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