants, resulting in cost 
        savings of $1,768 to $5,560 per birth. For women with high-risk 
        pregnancies, intensive maternity care saves $1.37 for every $1 
        invested in maternity care.
    (b) Purpose.--The purpose of this Act is to protect the health of 
women and newborns by ensuring that all women eligible for coverage 
through the Exchanges established under title I of the Patient 
Protection and Affordable Care Act (Public Law 111-148) and women 
eligible for other individual or group health plan coverage can access 
affordable health coverage during their pregnancy.

SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD FOR PREGNANT 
              INDIVIDUALS.

    (a) Public Health Service Act.--Section 2702(b)(2) of the Public 
Health Service Act (42 U.S.C. 300gg-1(b)(2)) is amended by inserting 
``including a special enrollment period for pregnant individuals, 
beginning on the date on which the pregnancy is reported to the health 
insurance issuer'' before the period at the end.
    (b) Patient Protection and Affordable Care Act.--Section 1311(c)(6) 
of the Patient Protection and Affordable Care Act (42 U.S.C. 
18031(c)(6)) is amended--
            (1) in subparagraph (C), by striking ``and'' at the end;
            (2) by redesignating subparagraph (D) as subparagraph (E); 
        and
            (3) by inserting after subparagraph (C) the following new 
        subparagraph:
                    ``(D) a special enrollment period for pregnant 
                individuals, beginning on the date on which the 
                pregnancy is reported to the Exchange; and''.
    (c) Special Enrollment Periods.--
            (1) Internal revenue code.--Section 9801(f) of the Internal 
        Revenue Code of 1986 (26 U.S.C. 9801(f)) is amended by adding 
        at the end the following new paragraph:
            ``(4) For pregnant individuals.--
                    ``(A) A group health plan shall permit an employee 
                who is eligible, but not enrolled, for coverage under 
                the terms of the plan (or a dependent of such an 
                employee if the dependent is eligible, but not 
                enrolled, for coverage under such terms) to enroll for 
                coverage under the terms of the plan upon pregnancy, 
                with the special enrollment period beginning on the 
                date on which the pregnancy is reported to the group 
                health plan or the pregnancy is confirmed by a health 
                care provider.
                    ``(B) The Secretary shall promulgate regulations 
                with respect to the special enrollment period under 
                subparagraph (A), including establishing a time period 
                for pregnant individuals to enroll in coverage and 
                effective date of such coverage.''.
            (2) ERISA.--Section 701(f) of the Employee Retirement 
        Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by 
        adding at the end the following:
            ``(4) For pregnant individuals.--
                    ``(A) A group health plan or health insurance 
                issuer in connection with a group health plan shall 
                permit an employee who is eligible, but not enrolled, 
                for coverage under the terms of the plan (or a 
                dependent of such an employee if the dependent is 
                eligible, but not enrolled, for coverage under such 
                terms) to enroll for coverage under the terms of the 
                plan upon pregnancy, with the special enrollment period 
                beginning on the date on which the pregnancy is 
                reported to the group health plan or health insurance 
                issuer or the pregnancy is confirmed by a health care 
                provider.
                    ``(B) The Secretary shall promulgate regulations 
                with respect to the special enrollment period under 
                subparagraph (A), including establishing a time period 
                for pregnant individuals to enroll in coverage and 
                effective date of such coverage.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning after the 2019 plan year.

SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT CHILDREN.

    Section 2719A of the Public Health Service Act (42 U.S.C. 300gg-
19a) is amended by adding at the end the following:
    ``(e) Coverage of Maternity Care.--A group health plan, or health 
insurance issuer offering group or individual health insurance 
coverage, that provides coverage for dependents shall ensure that such 
plan or coverage includes coverage for maternity care associated with 
pregnancy, childbirth, and postpartum care for all participants, 
beneficiaries, or enrollees, including dependents, including coverage 
of labor and delivery. Such coverage shall be provided to all pregnant 
dependents regardless of age.''.

SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS.

    (a) Coverage of Pregnancy.--
            (1) In general.--The Director of the Office of Personnel 
        Management shall issue such regulations as are necessary to 
        ensure that pregnancy is considered a change in family status 
        and a qualifying life event for an individual who is eligible 
        to enroll, but is not enrolled, in a health benefit plan under 
        chapter 89 title 5, United States Code.
            (2) Effective date.--The requirement in paragraph (1) shall 
        apply with respect to any contract entered into under section 
        8902 of such title beginning 12 months after the date of 
        enactment of this Act.
    (b) Designating Certain FEHBP-Related Services as Excepted Services 
Under the Anti-Deficiency Act.--
            (1) In general.--Section 8905 of title 5, United States 
        Code, is amended by adding at the end the following:
    ``(i) Any services by an officer or employee under this chapter 
relating to enrolling individuals in a health benefits plan under this 
chapter, or changing the enrollment of an individual already so 
enrolled due to an event described in section 5(a)(1) of the Healthy 
MOM Act, shall be deemed, for purposes of section 1342 of title 31, 
services for emergencies involving the safety of human life or the 
protection of property.''.
            (2) Application.--The amendment made by paragraph (1) shall 
        apply to any lapse in appropriations beginning on or after the 
        date of enactment of this Act.

SEC. 6. CONTINUATION OF MEDICAID INCOME ELIGIBILITY STANDARD FOR 
              PREGNANT INDIVIDUALS AND INFANTS.

    Section 1902(l)(2)(A) of the Social Security Act (42 U.S.C. 
1396a(l)(2)(A)) is amended--
            (1) in clause (i), by striking ``and not more than 185 
        percent'';
            (2) in clause (ii)--
                    (A) in subclause (I), by striking ``and'' after the 
                comma;
                    (B) in subclause (II), by striking the period at 
                the end and inserting ``, and''; and
                    (C) by adding at the end the following:
            ``(III) January 1, 2020, is the percentage provided under 
        clause (v).''; and
            (3) by adding at the end the following new clause:
    ``(v) The percentage provided under clause (ii) for medical 
assistance provided on or after January 1, 2020, with respect to 
individuals described in subparagraph (A) or (B) of paragraph (1) shall 
not be less than--
            ``(I) the percentage specified for such individuals by the 
        State in an amendment to its State plan (whether approved or 
        not) as of January 1, 2014; or
            ``(II) if no such percentage is specified as of January 1, 
        2014, the percentage established for such individuals under the 
        State's authorizing legislation or provided for under the 
        State's appropriations as of that date.''.

SEC. 7. 12-MONTH CONTINUOUS COVERAGE FOR PREGNANT AND POSTPARTUM 
              INDIVIDUALS UNDER MEDICAID AND CHIP.

    (a) Medicaid.--
            (1) Required for all eligibility pathways.--Paragraph (5) 
        of section 1902(e) of the Social Security Act (42 U.S.C. 
        1396a(e)) is amended to read as follows:
    ``(5) Any individual 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 that provides at least essential 
health benefits as described in section 1302(b) of the Patient 
Protection and Affordable Care Act, through the end of the month in 
which the 1-year period (beginning on the last day of her pregnancy) 
ends, regardless of the basis for the individual's eligibility for 
medical assistance, including if the individual's eligibility for 
medical assistance is on the basis of being pregnant.''.
            (2) Conforming amendments.--Title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) is amended--
                    (A) in section 1902--
                            (i) in subsection (a)(10), in the matter 
                        following subparagraph (G) by striking ``(VII) 
                        the medical assistance'' and all that follows 
                        through ``complicate pregnancy,'';
                            (ii) in subsection (e)(6), by striking 
                        ``60-day'' and inserting ``1-year''; and
                            (iii) in subsection (l)(1)(A), by striking 
                        ``60-day'' and inserting ``1-year'';
                    (B) in section 1903(v)(4)(A)(i), by striking ``60-
                day'' and inserting ``1-year''; and
                    (C) in section 1905(a), in the 4th sentence in the 
                matter following paragraph (30), by striking ``60-day'' 
                and inserting ``1-year''.
    (b) CHIP.--
            (1) In general.--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 12-month 
                continuous coverage for pregnant individuals).''.
            (2) Conforming amendments.--Subsections (d)(2)(A) and 
        (f)(2) of section 2112 of the Social Security Act (42 U.S.C. 
        1397ll) are each amended by striking ``60-day'' and inserting 
        ``1-year''.
    (c) Effective Date.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by this section shall take effect on the 1st day of the 
        1st calendar quarter that begins on or after the date that is 1 
        year after the date of enactment of this Act.
            (2) Exception for state legislation.--In the case of a 
        State plan under title XIX of the Social Security Act or a 
        State child health plan under title XXI of such Act that the 
        Secretary of Health and Human Services determines requires 
        State legislation in order for the respective plan to meet any 
        requirement imposed by amendments made by this section, the 
        respective plan shall not be regarded as failing to comply with 
        the requirements of such title solely on the basis of its 
        failure to meet such an additional requirement before the first 
        day of the first calendar quarter beginning after the close of 
        the first regular session of the State legislature that begins 
        after the date of enactment of this Act. For purposes of the 
        previous sentence, in the case of a State that has a 2-year 
        legislative session, each year of the session shall be 
        considered to be a separate regular session of the State 
        legislature.

SEC. 8. RELATIONSHIP TO OTHER LAWS.

    Nothing in this Act (or an amendment made by this Act) shall be 
construed to invalidate or limit the remedies, rights, and procedures 
of any Federal law or the law of any State or political subdivision of 
any State or jurisdiction that provides greater or equal protection for 
enrollees in a group health plan or group or individual health 
insurance offered by a health insurance issuer.
                                 <all>